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In addition to the face lift, our practice offers a host of other rejuvenating facial plastic surgery procedures. Brow lift (forehead lift) surgery can restore a youthful appearance by smoothing wrinkles across the forehead, elevating droopy eyebrows, and reducing excess skin above the upper lids.
The so-called chemical brow lift is done with selective use of BOTOX® Cosmetic to weaken muscles that pull down portions of your eyebrows. The most common facial surgery procedure performed at our practice is treatment of the eyelids (sometimes referred to as blepharoplasty, eye lift, or eyelid tuck).
During your consult we’ll review your medical history, including any eye problems you may have and medications you may be taking. Through eyelid surgery we try to correct loose skin on the upper and lower eyelids, as well as excess fat around the eye. The patient will be under local or general anesthesia during this out-patient procedure, which lasts between one and three hours depending on the extent of the procedure. The risks associated with the procedure are detailed in writing and discussed with you prior to surgery.
Fat grafting involves removal of fat from your tummy or thigh, processing it gently, and carefully placing very small portions of it in desired areas. During your consultation we will show you a variety of examples of other patients’ results.
Ours is a full-service practice comprising the entire spectrum of treatment options for disorders of the ear, nose, throat, neck and face, facial plastic surgery, audiology, hearing testing, and hearing aid services.
Additionally we focus on Plastic and Reconstructive procedures of the Face, head and neck, ranging from skin cancers to major cosmetic rejuvenation.
Facial Plastic surgical procedures in the privacy of our completely equipped office Operating Suite with Certified Anesthetist in attendance. Mountain Regional Voice Center allows evaluation and treatment of a full spectrum of voice problems utilizing the latest videostroboscopic techniques.
AbstractSeparation of the nasal and oral cavities by dynamic closure of the velo-pharyngeal port is necessary for normal speech and swallowing. IntroductionDynamic separation of the nasal cavity from the oral cavity is a necessary component in the production of normal speech. WAIT!You are missing out the opportunity to have an optimized profile with all your business details and unlimited appointment requests from fans. Harley was raised in the mountains of North Carolina and completed his secondary education at Tuscola High School, where he graduated as valedictorian. Harley embarked on five years of residency at Vanderbilt University Medical Center in head and neck surgery.
Harley has proudly served our nationa€™s veterans as a staff physician at the Charles George VA Medical Center in Asheville, a position he has held since he first set up practice in Asheville in 2008. Sutton Graham has an excellent reputation for achieving beautiful, natural-looking results with facelift cosmetic surgery. Two incisions less than one-inch long are made behind the hairline above the forehead, and two somewhat longer incisions are made in the temples. Loose skin on the upper lid may interfere with smooth makeup application, fill the space above the eyelid, hang down covering much of the eyelid, or make one look tired or inattentive. Some portion of the fat will be broken down and removed by your body, but generally one-third to one-half remains, probably for many years.
Graham will evaluate this area with you and offer suggestions during a facial plastic surgery consultation at his Greenville office.
Many patients lose youthful fullness, particularly in the areas beneath the eye sockets and lateral to the nose (anterior malar area). If your chin is under-developed, the jaw is not well defined, the lips don’t seem to fit, and the nose looks larger, chin augmentation with a solid silicone plastic implant may establish more balanced and attractive proportions.
Graham will evaluate your profile and will make treatment suggestions during a facial plastic surgery consultation at our practice in Greenville, South Carolina. Ideal candidates have good elastic skin tone, a localized fat collection, and generally are younger than 45 years of age.
Sutton Graham performs otoplasty for patients who are unhappy with the size or shape of their ears. Our practice serves patients from Spartanburg, Asheville, Anderson, and throughout the Carolinas who are looking for a skilled surgeon as well as a practice where they can feel comfortable.
The Mountain Regional Voice Center offers full evaluations of problems relating to the voicebox, including those of singers and musicians.
Velo-pharyngeal dysfunction (VPD) may either follow repair of a cleft palate or be independent of clefting.
This separation occurs in the anatomic space between the nasal and oral cavities known as the velo-pharynx. Patterns of velopharyngeal valving in normal and cleft palate subjects: a multi-view videofluoroscopic and nasendoscopic study. Comparative reliability of nasal pharyngoscopy and videofluorography in the assessment of velopharyngeal incompetence.
