Oculoplastic Surgeon Vs. Plastic Surgeon for Eyelid Surgery

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Reasons Why You Should Choose Oculoplastic Surgeon Vs. Plastic Surgeon for Eyelid Surgery

Plastic and reconstructive surgery can have a significant impact not only on your personal appearance, but also your level of self-esteem. Before having surgery, it is crucial to make a careful selection of who you will trust with your face. It is critically important to choose a highly trained doctor with the skill and experience needed to ensure the highest standards of safety, plus the desired clinical outcomes.

If you are considering eyelid surgery, you’ll face a fundamental choice: Oculoplastic surgeon vs. plastic surgeon. What’s the difference between these two types of doctors? And which one should you pick for your own eyelid surgery?


What’s the Difference Between an Oculoplastic Surgeon vs. Plastic Surgeon?

One of the most important distinctions between these two fields is that an oculoplastic surgeon has a practice that is more specialized to a particular part of the body, whereas a general plastic surgeon takes a more generalized approach, providing cosmetic and reconstructive procedures for the whole body.

To understand the importance of this distinction, it may be helpful to consider the specialized training that’s needed to become an oculoplastic surgeon. First, it’s necessary to become Board-certified in ophthalmology, then to gain membership to the American Society of Ophthalmic Plastic and Reconstructive Surgery. (Dr. Brian Biesman has been a member since 1993.)To qualify for membership in ASOPRS, it’s also necessary to complete a certified fellowship, to take a written examination and an oral examination, and to maintain continuing education moving forward. It’s a somewhat long road to go through, but it does ensure really strong expertise and excellence in the area of constructive and cosmetic eyelid surgery.

So, to become an oculoplastic surgeon, Dr. Biesman first trained in the field of ophthalmology. He then received specialized training in plastic and reconstructive surgery of the eyelids and the face. He does not do breast augmentation, tummy tucks, liposuction, or similar procedures that are commonly associated with general plastic surgery.

Given the more specialized nature of his practice, it is much easier for Dr. Biesman to be extremely familiar with the delicate anatomy of the eyelids and the eye sockets, and the complex relationship between the eyes and the rest of the face—because it does really all fit in together.

Someone who is a general plastic surgeon may do a variety of different procedures, whereas Dr. Biesman focuses on the eyelids, the upper face, the area around the eyes, and the mid-face.


Should You Choose an Oculofacial Surgeon for Your Eyelid Surgery?

Is this level of focus and specialization an advantage? There is a tremendous amount of variability from one patient to the next. Dr. Biesman has had patients come see him for cosmetic surgery, and he has diagnosed them with tumors behind the eye and even identified brain tumors. There are a lot of subtle changes that take place that are important to identify in order to ensure the patient’s overall health and safety, and in some cases to seek life-saving interventions. Dr. Biesman’s background as an oculofacial plastic surgeon really does help him identify these signs and subtle changes.

The eyelids are highly complex, and it’s important to find a surgeon who really understands the relationship between the eyelids, the bony eye socket, and the rest of the face to perform your surgery.

Does that mean that everyone who comes to see Dr. Biesman should have him do their surgery?  Not necessarily. It’s most important for you as a patient to feel comfortable with whoever is doing your surgery. You shouldn’t go to someone just because they have a great Instagram page. You shouldn’t go to someone because you heard they were good. You want to do your homework, but more importantly than anything else, you want to make sure you feel that that surgeon has a connection with you, listens to you, understands what your concerns are, and then has a plan that sounds like it should address your concerns in a reasonable way. 

You want expectations to be set realistically. You want someone to talk to you about what will happen if things don’t go as planned. Remember that in surgery, as in the rest of our lives, sometimes things don’t go just the way we want. It is necessary to know what happens if things don’t go well, and to feel confident that you made the right decision about the person who will take care of you even if things don’t go the way they want. Second guessing yourself or having regrets should be avoided at all costs. You want to feel like, no matter how things go, you made the best decision.

Dr. Biesman is extremely proud to be able to offer eyelid and facial surgery. He says it is very gratifying that patients do ask him to take care of them. It’s a fun part of his job to walk patients through their surgical journey from beginning to end.


