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All posts by Timothy Janiga

What is Otoplasty, and Who is a Good Candidate?


Otoplasty is a procedure performed on children and adults who would like to have their ears lay flatter against their head or who would like the shape of the ear changed. Most people believe otoplasty is only a procedure that pins the ear back to the head, or what’s called “ear pinning.” However, by definition it also includes procedures where the shape of the ear is changed. There are many reasons why people want to change the shape of the ear – including genetic abnormalities – but there can also be cosmetic reasons for the procedure.

When people are exposed to new social situations such as starting a new school, entering a new class, starting a new job or entering college, they may be exposed to a new set of people and feel uncomfortable if their ears do not lay flat against the head or if their ears have an abnormal shape. This is especially common in people with short hair and in those who wear their hair in a ponytail for particular activities. It may not have bothered the person when they were younger, but when these situations arise, ear shape or prominence may begin to bother them.

Otoplasty is performed in children to remove the prominence of the ears or to reshape an abnormally shaped ear the child was born with. With children, this procedure usually needs to be done in the operating room. The downtime after surgery is minimal, but anesthesia can make a child tired for about a week after a procedure.

For adults, both ear pinning and ear reshaping can be performed under local anesthesia in the office in most circumstances. The downtime is minimal, but for more involved cases there can be some discomfort for about a week.

If you or your child is having difficulty with the shape
or prominence of the ears, please call 775-398-4602 to make an appointment to see Dr. Timothy Janiga for a consultation.

This post was last updated on .

Medical tourism: approach plastic surgery abroad with caution


The trend of going out of the country to receive plastic surgery continues to increase. According to Patients Beyond Borders (www.patientsbeyondborders.com) over 1 million United States citizens traveled outside of the United States for medical procedures. The most common procedures are cosmetic dentistry, cardiovascular surgery, joint replacement surgery, fertility procedures, weight loss/lap band, and cosmetic surgery. Some of the most common countries that people travel to receive these surgeries are Costa Rica, India, Malaysia, Mexico, Thailand, Taiwan, and Turkey. The medical tourism industry continues to increase as healthcare costs in the United States increase. Deductibles for insurance are higher so patients are responsible for a larger portion of their medical costs, surgical facilities and hospitals are charging more for overnight stays and medication, visitation fees, nursing care, and postoperative care costs all continue to increase with time.

This discussion is not intended to disparage any other country or international physicians as there are a lot of great hospitals and great physicians locally and internationally, it is intended to educate you regarding the major risks of having procedures outside of the United States from my perspective.

Let us review some of the positives regarding hospitals, surgery centers, and physicians in the United States. Hospitals are regularly monitored by the government bureau called JAHCO. This agency will conduct surprise inspections, monitor infection rates, monitor patient volumes and readmission for complications. The hospitals in the United States must be accredited and certified in order to perform surgeries on patients with health insurance. Surgical centers whether inpatient or outpatient, must undergo similar accreditation by JAHCO and a separate surgical center accreditation to become an insurance certified surgery center. Physicians in the United States are monitored by their individual and respective boards, have to do continuing medical education in order to maintain their board certification, and can be researched on their state medical board website for certifications and disciplinary action. These are all safeguards put in place through the government and state agencies to ensure that the best safety measures and quality are provided to the patients in each state.

Internationally, there has been a movement to use the same American criteria for hospitals and surgery centers as an international standard. Our JAHCO will have its international version called Joint Commission International and the international surgical centers will also have a separate accreditation that should be closely equivalent to American standards. This criteria has been met by some international facilities. Physician certification in other countries varies by country. India and England for example follow a similar structure and certification, while some Asian countries have a completely separate way of certifying physicians as specialists that would perform surgery.