Comparison of multi-view videofluoroscopy and nasopharyngoscopy in the assessment of velopharyngeal insufficiency. Management of velopharyngeal dysfunction: differential diagnosis for differential management. Reliability of flexible fiberoptic nasopharyngoscopy for evaluation of velopharyngeal function in a clinical population.
Standardization for the reporting of nasopharyngoscopy and multiview videofluoroscopy: a report from an International Working Group.
Comparison of Tonar II, pressure-flow, and listener judgments of hypernasality in the assessment of velopharyngeal function.
The identification of nasal obstruction through clinical judgments of hyponasality and nasometric assessment of speech acoustics.
Correspondence between nasalance scores and listener judgments of hypernasality and hyponasality. The results of 100 operations for velopharyngeal incompetence--selected on the findings of endoscopic and radiological examination.
Limited value of preoperative cervical vascular imaging in patients with velocardiofacial syndrome. Speech prosthesis versus pharyngeal flap: a randomized evaluation of the management of velopharyngeal incompetency.
Process and outcome study of multidisciplinary prosthetic treatment for velopharyngeal dysfunction. Lateral pharyngeal wall and velar movement and tailoring velopharyngeal surgery: determinants of velopharyngeal incompetence resolution in patients with cleft palate. Obstructive sleep apnea and death associated with surgical correction of velopharyngeal incompetence.
Surgical management of velopharyngeal dysfunction: Outcome analysis of autogenous posterior pharyngeal wall augmentation. Radiographic and aerodynamic measures of velopharyngeal anatomy and function following Furlow Z-plasty. Furlow palatoplasty for management of velopharyngeal insufficiency: a prospective study of 148 consecutive patients. Pharyngeal flap and sphincterplasty for velopharyngeal insufficiency have equal outcome at 1 year postoperatively: results of a randomized trial. Comparison of resonance outcomes after pharyngeal flap and Furlow double-opposing z-plasty for surgical management of velopharyngeal incompetence. An outcome evaluation of sphincter pharyngoplasty for the management of velopharyngeal insufficiency.


Evaluation and treatment of velopharyngeal insufficiency: the University of Florida experience. Velopharyngeal surgery: a prospective randomized study of pharyngeal flaps and sphincter pharyngoplasties.
Long-term effects of pharyngeal flaps on the upper airways of subjects with velopharyngeal insufficiency. Sphincter pharyngoplasty as a treatment of velopharyngeal incompetence in young people: a prospective evaluation of effects on sleep structure and sleep respiratory disturbances. Comparison of obstructive sleep apnea syndrome in children with cleft palate following Furlow palatoplasty or pharyngeal flap for velopharyngeal insufficiency. Perception of post-palatoplasty speech differences in school-age children by parents, teachers, and professional speech pathologists. Harley is a plastic surgeon committed to providing his patients with superior care, cutting edge techniques, and outstanding results. He completed his undergraduate studies at Dartmouth College, graduating with the Cum Laude distinction, and completed medical school at the Vanderbilt University School of Medicine. After completion of this training, he pursued a second residency in plastic and reconstructive surgery at The Methodist Hospital in Houston, TX. Sutton Graham can perform advanced treatments to smooth, lift, and tighten facial contours. The layers that hold the brow in its low position are separated and repositioned and the muscles that cause frown lines to appear are selectively weakened. It can improve deeper forehead lines and low hairlines, but entails a longer incision and more numbness than endoscopic brow lift.
Graham will discuss your goals and the results that are typically achieved through this procedure. Post-operative medications include antibiotics, pain medications, and nausea prevention drugs. Age and genetics are primary causes, but sun damage, swelling, and allergy-related conditions all contribute.
Skin on the lower eyelid may drape loosely below the eye or accentuate texture and expression lines. Patients occasionally choose to maintain results by repeating the procedure again within seven to fifteen years.
Sutton Graham will discuss this treatment with you during a facial plastic surgery consultation at our practice in Greenville, South Carolina. The thickness is only millimeters, but it can make great improvements without making you look unnatural. Some patients are in their twenties, but have inherited an isolated double chin (without being overweight). The procedure is commonly performed on adults and children with large ears in order to improve their appearance and self-esteem.
