About Dr. Tollefson
Travis T Tollefson MD, MPH, FACS, is the Director of Facial Plastic & Reconstructive Surgery at UC Davis, where he and his team offer excellence in the full spectrum of pediatric and adult facial reconstruction and aesthetic surgery. As Co-director of the UC Davis Cleft and Craniofacial Program, he also provides surgical care for children and adults with cleft lip and palate, microtia, or head and neck vascular anomalies. Dr Tollefson enjoys the challenges of rhinoplasty and revision rhinoplasty, whether the patient is seeking improved nasal function, nasal appearance, or both. He recently co-chaired the clinical practice guidelines on rhinoplasty and is a strong patient advocate for his rhinoplasty patients.
Patient Education Emphasis
Dr. Tollefson is dedicated to providing the best possible educational experience so that each patient is fully involved in the decision-making process. Some patients take advantage of the clinic’s latest technologies during consultation, including 3D facial analysis using an automated stereophotogrammetry system, educational offerings on iPad’s in the clinic to inform patients about the patient’s problem, the potential treatment options, and the alternatives.
Non-surgical techniques
Dr. Tollefson and his team also specialize in non-surgical techniques to help you look your best at any age. To meet the needs of some patients, a surgical procedure is not always necessary. Non-surgical options are available such as laser skin treatments, dermabrasion, facial fillers, and Botox injections.
From Start to Finish
Whether you have always wanted to change the shape or function of your nose with a rhinoplasty, or have had a facial skin cancer removal (Mohs surgery) from your face, Dr. Tollefson emphasizes patient education and support for patients and their families for both surgical and non-surgical procedures. From the moment you step in to our clinic we hope you will ask questions and consider us partners in your care. Both Dr. Tollefson and his extraordinary nursing team to help guide you through your assessment, presurgical preparation, surgery and aftercare, or non-surgical procedure to achieve your best results.
To schedule a consultation, please call (916) 734-2347
- A child with a cleft palate will most often have surgical repair around 1 year of age.
- The goals of the surgery are to realign the speech and swallow muscles and repair the palate.
- For the next few years, most children will benefit from specialized speech therapy and some (approximately 15-25%) will require a secondary speech surgery.
- These speech surgeries are typically considered after the child is 4-5 years old, so that they can cooperate fully with the Velopharyngeal Dysfunction (VPD) workup. (link to ACPA speech patient info webpage)
- The VPD workup gathers information about the child’s speech,the amount of nasal air escape and hypernasality with phonation .
- We are very interested in the overall effects of the child’s ability to communicate.
- Overall, the child’s intelligibility can cause difficulties with speaking with friends, at school, and with family.
- We believe in learning more about how this can affect the quality of life of both the child and their family. We collect a short survey (VELO) on all of our patients so that we can better address their needs. We have also developed a Spanish language VELO to meet the needs of our patient population.
- If Dr Tollefson and his specialized speech-language-pathologist determine that a speech surgery is warranted, we promote a shared decision-making process with parents.
- A child with a cleft palate will most often have surgical repair around 1 year of age.
- A child with a cleft palate will most often have surgical repair around 1 year of age.
A view of a pharyngeal flap seen with a scope through the nose is shown . Often this surgery is chosen during the VPD workup if the soft palate is not touching the back of the throat (a gap in the posterior pharynx), and the side walls are moving really well. 
This revision palate surgery is completed to reposition the muscles of the soft palate and to use a Z-shaped pattern to the incisions, which can add length to the palate and allow it to better touch the back of the throat. 
The tissue flaps are from the “pillar” from behind the tonsils ( or where they used to be for children who have had tonsils removed). Often this procedure is chosen after the VPD workup if the soft palate is moving backwards well but the sides of the throat are not moving well. Repair of facial cancer defects that have been created using the Mohs technique often utilize healthy adjacent skin flaps or skin grafts. Large facial cancers occasionally need to be repaired using free tissue transfer, ie skin, muscle, and/or bone from a different part of the body brought to fill the facial defect.
How to Prepare for Rhinoplasty Surgery
Nasal surgery can correct functional breathing problems (septoplasty) and the aesthetic appearance of the nose (rhinoplasty). Reshaping the nose requires careful attention to facial balance and proportion, resulting in a nose that looks natural and in proportional balance with other facial features. Creating this balance is an art and can significantly enhance facial appearance. Rhinoplasty is often performed under local anesthesia with minimal time off from work.
