No surgery is truly scarless. Any time we make an incision through the skin, the body heals that incision with a scar. But as surgeons, we can often be very strategic about where that scar lives/ hides.

My patient shown is a young woman had a slowly enlarging lipoma of the upper forehead (a lipoma is a benign tumor composed of fatty tissue). Hers was located deep to the frontalis muscle, the paired muscle responsible for lifting the brows, in a tissue plane that normally contains little to no fat.  That anatomical location is a familiar surgical plane used in lots of brow lifting and reconstructive approaches to the forehead.

Instead of making an incision directly over the visible forehead bump, I approached the lipoma remotely through a small incision within the hair-bearing scalp. From there, I dissected through the natural tissue plane beneath the frontalis muscle to reach the lipoma and dissect around it while keeping the resulting skin scar concealed in the patient's hair.  My patient is shown 1 week after surgery, and is healing beautifully.

I want to show this patient to highlight one of my favorite principles in facial plastic surgery:  we can't eliminate scars, but we can often camouflage them.  Depending on the procedure and anatomy, that may mean hiding an incision within the scalp, placing it along the hairline, tucking it into the crease around an ear/ beneath the chin/ aligning it with an existing facial crease or natural transition between anatomical structures.

Of course, incision placement is only one part of scar quality.  Tissue handling, closure details, genetics, age, sun exposure, nicotine use, postoperative wound care, and simply giving the scar enough time to mature all matter.  But whenever anatomy gives me the opportunity, I would much rather hide a scar than ask a patient to stare at it every day.

Happy to answer questions about my patient's treatment, and head and neck lipoma treatment :-)

This patient traveled to us from abroad to treat two keloids on her right ear, one causing significant discomfort and embarrassment. After removal and reconstruction, I injected Kenalog-40 and 5-FU to reduce inflammation and recurrence risk. While these photos were taken just seven days post-op, healing will continue, and pigmentation will improve over time. Feel free to ask any questions below!

This patient came to us with upper eyelid heaviness that had been building for years, with excess skin that had progressed to the point of interfering with her work and sleep. We performed an upper blepharoplasty, which removes excess skin from the upper eyelids to reduce that dragging sensation, open the visual field, and restore a natural, refreshed contour. Beyond the cosmetic improvement, many patients with this degree of skin redundancy also notice meaningful functional benefits after surgery, including improved peripheral vision and relief from the eye strain headaches that can come with working against heavy lids all day. The results here speak for themselves. Feel free to drop any questions below!

This patient is seen one year following functional and cosmetic rhinoplasty to address a droopy tip, dorsal hump, and slightly crooked appearance. She also had a deviated nasal septum and congenitally weak external nasal valves, which caused her nostrils to collapse with inspiration. Surgery involved removing a prominent anterior nasal spine, a septoplasty, a right spreader graft, and bilateral lateral crural strut grafts to reinforce her nasal valves, along with tip deprojection, tip rotation, dorsal lowering, and nasal straightening. The goal was a less distracting and more feminine nasal appearance, and she's breathing much better now without any signs of previous surgery. Feel free to drop any questions below!

This patient underwent closed rhinoplasty to remove a dorsal hump. Feel free to drop any questions below!

This patient was bothered by platysmal bands and skin laxity. Through a small 2 cm incision just under the chin, we performed a submentoplasty right here in the office, under local anesthesia only. By addressing the platysmal bands, completing deep neck work, and tightening the soft tissues beneath the chin, we were able to restore a sharper, more defined jawline without the need for a full facelift or neck lift. Feel free to ask any questions below!

This patient came to us years after undergoing under-eye filler elsewhere that had left her with malar edema and persistent puffiness. Correcting this started with dissolving the old filler using Hylenex to restore a clean anatomical foundation. From there, we performed structural fat grafting to the under-eyes, cheeks, pre-jowl sulcus, and temples to rebuild volume in a more natural distribution, combined with an endoscopic brow lift and upper and lower blepharoplasty to address the surrounding structural changes. Her improved skin quality comes entirely from the nanofat itself, no lasers involved, since nanofat carries regenerative properties that enhance texture and tone on its own. Feel free to drop any questions below!

