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Surgical Procedures

Looking and feeling our best helps increase confidence and self-esteem. When it comes to rejuvenation or reconstruction to the areas of the head and neck, patients will seek surgical options for a variety of reasons. Patients should ensure they’ve selected the right surgeon and facility to guarantee the safest, most precise results.  

Dr. Olds is the only facial plastic and reconstructive surgeon in Billings and one of only two facial plastic and reconstructive surgeons in the state of Montana. She brings new services to the community, including

· complex and revision rhinoplasties

· full-face surgical rejuvenation for facial aging

· liquid rhinoplasty

· PDO threads

· repair of traumatic facial injuries

· complex skin cancer reconstruction

· surgical and nonsurgical gender confirmation procedures

Additional Surgical Procedures

Brow Lift 

While people age at varying rates, often the brow and forehead show signs of aging more quickly than other areas of the body. When the forehead and/or the eyebrows sag and lines appear on the forehead, between the brows or across the nose, it often portrays anger, hostility, fatigue or other unintended emotions. A tired, angry or sad expression may not reflect how you truly feel. This, coupled with the fact that these structures are a major focal point of expression, makes rejuvenation of the forehead and brow a commonly requested surgery. 

When performed properly, a brow-lift should ensure a more youthful and refreshed look and should not leave patients looking overly-pulled or surprised. This complication, often present in Hollywood celebrities, is not considered aesthetically pleasing to most.  

There are different approaches and techniques to performing a brow lift procedure. Knowledge of the anatomy, as well as the indications and technical aspects of these varying surgeries, is paramount for a good outcome and avoidance of complications. 

During an initial consultation a detailed examination of the upper third of your face will be performed, as well as discuss your needs to develop a care plan that is right for you. Dependent upon the approach, downtime for a brow-lift may take seven to fourteen days. In some circumstances, patients who experience visual field obstruction will be able to obtain insurance coverage for a brow-lift; often performed concurrently with an upper eyelid blepharoplasty.

Blepharoplasty (Eyelid Lift)

The eyes are considered one of the most expressive and defining features of the face. Unfortunately, as we age, the eyes are often one of the first facial features to show signs of aging. This can make us look tired, aged, and even angry.

Blepharoplasty is a common procedure that is performed to lift upper or lower eyelids (or both), leaving the patient looking more youthful, rested, and alert. A blepharoplasty involves a surgical modification of the eyelid during which excess tissue, skin, and fat are repositioned, while surrounding muscles and tendons can be reinforced if necessary.

An upper eyelid blepharoplasty can be a cosmetic or non-cosmetic procedure. The scar is hidden in the natural lid crease and should be undetectable. Recovery time is approximately seven to ten days. If a droopy brow is equally contributing to functional or aesthetic changes of the eyelid and upper third of the face, a brow-lift can be performed in conjunction with this procedure.

A lower eyelid blepharoplasty is performed for cosmetic reasons to reduce wrinkling of the skin and to improve bags and puffiness under the eyes. Depending on the patient’s specific needs, the incision is either made inside the lash line or on the outside, just below the lash skin. A laser treatment can be performed simultaneously to provide a smoother appearance and tighten skin under the eyes. A cheek lift can also be performed for further rejuvenation of the malar region. Downtime for a lower eyelid blepharoplasty is approximately seven to fourteen days.

Earlobe Repair

Earlobe Repair is most often a simple, in-office procedure that can repair torn, stretched, or damaged ear lobes. Depending on individual circumstances, earlobe repair can be performed immediately following an injury or at a later time when the wound has healed and the earlobe is no longer inflamed. In a majority of cases, non-absorbable sutures are used for repair and the wound is re-evaluated a week following the procedure. After several weeks, we typically schedule a recheck of the wound and re-pierce the ear if the patient so desires. 

Facelift Surgery

  • A facelift is a surgical procedure performed to reduce signs of aging, such as:
  • Drooping or sagging in the midface
  • Deep creases along the nose, which extend to the corners of the mouth
  • Displaced facial volume/fat
  • Loss of muscle and skin tone as well as volume in the lower face, which can create jowls
  • Loose skin or fatty deposits under the chin and jaw, which gives the appearance of a double chin
  • Redundant neck skin and platysmal bands

There is a stigma that facelifts are painful, and require extensive down time, and that they cause apparent scarring or an over-pulled, unnatural look. While evidence of these types of facelifts is plentiful in the media, our goal is to provide a facelift that will leave you with a natural, well rested look. We also strive for concealed incisions and minimal downtime.

There are a variety of facelifts that can be performed depending on your needs, expectations and facial composition. Our facelifts are performed using innovative techniques that reduce the appearance of surgical scars and subsequent downtime. When performed properly, the patient should have well-placed, nearly invisible scars.

Our staff strive to make you feel comfortable and at ease while you’re in our office. Our patients can expect a thorough, easy to understand explanation of the different aspects of surgery and recovery. Expected downtime for a facelift is contingent on the type of facelift and the individual patient, but in general patients can expect a downtime of ten to fourteen days.

Facial Implants

Traditionally, attractive faces tend to be comprised of features that complement one another. A small chin or recessed cheeks may portray an unbalanced face and make the nose appear larger than it is, create redundant neck skin, cause facial asymmetries, or can worsen the jowls and nasolabial fold (parentheses).

In some patients, inserting a facial implant to better complement other facial features can greatly improve their appearance. During your consultation, your face and neck will be assessed we will help you decide if a facial implant is right for you. Facial implant procedures can coincide with other facial surgeries including but not limited to the following: rhinoplasty, facelift, or SlimLipo of the neck.

