Recently, we have seen a number of patients who have had a filler- juvederm, perlane, artefill, radiesse, restylane- placed in their nose. Some of these patients have never had previous surgery while some have had previous rhinoplasty and were using the filler to further revise/correct the nose thereafter.
Universally, the patients that we have seen who had nonsurgical rhinoplasty felt that the procedure was causing their nose to look bigger. Now, in fairness, we are seeing those patients who are unhappy with their results and there are likely to be many patients who are perfectly happy after having done an injection rhinoplasty.
If you have had a filler placed in your nose, the important questions we want to know before considering surgery are:
1. Which filler was used?
a. As you can imagine there is a big difference in approach for someone who had juvederm/ restylane placed in the nose- which generally last about 6-9 months- vs someone who had artefill or silicone- which are permanent fillers.
2. How much was injected?
a. Again, if only a small amount of filler- say 0.1 cc was injected to fill in a single depressed space we can move forward with surgery sooner that with someone who has had 2 or 3 cc of fillers injected during multiple visits at multiple different sites.
3. How long ago was the filler injected?
a. Again depending on which filler was used that will help us determine when it would be best to proceed with surgery.
The reason these details are important is because as we all know rhinoplasty is a procedure of millimeters and the details of how long ago and how much filler was placed are crucial toward the final goal. The last thing we want to do is assume all the filler is gone and go in to do surgery only to find many months later that more filler dissipated and now the nose is smaller than we had intended.
As a result, we do not have a blanket approach toward when to proceed with surgery. These details are all individualized to each patient and the details of the procedures they had undergone.
All this being said, we have operated on patients who have had restylane, juvederm, perlane, radiesse, artefill and silicone and had fantastic success by individualizing each patients treatment plan.No comments
At the start of the new year, we want to take the opportunity to thank you, our readers and patients, for your ongoing support of our practice. Last year was an exciting year for us at Profiles. We celebrated our 5-year anniversary in practice together. And, 2012 saw the launch of our new skin care line, JolieMD Metamorphosis. We’re looking forward to seeing what 2013 will bring.
We want to wish you much happiness and success in the coming year. Whether you are actively considering rhinoplasty or facial rejuvenation surgery, or just in the information gathering phase, we hope you find our blog helpful and informative. We are always looking for new and interesting topics of discussion, so please feel free to post questions or comments. If you are interested in a surgical procedure at Profiles, please contact us on our practice website (www.beverlyhillsprofiles.com). All our best to you for 2013.No comments
In general, it is best not to massage your nose after rhinoplasty as it is possible, although unlikely, that vigorous rubbing or manipulation in the first few weeks could pop a delicate stitch and disturb the corrections made or affect the cosmetic result. Some people habitually rub the tips of their noses. Recognize that this will not likely ruin the result but may cause more irritation and swelling.
That being said, your nose is not glass after surgery. In fact, it can often feel quite stiff and wooden for a period of several months after surgery. Rolling over onto your nose during sleep or lightly bumping your nose will not make it end up on the side of your head. So, you don’t have to walk around in a bubble after surgery.
After about a month, the skin starts to wrap around the cartilage, and the bone is pretty much set, so contact to your nose is less likely to cause any shift or problems with healing. Likewise, a small rind of fibrous tissue or scar has started to form that will likely hold the cartilage in place even if a stitch were to loosen at this stage.
Some surgeons recommend ‘nasal exercises’ which essentially amount to light lymphatic drainage. These will not be harmful but may not do much either. Instead, we ask patients to tape the nose at night for the first month to help skin contract and push out swelling. If you have any questions about nasal massage, ask your surgeon for his or her preferred routine after surgery.No comments
There are two questions at the forefront of most people’s minds when considering rhinoplasty. When will I look good enough to go back to work, school, or social activities? And, when will I see the result I want?
The first answer is easy. Swelling and bruising should be gone in the vast majority of patients within one week after surgery. At one week, most everyone is comfortable going back to normal social and work activities. That being said, your nose will still feel a little strange at that time. It will probably be a little numb and stiff, and your smile may feel tight or awkward. No else will notice this but you will be aware of it. It’s extremely rare for anyone to notice what’s different about you unless you’re announcing your impending surgery to friends or to the whole workplace. Most of our patients tell us they here statements like “Hey, you look good”, or rarely “There’s something different but I can’t put my finger on it”. The reason is that there is not an immediate dramatic change. In most cases, the change is gradual enough that it is seen only when we focus on the nose.
On the second question, you should be seeing a real and meaningful positive change in your appearance even within a week or two after surgery. But, at this stage, you may only be about halfway to the imaged or desired result. We are talking here about detail or refinement. The skin has been lifted and changes made to cartilage and bone underneath, and it takes weeks and months for the skin to contract around the bone and cartilage. Until then, the skin can feel a little ‘loose’ or spongy. As the skin contracts, it ‘shrink wraps’ onto the change structure allowing more detail to show through.