There are some risks outside of accreditations and certifications that patients should also be aware of. First and foremost is having to travel after having surgery. The postoperative recovery period varies for each type of surgery, but can range from a week to three months depending on how involved your surgery. Traveling on an airplane a short period of time after surgery can increase your risk of blood clots in the legs and may predispose you to bleeding or infection at a time while you are traveling and not able to reach a physician quickly. Additionally, postoperative complications are possible for months after your surgery. Most complications occur within the first three months, but it is possible to have new pain, infection, or an issue with an implantable device months to years after that surgeries been performed. If your physician is located outside of the country it will be difficult for you to find postoperative care especially for an immediate complication while you were traveling. Lastly, most health insurance plans now have provisions in their policies that they will not cover any complications from surgery performed outside of the United States. This means if you have a complication such as bleeding, infection, or a problem with an implantable device, any emergency services that you received in the United States afterwards maybe denied through your health insurance policy. Your health insurance wants you to have surgery at a contracted, accredited facility with a board-certified surgeon that has been vetted by your insurance company as an approved and credentialed physician in that specialty.

In conclusion, the motivation for having procedures outside of the United States is usually a financial motivation as it is less expensive in general to have procedures performed in other countries. However, safety is the utmost priority when it comes to your health and this should be your first and foremost consideration when making the choice to have an operation. There is no system that is perfect, including the healthcare system in the United States, but it is no coincidence that important figures from across the world travel here to have their surgeries performed, why would you go somewhere else?


– Dr. Timothy Janiga

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Cosmetic Surgery is on the rise. Will you partake?

Botox Injections

TIME magazine’s June 18 cover story was titled, “Nip. Tuck. Or Else. Why you will be getting cosmetic procedures even if you don’t want them.” After reading this article, I was excited to see some things mentioned, and I disagreed with one major point.

The concepts that I thought were covered well were numerous. The article also did a great job of talking about different types of surgeries and the different types of patients that are getting surgery in the U.S. The general idea that the old concept of hiding your procedures was mostly de-bunked and the new ideas of being proud of your choices were reviewed. The best part of the article, in my opinion, was the outline of the increase in cosmetic procedures. It is true that cosmetic procedures continue to increase every year as new technologies, less invasive procedures and great techniques improve. So, it’s little surprise we’ve seen a rise in procedures.

The one area that was covered extensively in this article that I disagreed with was the idea that plastic surgery is done – and will be done – because people are trying to keep up with their neighbors. In my practice, I do not find this to be true.

In general, most women (and men) come in to my office to improve a particular area that bothers them. The patient may be a mother who would like to get her pre-baby body back with a mommy makeover, a person changing career tracks and wanting to look their best with a facelift, or someone who has always been bothered by a particular area on the body such as the nose. Overall, my patients are everyday people with families and jobs who just want to look their best. These men and women are usually referred by a friend who has had surgery with me, but they do not come in because their neighbor had surgery.

The article in TIME is a good read, full of information, but a few areas should be taken with caution.

If you are considering plastic surgery, do it for you! Call us or go online to schedule a consultation with a board-certified plastic surgeon who can help you decide which procedures are best for you.

This post was last updated on .

Rhinoplasty: cosmetic benefits versus health benefits


Rhinoplasty is one of the most common surgeries I perform. Frequently, I am asked the difference between rhinoplasty for cosmetic reasons and rhinoplasty for medical reasons and what are the benefits of each. In order to answer this question, we first need to discuss the different types of surgery that can be performed on the nose. These procedures can be performed in combination or alone depending on your specific situation.

“Functional rhinoplasty” and “septoplasty” are the terms used for internal nasal surgery performed through your medical benefits on your health insurance. This is performed when the septum (the wall down the inside of the middle of your nose) is deviated (moved to one side) and inhibiting your ability to breathe or the ability of the sinuses to drain, causing chronic sinus infections. This surgery is mostly performed inside the nose and relocates the septum to a central location, allowing both sides of the sinuses to drain and air to flow through. This type of surgery is performed purely to improve breathing or sinus drainage and does not include any external procedure to improve the look of the nose. That said, cosmetically if the septum is deviated, the nose usually appears slightly crooked. Fixing the deviated septum usually improves the appearance of a “crooked nose.”