We also offer full audiology services including complete audiograms, balance testing, and hearing aid sales and service. While the diagnosis of VPD is made by audiologic perceptual evaluation of speech, identification of the mechanism of the dysfunction requires instrumental visualization of the velo-pharyngeal port during specific speech tasks. He is a recipient of the Hospital Award of Excellence, selected by the chief residents of every service, and the Deana€™s Award of Distinction, chosen by the dean for outstanding qualities of leadership and humanitarian service. In addition, he trained at the prestigious MD Anderson Cancer Center, performing cancer reconstructive surgery.
A face lift can address these concerns, helping to restore youthful-looking beauty for both our male and female patients. The lift is supported by hidden internal sutures, and the incisions are covered by your hair. He can also answer any questions you may have about combining brow lift with laser resurfacing, eyelid or face lift surgery, or liposuction under the chin. Specialized post-operative massage techniques and makeup advice are usually provided by our Skin Care Specialist. Please contact us today for more information on eyelid surgery at our practice serving Spartanburg, Anderson, and surrounding communities. We invite you to contact our practice today and learn more about facial contouring possibilities. Chin implant surgery is performed while the patient is sedated with local or general anesthesia.
An elastic support band will be worn for 1-3 weeks after the procedure to facilitate healing.
For more information on ear surgery, please contact the Aesthetic Center for Breast and Cosmetic Surgery.
Matching the specific intervention for management of VPD with the type of dysfunction, i.e. This anatomic locus, the velopharynx, becomes a modifying adjective for the several terms used to describe its dysfunction in literature: velo-pharyngeal insufficiency, velo-pharyngeal incompetency, velo-pharyngeal inadequacy and velo-pharyngeal dysfunction.
Additional procedures such as BOTOX® therapy, brow lift, or laser treatment may also be discussed and Dr. Most proponents of fat grafting consider the results after six months to be long-lasting; however, complete disappearance is possible. Graham recommends treating this condition with your own fat (autologous fat grafting, fat transfer). The Aesthetic Center for Breast and Cosmetic Surgery receives patients who are interested in cheek augmentation, brow lift, and eyelid surgery from throughout the Carolinas, including Asheville, Spartanburg, and Anderson.
Velo-pharyngeal dysfunction (VPD) is the preferred nomenclature of this author, and others [1],[2],[3] due to the ambiguity of the acronym VPI and association of the various "I "nouns with etiologic specificity.
Harley has published many peer-reviewed journal articles, including a publication documenting patient satisfaction following facial cosmetic procedures performed under local anesthesia.
The other team members at the Aesthetic Center for Breast and Cosmetic Surgery are also knowledgeable and dedicated to ensuring that your procedure is a success. We’ll evaluate your progress several times over the first few months following brow lift surgery. The amount of discoloration in the treatment area varies, but usually resolves in one to three weeks. The contour improvement with neck and chin liposuction is quite significant, but it is important to maintain a stable weight to ensure that results last.
He has extensive experience with a breadth of cosmetic techniques, including facial, and non-invasive procedures.
We invite you to read more about the various facial plastic surgery procedures at our Greenville practice. Graham recommends using your own fat (autologous fat grafting, fat transfer) to enhance lip fullness, and improve the area between the lips and chin. Risks will be discussed and listed for you before the scheduling of your chin implant surgery.
This article discusses the normal function and dysfunction of the velo-pharynx with respect to evaluation as well as management and outcome of the dysfunction. Offering treatments ranging from brow lift to eyelid surgery to patients from Asheville to Spartanburg, we have helped many patients from throughout North and South Carolina achieve their cosmetic goals. For additional information or to schedule a brow lift consultation, contact our practice serving Asheville, Spartanburg, and communities throughout the Carolinas. The unifying theme is differential management for differential diagnosis.Functional Anatomy of Velo-PharynxThe velo-pharynx is the space that connects the nasal and oral pharynges. This space is delineated by myomucosal structures: anteriorly - the velum (soft palate), posteriorly - the posterior pharyngeal wall, and laterally - the right and left lateral pharyngeal walls.


