Dr Wallace is an experienced aesthetic plastic surgeon.  For many years he has been on Top Doctor and Best Doctor lists as voted by his peers. 
He serves as Professor and Chairman of the Dept. of Plastic Surgery at UTHSC and has educated trainees in plastic surgery for 24 years.  

Robert D. Wallace, MD

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Aesthetic plastic surgeon

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A series of small injections of a purified neurotoxin that temporarily blocks nerve impulses to muscles or other tissues, causing the muscles to relax.  When muscles relax, the overlying skin moves less, effectively reducing wrinkles.  Botulinum toxin injections can be strategically placed for various other indications, including rejuvenation of the upper and lower face, reducing sweating, and medical conditions such as migraine. The effects usually wear off after a few months.

Botulinum toxin injections

The most commonly used fillers today are non-permanent and consist of hyaluronic acid, a naturally occurring molecule found in skin, joints and in the eyes.  Several brands of hyaluronic acid filler are available.  They all comprise a clear, soft, sterile gel that is injected into the skin or beneath the skin to soften lines, contour facial features, or add volume.  Fillers may be injected under local anaesthesia, and results can last about 6-18 months.

Fillers

The brows are lifted using keyhole surgery.  Small incisions, usually 4-5,  are made behind the hairline and instruments with cameras and lights are used to guide the surgery.  During the endoscopic brow lift procedure the tissues near the brow are released under the skin so the brows can be elevated to the desired position.  The tissues may then be anchored to the bone to maintain the brow lift.

Endoscopic brow lift

The brow is lifted by placing an incision at the brow hair itself.  This incision may be placed in an existing line or wrinkle to hide it as much as possible.  Some skin is removed and the incision is closed with stitches, lifting the brow to an elevated position.

Direct brow lift

This surgical procedure helps make the eyes appear more youthful by removing excess skin, muscle and fat between the eyelids and brows. A small incision is made in the crease of the eyelid either under local or general anaesthesia. Fine stitches are used to close the incision and these are usually removed 5-7 days after surgery. Upper blepharoplasty rectifies the hooding that occurs with aging in some people.

Upper blepharoplasty

Also known as abdominoplasty, a tummy tuck is a surgical method to flatten the tummy and reduce loose skin by tightening tummy muscles and trimming away excess skin and fat in the lower abdomen. The incision and scar usually runs from one hip to the other hip, allowing the overhang or sagging skin to be removed. Usually the surgery is performed under general anaesthesia. You may have drains after surgery and a compression garment to wear for a few weeks.

Tummy tuck

This procedure helps improve under-eye bulges or bags as well as loose skin. The incision used is either just under the eyelashes in the skin (transcutaneous) or on the inside of the lower eyelid (transconjunctival). Variations in lower blepharoplasty include trimming away excess bulging fat, repositioning this fat to reduce under-eye hollows, and supporting the outer lower eyelid with fine stitches to prevent it from sagging and improve the shape of the lower eyelid.

Lower blepharoplasty

Fat is taken from one part of the body, such as the inner knee or lower tummy, using a mini-liposuction procedure, and injected into the face to add volume, contour, or define certain features.  The procedure requires careful technique to ensure as much of the fat as possible survives. The fat cells are injected using special blunt instruments called cannulas.  Fat grafting can provide a lasting effect in facial rejuvenation either performed on its own or in conjunction with other procedures.

Fat grafting

These soft, flexible implants consist of medical-grade biocompatible silicone that can be implanted into human tissues.  Implants come in various shapes and sizes to enhance or augment features including the chin, cheeks, and lips.  An incision is made and the implant is placed using sterile technique. Silicone implants are permanent and do not dissolve, but can be removed or replaced.

Silicone implant

A surgical procedure using an incision at or behind the hairline to lift the soft tissues of the forehead. A forehead lift can improve deep forehead wrinkles and lift the brows. The procedure is usually performed under general anaesthesia and requires some dissection under the skin to effectively lift the forehead and hold it in place.

