Tag Archives: looking better

After Rhinoplasty: What to Do

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"A surgeon operates with his surgical nurse standing beside him"

In Surgery

One of the most common questions asked by nose job patients is: “After rhinoplasty, what should I do, doctor?”

Overall, don’t put any pressure on the newly rejuvenated nose. Some patients have even found that industrial protection type eye glasses are too heavy to sit on the bridge of the nose.

Our patients can wear contacts one to two days after cosmetic surgery; for those who must wear eye glasses, we show them how to suspend their spectacles from the forehead so there is no pressure on the nasal bridge; that continues for five weeks.

Most cosmetic plastic surgeons have lists of recommendations on how to care for one’s self after nasal surgery so be sure and follow those instructions.

It’s obviously also a good idea to stay away from any sport, hobby, pastime or person which could involve a blow to the nose.

Many are curious when they can resume regular workouts and exercise. For the first seven to 10 days after nose job surgery, let your body concentrate on healing and catch up on your reading although slow walking and stretching can start the day after surgery.

But exercise that really gets the blood going is not a good idea because increased blood pressure can lead to a bleeding nose and a possible increase in swelling and bruising. Another caution about nose bleeds: don’t blow your nose for the first 10 days after rhinoplasty surgery.

If you have stopped smoking for some weeks before rhinoplasty surgery, let the smokes lay unlit for a while longer – the nicotine in tobacco injures veins and reduces the blood flow which is needed to promote healing.

If you are fond of herbs, beware the “Four Gs”: garlic, gingko, ginseng and ginger. Those substances can affect blood clotting and a good cosmetic surgery result.

Catch up on your Z’s because adequate sleep ensures quicker recoveries. Also, mild pain medications, if needed, are usually available to help you sleep. Most patients find the nose is dry after surgery. But you can keep it better humidified by using saline nasal sprays.

Following doctors’ instructions usually means you are good to go in seven to 10 days….. although it may require a month for your breathing to reach its optimal level.

 

The rhinoplasty patient below had the bump on her nose removed while the scoop above the tip of the nose was corrected. (Robert Kotler, MD photo)

"A lovely woman shows her nose, before and after rhinoplasty

Before and After Rhinoplasty

Non-Surgical Cosmetic Surgery to Rule in 2012

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"A man and a woman sit at a table staring into a glass ball"

2012 Cosmetic Surgery Trends

A major plastic surgery organization for surgeons worldwide, the International Association for Physicians in Aesthetic Medicine (IAPAM) queried its global membership, medical professors and other experts in aesthetic medicine to predict some of the major trends you are likely to see among plastic surgeons during 2012.

  • Nonsurgical and minimally invasive cosmetic surgery procedures will top the charts.

Some experts say the economies of the major nations still dictate that many patients must forgo more expensive surgical face lifts for less expensive facial fillers.

But that’s always the nature of a recession: people learn to cut, squeeze, trim and make do with less until the good times start to roll again.

Also look for:

  • Combination packages.

More cosmetic surgeons will offer medical skin care, facial injectables and laser conditioning in a single treatment package.

More cosmetic injectables: Botox will have more competitors that create the same wrinkle removing effects. Already, a rub-on Botox cream is completing clinical trials. Plus, new fillers like Belotero and LaViv may come into wide use. (Read more about LaViv, a facial injectable  made from the patients’ own cells.)

  • More uses for neurotoxins.

Botox, Dysport and Xeomin are in a class of medications known as “neurotoxins.” As time goes on, more uses are found for neurotoxins which are now used to treat migraine headaches, stop excessive sweating and halt other medical woes. Already, according to the IAPAM, one professor is using Botox and Dysport together to reshape the face, instead of just removing its wrinkles.

One nonsurgical procedure that is rising on more patients’ radar screens: permanent, non-surgical rhinoplasty.

Used in cases where only the outside of the nose needs correction, a needle replaces the scalpel to fill in humps, depressions and other unsightly nasal marks.  And, for the many budget-concerned patients who have learned to do more with less, a non-surgical, permanent nose job costs a fraction of surgical rhinoplasty in both money and time.

Many patients with botched nose jobs are candidates for the procedure.

(Read more about permanent non-surgical rhinoplasty.)

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.

Nose Jobs of The Rich and Famous: Miss California

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"Miss California shows her nose job in before and after pictures

Miss California Before and After Rhinoplasty

When the new Miss California, Natalie Ann Pack, was a kid bouncing on a trampoline, her brother mistimed a bounce and smacked Natalie in the nose with a knee. The result: Natalie’s broken nose.