Turbinate repair is another medical procedure that was performed inside the nose. The turbinates are the tissues on the wall of the nose that secrete mucus and swell in response to allergies. In people with severe allergies, the turbinates can swell enough to obstruct breathing and cause problems with sinus drainage and airflow. The turbinates can be lessened in size with surgery. This improves airflow through the nasal passage, decreases mucus secretion and allows the sinuses to drain better.

Polypectomy is another procedure that can be performed medically inside the nose. Polyps are small grape-like sacs that grow from the sinus walls in response to severe allergies. These sacs can cluster and obstruct sinus drainage, impede airflow and cause chronic sinus infections. Polyps can be removed surgically with a polypectomy. Removing these polyps allows the sinuses to empty, improves airflow and decreases sinus infections.

Most of the cosmetic procedures performed on the nose are performed to improve the external appearance of the nose. Cosmetically, there are a few areas people like to improve on the nose. The dorsal hump, nasal tip and overall size can be improved with cosmetic rhinoplasty. When performing a rhinoplasty for cosmetic reasons, it is important to always consider the functional aspect of the nose. In every rhinoplasty I perform – whether cosmetic or functional – I want the patient to be able to breathe better following the procedure.

The dorsal hump is the bone and cartilage at the top portion of the nose. At times, this hump can be more prominent and make people feel as though the nose is hooked or broken. This can be a normal anatomic variance, but it often bothers a significant number of people from a cosmetic perspective enough to seek out surgery. For this procedure, we shave down the bone and cartilage where the bump is to improve the contour and external appearance of the nose.

Tip rhinoplasty can be performed in conjunction with dorsal hump removal, but also is performed commonly alone. Tip rhinoplasty is performed on the very bottom of the nose for patients who do not like the appearance of that area. The tip can be lowered, raised, widened or thinned out without changing the shape of the nasal opening. This surgery improves the appearance of the bottom portion of the nose and the nasal opening.

When patients come in to be seen for cosmetic rhinoplasty, they often just want the nose to be “smaller.” Making the nose smaller usually involves a combination of tip rhinoplasty as well as some version of dorsal hump shaving to make the nose smaller.
Each procedure we perform is specific to your situation and can be combined with other procedures to give an overall improvement in function, cosmetic appearance, or both.

If you have a problem with the inside function of your nasal passages, please call Janiga MDs and make an appointment with me, Dr. Timothy Janiga, for your complimentary cosmetic rhinoplasty consultation or your insurance appointment

This post was last updated on .

Plastic Surgery Summer Trends


As summer enters full swing, we have seen an increase in body cosmetic procedures such as breast lifts, breast augmentations, abdominoplasty (tummy tucks), mommy makeovers, breast reductions and liposuction.

With warmer weather comes bathing suits, shorts and tank tops, bringing attention to parts of your body that may bother you. As a result, people start thinking about making improvements in these areas. Breast augmentation is common throughout the year, but tends to increase in warmer months and just before wedding season. Similarly, mommy makeovers, breast reductions, breast lifts and liposuctions become more common in the warmer months.

Wedding season, New Year’s, birthdays and the start of the summer months are just a few reasons (and seasons) that motivate people to come in for a cosmetic surgery consult. Whatever the motivation and whatever the season, Janiga MDs is here to give you the best opportunity to look and feel your best.

Get ready to hit the beach with confidence. Make your complimentary consultation with Dr. Timothy Janiga to see which of these procedures is best for you.

This post was last updated on .

How Young is Too Young for Cosmetic Surgery Procedures?

There’s been a lot of hype and interest in some of the young starlets having cosmetic procedures performed at very young ages; sometimes even younger than 18-years-old. While each situation is unique – and there are specific times where cosmetic surgery can be performed for patients younger than 18 – my general rule is usually 21 or older.

Let’s first discuss some of the special circumstances that might allow someone under 21 to have a cosmetic procedure. First and foremost, parental consent is required for patients younger than 18, except those who are emancipated adults. If that consent has been obtained, some special circumstances that might allow cosmetic procedures for people under 21-years-old would include genetic abnormalities of the chest wall, hypoplastic (underdeveloped) breasts, abnormalities of the jaw bones that would impede normal chewing and development, deviated septum in the nose preventing breathing, disfiguring scars after an accident, or other abnormalities that prevent normal growth and development or are psychologically damaging.