What is Dr. Biesman’s Background as an Oculofacial Plastic Surgeon?

Dr. Biesman has an advanced level of education and experience in the field of oculofacial plastic surgery. He earned his undergraduate and medical degrees from the University of Michigan, graduating with high honors. He completed his Ophthalmology residency at the Illinois Eye and Ear Infirmary and then went on to fellowship training in Ophthalmic Plastic and Reconstructive Surgery at the prestigious Manhattan Eye, Ear, and Throat Hospital in New York, NY. 

Dr. Biesman ultimately spent some time in Boston, MA, assuming the Directorship of the Eye Plastics and Orbit Service and the Center for Aesthetic Eyelid and Facial Surgery at the New England Medical Center. During this time, he served as an Assistant Professor of Ophthalmology at Tufts University School of Medicine.

He has had his own busy practice in Nashville, TN since 2002, and also remains active in clinical research. He has been named one of America’s Best Doctors every year from 2004 to the present day.


Find Out More About Eyelid Surgery

To schedule a consultation appointment with Dr. Biesman, or to learn more about eyelid surgery, we welcome you to contact our practice (615)329.1110.


What Is A Liquid Facelift? – Overview by Oculofacial Surgeon

Home » Blog » 2021 » November

What is a Liquid Facelift And Is It Right For You?

As we get older, we all begin noticing unwanted signs and symptoms of the aging process, including fine lines and wrinkles, lost volume, and more. There are a number of options available for facial rejuvenation, though these different treatments vary both in what they can accomplish, and how extensive their results can be. One treatment that patients should be aware of is what’s commonly known as the liquid facelift.

“Liquid facelift” is a term that physicians didn’t come up with so much as patients did… but nevertheless, it has become a huge term on social media, and it’s a procedure that more and more patients are aware of. As such, it’s worth pausing to consider these questions: What is a liquid facelift, what does it do, and are you a candidate for it?


What is a Liquid Facelift?

To start with, it’s crucial to understand that facelifting surgery is surgery that’s performed to rejuvenate the lower face and neck, the jawline, and the area under the chin. It is particularly useful when there is a lot of excess skin and a lot of sagging.

A liquid facelift does not accomplish the same thing as a surgical facelift. There are lots of changes that occur to the face over time that surgery won’t fix. For example, over time, our faces tend to lose volume. We get hollow in the temples, under the eyebrows, and under the eyes. The soft tissue in our cheeks begins to deflate, which can lead to deeper wrinkles and lines. We also see changes along the jawline, changes in the chin, even changes in the lips. Almost every part of the face will be affected over time by changes to natural volume.

That brings us back to the liquid facelift, which is a way to rejuvenate the face both by recontouring (meaning to pick things back up and reposition them) and by restoring the volume that’s been lost with age. Note that a liquid facelift cannot reposition as effectively as surgery can, but it can still offer some very positive results.


How Does the Liquid Facelift Work?

How does all of this happen? Liquid facelifts are performed with the use of soft tissue fillers to address those changes that occur as a result of deflation, and to some degree the sagging of tissue for patients who really aren’t great surgical candidates.

Liquid facelifts are performed in our office without the need for sedation or anesthesia, though many patients opt to receive a topical anesthetic (or “numbing cream”) before their treatment begins.

Once the patient is comfortable, soft tissue fillers are used strategically to produce a more relaxed and natural facial appearance. Click here to get your guide to facial fillers and learn more about Dr. Biesman’s approach to facial contouring with injectables. 

What is the Recovery from a Liquid Facelift?

One of the reasons why patients are drawn to the liquid facelift is that the recovery is much less extensive than what you’d experience with a surgical facelift.

After their liquid facelift, most patients experience very little discomfort. However, some swelling or bruising may occur. Dr. Biesman’s patients who experience bruising are invited to contact the practice to arrange for a complimentary laser treatment which can help to resolve the bruising more quickly.


What’s the Difference Between a Surgical Facelift and a Liquid Facelift?

One thing that patients should know about these two procedures is that they can often be complementary. A liquid facelift may be performed to restore lost volume and to improve the facial contour, while a surgical lift can be more effective at re-suspending tissue that has succumbed to time and gravity, or is simply present in an excess quantity. 

