Category Archives: Non-Surgical Revision

Bad Plastic Surgery: Finding A Better Fix

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"A smiling young couple do a computer search"

Searching for Surgeons

The stories of bad plastic surgery seem to always have a common beginning; either somebody does not like the appearance of his or her nose or needs internal nasal surgery to:

  • Fix a once broken nose
  • Repair a deviated septum
  • Reduce turbinates

But then, things go wrong. Patients often quickly choose the closest plastic surgeon, the doctor who charges the least or the cosmetic surgeons they heard about through Aunt Sally’s boyfriend’s cousin.

However, a recent patient, 34-year-old J.G., at least made a stab at researching a qualified, trained, certified and experienced nasal surgeon near his Texas home to correct his deviated septum.

Although the Texas surgeon that J.G. found and used is:

  • A book author
  • Won awards for his work
  • Was well respected in his medical community

the procedure did not turn out well at all and made J.G’s breathing even worse. A deviated septum that twists and turns inside the nose creates additional blockages to healthy breathing.

J.G. then widened his search for nasal surgeons worldwide to correct the damage  before landing in our Beverly Hills office. (Read more functional and cosmetic surgery patient stories.)

Finding corrective, or revision nasal surgery, requires much more research than finding a good surgeon for a first nose job.

Why? Revision nasal surgery is so much harder for many cosmetic plastic surgeons who routinely turn out first rhinoplasties day after day, they shy away from corrective surgery.

His corrective surgery went well with the breathing problem normalized.

Then, J.G. found that marks on the outside of his nose could be corrected without yet another trip to the operating room. He opted for permanent nonsurgical rhinoplasty which involves a series of quick injections in the office, separated by ten to 12 weeks.

(Read more about “Rescue” rhinoplasty, another moniker for permanent, nonsurgical rhinoplasty.)

So, for a while, J.G. traveled from his Texas home to Beverly Hills every three months to complete a corrective, non-surgical rhinoplasty that yielded a handsome nose which flattered his profile.

He then capped off his visits by having neck sculpture and was a very happy camper indeed.

Permanent non-surgical rhinoplasty?

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"A lovely woman closes her eyes as a needle approaches her nose"

Injection Rhinoplasty

Quite a few rhinoplasty surgeons offer non-surgical (or injection) rhinoplasty. But does it last?

Facial fillers like Sculptra, Radiesse, Juvederm and Restylane are often used. But they dissolve back into the body within six months to a year. That means more trips back for additional injections and more time lost from work.

But, permanent injectable fillers last as long as you do. To date, there are only two for the face:

  • Artefill
  • Silikon 1000

While Artefill is intended for the deep creases, lines and age-revealing folds in the face, Silikon 1000 is used for permanent nose jobs done by injection. And that’s only if you need correction on the outside of the nose.

With Silikon, you can get a preview of coming attractions.

If you have divots, marks, scars, pocks, a nasal hump, a low bridge or other marks on the surface skin of the nose, only a few U.S. rhinoplasty specialists offer Silikon 1000 corrections. The very best surgeons can show you what your nose will look afterwards by using sterilized saline – plain old salt water – to reveal what the Silikon 1000 injections will do for your nose.

Saline improvements last perhaps an hour, long enough to snap a few pictures. Compare the saline test shots with pictures showing the nose in its natural, unrepaired state and then decide if you want to make it permanent.

Silikon 1000, a medical grade silicone, is used in internal eye surgery. A standard, approved and legal part of any medical practice – including those of cosmetic plastic surgeons – is using a substance or technique “off-label”.

Meaning? While the substance has not been tested by the FDA for that particular use, it is the best treatment available to the doctor who has seen it work in many patients.

Some history:  Silikon 1000 for injection rhinoplasty has been used successfully in nasal skin improvements for the last 50 years. According to scientific literature, the secret is placing tiny micro droplets just under the skin to plump out and disguise hollow places.

(Read more about permanent, non-surgical rhinoplasty in Plastic and Reconstructive Surgery, a professional magazine for plastic surgeons.)

For instance, a nose with a large hump can be made to look straight again using no more than 1/8th of a teaspoon of Silikon 1000 injected at many different locations on the nose.