Forehead lift

Surgical correction or reshaping of the nose performed as an open or closed procedure, depending on the aims of surgery. Open rhinoplasty requires more extensive incisions to display the structures under the skin. Sometimes cartilage grafts are used to reshape the nose. Rhinoplasty can be performed to make the nose straighter, more defined, reshape the tip, reduce nostril size and refine other nasal features. Rhinoplasty and septorhinoplasty are also performed to improve breathing.

Rhinoplasty

An incision is made immediately under the nose to hide the scar, and a variable amount of skin is removed. When the incision is closed with stitches, the lip elevates, resulting in a more youthful or rejuvenated appearance. The surgical lip lift can also evert the upper lip, making it appear fuller. Stitches are removed after approximately one week. Variations in the shape of the incision are designed to lift the lip in different ways, such as defining the cupid’s bow.

Surgical Lip lift

This fat gives fullness to the lower face, between the jowls and the cheeks.  Partial removal of the buccal fat is performed to reduce a full lower face, or “chipmunk cheeks”.  Buccal fat removal is usually done through a small incision on the inside of the mouth where the fat is gently retrieved.  It may be performed under local anaesthesia or as part of other surgical procedures.

Buccal fat removal / Bichectomy

A lift of the middle part of the face including the cheeks, nose-to-mouth folds and mouth corners. This may be performed through incisions placed behind the hairline near the temple, in the lower eyelid, and in the mouth. Special stitches may be used to lift and suspend the tissues of the midface to improve the shape of the face, reduce sagging, and lift the cheeks.

Midface lift

This surgical procedure has been used for many years to improve sagging of the face due to aging. A traditional facelift incision is usually made in front of the ear, along the hairline, and inside the hairline. There are various types of facelift procedures. Drains and bandages may be placed to ensure optimum recovery after surgery. A neck lift is frequently performed at the same time.

Face lift

A short scar facelift is a surgical procedure that lifts the face through an incision that may be shorter than a traditional face lift incision.  The incision is usually placed in front of the ear.  Different techniques can describe a short scar facelift.

Short scar facelift

The Minimal Access Cranial Suspension (MACS) lift is a surgical procedure that lifts the face through an incision along the hairline and in front of the ear.  The tissues under the skin are lifted using stitches that are anchored.  Some skin is removed near the hairline. The MACS lift may be considered less invasive than some forms of traditional facelift.

MACS lift

A deep plane facelift is a surgical facelift procedure involving techniques that pass deeper into the face, underneath the muscular layers.  This differs from facelifts that lift and stitch skin and underlying layers that lie close to the skin.

Deep plane facelift

A surgical neck lift usually involves tightening the muscles to remove the sagging and improve the angle under the chin, as well as lifting and trimming excess skin. This is commonly performed together with a face lift. The incisions and scars vary, but can be behind the ear and into the hairline and a smaller incision under the chin to access the muscles. A neck lift is a definitive surgical rejuvenation that requires healing and recovery.

Neck lift

Liposuction is used to contour the body by removing fat that lies under the skin through special suction tubes called cannulas. Liposuction can be performed under local anaesthesia or general anaesthesia. Almost all parts of the body can be treated with liposuction. Various forms of liposuction exist, including those that use suction alone, or those that use energy to assist the procedure, such as laser, ultrasound, or vibration.

Liposuction

A skin resurfacing or peeling treatment that uses chemicals, usually special acids, to remove the top layer of skin. A chemical peel is indicated to treat pigmentation, sun damage, acne, or fine wrinkles. The depth of peel, results, and recovery period depend on which chemical is used during the peel. Chemical peels can be superficial, medium depth, or deep peels. Peeling agents include salicylic acid, azelaic acid, glycolic acid and trichloroacetic acid (TCA).