Nonetheless, Natalie went on to model and was named Miss California, January 15th.  A broken nose leads to other medical problems as well, probably restricting her breathing. If a broken nose is not treated within about ten days, the broken bones heal as they are, often creating twisted nasal passages that restrict healthy breathing.

Other people in the same boat as Natalie are often those with:

The plastic surgeon who performed the procedure blogged: “Natalie was concerned about the asymmetry of her nose as well as an overall feeling of visual heaviness.”

Last year, Natalie got a functional and cosmetic rhinoplasty, creating a better nose and taking care of some internal blockages that prevented healthy breathing.

Results? Natalie’s health profile improved. She told an interviewer about the effects of her nose job: “I can breathe, I don’t get headaches, I can sleep, the modeling pictures are better.”

Natalie’s plastic surgeon, quoted in the Orange County Register, said “she went from a nine to a 10” on the beauty scale

So why does a nose job make a person more beautiful? Or handsome? Because the nose is so prominent, it dictates how the eye takes in and “sees” a face.

When a nose is larger or swollen and thick as was Natalie’s, the eye mostly sees – and often gets stuck on – the person’s nose.

But when a nose is proportional, balanced and fits the face and profile, our eyes move up to take in the eyes and then the whole face. The person just looks better to us.

Many rhinoplasty patients opt for adding a little bulk to their receding chins, making their appearance go from never to constantly noticed and appreciated. However, Natalie’s chin needed no augmentation.

The January/February issue of Archives of Facial Plastic Surgery, a professional magazine for plastic surgeons is reporting additional benefits to a nose job that brings a face into better harmony. It may also make you look younger. A study of 53 patients found a rhinoplasty may make patients look 1.5 years younger.

(Read more about the nose job study.)

Fat Injection? Facial Fillers? Which is best?

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"A closeup shows where a woman will have a facail filler to plump up signs of aging

Filling a Nasolabial Fold

So much is being written about fat transfer, (a cosmetic plastic surgery procedure that takes fat from where you don’t want it and applies it to where you do want it) that many are asking facial plastic surgeons:

  • Can fat injection be used to fill in grooves, folds and deep facial wrinkles?

The procedure is also known as fat grafting and fat transplantation.

Mostly, patients want the following filled:

  • The nasolabial lines, running from the corners of the nose to the corners of the mouth
  • The sardonically named “drool lines” that run from the outer edges of the lower lip down the chin

Also responsible for normal facial aging – and open to fat grafting — are sunken cheeks and hollow, under eye areas.

Fat transfer is extremely time-consuming: the surgeon must liposuction a donor area – usually the tummy or the buttocks – then filter and prepare the fat for injection.

The plastic surgeon then painstakingly places dozens, if not hundreds, of fat droplets through layers of tissue and muscle.

The key to lasting fat transfer is finding a blood supply. Top practitioners say droplets of fat no larger than a small pearl stand the best chance of surviving.

Long story short?  Sometimes fat transfer works as intended. At other times, transferred fat is absorbed into the body.

Cosmetic Surgery Times, recently interviewed two top cosmetic surgeons, one of whom is very pro-fat transfer while the second is decidedly not.

Observed the more skeptical cosmetic surgeon, Val Lambros, MD, about another rarely mentioned consideration: “Injected fat can also grow.”

Will that become a problem over time?

Meanwhile, the fat grafting advocate, J. William Little, MD, says that rejection does not take place because the transferred fat is your own natural tissue.

However, transferred fat can’t be removed. What happens if injected fat on one side of your face grows while the fat on the opposite side stays as is?

(Read more about the virtues and vices of facial fat grafting.)

Meanwhile, cosmetic plastic surgeons offer a handful of facial fillers that are proven to be reliable, predictable and, not least, wildly popular with consumers. Those fillers include:

  • Juvederm
  • Radiesse
  • Sculptra
  • Restylane

With the exception of Artefill, the fillers are absorbed into the body, but you know what you’re getting.

Sculptra can last up to five years in some cases although it requires several months for results to appear.

Cosmetic Surgery Implants – for Faces

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"A young woman becomes lovely with only the addition of a chin augmentation device"

Chin Augmentation Only

When people hear the words “cosmetic surgery” and “implants” used in the same sentence, they usually think of buxom Hollywood movie stars and models who sometimes overdo it while going for a more feminine figure.

But implants are not just for bosoms, any more. Some are used in facial cosmetic surgery. Solid silicone facial implants are perfectly safe; in fact, the same material is routinely used in artificial joints and heart valves.

Probably the most common are the implants that augment a weak profile when a patient is having rhinoplasty or a revision nose job.

