Typically, I do otoplasties in my office in adults under local anesthesia.  If an adult wants to have the procedure under sedation or general anesthesia in the hospital, that is fine with me.  The procedure is easy for the patient under local anesthesia and most adults prefer to do it this way. In children, I always do the procedure under general anesthesia in the hospital.

I do many mini-facelifts.  The mini-facelift that I do is very effective in the right patient and it is significantly less surgery then a traditional facelift.  Many of these procedures are done under local anesthesia in my office whereas a traditional facelift is done in the hospital under sedation or general anesthesia.  The mini-facelift that I do works on the cheeks, jowls and neck.  If a patient has a very heavy neck, a traditional facelift is a better procedure.  If the issue is simply laxity of the cheeks, jowls and neck, a mini-facelift is an excellent procedure with very high patient satisfaction.

I would have to see you or at least photos of you to give an intelligent opinion as to what procedures you need.  A very common combination of procedures in your age group is a brow lift with a blepharoplasty and a facelift (mini or traditional).

Botox or Dysport injected in the glabella (the area between the brows) and just above the brows in the muscles that cause the vertical creases, into the crow's feet and into the lateral area of the brows weakens the brow depressor muscles and does cause brow elevation.  The elevation is not as significant as that seen with a surgical brow lift.

I use many cartilage grafts in rhinoplasty.  Most of the grafts are sewn in place so that they don't move. Occasionally, they are placed in a precise pocket that holds the graft in place and doesn't require any sutures.