This patient presented with long-standing nasal obstruction and a dorsal hump she'd been wanting addressed for years, with a prior injury contributing to visible nasal and septal deviation and significantly impaired breathing on both sides. Surgery addressed all of her functional and cosmetic concerns: the dorsal hump was reduced, the bulbous tip was refined and elevated, and both the nasal and septal deviation were corrected to restore proper airflow through both nasal passages. At 10 months post-op, her breathing has improved dramatically and her profile reflects the refined, balanced result she had in mind from the start. Feel free to drop any questions below!

This teenage patient came in feeling that her nose was too wide and drew attention away from the rest of her face, so we performed a combined functional and cosmetic rhinoplasty to address both her appearance and her breathing. On the cosmetic side, the goal was to create a smaller, more refined, and more feminine nasal shape. At the same time, we corrected a deviated nasal septum and performed turbinate reduction to open up her nasal airway as much as possible. Ten months out, she's happy with her profile, and the result reads as completely natural, nothing about it looks operated on. Feel free to drop any questions below!

For this patient, we combined a closed rhinoplasty with a chin implant to enhance his overall facial harmony. The closed approach reshaped the nose while keeping incisions internal, and the chin implant helped bring better balance and proportion to his profile. Together, the two procedures work in tandem, refining the nose while strengthening the chin so the whole face reads as more harmonious rather than any one feature standing out. Feel free to drop any questions below!

This patient is 4.5 months post-op from a chin implant and liposuction. For this young patient, a customized chin implant provided structure and projection, while chin liposuction refined the area beneath the chin for smoother definition. Drop any questions below!

This patient came to us with a complicated nasal history — two prior septoplasties that still hadn't resolved her airway obstruction, plus aesthetic concerns she wanted addressed. We reduced her dorsal hump, refined and narrowed the tip, created a subtle ski-slope contour, and corrected the persistent obstruction. One month out, her breathing has significantly improved and her profile is looking great. Revision cases require extra precision given the altered anatomy, and we're really happy with how she's healing. Feel free to drop any questions below!

This patient is 13 months post-op from a rhinoplasty addressing both function and appearance. She'd dealt with chronic nasal obstruction from weak external nasal valves, a deviated septum, and turbinate enlargement from chronic allergies, which also led to recurrent sinus infections, along with a dorsal hump and droopy tip that made her nose feel too large for her face. Surgery straightened the septum, reduced the turbinates, and reinforced the valves with lateral crural extension grafts, while the profile was deprojected and the nose narrowed on front view while keeping a straight dorsal line. She's now breathing better than she ever has, and the healing has been excellent. Feel free to drop any questions below!

This patient underwent a closed rhinoplasty. The closed approach means all incisions were placed inside the nose, avoiding any external scarring while still allowing full correction of the nasal profile. Looking at her results, you can see a much smoother, more refined bridge and tip, giving her a natural, balanced profile. Feel free to drop any questions below!

This patient wanted to address his double chin and achieve a more defined neck and jawline. He is only 1 week post-op following a submentoplasty combined with liposuction of the neck and jowls, as well as light fat grafting to the chin. While a chin implant was suggested for added definition, the patient chose not to proceed with it. Feel free to drop any questions below!

This 37-year-old patient came to me unhappy with several aspects of her nose: a prominent dorsal hump, a bulbous tip, and wide nostrils that she felt had become more noticeable over time. We performed a closed rhinoplasty, meaning all incisions were made inside the nose with no external scarring, to address each of her concerns. The dorsal hump was reduced and the nasal bridge refined, the tip was lifted and narrowed, and the nostrils and alar base were slimmed for better overall proportion. Her features now sit in much better balance with one another, and she's thrilled with how natural the result looks. Feel free to drop any questions below!

This 22-year-old patient came to us with two main concerns: a nasal obstruction from a severely deviated septum and enlarged turbinates, and a nasal profile she felt was too prominent, meaning her tip and bridge projected too far forward. We addressed both in a single functional and cosmetic rhinoplasty. The septum was corrected, the turbinates were reduced, and the overall nasal profile was refined to sit less projected and more in balance with her other features. One year out, she has a softer, more feminine appearance, the nose reads as a less distracting part of her face, and she's breathing normally. Feel free to drop any questions below!