Other facial implants include those for:

  • Jaw
  • Cheek
  • Chin

Unlike breast implants which come with a choice of saline or silicone fillings, facial implants are made from a solid medical grade silicone.

A soft but solid implant – for the lips – came into the world of cosmetic and plastic surgery in 2007 but did not go over big with patients because time and many flapping jaws showed the kisser augmentations made quite a few unkissable due to:

  • Hardness
  • Scar tissue
  • Infections
  • An unnatural appearance
  • Breaking back through the skin

According to the American Society of Plastic Surgeons (ASPS) 17,143 lip augmentations – not involving injections – were done in 2010. But that was a 21 percent reduction from those done in 2009.

Consequently, most patients who want fuller lips now choose injections of Restylane, Juvederm and other facial fillers.

In about 20 percent of rhinoplasty cases, a chin implant is also used due to the patients’ receding chin lines. Rhinoplasty done alone in such cases usually does not improve patients’ facial appearances because the profile isn’t balanced.

Jaw and chin implants are often placed from inside the mouth while cheek implants can be inserted through the lower eyelid, leaving no scars whateve on the facial skin.

Nasal implants are small and can be inserted from inside of the nose, again leaving no surgical marks on the facial skin.

Patients should select their cosmetic plastic surgeons with great care because facial implants require a perfectly sized pocket which can’t be too large or too small or problems with the implant will show up later. For instance, the implant could slip out of its chamber.

Top facial plastic surgeons make sure some implants last by stitching the implant to the fascia, a tough sheet of tissue that covers the facial bone. Sometimes, surgical screws fasten implants down.

Cosmetic Surgery’s Bogus Devices

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"A lovely woman holds a so-called lip pumper to her mouth, trying to make her lips bigger"

Lip Augmentation?

Read the wildly popular RealSelf.com and you may see a few people writing in to ask if the plastic surgery equivalents of real estate lots under swamp water in Florida are real.

For instance, one correspondent wanted to know if a British product known as tummy tuck something-or-the-other could actually create the equivalent of the plastic surgical procedure of the same name. The product is a dietary supplement containing green clay (really!) fennel seeds and tropical drinks.

Another oft-touted gizmo, pictured above, purports to perform lip augmentation by literally pumping up your kissers via vacuum pressure.

One of the more laughable bogus cosmetic surgery products is a large clip — much like those used to close potato chip bags. On second thought, it could very well be an actual potato chip bag clip! We would love to mention its name but, in fairness, we have not examined it nor tried it on a patient.

However, we can point you to a RealSelf.com post that asks: “Do nose reshaping devices work?)

Noted one M.D. respondent: “..This is most certainly a waist (sic) of money.”

But his answer was right on. You can’t change the shape of a nose by compressing it with a giant clip – or even a steel vise – because the elements of a human nose have a type of memory and without surgical alteration return to their original positions.

Even stranger, several of the nose clip makers are battling over the nose clip reduction turf, claiming that one maker is the real deal while the others are shoddy imitations that will do nothing in the way of cosmetic nasal improvements.

One maker of a rhinoplasty-via-nose-clip device lives in Japan while the other, or others, are apparently home grown and claim to be more familiar with American  cosmetic nose needs.

The nose clip makers also have a busy marketing campaign that seems to find its way into many otherwise well-intentioned bulletin boards and websites striving to give out legitimate information about all types of cosmetic plastic surgery. (Read one nose reduction clip comment at Yahoo.com.)

Scanning the Internet for additional devices that will do nothing but reduce the size of your wallet or purse, you may have seen breast lift tape. (“Gives new meaning to uplift.”) Does it work?  You decide!

Of course, there is yet another use for nose reduction clips: they work really well to keep nachos and potato chip and bags tightly closed.

Rhinoplasty Nasal Packing: No Need for Pain!

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"A close up shows a nasal surgeon removing the packing from the nose of a patient on the table"

Nasal surgery, Nasal Packing Removal

Take a look at the post just before this one and you’ll see that some 253,000 Americans had rhinoplasty during 2010.

Add to that nearly half million people who had sinus surgery and the many thousands who had:

  • Septoplasty
  • Turbinate surgery

And you’re talking about close to a million nasal operations.

In many of those procedures, facial plastic and sinus surgeons pack the inside of the nose with various materials that stop bleeding, deliver medications and hold things in place.

Nasal packing often consists of:

  • Strip gauze
  • Telfa, a type of cotton that won’t stick to the wound
  • Many other cloth-like materials

But an old concept that has stuck like glue with the public is that nasal packing removal is a trip through Hell.

Now, we realize that, perhaps, some surgeons are not quite as attuned to patient comfort after a surgical procedure as they should be, particularly if they themselves have not had surgery.

