Tag Archives: happy patients

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.

After Rhinoplasty: Nose Packing Relief

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"A sketch shows where in the nose a nasal airway is implanted"

Kotler Nasal Airway

We once once saw a patient who wanted a revision rhinoplasty to correct a bad nose job done elsewhere. Before leaving, he said: “Hey, wait! Does this involve nasal packing after the surgery?”

We replied that virtually all nasal surgeries require packing after surgery, done to:

  • Hold internal structures in the proper place
  • Reduce bleeding, if any
  • Deliver important medications to nasal tissues

Often those meds are antibiotics and medicines that speed healing.

But, one to five days of nasal packing can be too much for some, including this patient who left the office, saying, “Forget it!”

Many nose job patients hate breathing through their mouths while some say that nasal packing makes them feel like they have clothes pins on their noses. Yet another said nasal packing was like being water boarded. Some can’t sleep. We’ve heard others complain of anxiety and claustrophobia.

Added it all up, it amounts to a lot of patient discomfort. In our specialty, surgery of the head, face and neck, nasal packing is used in:

  • Rhinoplasty
  • Sinus surgery
  • Septoplasty
  • Turbinate reduction

That amounts to about 1.5 million operations yearly. So we began to think: is there a way patients could breathe through the nasal packing?

After more thinking and tinkering, we developed a special twin airway tube , the Kotler Nasal Airway, which is inserted into both nostrils with the nasal packing placed around it.

We often wonder why nobody ever thought of it before; after all, it’s the same principle used for life masks made in the Middle Ages.

Back then, the artist put one straw into the subjects’ nostrils, packed the whole face and nose with wet clay – allowing the straws to emerge into the air, of course– and waited for the clay to dry.

The Kotler Nasal Airway was tested on 140 patients and is FDA-cleared.

One patient, Todd, later wrote he put up with a botched nose job done by a plastic surgeon elsewhere for seven years because he did not want to suffer through nasal packing again.

But when he found out about our nasal airway, he agreed to revision rhinoplasty. After surgery, he said he was comfortable and relaxed compared to his first experience with nasal packing which, he wrote: “I wanted to take out every minute it was in my nose.”

(Read patient Q&As about the Kotler Nasal Airway after nasal surgery.)

Or, watch a video in which a rhinoplasty patient talks about the airway.

"A patient's nose is shown with nasal airway tubes inserted after a nose job"

Kotler Nasal Airway

Beverly Hills Rhinoplasty –Via “Virtual” Visit

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"A lovely doctor talks wtih a patient on her cell phone while checking information on her computer"

Cosmetic Surgeon: Beverly Hilss -- Patient: London

It’s often said that Beverly Hills is the Mecca of global plastic surgery. Some cosmetic plastic surgeons on Park Avenue in New York City might argue, but people do come here from all over the world for rejuvenation surgery.

It’s partly because a perfect storm of world-class universities, leading practitioners and a global tourist location are centered in one place.

But think of the logistics for rejuvenation surgery if you live far away: first, you must come for an initial consultation and exam, then have some medical tests to show you are healthy enough for surgery, show up on the surgical date, report back the next morning, recover and then go home.

There’s a better way: It’s not exactly one-stop shopping, but you can reduce the trips to Beverly Hills through “virtual visits.” (Read more about distant plastic surgery appointments.)

Here’s the low-down: many cosmetic plastic surgeons (like us) use Skype and then get through regular or email a detailed set of pictures of the areas – like a nose job or a facelift — you want treated . A medical history is also needed but you don’t have to be here in person for that.

At that point,cosmetic surgeon and patient chat on the phone or over Skype; the cosmetic surgeon has all the documents needed right before his eyes to discuss the case.

California law requires a full physical before cosmetic plastic surgery, but that can be done in the patient’s home nation or state. Once the traveler arrives in Beverly Hills, patient and surgeon go over everything again in the office and take care of whatever hands-on business is left. (Not everything can be done through Skype or email!)

We have seen patients recently from Italy, England, Germany, Denmark and other nations. We ask them to stay for 10 days after surgery but most don’t mind, especially the patients from England who, at home, are very keen on visiting Italy. So we let them know that Santa Barbara and San Diego have the weather, beaches and sea conditions that most resemble Italy.

Does it work? You decide. The professional magazine for doctors, Journal of Telemedicine and Telecare once rounded up a group of 175 patients. Half had only in-office visits and while the others had mostly virtual and real world visits to doctors’ offices.

Results? The in office group reported a satisfaction rate of 80 percent while the virtual group said their satisfaction rate was 84 percent.

Maybe fewer L.A. traffic jams had something to do with happier patients!

( Look at some before and after cosmetic plastic surgery pictures)