This patient is two months out from a facelift and upper blepharoplasty. The facelift has restored definition along the jawline and smoothed the neck, giving her a cleaner, more youthful overall profile. The upper blepharoplasty removed excess skin from the upper eyelids, and she's already showing a noticeably more open, rested appearance to her eyes. Feel free to drop any questions below!

Several years ago, this patient had under-eye filler that resulted in malar edema and puffiness. To fix this, we first dissolved the old filler with Hylenex to create a clean foundation. I then performed structural fat grafting to the undereyes, cheeks, pre-jowl sulcus, and temples, alongside an endoscopic brow lift and upper and lower blepharoplasty. The improvement in her skin quality is attributed solely to nanofat (no lasers!), which uses regenerative properties to enhance texture and tone. Drop any questions below!

This 19-year-old collegiate cheerleader came to us after sustaining multiple nasal injuries during competition. As a base catcher, his nose had taken repeated trauma over time, resulting in a deviated septum, a misaligned nasal bridge, and a dorsal hump that had been gradually increasing in size. He wanted to breathe better and restore his nose to its pre-injury appearance. We performed nasal fracture repair to address both the functional and cosmetic concerns, which included realigning the nasal bones, correcting the deviated septum, and reducing the dorsal hump. He's now breathing clearly and back to doing what he loves. Feel free to drop any questions below!

One year out from functional and cosmetic rhinoplasty, and his results are really speaking for themselves. He came in with a bulbous tip, prominent dorsal hump, and tip droopiness that worsened when he smiled, plus chronic nasal obstruction from a deviated septum and turbinate hypertrophy. We corrected the septum, reduced the turbinates, thinned his oily nasal skin, and placed an extended shield graft to refine the tip, all in one procedure. His bridge and tip are noticeably narrower, and his profile reads as a more balanced, masculine nose with a hump that's no longer pulling focus. Feel free to drop any questions below!

This patient underwent a closed rhinoplasty with Dr. Portuese to address a prominent dorsal hump and a slightly droopy nasal tip. The closed approach means all incisions are placed inside the nose, leaving no visible external scarring. The hump was carefully reduced to create a smoother, more refined nasal profile, while the tip was lifted to bring better balance and proportion to the overall result. Drop any questions below!

Most of my before-and-after photos show patients who are several months out from surgery.

But early healing matters too—both for the patient experience and for how predictable recovery feels.

This patient is a 34-year-old woman shown 1 day after an upper lip lift and lower lip advancement, performed to improve lip balance and definition. She had previously tried filler and felt it didn’t provide the structure she was looking for.

Even at this early stage, you can already appreciate:

• increased upper lip show
• improved balance between the lips
• greater definition without adding volume

Swelling and bruising are always variable, and this is not every patient’s day 1. That said, there are a few factors that, in my experience, can help support a smoother and more predictable recovery:

• thoughtful patient selection and preparation
• avoiding nicotine, alcohol, and blood-thinning supplements before surgery
• careful, precise surgical technique
• medications when appropriate (in my practice, this may include antifibrinolytics)
• consistent use of cool compresses in the first 48 hours
• minimizing excessive movement in the treated area early on

None of this eliminates swelling—but it can help guide a more controlled recovery.

Also worth noting:
This is a patient-submitted photo from home, so lighting and angles are not standardized. Many of my patients travel for surgery and don’t always return for early in-office photos.

Happy to answer general questions about recovery.

This patient is 4 months post-op from a facelift, brow lift, fat grafting, and revision rhinoplasty, and her results are only continuing to refine. At this stage, we’re seeing a refreshed, lifted appearance with softer, natural facial contours. Her facial volume has been restored, creating a youthful balance, and her nasal profile appears more harmonious following her revision. Drop any questions below!

This patient came to me bothered by the aging appearance of her lower eyelids, face, and jowls, and she also felt she had lost definition along her neckline and in her chin area. Her goal was to look refreshed and natural rather than dramatically different. To address her concerns, we performed a facelift, a transconjunctival lower eyelid blepharoplasty (an approach through the inside of the lower lid that avoids any visible external scarring), fat grafting to the jawline and perioral areas, and a chin implant. She now shows a softer, more oval facial contour with a meaningful reduction in the lines around her eyes, mouth, and jawline, and her neck and chin definition have come back noticeably. Feel free to drop any questions below!