The body walls off the tiny micro-droplets, creating a plumping action that fills in humps, scars, lines and other marks on the nose.

"A very pretty young woman shows her nose before and after injection rhinoplasty"

Before and After Non-surgical Rhinoplasty

The woman’s nose, left, caved in from a failed surgical rhinoplasty done elsewhere. Right, the results of permanent non-surgical injection rhinoplasty. No further surgery needed.

Face Lift and Fat Transfer

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"A man holds his bulging belly which falls over his belt"

Fat? A Facial Filler?

In cosmetic plastic surgery, fads come and go.

One of the most widely discussed now is fat transfer. At first, it sounds like the perfect solution: take fat from where you don’t want it and put it where it makes you look younger.

But you know the old saw: “If it sounds too good to be true — it usually is!”

Known alternately as fat grafting, fat injecting, autologous fat transfer, (and medically, platelet injection fat transfer) some patients ask for fat injecting to:

  • Fill sunken places below the eyes
  • Plump skin creases known as nasolabial folds, the deep wrinkles running from the corner of the nose to the mouth’s edge
  • Mask deep forehead lines
  • Build out sunken cheeks
  • Disguise “Marionette lines” running from the corners of the mouth down the chin

Only problem: fat injections can be unpredictable. The whole process depends on injected fat finding a blood supply. Otherwise, it withers and dies.

Fat can also grow beyond the correction you seek. And if you don’t like it, you’re stuck; it can’t be removed.

Everything a facial plastic surgeon does must result in balance. For instance, if we injected the same amounts of fat into each cheek, we could not be sure of facial balance. One cheek may yield plumpness while the other becomes hollow.

Another consideration: due to Mother Nature, fat injecting works better on younger patients while those really need face lifts are older.

Nonetheless, it’s the older patients who need the padding just beneath their facial skin. Much of aging’s effects are caused by facial fat loss, resulting in those wrinkles, folds and deep lines.

Meanwhile, we already have excellent products that perform that same function. Grouped together, they are known as facial fillers.

Of course, most are not very long lasting. While we have seen some cases of Sculptra lasting half a decade, (and Artefill being permanent,) the others last four to six months, including:

  • Restylane
  • Juvederm
  • Radiesse

The other advantage with facial fillers: doctor and patient can immediately see the results. (It takes a few months for Sculptra to take effect.)

Another consideration: fat injection done properly takes incredible skill. One leading cosmetic plastic surgeon discovered that a teaspoon of the patient’s own fat injected near muscles is too big to find a blood supply.

However, fat droplets the size of a pea stand a better chance.

(Look at some face lift before and after pictures – not done with fat transfer)

PLASTIC SURGERY BUSINESS ON THE RISE

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 Recently, a press release from one of the plastic surgery trade organizations reported that there was an increase in activity in the plastic surgery community.  That was said to be harbinger of better economic times to come. 

Frankly, I am not so sure of that.  The growth in cosmetic procedures is not in the surgical arena.  It is in the non-surgical office treatment arena.  So, as I see it, the increase in the “ plastic surgery business” is not in the plastic surgery but in the syringe and needle department.

Botox Cosmetic, Dysport, Restylane, Juvederm, Sculptra, and Radiesse, Artifill and medical-grade liquid silicone are all good and valuable treatments that patients are flocking to. 

We cosmetic surgeons are glad to have these excellent products available to us, but the reality is, alone, they cannot do the job.

Today’s patients, watching their budgets, are apt to opt for the non-surgical treatments before the more major treatments, such as face and neck lift, neck sculpture, upper and lower eyelid surgery, brow lift, chemical skin peel, or laser skin treatments.  It is understandable. Office treatments require no time off, are virtually painless, and are far less expensive. 

It may be that we never reach the numbers of surgical procedures that were done before the current Great Recession.  While the cutting and sewing procedures are available for patients, the utilization may be less because of economics, primarily.  Understanding that, many practices are offering reasonable discounts to aid people who might otherwise not be able to afford the procedures.

When consulting with doctors, be sure to ask about all treatments available, both surgical and non-surgical. And, ask how you can shave some dollars from the cost without sacrificing quality.

I have some hints on that for you on a future blog post.