The Surgery
First, incisions are made and the bone and cartilage support system of the nose is accessed. The majority of incisions are made inside the nose, where they are invisible. In some cases, an incision is made in the area of skin separating the nostrils. Next certain amounts of underlying bone and cartilage are removed, added to, or rearranged to provide a newly shaped structure. For example, when the tip of the nose is too large, the cartilage area is sculpted to reduce size. The angle of the nose in relation to the upper lip can be altered for a more youthful look or to correct a distortion.
The tissues are then redraped over the new frame and the incisions are closed. A splint is applied to the outside of the nose to help retain a new ship while the nose heals. Soft, absorbent material may be used inside the nose to maintain stability along the dividing wall of the air passage called the septum. Alternatively, soft nasal support that permit nasal breathing post-operatively can be placed. Risk factors in rhinoplasty are generally minor.
Post Surgery
Immediately after surgery, a small splint will be placed on your nose to protect it and to keep the structure stable for at least five to eight days. If packing is placed inside the nose during surgery, it is removed the morning following the surgery. Your face will feel puffy, especially the first day after surgery. Pain medication may be required. You are advised to avoid blowing your nose for seven days after surgery. In the immediate days following surgery, you may experience bruising and minor swelling in the eye area. Cold compresses often reduce the bruising and discomfort. Absorbable sutures are usually used that do not have to be removed. Nasal dressing and splints are usually removed six or seven days after surgery.
It is crucial to keep your head elevated after surgery. Some activities will be prohibited in the weeks after the procedure. Sun exposure, exertion, and risk of injury must be avoided. If you wear glasses, special arrangements must be made to ensure that the glasses do not rest on the bridge of the nose. Tape and other devices are sometimes used to permit wearing glasses without stressing the area where surgery was performed.
Follow-up care is vital for this procedure to monitor healing. Obviously, anything unusual should be reported immediately. It is essential that you keep your follow-up appointments. Insurance does not generally cover surgery that is purely for cosmetic reasons.
Dr Tollefson actively treats children and adults with orbital, mandible, midface, nasal and other facial fractures. Craniomaxillofacial reconstructive surgery deals with injuries to the face, neck, and skull that may be caused by sporting injuries, car accidents, or while at work. We want our patients to return to their daily lives with the least disability as soon as possible. Treatment may be coordinated with other specialists to obtain the best results, which may include dentists, orthodontists, 3D printing engineers, neurosurgeons, and ophthalmologists.
Dr Tollefson is on the Board of Directors for the AO CMF North American Education Board, which is dedicated to improving patient outcomes after facial fractures. He teaches courses around the US and internationally. Before treatment some patients with jaw fractures complain of difficulty eating, difficulty opening the mouth (trismus), and the teeth not aligning correctly (malocclusion). The goals of treating a patient like this will be to wire the jaws into the correct occlusion (relationship between the upper and lower teeth), to use titanium screws and plates to fixate the fractures internally, all while using the most minimal access through incisions.
Athletes may be struck in the eye socket or nose while playing sports. The patient problems that Dr Tollefson is then treating may include double vision (diplopia) or nasal obstruction and a crooked nose. Orbital fracture repair and repair of a traumatic nasal deformity are two special areas of Dr Tollefson’s interest. 3D CT scans and model printing as well as intraoperative CT scans are used to assure that the bones of the face have been well-aligned.
Lastly, skin scarring from these traumatic causes can be treated with laser resurfacing, dermabrasion or the full line of scar revision techniques and microfollicular hair transplantation.
Treatment of Facial Paralysis (reanimation)
Dr Tollefson specializes in the repair of facial nerve injuries with the full spectrum of nerve repairs, cable nerve grafts, static facial slings, and facial reanimation techniques. Dr Tollefson employs the most up-to-date facial reanimation techniques such as the masseteric nerve transfer, sural nerve cross-face grafting, temporalis tendon transfer (orthodromic) and free tissue transfer.
Microtia repair Surgical correction of a congenital missing ear. An ear is created using a cartilaginous framework fashioned from rib cartilage (stage I), and subsequently refined by creation of an ear lobe (stage II), and creation of a crease behind the new ear (stage III).