Chemical peel

This treatment uses tiny needles to penetrate the skin and deliver heat at the same time.  Radiofrequency energy passes through the needles in order to provide heat, either through the whole needle or just the tip. Radiofrequency needling is designed to stimulate collagen and tighten tissues more than needling alone.  The treatment is usually performed using local anaesthesia.

Radiofequency needling

Skin tightening that occurs when collagen is stimulated due to heating of the tissues from radiofrequency (RF) electromagnetic energy. Usually a solution is applied to the skin and a probe passes over the surface, gently heating the tissues to the desired temperature. External RF is a non-invasive treatment. A number of treatments may be recommended.

Radiofrequency external skin tightening

Skin tightening that occurs when the undersurface of skin is heated to a certain temperature using probes that emit radiofrequency (RF) electromagnetic energy.  This treatment is usually performed using anaesthesia, allowing a small incision so the internal probe can be passed into the layers beneath the skin.  The internal probes heat and stimulate collagen, resulting in a tightening effect over time.

Radiofrequency internal skin tightening

The delivery of ultrasound waves through the skin to the underlying fat in order to reduce or destroy fat cells.  Most devices used to reduce fat non-invasively use focused ultrasound:  sound waves that focus at a particular point under the skin to burst fat cells.  Localised areas are treated, such as lower tummy or love handles, and more than one session is normally advised.

Non-invasive ultrasound fat reduction

Removing excess skin and fat in the lower tummy and using an incision that is shorter than a traditional tummy tuck or abdominoplasty. The scar after a mini tummy tuck does not run all the way from one hip to the other.  The tummy muscles may or may not be tightened during a mini tummy tuck.  You may have drains after surgery and a compression garment to wear for a few weeks.

Mini tummy tuck

Increasing the size of the breasts with surgery, usually using silicone or saline implants.  Various implant sizes and shapes can be chosen depending on the desired effect.  Common techniques for placing the implants include an incision in or near the breast crease below the breasts, or around the nipples. The procedure is usually performed under general anaesthesia. An assessment before breast augmentation is used to decide which implant should be chosen and where exactly it should be placed.

Breast augmentation

Fat is taken (harvested) from different parts of the body, such as the thighs or tummy, using liposuction and injected into the breast area. Breast fat grafting is used to add volume to the breasts, correct symmetry, or during breast reconstruction. Once fat is collected, it is usually treated to clean and purify it. The fat is prepared in syringes and injected carefully above and below the breast gland using a special technique in order to help the fat cells survive in their new position.

Breast fat grafting

A surgical procedure that improves the appearance of sagging breasts by elevating them to a higher position. Although different techniques exist, a common method involves an incision around the nipple area, downwards, and underneath the breast. Sometimes the incision is restricted to around the nipple in less extensive lifts. A breast lift can be performed as part of breast augmentation or breast reduction. Breast lift surgery is usually performed under general anaesthesia.

Breast lift

Surgery to reduce the volume and size of the breasts.  Breast reduction is performed under general anaesthesia and requires incisions and the removal of tissue.  It may be performed for aesthetic or functional reasons.  During breast reduction surgery, a lift is frequently performed, so the volume and position of the breasts improves.  Drains may be placed following breast reduction for a few days.

Breast reduction

The size of the nipples or pink part around the nipples (areolae) is reduced with nippled reduction surgery. A sizer is often used to measure the target circumference of the nipple areola complex (NAC). Then the excess, unwanted areola is removed using an incision. Fine stitches are used to close the skin so the scar heals well and becomes difficult to notice over time.

Nipple reduction

Improving the appearance of obvious dimples, usually in the buttocks and thighs, by placing a small cutting device under the dimple.  This procedure is usually performed under local anaesthesia.  After the areas are marked and the numbing is applied, a small needle or special cutting blade is inserted under the skin to release the dimple that is being pulled down by fibres under the surface.  A compression bandage or garment may be advised after the treatment.