While swallowing and during the production of specific speech phonemes, the muscles surrounding the VP space contract, thereby, moving their overlying mucosa three-dimensionally to separate the nasal and oral cavities by closing the space. Because this motion resembles that of digestive tract sphincters, the zone of dynamic action is often referred to as the velo-pharyngeal sphincter even though it lacks discrete, circularly enclosing muscle(s). The space that is dynamically opened and closed is referred to as the velo-pharyngeal port.
Normal function of the velo-pharynx requires not only closure of the port but also proper coordination and speed of closure as well as re-opening appropriate for the specific task. The clinical signs and symptoms of a non- or minimally patent velo-pharynx include nasal airway obstruction affecting breathing as well as secretions, mouth breathing with chronic open-mouth posture, diminished nasal resonance for appropriate phonemes (hypo- or de-nasality), and obstructive sleep apnoea.Evaluation of Velo-Pharyngeal FunctionAll of the clinical signs and symptoms of VPD which aid in its diagnosis can be perceived and documented by a trained observer using auditory and visual perceptual assessments.
Visualization alone can document the anatomic locus of the dysfunction; however, quantification is difficult and the techniques are cumbersome and expensive.
Physical parameters are usually recorded quantitatively and for some can be obtained with minimal disturbance of the subject and at low cost.
For this reason, functional velo-pharyngeal visualization prior to velo-pharyngeal management has become the standard of care. These examinations should be conducted by individuals skilled not only in instrumentation (endoscopy, radiology) but also in eliciting standard speech samples designed to assess velo-pharyngeal function in both spontaneous and provocative speech.
While both the imaging and speech sampling functions can be performed by the same individuals, the majority of velo-pharyngeal centres utilize two professionals to optimize each aspect of the examination: An instrumental visualizer (endoscopist or radiologist) and a speech pathologist. The recommendations are then communicated to the family and, when old enough, to the patient, by post, followed by an office consultation as required.Ideally, as in all of healthcare, treatment should be based upon aetiology. Unfortunately, as with most of healthcare, treatment for VPD is only available for the consequences of an aetiology rather than the primary cause. While specific aetiologies can be associated with VPD, currently only one intervention for VPD specifically addresses the aetiology: intravelar veloplasty for congenital non-continuity of the velar muscular sling (sub-mucous cleft palate). This obstruction may be removable (speech prosthesis) or permanent (pharyngoplasty operations). The challenge for the velo-pharyngeal surgeon and the other VPD team members is to select which of the possible interventions will optimize outcome and minimize morbidity.The Velo-Pharyngeal Dysfunction Management AlgorithmOver the past 30 years, I have had the good fortune to work with two velo-pharyngeal management teams whose members were well-trained, experienced and with little turn-over.
A VPD care algorithm formulated some 25 years ago [21] is still in use [Figure - 1] and [Figure - 2] followed by modifications with the introduction of new technology, unfamiliar operations, and lessons learned from other colleague via symposia and the literature.
The basic principle of differential management for differential diagnosis has, however, remained constant. The primary decision is whether or not the patient is a candidate for velo-pharyngeal surgery. Absolute contraindications to VPD surgery include: other congenital defects that unacceptably increase anaesthetic risk (such as uncorrected or uncorrectable cardiac or pulmonary disease), an unstable probably progressive neurological degenerative disorder, and parental opposition to surgery. Relative contraindications include a history of prior or concurrent obstructive sleep apnea, a small mandible, and an ectopic carotid artery (as can be seen in some 11q22 deletion patients). A speech prosthesis is the preferred management for the neurologically unstable patient with VPD due to either a myoneurally deteriorating disease or a still resolving head injury. If the patient is determined to be a candidate for surgical VPD management, the next decision would be the type of operation to be performed.
Prior to discussion of the choice of operation, it is important to define the goals of intervention so that success and failure can be monitored.
