Correcting A Short Nose Is A Common Beverly Hills Nose Surgery

Posted on September 25, 2009 by admin

Correcting A Short Nose Is A Common Beverly Hills Nose Surgery

Revision rhinoplasty is common in Beverly Hills because there is a certain percentage of patients who are unhappy with their surgery previously performed elsewhere. Here in Beverly Hills, where we have several surgeons with a long track record of experience and superspecialization, patients congregate to have the more the difficult nasal surgeries performed.

One of the more common consequences of an overzealous or overdone rhinoplasty is that the nose is “too short.” The nose tips up and the angle between the nose and the lip is so great that sometimes it looks like the nostrils may fall prey to a thunderstorm. Perhaps there was inadequate surgery done at the junction between the nose and the lip. This can be improved. The nasal spine and the caudal septum, whether straight or deviated, may be altered and that sharpens the nose-lip angle. This makes the nose look much less pug or upturned. If that is not an option, cartilage can be transplanted just behind the tip to push it forward. Another technique is to use a filler to plump the skin of the tip just between the opening to the nostrils and this again leads to a more satisfactory nose-lip angle. Also remember that a nose looks overly-short if the bridge has been taken down too much. If the nose has that overdone ski-slope look, filling this defect either with a cartilage graft or even with office-performed filling injections will raise the bridge and make the nose look much less short.

Understand that much of what we do has to do with illusions and appearances – small differences can make a big difference.

Beverly Hills Open Rhinoplasty

Posted on September 24, 2009 by admin

Beverly Hills Open Rhinoplasty

The term open rhinoplasty refers to an operative technique whereby a single external incision is made to facilitate the exposure and visualization of the structures to be altered in cosmetic plastic surgery of the nose.

Think of it as opening the hood of your car to work on the engine. The incision is a horizontal incision made across the columella, which is the external vertical partition that separates the two nostrils. This incision links up with typical incisions made within the nostril that are used in the closed rhinoplasty or alternative and classic technique.

Many surgeons prefer the open rhinoplasty because they have ease of operative techniques. The bare cartilages of the tip and middle third of the nose are admittedly more easily made available for whatever changes will be made. Now, there are some issues that need to be considered. The swelling and bruising will be a bit more obvious and last longer. There is introduction of some additional risk with respect to healing. Should an infection occur in the tip of the nose, the tissues are rendered a bit more susceptible because of the multiple incisions. Generally, fewer incisions are preferable in any and all operations since each incision can interfere with blood supply and therefore lessen resistance to infection.

The incision does heal nicely, although, in some people, it can be obvious.

I think the most important reason to use the open rhinoplasty technique and to accept the possible visibility of the incision and the additional risks are that there are some noses where there are major asymmetries such as cleft lip and palate noses, where indeed it is easier to restore symmetry when one has more exposure, and will be doing a lot of “add on”, such as transplanting or grafting cartilage to the tip.

Avoiding the Beverly Hills Rhinoplasty Saddle Nose

Posted on September 18, 2009 by admin

Avoiding the Beverly Hills Rhinoplasty Saddle Nose

A rhinoplasty saddle nose occurs because the internal supports have been weakened or removed. The upper bridge of the nose is bone but the lower portion of the bridge of the nose is cartilage. If too much of the septum underneath either is removed, there will be a collapse of the bones and/or collapse of the upper lateral cartilages which rests upon the septum and when they “fall” into the nose, the outside appearance looks like a saddle.

Assuming that the breathing has not been impaired, the correction is by insertion of the patient’s own or transplanted tissue. Some surgeons prefer bone. Others prefer cartilage and some use another material, from under the skin, called fascia. Or one can insert a custom-made or custom-trimmed prosthetic part. Generally these are solid medical-grade silicone, the same material that is used in artificial heart valves and artificial joints. It can be sculpted to the size of the saddle-depression and then tucked underneath the skin through internal nasal incisions. Afterwards, there is no saddle and the profile is straight. But an alternative is filling injections. Temporary injections are fine but most patients coming to Beverly Hills for revision rhinoplasty certainly are also offered the possibility of a permanent filling injection. Medical grade liquid silicone which has been used in the United States for over 50 years, in droplet form, is a very practical solution to correcting a saddle nose post-rhinoplasty.

Beverly Hills Revision Rhinoplasty For Aging Noses

Posted on September 16, 2009 by admin

Beverly Hills Revision Rhinoplasty For Aging Noses

Some patients had a rhinoplasty when they were young. Although the nose ages less in terms of drooping, it still may have some elongation with age. For that reason, generally, a relatively straightforward and uncomplicated “lift” is performed for senior citizens. Since the general outline of the nose is satisfactory after the original rhinoplasty, this is a matter of shoring up the tip which has tended to droop. If the patient has an overactive muscle which depresses the tip with smiling, then that needs to be released from the tip of the nose so that there is no constant downward pull by this depressor septi-muscle that originates in the upper lip.