In other words, these procedures are intended to accomplish different goals, and as such, it’s inaccurate to say that one is superior to the other.


How Long Do Liquid Facelift Results Last?

Patients often want to know for how long their liquid facelift results will last. The timeline can vary depending on the type of injectable fillers used. Some fillers last for only a few months, while others may last for up to two years.

During your consultation with Dr. Biesman, he will be happy to speak to the type of filler he recommends, as well as to the potential advantages of “maintenance” fillers to extend your initial results.


Is the Liquid Facelift Right for You?

How do you know if you are a good candidate for a liquid facelift? First and foremost, it is important to meet with an experienced oculofacial plastic surgeon, like Dr. Biesman, who can assess the changes to your face and inform you as to which type of intervention is right for you. Always seek the expertise of a facial or oculofacial plastic surgeon to determine the path of facial rejuvenation that’s best suited to your anatomy and your aesthetic goals.

Generally speaking, if your biggest concern is fullness of your neck, heavy jowls, your eyebrows dropping below the bony eye socket, or your lower eyelids being really puffy, surgery really is going to be the best option for you. But for those patients who don’t have changes that are so advanced, particularly those who have been relatively thin and fit their whole life but notice that they are looking older, liquid facelifts can be ideal.

Often, Dr. Biesman will ask patients to pull up their social medial to show him some old photographs, allowing him to look and see what’s changed and then use injectable fillers in various parts of the face, starting at the top and working down to help restore a more natural, youthful appearance, without it looking like the patient has had any work done.


Schedule a Liquid Facelift Consultation Today

Dr. Biesman has been performing facial rejuvenation procedures since the early 1990s, and has a wealth of knowledge and expertise regarding the use of soft tissue fillers to address wrinkles, lost volume, and related changes. To find out more about this procedure and your candidacy for it, click here to view Dr. Biesman’s injectable filler before and after photos then schedule a consultation with Dr. Biesman at your convenience.

Benefits of Masseter Botox – Jawline Contouring

Home » Blog » 2021 » November

All About The Benefits of Masseter Botox

Botox is a popular injectable treatment, well-known for its effects relaxing the muscles and smoothing certain types of wrinkles and fine lines. In addition to its applications for facial rejuvenation, Botox can also be injected into the masseter muscles, which is one of the muscles that control the jaw.

For some patients, this application of Botox may sound a little odd. Many years ago, Dr. Biesman remembers being in a meeting with senior leaders from the company Allergan, who were looking down the road for potentially new and useful applications of Botox. There was a small group of physicians, Dr. Biesman among them, who were in agreement that using Botox in the jaw muscles was a really promising idea that needed to be explored. The scientists at Allergan felt there was no way this application of Botox would ever become popular; they simply couldn’t imagine it. 

Several years later, Dr. Biesman and his team have performed two clinical trials on masseter Botox injections and studied the benefits of masseter Botox injections. Soon, Allergan will be able to begin advertising this particular use of Botox. When it comes to jaw injections, things have truly come full circle. But what exactly are the benefits of masseter Botox, and for what issues is it an effective treatment?


What are the Benefits of Masseter Botox?

There are two main reasons for injecting the jaw muscles with Botox. One reason is for facial shaping. The jaw muscle can be very prominent in some people. For example, when you bite your teeth together, you can sometimes see the jaw muscle pop out. Some people even have a square type of jaw because their jaw muscle is so prominent.

Some people like that contour, and that’s okay. By the same token, some people would like their jaw to look more slim. As such, one of the reasons Dr. Biesman uses Botox in the jaw muscles is for slimming the face.

The other main reason to use Botox in the jaw muscles is to relieve the symptoms of clenching and grinding the teeth. People who don’t clench or grind may not be able to relate to this, but for those who do, it can really be an issue. People who clench and grind their teeth will often break their teeth. They may also grind their teeth together at night so loudly that their partner stays awake or cannot sleep in the same bed. There are other times when people are so sore, or have so much pain from grinding, that they really have a tough time getting through the day. 