Interestingly, the FDA will not allow silicone breast implants to be placed in anyone younger than 22, even if they are born with genetic abnormalities or disfiguring medical conditions. Fillers such as Restylane and JuvĂ©derm are not approved for anyone under 22. Botox and Dysport are approved for 18 and older. All of the above factors need to be considered in addition to a young person’s mental health, parental involvement and long-term safety.

For adults older than 21, some factors are less complicated. When you’re 18, you are considered a legal adult and can consent to surgery. The FDA will allow fillers and silicone implants for adults over 21, so those issues are removed from the equation. But, whenever I am considering an operation on a young person – whether it be for strictly cosmetic purposes or for developmental abnormalities – there are many factors to take into consideration.

Please make an appointment with me, Dr. Timothy Janiga, so we can discuss both your personal situation and what is most appropriate for you.

~ Dr. Timothy Janiga

This post was last updated on .

How to Maximize Your Cosmetic Surgery Results

You’ve done the research, you’ve saved for the procedure and now you’ve finally pulled the trigger on the cosmetic surgery procedure you’ve wanted for a long time. Now what? I am often asked by my Reno plastic surgery patients, “What can I do to get the best results from my surgery?”

There are two ways to answer this question: the short answer and the long one. Today, we’re going to give you both.

Reno Cosmetic Surgery Results

The short answer:

The best thing you can do to maximize your outcome after surgery is to follow your pre- and post-operative instructions diligently. There are a lot of things that we are not able to control or predict when it comes to cosmetic surgery, but for everything that we can control and predict, we like to try to make sure those things happen.

The long answer:

When you book a surgery with Janiga MDs, you are provided written and verbal detailed pre- and post-operative instructions. It is very important to follow these instructions carefully to maximize your results.

The instructions before surgery include preoperative tests that vary by procedure, like a mammogram, bloodwork, abstaining from certain medications while making sure you take others. We ask you to get a good night’s sleep beforehand, as surgery is taxing on the body. It’s also important to have a good support system in place ahead of time so someone else can care for your basic needs while you recover.

Postoperatively, you will receive similar printed instructions, as well. These include details about when to restart your medications, as well as any food restrictions, how to take your medication for discomfort, phone numbers to call in case of emergency and approved activity level after surgery.

This last one is important. Often we hear from patients who feel good and would like to be more active than our instructions state, but it is crucial to your recovery that you refrain from too much activity too soon. Patience is key to achieving the best results from your cosmetic surgery procedure.

Many factors go in to a surgical procedure and maximizing outcomes. As a patient, your most significant contribution to this surgery is your full participation in the before and aftercare.

Call our Reno plastic surgery offices any time to discuss your cosmetic surgery needs. You can trust us to provide you with the best comprehensive care available.

~ Dr. Timothy Janiga

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The Benefits of Having Dermatology and Plastic Surgery in the Same Office

The specialties of dermatology and plastic surgery complement each other exceptionally well. We like to say that where one begins, the other ends, but it is a continuum. At Janiga MDs in Reno, most of our patients take advantage of both the plastic surgery and the dermatology side of the practice.

janiga mds reno

One great example of how plastic surgery and dermatology work together is in how we treat patients who are looking for an anti aging affect for their face. From the plastic surgery side, we can treat those larger issues that require surgery like removing excess skin, tightening underlying structures, and removing fatty deposits. From the dermatology side, we can improve the texture and tone of the skin, improve volume with fillers and help with fine lines and wrinkles.

At Janiga MDs, our patients enjoy a well-rounded approach to treatment. For example, all of our surgery patients receive a gift certificate to have a complimentary consultation with my wife our dermatologist, Dr. Jennifer Janiga.