Typically there is a stretching of the internal tissues of the nose with age and by removing some of the internal tissues, this will raise the tip, and make the face look less elderly.

It is interesting to observe Leonardo da Vinci’s anatomical and facial sketches. He very clearly and accurately depicted the changes in facial structure that occur with age including lengthening and drooping of the nose, the drooping of the cheeks and the chin.

Beverly Hills Closed Rhinoplasty

Posted on September 11, 2009 by admin

Beverly Hills Closed Rhinoplasty

Closed rhinoplasty refers to the standard and classical technique of making all the incisions necessary to perform cosmetic nasal surgery within the nostrils and confines of the nose. Many surgeons, particularly those rhinoplasty superspecialists with long experience cosmetic plastic nasal surgery, feel that they can accomplish what needs to be done entirely through those internal incisions. There is no question that it requires more skill and manual dexterity.

A recognized advantage of the closed rhinoplasty technique is that, by avoiding an external incision below the nose tip, there is a reduction the chance of compromised circulation to the tip of the nose. Should there be poor tip skin circulation in the post-operative period, there is some risk of loss of the skin and underlying tissues, which is catastrophic. Likewise, using the closed rhinoplasty approach, generally, there is a lesser chance of infection and wound breakdown with scarring. That is also related to circulation, the currency of good healing. Infection tends to take hold where circulation has been compromised. These are risks that one should want to avoid if possible.

Personally, I like the closed approach since I was raised on it. Very comfortable with my consistent technique.

I have performed over 4,000 nasal surgeries, most including a cosmetic component and I used the closed rhinoplasty technique for nearly all. Only two or three operations utilizing the open rhinoplasty or external approach. I wasn’t unhappy with the external approach, and it was not difficult, but I do feel that if I am capable of delivering satisfactory results through an internal, scar-free procedure, that’s better for patients.

A Balance And Natural Look Is The Desire Of Every Beverly Hills Rhinoplasty Surgeon

Posted on September 8, 2009 by admin

A Balance And Natural Look Is The Desire Of Every Beverly Hills Rhinoplasty Surgeon

It is very important that a nose look natural. This includes balance. Balance is defined as appropriate relationship between the tip and the bridge. If at rhinoplasty, the bridge is created too low, there becomes a ski-slope appearance which actually makes the nose look more protuberant from the face. This is never satisfactory. Also, if the tip drops and looks round after surgery, then the bridge looks higher and the nose has a very unsatisfactory look. This lack of balance can be corrected, of course, but it is best to have the original surgery avoid this problem.

The other issue, which I discuss in my book, Secrets of a Bevelry Hills Cosmetic Surgeon, is how the nose looks from the front with respect to the tip versus the bridge. If the tip is too wide for the bridge, particularly if the bridge has been overly narrowed by previous surgery, then the answer lies in correcting the bridge and not the tip. On the other hand, sometimes if the bridge looks quite satisfactory, the tip of the nose is too bulbous, too wide, too bulky, then the tip must be addressed to bring it in harmony with the bridge.

Cost of Dysport in Beverly Hills

Posted on September 2, 2009 by admin

Cost of Dysport in Beverly Hills

Dysport, which is distributed by the same company, Medicis, which markets the well known facial filling injection, Restylane, is now available.

FDA-approved Dysport works essentially like Botox with respect to its paralyzing effect upon the nerves which power the muscles on the face. As the nerves lose their ability to stimulate muscle contractions, the frown lines, horizontal forehead lines and crow’s feet—smile lines around the eyes — tend to soften or diminish.

Dysport has a long history outside the United States. Nearly 20 years ago, it was developed in England and, as was Botox, originally was used in ophthalmology and other specialties. Dysport and Botox both have long track records of efficacy and safety.

It is important for us to try to evaluate and come to some judgements as to whether Dysport has advantages over the well established Botox. Apparently, the onset of the action of Dysport is quicker than that for Botox. This allows one to see the results quicker. Of course, if there is a little “touch up” or add- on necessary, that can be performed. Another stated advantage is that it seems to generate less of a stark or frozen look. The reports are that people don’t look “done.” There is evidence to show that it also lasts longer.

Currently, there is a cost differential. Introductory price for Dysport is about 15% less than for a comparable dose of Botox. So, if in fact the over four month duration of Dysport exceeds that of Botox and the cost is less, then we can expect to see more utilization of Dysport and then we will know more about it.

Remember, it always takes time for doctors to understand the benefits and disappointments of new medications or treatments. Stay tuned.