It is important to recognize that surgery per se cannot normalize speech; surgery can alter undesired movement of air and sound into the nose during speech. Elimination of the abnormal articulatory adaptations that an individual has made for this velo-pharyngeal escape in the attempt to produce intelligible speech requires behavioural modification therapy, i.e. Thus the individual with VPD without mal-articulations can have normal speech following velo-pharyngeal surgery without post-operative speech therapy. Most individuals with VPD, however, have some mal-articulations and therefore require post-operative speech therapy to achieve normal speech. This is contrary to the basic healthcare principle of differential management based upon differential diagnosis. We, as others, therefore perform several different operations: individualizing intervention for each patient based upon consideration of a combination of the dynamics of the velo-pharyngeal port and the patient's other medical factors. For us, the two critical velo-pharyngeal function elements are the pattern of closure and the size of the residual gap. Of the four anatomic structures involved in velo-pharyngeal closure (velum, right and left lateral and posterior pharyngeal walls), the degree of movement of the two lateral walls is the prime determinant. When lateral wall movement can close at least 50% of the distance from rest to anatomic sagittal midline, a narrow to medium width superiorly-based pharyngeal flap can be performed without concern of obstructing the nasal airway and inducing severe obstructive sleep apnoea. We had an unsatisfactory experience with autologous posterior pharyngeal wall augmentation for small gaps and no longer perform that operation. Some authors report satisfactory management of small velo-pharyngeal residual gaps using a Furlow's Z-plasty [33],[34] but we have no experience with this procedure. Outcome AssessmentThere is no consensus regarding the method and timing of outcome assessment following VPD management. For decades, the protocol used by the velo- pharyngeal teams I have participated in has been a combination of perceptual and instrumental velo-pharyngeal function assessments at 3 and 12 months post-management. Having learned the post-operative characteristics of both successful and unsuccessful types of VPD management, we now continue perceptual speech evaluations at 3 and 12 months post-operatively but restrict post-operative instrumental velo-pharyngeal functional visualization to those patients who have persistent symptomatic VPD.
Morbidity for both pharyngeal flap and sphincter pharyngoplasty consisted of persistent velopharyngeal dysfunction, impaired nasal secretion drainage, and obstructive sleep apnoea. The peri-operative morbidity associated with surgical repair of cleft lip and cleft palate consists of bleeding, infection, dehiscence, fistula formation or tissue loss.
While these may compromise the aesthetic and functional outcome of the operation, once healing is completed, the degree of morbidity does not progress. On the other hand, when the patient who has undergone surgical velo-pharyngeal port diminution lives far from the treating facility and does not return for follow-up, the complications of velo-pharyngeal port stenosis are often unrecognized and untreated causing further morbidity. The question that arises therefore is whether it is wise to offer VPD surgery in such situations. Our practice in such environments is to leave the residual VP port(s) larger than we do in my own hospital for local patients with the surmise that it is better to have some residual VPD than to have obstruction of the nasal airway.An additional difference between cleft-care in developed versus developing areas is the average older age of unrepaired patients. It is generally accepted that palatoplasty after 18 months of age in a normally developing individual is less likely to result in normal velo-pharyngeal function than when performed before 18 months of age.
For this reason, some surgeons have advocated combining a primary pharyngeal flap with palatoplasty in the older, unrepaired, speaking individual. While we are unaware of any data to support or refute this practice, we subscribe to it when neither follow-up nor speech therapy is likely. As stated above, the diagnosis of VPD is made by auditory and visual perceptual assessment of speech. Differential diagnosis of the mechanism of the dysfunction can only be made with visualization of the VP port during specific speech tasks.
Prior to the advent of dynamic fluoroscopic VP evaluation in the 1970's, surgical VP management was performed blindly in industrialized regions.
The author is unaware of any data to endorse or condemn blind VPD management in such environments. The author, however, advocates that while teaching VPD management operations to surgeons who lack the benefits of VP functional visualization in their diagnostic armamentarium, it should be with the expectation that they shall, at a later date, acquire the necessary diagnostic technology to aid them in differential management based upon differential diagnosis.ConclusionDifferential management of VPD based upon differential diagnosis of the dysfunction yields a high percentage of success with minimal morbidity. Although primary VP narrowing synchronous with palatoplasty is not advocated for younger children with unrepaired cleft palate, a primary pharyngeal flap with palatoplasty may be beneficial in the older unrepaired cleft palate individual.



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