Dr. Biesman often sees patients who have seen dentists, gotten mouth guards, and chewed right through their mouth guard, without experiencing any relief. Other patients try acupuncture and a range of other treatments, none of which have proven successful. Botox is a great treatment for relieving the discomfort associated with people who clench and grind their teeth.


Is Masseter Botox a Good Treatment for TMJ?

One point that’s really important concerns TMJ, or temporomandibular joint syndrome, and its relation to the jaw muscle. It’s true that people who clench and grind their teeth may experience symptoms like those associated with TMJ. However, TMJ is a complex disorder that has multiple different causes, of which the jaw muscles may be one. Dr. Biesman likes to be clear with patients that he is not a TMJ specialist. If someone comes to Dr. Biesman saying their primary issue is that they have TMJ, he will typically advise them to seek a specialist first, whether that means an oral surgeon or a dentist. If the specialist recommends Botox as a form of treatment, that’s certainly something Dr. Biesman can provide.

The vast majority of the patients Dr. Biesman treats with Botox for their masseter muscles are either trying to pursue slimming of their face to get a more feminine appearance, or they clench and grind their teeth.


What to Expect from Masseter Botox Treatment

Botox is a minimally invasive, in-office treatment that is FDA approved and, assuming a skilled injector, generally very safe. Anesthesia and sedation are not required for Botox treatment. Botox injections are performed with a small needle, used to administer Botox into muscles along the lower face, the jaw, and the upper part of the neck.

While some patients may begin to see some positive effects right away, it usually takes up to two weeks before patients experience the full results of their Botox treatment. The effects of Botox are not permanent, and many patients return for “maintenance” injections every three or four months, allowing them to extend the positive effects and benefits of their masseter Botox treatments.

There is very little recovery time associated with Botox, and the side effects tend to be very mild. These effects can include some bruising or soreness around the injection site. Side effects of Botox usually resolve on their own within a matter of days. Click here to learn more and view Dr. Biesman’s Botox before and after photos.


Finding the Right Injector for Masseter Botox

Another important point to be aware of is that injection of Botox in the jaw muscles is actually fairly tricky. When performed well, the results can be truly outstanding. However, it is truly important to find an injector who is very experienced. With inexperienced injectors, you can get the smile being affected, you can get ineffective treatments of the jaw muscle, and you can get incomplete treatment for your clenching and grinding symptoms. The results can be suboptimal overall.

Patients are encouraged to do their homework, and find somebody who is really experienced and understands the anatomy of the jaw muscles. With that said, definitely think about jawline contouring with Botox for the jaw muscles if you are interested in either slimming your face or treating symptoms for clenching and grinding your teeth.


Learn More About the Benefits of Masseter Botox

If you have any further questions about getting masseter Botox, or believe you may be a good candidate for this treatment, the next step is to schedule a consultation. Make an appointment to speak with Dr. Biesman at your convenience.

Benefits of Laser Skin Resurfacing and The Types of Lasers

Home » Blog » 2021 » November

Many patients come to Dr. Brian Biesman with specific questions about the
benefits of laser skin resurfacing, the types of lasers available today,  and about its appropriateness for addressing their particular skin concerns.

Dr. Biesman has been performing laser skin resurfacing since the early 1990s. And, he has been fortunate to play a significant role in the development of several new technologies over the years, as well as techniques. This article will provide some basic guidelines as to what laser skin resurfacing is, why it is used, and when it is or is not recommended.

To begin with, what is laser skin resurfacing? Laser skin resurfacing is a procedure in which a qualified doctor, like Dr. Biesman, uses lasers to cause a controlled injury to the skin. As the skin heals, you will often see a remarkable transformation.

Dr. Biesman’s background as an oculofacial plastic surgeon leaves him to be especially interested in resurfacing the eyelids. His many years of experience and his expertise as a laser surgeon make him uniquely qualified to perform laser resurfacing of the face, neck, chest, arms, and more. Lasers can be used all over the body to achieve a wide range of beneficial outcomes.