During this consultation, they can talk to Dr. Jennifer about how they can maintain their youthful appearance after surgery and into the future. When she meets with people after I have operated on them she will advise them about skin checks, brown spots, fine lines and wrinkles and what products would best work for them. Often times these surgery patients will opt to receive lasers, botox or filler to complete their anti aging goals.

The reverse is also true. A lot of our dermatology patients will see Dr. Jennifer Janiga for many years and then decide that they would like to have surgery. Lasers, filler, botox and product are great for maintenance of the skin, but sometimes the only thing that will fix laxity issues is removing and lifting the skin, and that’s where I come in.

By having both dermatology and plastic surgery in the same office, we can offer a well-rounded approach to procedures and skin care. Many times I will see a patient for surgery and let them know they are not ready for that extensive of a procedure and my wife will perform a less invasive treatment for them. This holds surgery off sometimes forever and other times for a few years.

This combined all-inclusive approach allows our patients to get the best long-term result as possible with the best approach for their individual needs.

Call our Reno plastic surgery and dermatology offices any time to set up your consultation. We can help you decide if you should see Dr. Jennifer Janiga in dermatology or myself, Dr. Timothy Janiga in plasic surgery (or both).

~ Dr. Timothy Janiga

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Breast Augmentation with a Lift vs Just Breast Augmentation

Many women come for a consultation and are not sure if they need a breast augmentation alone or a breast augmentation with a breast lift (also called a mastopexy augmentation). Most women would prefer to have the augmentation alone and hope that this would give them enough of a lift, but this is not always the case.

These are two completely different surgeries that I will try to differentiate today.

breast augmentation with a lift

Breast augmentation is performed for women who would like an increase in the size of the breast, but are less concerned with lifting the breast. A breast augmentation or boob job procedure is performed by using an incision either under the breast, around the areola, or in the armpit where an implant is inserted through the incision. The volume of the implant does give some lift effect, but this is not its primary purpose.

Breast augmentation with a lift also called mastopexy augmentation is usually necessary in women who are looking for a larger size and a lift in the position of the breast. Many have lost a significant amount of weight, have been pregnant multiple times, or have a natural genetic tendency to have pendulous breast tissue.

A breast lift with augmentation entails more incisions than breast augmentation alone. The anchor incision is the most common type but vertical lifts are also possible, decreasing the number of visible scars. The excess skin is removed and the nipple areolar complex is repositioned to be in a more youthful position. Before closing the tissue, the implant is placed to help with size.

You can see some amazing breast augmentation and breast augmentation with a lift/mastopexy augmentation before and after photos on our website.

It is difficult to know whether you will need a breast lift with augmentation or a breast augmentation alone, come to our Reno plastic surgery office for an evaluation with Dr. Timothy Janiga to see which of these procedures is best for you.

~ Dr. Timothy Janiga

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Transformation Tuesday: Patient Before & After

For this month’s before & after transformation we chose a patient who had a treatment plan that was customized to her specific needs. As with all of our Reno plastic surgery patients, we evaluate this patient’s needs and requests to create a treatment protocol that fit her needs.

In this patient’s before photo she has a significant amount of laxity in the lower face and neck, requiring a facelift, but one of the things that also really bothered her was her upper lip.

facelift before

Many people will advise filler or fat grafting to this patient’s upper lip, but this case is a more difficult one. This is a perfect example of a woman with a naturally aged and very thin upper lip. No matter how much filler or fat you place in this upper lip you will not get the results you are looking for. You will get that characteristic overfilled duck shape lip that we all dislike.

This patient received an in-office face and neck lift, which had minimal recovery time, and an in-office upper lip lift. An incision was made below the nose and a portion of the skin was removed.

mini facelift after

You can see that this gives her the natural shape of her youthful upper lip back and a beautiful Cupid’s bow shape.  No filler or fat was placed in the lip, the before and after are 6 weeks apart and she has nothing but her natural anatomy.

Come visit our Reno plastic surgery office and have a personalized one-on-one consultation with me.  We can discuss if you need one of our customized procedures including lip lift, in office facelift, earlobe repair, or possibly revisionary surgery from previous operations.

~ Dr. Timothy Janiga

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