Cellulite dimple release

Surgical removal of excess, sagging skin in the upper arm. Usually, an incision is made from the armpit area, along the inside of the arm, to the inner elbow. An arm lift is usually performed under general anaesthesia and requires a compression garment to be worn afterwards for a number of weeks. The scar is placed on the inside of the arm so it is less noticeable. An arm lift is sometimes required if skin tightening treatments or liposuction are not considered appropriate due to excessive skin laxity.

Arm lift / brachiaplasty

Surgery to reduce sagging skin and laxity in the inner thighs. Typically performed under general anaesthesia, a thigh lift provides a definitive tightening in the upper and inner thigh areas, particularly in cases where non-surgical options would not be effective enough. Incisions may be made in the groin area and along the inner thigh. A compression garment may be recommended for a period of time during the recovery.

Thigh lift

Tightening and removing excess skin that occurs in the upper tummy rather than the lower tummy.  Surgery involves making an incision along the upper tummy and under both breasts. The muscles along the tummy may be tightened at the same time. Drains and a compression garment may be used during the recovery after surgery.

Reverse tummy tuck

Surgical reconstruction of the belly button to make it appear more beautiful. It may be performed on its own or as part of a tummy tuck. The position, shape, or depth of the belly button may be modified during an umbilicoplasty.

Umbilicoplasty

Surgery to remove a previously placed implant, such as a silicone implant.  This may occur in order to change the size, or simply to remove the implant out of choice or for medical reasons. An implant may be removed if there is an infection, it is not in the correct position, or if an abnormally thickened capsule forms around the implant causing hardening, distortion or pain.

Implant removal

Surgically improving the appearance of a pre-existing scar using various techniques. The existing scar is often removed using a separate, new incision. The edges of the new wound are brought together in a way that reduces tension on the healing incision, so that the scar becomes less obvious.

Scar revision

Increasing the volume and enhancing the shape and contours of the buttocks using your own fat. Fat is collected (harvested) using liposuction from areas such as the tummy, back, or thighs. The fat is usually prepared in order to purify or clean it, before injecting it carefully into the buttock area using special techniques and instruments called cannulas.

Buttock fat grafting

Surgical trimming of the labia, usually the labia minora (inner lips close to the vagina).  Various techniques exist depending on the anatomy and surgeon's experience, including trimming excess tissue around the clitoris.  The labia majors (outer lips) can also be reduced if there is too much skin when filling this area is not appropriate. A labiaplasty for cosmetic reasons is designed to provide a neater appearance.  It may also be performed for functional reasons, usually to reduce discomfort.

Labiaplasty

Fat is harvested from another area using a mini-liposuction technique.  The fat is prepared in smaller syringes and injected into the labia majora (outer vaginal lips).  Fat grafting makes the labia appear more plump  and youthful.  The procedure can be performed under local or general anaesthesia.

Labia majora fat grafting

Usually a temporary filler such as hyaluronic acid is used to instantly restore volume to the labia majora (outer vaginal lips) as an alternative to fat grafting.  Local anaesthetic maybe applied before the filler is injected under the skin using a blunt tipped instrument called a cannula.  The filler treatment is designed to make the labia majora appear more plump and youthful, particularly when skin wrinkling has occurred due to volume loss with aging.

Labia majora fillers

Surgical remodelling of the soft tissues or cartilage of the ear to improve shape, symmetry, or projection.  Various otoplasty techniques have been described to treat congenital conditions, or changes that have occurred over time or with trauma.  A head bandage is usually required after otoplasty surgery.

Ear surgery/otoplasty

Surgery designed to flatten and improve the contours of the male chest due to excessive tissue. There may be excessive gland and fat beneath the skin. The gland can be removed surgically through an incision around the nipples. Since gynaecomastia is often a mixed picture of fat and gland, liposuction is frequently performed to improve results. Gynaecomastia surgery can be performed under local or general anaesthesia. A compression garment is applied after the procedure.

Robert D. Wallace, MD

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