(NOTE: We have gone under the knife for a nose job and know what it’s like from a patient’s perspective).

However, a surgeon has no excuse for not providing the patient maximum comfort and freedom from anxiety.

Here is how we do it:

During the first consultation, patients are told not to worry about removal of nasal packing. If they are having a rhinoplasty, a single Telfa tampon is removed one to two days after surgery.

If the patient is having more major surgery, like rhinoplasty with septoplasty and turbinate resection to relieve nasal obstruction, that packing may remain for five to six days.

However, patients will be breathing through their noses thanks to a Kotler Nasal Airway™ laid in the nose with the packing then put in around it. (Read more about the Kotler Nasal Airway.)

When patients are told ahead of time not to worry, they are also told why they shouldn’t worry.  The answer?  Topical anesthesia.

When a patient has removal of the tampon, or gauze pad, the first thing we do is dribble some liquid anesthetic into the nose.  Within three to four minutes, the nose is numb.

The medication also shrinks the lining of the nose. Thus, a looser fit is created between the packing and the nose’s interior.

Most patients – wondering when the pain will strike — are shocked when we remove – without sensation– the nasal packing. Only then do they realize the process is over.

Patients should always ask questions before any procedure and be certain that the doctor will provide them comfort and freedom from anxiety.

But for some patients, there will always be anxiety that begins to interfere with their lives.  For those patients, we prescribe an anti-anxiety medication like Valium.

Those with a low pain threshold also get a prescription for pain medicine – either the medicine they took after surgery, or a new medicine.

In medical practice, as in so many things in life, it’s about detail, compulsiveness, and in medicine, consideration for the patient.

"A close-up shows the Kotler Nasal Airway in the nose of a patient on the table"

After Rhinoplasty: Kotler Nasal Airway

Cosmetic Surgery: Top 5 for Your Age Group

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"People of all ages line up, one behind the other"

Cosmetic Surgery line to see the Doctor

Cosmetic plastic surgery procedures are picking up steam, with more people going under the knife, but did you ever wonder what – and how many — facial cosmetic surgery procedures your particular age group is having?

Teens want more than anything to fit in with their friends. According to the 2010 American Society of Plastic Surgeons (ASPS), people 13 to 19  consider the following their most favorite facial plastic surgeries:

  • Nose reshaping (rhinoplasty) –35,005
  • Ear Surgery (Otoplasty) 8,763
  • Dermabrasion – 2,907
  • Eyelid surgery (Blepharplasty) – 1,922
  • Chin augmentation –1,070

In the 20s, men and women want to make a big splash as they move into the world of work and adult social whirls. So the top 5 facial rejuvenations 20-somethings crave are:

  • Nose jobs – 75,546
  • Ear surgery – 8,717
  • Eyelid surgery (blepharoplasty) – 3,820
  • Dermabrasion – 4,556
  • Chin augmentation – 1,637

People in their 30s are really starting to roll, raising children and swinging for the fences on the job. The top 5 cosmetic procedures they want are:

  • Rhinoplasty –62,447
  • Eyelid surgery – 14,143
  • Ear surgery – 5,190
  • Face Lift  (Rhytidectomy) -1,717
  • Cheek implants (malar augmentation) 1,611

When the 40s and early 50s roll around, people are still involved with family and career but are becoming ever more aware of health and appearance. These good folk want to look rested, refreshed and full of energy on the job.

Thanks to the changes we see in our mirrors, the top 5 plastic surgeries that group wants are:

  • Eyelid surgery  – 88,501
  • Rhinoplasty – 54,822
  • Face lift –36,533
  • Dermabrasion – 26139
  • Forehead lift – 17,477

Among the 55 and over set, many are still working, putting kids through college and probably concerned more than ever about looking haggard, tired and listless in the workplace due to normal aging. Their top 5 facial procedures are:

  • Eyelid surgery – 100,378
  • Facelift – 74,382
  • Dermabrasion – 27,407
  • Nose reshaping – 24,441
  • Forehead lift – 23,228

Having waded through a long set of dry statistics, what’s your guess for the top facial plastic surgery for both men and women?

Answer? Nose reshaping! 253,000 nasal surgeries were done in 2010.

Overall, in 2010 (the most current year for which we have statistics) women of all age groups had 189,000 nose jobs while men during the same year went to rhinoplasty surgeons 64,000 times.

Next most popular: Women of all ages had 177,000 eyelid surgeries while men had 31,000 procedures to trim sagging eyelids from their peepers and loose the bags from under their eyes.

Is it any wonder people blog so much about finding a qualified, experienced rhinoplasty surgeon?