Chin Implants – A chin implant is generally used for patients with a smaller chin, but who have normal dental occlusion. In some circumstances, patients with an overbite may be candidates depending on the severity or cause and if there are contraindications to orthognathic procedures.

The implant is typically inserted through a small incision under the chin and can be implanted in-office, within 60-90 minutes. Downtime is typically 7-10 days, although swelling may persist for several weeks. A chin implant can add definition to the lower third of the face and improve the appearance jowls or redundant neck skin.

Cheek implants - Cheek implants are performed less frequently than chin implants, due to the wealth of volume enhancement methods in this region of the face, like facial filler. Patients with bone loss, or who are seeking a more permanent improvement, may choose this as an option for facial rejuvenation.

The implant is inserted in a small incision inside the mouth which can either be done in-office or under a general anesthetic. Downtime is typically 7-14 days, but cheeks may remain swollen for several weeks, to a few months following the procedure. The implants serve to define and highlight the cheekbones, while adding volume to areas that are recessed or flat.

Fat Transfer

Fat Transfer refers to a natural process of taking fat from one area of the body, such as the abdomen, and using it to replenish facial volume that’s been lost during the aging process. Common areas to administer fat include the lips, mouth, cheeks, nasolabial folds, chin, and underneath the eyes. Fat transfer works best when multiple areas are targeted to produce facial symmetry. The procedure transfers fat through tiny punctures to the skin and therefore causes very little downtime.

Patients that are dissatisfied with their facial fullness can benefit from a fat transfer procedure. As we age, the dermis under the skin weakens, often leaving behind a thin, sagging face. This can happen to men and women of many body types. The goal of the fat transfer procedure is to enhance facial features to provide desired fullness, volume, and lift.

The advantage of a fat transfer over other methods of volume augmentation is that the patient’s own tissue is used and the injected fat becomes permanent. These volumizing fat injections are a nice compliment to a facelift and other facial procedures. 

Provided courtesy of Mark Berman, MD and reprinted with permission by Palomar Medical Technologies, Inc.

Submental/Head and Neck Liposuction

Liposuction of the head and neck is a minimally invasive procedure designed to remove unwanted fat and diminish skin laxity with minimal downtime.

Liposuction typically takes 60-90 minutes and is performed with a small laser cannula that is inserted through two, three millimeter incisions in the neck, while the patient is under local anesthesia or mild sedation.

Downtime is usually one week and results are visible within a few weeks and continue to improve over 3-6 months. During your consultation, our professionals will help you determine if you are a good candidate for this procedure or if one of our many other surgical or non-surgical options would be the best for you.

Rhinoplasty (Nose Reshaping)

A Rhinoplasty is a surgical procedure to reshape the nose and may be performed for cosmetic, functional, or a combination of these two reasons. It is important to note that even a solely cosmetic operation may improve the function of the nose. Interested candidates should choose a plastic surgeon who understands the physiology of the nose and the myriad of conditions and diseases that can affect its function.

Our goal is to ensure that your nose functions normally and provides a natural looking appearance that suits your facial structure. On average, our office performs hundreds of nasal operations each year, providing us with incomparable experience and expertise.

Common patient complaints include; disproportionate nose, wide bridge, bump, depressed bridge, large or bulbous nasal tip, crooked nose, deviated septum, breathing difficulties, wide or upturned nostrils, and/or nasal asymmetry. During your new patient consultation, we will examine the structure of your nose, internally and externally, to evaluate areas of concern and develop a personalized care plan for you.

Scar Treatment

Scars occur for multiple reasons such as accidents, surgical procedures, burns, or acne. Scars may be located in a noticeable area or heal in a noticeable manner.

Many scars can be discolored, raised or depressed, are hypertrophic, or in some cases keloidal. Thankfully, scars may be improved upon and become less noticeable using injections, lasers, and other forms of resurfacing, such as microneedling or re-excision and closure.

There are many options to treat facial scarring. It is important to choose an office that offers a wide array of options to improve scars. During your new patient consultation, Dr. Olds will review possibilities with you and suggest the best route for your skin type and type of scar.

Provided courtesy of Girish Munavalli MD, MHS (Acleara) and reprinted with permission by Palomar Medical Technologies, Inc.

Skin Lesions - Skin Tag, Mole, Cyst, Lypoma and Wart Removal

Moles, cysts, lipomas, warts, skin tags, and other skin lesions, are very common and may be removed to avoid further growth, progression to malignancy, infection, or even to avoid feeling self-conscious. Depending on the type of lesion, removal of the lesion may or may not be covered by your insurance.

When thinking about removing a skin lesion, it is important to discuss what to expect with your doctor. In most cases, lesions can be excised, shaved down, or removed quickly in the office. Some lesions are more invasive and may need to be removed entirely and stitched with sutures.

In a handful of cases, it may be necessary to remove the lesion and a margin of bordering skin, which may leave a larger wound than originally expected. Surgery may even be recommended in an effort to remove a skin lesion that is showing pre-cancerous or cancerous signs. In most circumstances, after the lesion has been removed, a small sample of the lesion is sent to a laboratory for examination.

Upper Lip Lift

A surgical procedure that elevates the position of the upper lip by excising skin below the base of the nose, shortening the space above the upper lip. This helps to create a more full, relaxed and beautiful smile. Lip lift procedures are performed in office under local anesthesia. No muscles or nerves are cut which allows all facial elements to maintain their natural expression. Downtime is 4-7 days and the majority of swelling will reside after 3-4 weeks.

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For an appointment or consultation, please call us at 406-657-4653 or 1-800-332-7156, ext. 4653.


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