The Benefits of Laser Skin Resurfacing

There are a number of things resurfacing doesn’t do, but there is also a ton of stuff that laser resurfacing does do. Laser skin resurfacing is great for treatment of:


  • Sun damage
  • Photoaging
  • Aging changes in your skin
  • Fine wrinkles
  • Deep wrinkles
  • Superficial discoloration
  • Deeper changes in the skin
  • Treatment of surgical scars
  • Treatment of traumatic scars
  • Treatment of acne scars
  • Treatment of burn scars


A lot of patients ask specifically about laser skin resurfacing as a treatment for melasma or hyperpigmentation. Melasma is the brown discoloration that many patients get; it is an extremely common problem, and it is also very tough. It’s not something you can cure with laser resurfacing. Sometimes lasers or other energy-based devices, like IPL, can be used to help manage it, but for the most part melasma is a condition that’s best managed medically. 

For example, laser resurfacing does not treat spider veins, it doesn’t treat blue veins under the eye, it doesn’t remove tattoos, and it doesn’t treat vascular birthmarks, all of which can be treated with other types of laser therapy.

Types of Lasers Used for Resurfacing Treatments

The spectrum of laser resurfacing devices is broad. If you have very mild changes in your skin, you just need a light resurfacing treatment. Dr. Biesman and his team also perform laser skin treatments on a maintenance basis to keep your skin looking fresh and beautiful.

If you happen to be someone who hasn’t kept up with skincare over the years, and if you have a lot of sun damage, deep wrinkles and lines, or discoloration, there are types of lasers that can address that, as well. 

Some lasers are more aggressive in their treatments, and some are more superficial. It is crucial to note that aggressive lasers aren’t always better. Dr. Biesman’s job as a leading expert in laser surgery is to match the aggressiveness of the treatment with your condition. 

Superficial conditions that are very mild can be addressed with very light treatments, where there may be just a day or so where your skin is pink, but with no real downtime. More advanced changes may take a couple of weeks to heal, but you get long-lasting results if you’re willing to put in that investment. More aggressive treatments can give you years, if not decades, of outstanding results. By contrast, a very superficial treatment with minimal downtime is something that you’ll probably need to keep up with on a regular basis. 


Specific Types of Lasers

A lot of patients ask for treatment with certain, specific types of lasers. As you consider your own aesthetic objectives, it may be helpful to have some background knowledge about the different lasers that are available for skin resurfacing. 

One very popular, well-known brand name is Fraxel. Fraxel is just that: A brand name, like Mercedes, BMW, or Chevrolet. Under that umbrella, there are actually a number of different devices. There is no such thing as a generic “Fraxel treatment.”

Some Fraxel laser treatments are associated with a little bit of pinkness of the skin, but very little in the way of healing. Others come with a bit more downtime, and some can actually have a full one to two weeks of downtime.

Some laser resurfacing treatments, such as the UltraPulse (which is the original gold-standard device), can have anywhere from three days of recovery time to a full two weeks. 

When treating scars, and especially acne scars, Dr. Biesman may do something called fractional skin resurfacing. This usually involves three to six days of recovery time. It will probably take more than one fractional skin resurfacing treatment to get best outcomes, because by definition these treatments only affect a fraction of the skin’s surface. After two or three treatments, most patients see great results.

In general, the more aggressive the treatment, the longer the recovery, the better the results, and the longer those results last. The less aggressive the treatment, the faster the recovery, the lower the risk, and the greater number of treatments required. Additionally, you will probably need to keep up with these less-aggressive treatments on a more regular basis.


The Risks of Laser Skin Resurfacing

There are risks associated with any medical procedure, and laser skin resurfacing is no exception. It’s really important to understand the relative level of risk involved with the treatment that is recommended for you.

In most cases, the risks are minimal. If your treatment is performed by someone who is extremely experienced and knowledgeable, then even if something starts to go sideways, it can be recognized and treated. It is very uncommon for there to be anything that doesn’t go well with a laser resurfacing treatment.

Learn More About the Benefits of Laser Skin Resurfacing

Overall, this is a phenomenal procedure, and Dr. Biesman encourages patients to find out more about all of the benefits of laser skin resurfacing and its potential applicability. Click here to view Dr. Biesman’s  laser skin resurfacing before and after photos and contact our office to schedule a consultation appointment.