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Rhinoplasty: Another Ethnic Group Wants Better Noses

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"Blooywood actor and actress heat up the action for the camera"

Bollywood Action

If rhinoplasty weren’t already the most difficult cosmetic plastic surgery, yet another wrinkle has cropped up in the art and science of performing ethnic nose jobs.

Various U.S. ethnicities crave better noses that fit their faces and flatter their profiles. But, at the same time, those patients want to keep their ethnic identities. For instance, African-American patients may want a less wide nose but they do not want the slim nose typically appearing on a Northern European background person. (Read more about ethnic rhinoplasty.)

So good cosmetic plastic surgeons tread carefully and are well studied in what exactly makes an ethnically appropriate nose. In North American, that means knowing the facial characteristics of:

  • Asians
  • Anglo-Saxons
  • African-Americans
  • Hispanics

Now, a new group has been studied. Writing in the current issue of Plastic & Reconstructive Surgery, a medical journal for plastic surgeons, three cosmetic plastic surgeons studied the nose job requests of Americans with roots in India.

The traditional emphasis in India has been on “internal beauty” (READ: never mind what a nose looks like.) And then the influence of “Bollywood”, the center of films in India, started more people thinking about their appearance. According to the article, India-based plastic surgeons counted 60,000 cosmetic rhinoplasties in 2009.

When more people born in India moved to the United States — and came under the influence of Hollywood beauty standards — the trickle of interest in better noses became a tidal wave.

Three plastic surgeons studied 35 Indian-American women who were unhappy with their noses. Results? A large majority wanted nasal humps flattened. They also complained of nasal tips that pointed down, especially when smiling or a nose that was just too large.

These subjects also wanted to preserve their ethnic identities; but fewer requested reduction of wide nostrils; one patient who wanted only slightly more narrow nostrils brought in the before and after rhinoplasty pictures of an African-American woman who also had very slight nostril reduction.

Another subject, 28, asked for a hump reduction. But the cosmetic surgeon, while examining her nose, found a deviated septum which blocked her breathing.

So, like many American nose job patients, she had septoplasty and cosmetic rhinoplasty in one surgical session.

Results? She breathed better and looked better.

(The patient, below, allowed her full beauty to come through by removing the hump on her nose.)

"A lovely woman shows the difference a bump removal from her nose makes"

Hump Removal

Nose Job: How Teens Can Ask Mom & Dad for It

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"A seemingly pretty teen hides her face in shame due to a big nose"

"Don't look at my nose!"

If you’re a teen boy, at least 17, or a 15 or 16-year-old girl, you may be old enough for a cosmetic nose job.  One thing’s for sure, you’ve got lots of company: in 2010, the best year we have for statistics, about 35,000 American teens had rhinoplasty.

But how do you ask mom and dad?

You’ll make a better case for rhinoplasty if you have been teased at school or if you have a cruel nick-name like “Big Nose.” Then, your self-confidence is flattened. So you dread giving that speech in a class. You also probably don’t want to raise your hand – even when you’re the only one who knows the answer—because you don’t want attention. Some teens go to great lengths to hide their noses, letting their hair grow down over the face or pulling down a baseball hat.

So what to say to parents? Try: “I feel singled out because of my nose – it’s actually holding me back. Because my nose is ugly, I feel ugly and I don’t volunteer for things, I don’t join things and I don’t speak out because I don’t want to people to notice me. I have about zero self-esteem.”

Rhinoplasty changes the entire appearance of a face; when looking at a person with a bad nose, the eye stays on the nose. But when a nose fits and flatters a face, the observing eye then takes in the person’s eyes. (Just look at the teen before and after rhinoplasty picture, below.The only change was to her nose.)

Explain that the ear pinning operation – otoplasty – is often given to kids with big, stand-out ears before they start first grade. It’s because the teasing starts immediately and can sour a youngster on education for life.

Then, go on your computer and Google the studies that find attractive people:

  • Do better in school
  • Get more attention from teachers
  • Make more money at work
  • Are treated better by peers
  • Are more likely to have leadership roles

Offer to pay as much as you can now and repay any money mom and dad spend.

When you go see the cosmetic plastic surgeon, he or she wants to see:

  • The teen has initiated the request
  • You have reasonable goals (i.e. don’t ask for Anglie Jolie’s nose!)
  • You are mature enough to deal with nasal plastic surgery, a little post-op discomfort, having black and blue marks on your face for perhaps seven days and can give up sports for three to four weeks.
"A very pretty girls shows in before and after pictures the difference a nose job has made"

Before and After Teen Rhinoplasty

Rhinoplasty & Nasal Surgery for Pitcher – for Free!

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"Mets pitch Jon Niese is shown at bat before his nose job"

Before Rhinoplasty

When two Big League baseball players were chatting in a locker room in the summer of 2011, one heard his pal saying he would like to have a rhinoplasty along with correction of a deviated septum.

A septum is the thin wall of cartilage separating the nostrils. And we’re talking really thin – as in egg shell thin. Sometimes, people are:

  •    Born with a deviated septum
  •    Injured
  • Hit in the face with a baseball
  • Dive nose first into a base

Met pitcher and Lefty Jonathon Niese had his site set on a cosmetic rhinoplasty that included fixing his crooked septum. Trouble is, if the septum is bent out of shape that affects the breathing. And you know how it is with sports stars – they just gotta breath right.

But Niese seemed to be getting along O.K. and said he would get around to the nasal surgery someday. The cost of the rhinoplasty and septum repair would be about 10 grand, according to a New York plastic surgeon.

“Oh yeah” says Carlos Beltran. “What if it was already paid for? Would you do it then?”

“Of course,” says Niese.

So teammate Beltran pipes up right out of the blue and says to Niese: “Well then, go ahead and get the nose job. I’ll spring for it.” Beltran and Niese were with the Mets from 2008 to 2011.

And then a wrinkle crops up. Beltran gets traded to the St. Louis Cardinals.

Meanwhile, the New York papers get involved and report that Beltran recommended the plastic surgery, a supposition Beltran — who doesn’t know beans about cosmetic plastic surgery — denies.

Says Beltran, fully aware his pal is with another team: “I will have a check ready when the teams met.”

Niese had the nasal surgery in October, 2011, now notices a major league improvement in his breathing (as well as the appearance of his new nose, below!) and looks forward to receiving a  $10,000 check from Beltran who has announced his check is as good as his word.

Sometime after the national anthem is played on March 1, the two teams will face off during Spring training in Jupiter, Florida and Beltran will fork over the nose job money in person.

How’s that for a new high sportsmanship?

"Jon Niese is shown after his rhinoplasty"

After Rhinoplasty

 

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.