Drooping of the skin around the eyebrows can create a tired, sad appearance. A browlift can correct this condition and lessen the appearance of excess skin of the upper eyelids. New video-assisted technology that allows this procedure to be performed with a few small incisions. The endoscopic browlift technique is less invasive and creates less swelling and bruising, with minimal complications. Endoscopic browlift is often performed in conjunction with eyelid surgery to rejuvenate the entire orbital and eyelid region.
The Surgery
The main difference among the various options for forehead lifting consists of the placement of the incision.
The newest approach we incorporate is endoscopic surgery. Several small one-half-inch to one-inch incisions are placed just behind the hairline. Although this technique may require more surgery time, it is less invasive and results in a smaller chance of temporary scalp numbness.
The procedure takes between one and two hours to perform. It is most likely performed under IV sedation or twilight anesthesia.
Post Surgery
You will experience a certain amount of swelling and bruising in the 10-day period following surgery. In some patients, this condition may include the cheek and eye area as well as the forehead. You will be advised to keep your head elevated in order to reduce swelling. Cold compresses may further reduce swelling. As the incisions heal, you may experience some numbness as well as itching, both of which will diminish with time. The sutures are usually removed within 7 to 10 days following surgery. If bandages have been used, they are removed in one to three days. It is important to follow instructions of when to resume normal activities. For most patients, the recovery time will not exceed two weeks, but patients may still be advised to avoid strenuous activities for longer periods. Any prolonged bruising can be camouflaged with standard make-up techniques.
Insurance does not generally cover surgery that is purely for cosmetic reasons.
The Surgery
An incision is made either in the natural crease line just under the chin or inside the mouth, where the gum and lower lip meet. By gently stretching this tissue, a space is created where an implanted can be inserted. This implant made of synthetic material that feels much like natural tissue normally found in the chin, is available in a wide variety of sizes and shapes. This allows custom fitting of the implant to the configurations of the patient’s face. After implantation, fine sutures are used to close the incision. When the incision is inside the mouth, no scarring is visible. If the incision is under the chin, the scar is usually imperceptible.
In chin reduction surgery, incisions are made either in the mouth or under the chin. The bone is sculpt to a more pleasing size. For orthognathic surgery, an incision is made inside the mouth and the facial bones are repositioned. The procedure, depending on the extent of the work, takes from less than an hour to approximately three hours.
Post Surgery
Immediately after surgery, the surgeon usually applies a dressing that will remain in place for two to three days. You will experience some tenderness. Post-operative discomfort can be controlled with prescribed medications. Chewing will probably be limited immediately after chin surgery, a liquid and soft food diet may be required for a few days after surgery. Most patients feel a stretched, tight sensation after the surgery, but this usually subsides in a week.
Insurance does not generally cover surgery that is purely for cosmetic reasons. Surgery to correct or improve genetic deformity or traumatic injury may be reimbursable in whole or in part.
Eyelid surgery is one of the most effective ways to improve facial appearance. As we age, the eyelid skin stretches, muscles weaken and fat protrudes. Through tiny incisions along the natural crease of the upper lid, inside the lower eyelids, or just below the lash line, the doctor removes excess skin and fat that cause bags and puffiness. The result is a refreshed appearance with a younger, firmer looking eyelid. In some patients, a browlift is recommended with eyelid surgery to correct a drooping brow and smooth the forehead. Due to the nature of the skin in these areas, recovery time is minimal and scars are almost nonexistent.
The Surgery
In upper eyelid surgery, individual lines and creases of the lids are marked in order to keep the scars as invisible as possible along these natural folds. The incision is made, and excess fat, muscle, and loose skin are removed. Fine sutures are used to close the incisions, thereby minimizing the visibility of any scar.
In lower eyelid surgery, an incision in an inconspicuous site along the lashline and smile creases of the lower lid. Excess fat, muscle, and skin are then trimmed away before the incision is closed with fine sutures. Eyelid puffiness caused primarily by excess fatty material is removed. When sutures are used to close this kind of incision, they are visible to the eye. They are also self dissolving and leave no visible scar. Under normal conditions, blepharoplasty can take from one to two hours.
Post Surgery
Immediately after the surgery has been completed, tiny sterile bandages may be applied. This is not done for transconjunctival blepharoplasty. It is not crucial that the eyes be covered. However, an ointment to prevent dryness of the eye area may be used. A certain degree of swelling and bruising is normal. Cold compress, as well as head elevation when lying down, will enhance healing and relieve discomfort. Medication can be prescribed for discomfort.
For a week and a half following blepharoplasty, you will clean the eye area (the eyes may feel sticky, dry, and itchy). Eyedrops may be recommended. You will be provided with a list of activities and environments to avoid in the weeks immediately following surgery. Permanent stitches will be removed in three to five days after surgery. Self-absorbing stitches will dissolve on their own.
Insurance does not generally cover surgery that is done purely for cosmetic reasons. Surgery to correct or improve vision or surgery for eye deformity or injury may be reimbursable in whole or in part.
The facelift procedure can dramatically improve sagging skin of the cheek, jowls, and neck. It especially tightens the neckline and decreases the deep folds around the mouth. Dr. Tollefson is one of a few surgeons in the area performing the deep-plane facelift; a technique designed to provide significant tightening of the facial skin, while maintaining a natural appearance. The facelift procedure can be performed alone, or in conjunction with other aesthetic procedures, such as eyelid surgery or nasal reshaping.
The Surgery
An incision in the area of the temple hair, just above the front the ear, and then continues around the lobe, circling the ear before returning to the point of origin in the scalp (actual placement of incisions will vary from patient to patient). The skin is raised outward, the underlying muscle and connecting tissue is repositioned and tightened. Some fat may be removed, as well as excess skin. For men, the incision is aligned to accommodate the natural beard lines. In all cases, the incision is placed where it will fall in a natural crease of the skin for camouflage. After trimming the excess skin, the incision is closed with fine sutures and/or metal clips, which permit surgery without shaving hair from the incision line. Depending on the extent of the surgery, the process can take from two to four hours. When the procedure is performed with a combination of mild sedatives, local anesthesia, and a mild intravenous anesthesia, the patient will experience little discomfort. Sometimes a general anesthesia is used for facelifts. Following the surgery, a dressing will be applied to protect the entire area where the incisions have been made.
Post Surgery
Even though most patients experience very little pain after surgery, medication will still be prescribed. Some degree of swelling and bruising is unavoidable, and you will be instructed on the use of cold compresses to keep the swelling to a minimum. Any dressing will be removed within one to three days. You will be instructed to keep your head elevated when lying down, to avoid as much activity as possible, and to report any undue discomfort. Though there are few risks in facelift surgery and thousands are preformed every year, some risk exists in any surgery.
All sutures and staples are usually removed 5 to 10 days following surgery.
Recovery usually takes two to three weeks, though many patients go back to work in two weeks. Scars are usually not noticeable after enough time has passed for them to mature. In any case, they are easily disguised in natural skin creases, by the hair, or in persistent cases, by makeup until total healing has occurred. Bear in mind that the aging process continues after surgery and that some relaxation of tissues will occur over the first few weeks.
Insurance does not generally cover surgery that is done purely for cosmetic reasons.
Many new therapies and technologies are presently available to enhance the appearance of thin and wrinkled lips. These include fat transfer, injection of various filler materials (such as collagen, Restylane, Artecol, etc.) and placement of surgical implants. These procedures can restore a youthful appearance to the lips, minimize vertical wrinkles, or create a voluptuous and sensuous look.
BOTOX Cosmetic is a quick and minimally invasive procedure. You doctor makes a few tiny injections into the muscles that cause moderate to severe frown lines between your brows.
Your doctor will determine exactly where to administer the injections to achieve the best results. No anesthesia is required, although a cold pack or anesthetic cream may be used to numb the area prior to injection.
The entire procedure takes approximately 10 minutes, and there is no downtime afterward. Discomfort is minimal and brief. Localized pain, infection, inflammation, tenderness, swelling, redness, and/or bleeding/bruising may be associated with the injection.
You can expect to see results within days after your treatment. The appearance of the area between your brows may continue to improve for up to a week.
BOTOX injections help minimize or eliminate deep wrinkles caused by muscle contraction. This method is used primarily for wrinkle lines of the forehead, between the eyebrows, and the crow’s feet next to the eyes. Botox injections are simple, effective and allow you to return to work immediately. Result last four-to-six months and can be repeated.