Some factors can affect this timing. Thicker, more oily skin can often take longer to contract. If the nose was made smaller or narrower, it will take more time for the skin to contract to that level. On the flipside, if the tip was projected or the bridge raised and augmented, you will generally see more definition sooner after surgery. Revisions can sometimes be slower to heal although not always. If a large amount of scar was taken out during a revision and cartilage resupported, the skin will likely be able to drape better more quickly.
Of course, there is some individual variation here. Some patients look fantastic after 3 months and healing is essentially done. Others may have some fluctuating puffiness and continued improvement well over a year or longer after surgery. Your surgeon will be able to give you a sense of your expected course of healing during your pre-op visit. Things can also be done along the way to help swelling go down and have you looking and feeling great as quickly as possible.
Check out another one of our blogs on healing after rhinoplasty.No comments
For many of our African American patients there is some real confusion as to what rhinoplasty can accomplish. The problem is that after having seen a number of different surgeons for consultation they are repeatedly told that in order to accomplish any “real” change they need to have the bridge of their nose built up.
The problem is that for most of you, it is not the profile view that has ever bothered you- it’s how wide your nose looks on front view that made you feel like your nose does not quite fit.
Unfortunately, many surgeons are not comfortable in dealing with the excessive width of the tip and nostrils and will instead focus on building up the bridge to make it look narrower. Again, while this treats part of the problem it does not address the tip and as a result your nose can still feel excessively wide. Moreover, because the surgeon often uses your septal cartilage in order to build the bridge it makes revision of the tip much more difficult.
In our experience, traditional reduction rhinoplasty generally does not work very well for African American patients. The reasons for this have been addressed in previous blogs on the topic, but suffice it to say that in most African American patients there is a layer of fibrofatty tissue that underlies the skin that covers the tip and makes the tip excessively wide and undefined. In order to create more tip definition and make it look more refined, this fibrofatty tissue often has to be dealt with during surgery and at least partially removed so that the skin can then contract down to the cartilage.
When we then couple this with suture techniques to help refine the tip and do alar base surgery (nostril narrowing) that addresses both the flare of the nostril as well as the width of the nostril (sill width) you can really tailor the procedure to address your goals in a very natural way. By combining all of this we have found that our patients are able to address the excessive width of the their nose and end up with a nose that is natural and stable so that they no longer have to think about their nose any more.No comments
The open rhinoplasty approach offers unquestioned advantages when operating on the nasal tip. But, what if you just want to reduce a nasal bump? Should it be done closed or open?
The answer, in our opinions, depends on the extent and location of the bump. Some people have a bump that is mostly isolated to the bony part of the bridge. If the bump is mostly bony and in the upper third of your nose, it is perfectly suitable to go through a closed approach. The bony bump can be rasped or shaved down and then osteotomies can be done to narrow or straighten the bones as needed.
For many people, however, the bump is not just in the bony part of the bridge, but is more of a curve that goes all the way from the forehead down to the tip. In these cases, the bump involves the middle portion of the nose which we call the mid-vault. This area, made up of cartilage sidewalls attached to the septum in the middle of your nose, is a vital part of the nasal airway. For this reason, we prefer an open approach when addressing these types of bumps.
The reason we prefer an open approach is that it is critical to re-support these sidewalls to preserve breathing after a bump is taken down in the mid-vault. In a closed approach, the cartilage sidewalls are often reduced along with the bump and the normal connections between the sidewalls and septum are released and left unattached. If left to heal this way, the sidewalls can lose support and fall in or collapse, leading to breathing problems or apparent crookedness, something we call internal valve collapse. The advantage of an open approach is that it provides the access and visibility for the connections between the sidewalls and septum to be more easily and more accurately sutured back together, minimizing chances for poor healing. In a closed approach, reaching this area with a suture from underneath the skin is both less precise and more difficult to accomplish. As a result, some surgeons who prefer a closed approach do not do this, increasing the risk for mid-vault collapse in the long-term. By re-supporting the nasal sidewalls through an open approach, the chances for breathing issues after rhinoplasty can be kept to a minimum.
Whether your nose is operated from an open vs closed technique should honestly not be the dominating question. What is important is that the surgeon you choose has a lot of experience with rhinoplasty and can choose the best approach for your nose in order to optimize your chances for a great result and minimize chances for risks from the procedure.No comments
One of the main fears patients have regarding rhinoplasty is that they will bruise severely and that the bruising will result in them needing extended time off from work and away from friends.
While this is a very valid concern, here at Profiles we are very happy to be able to say to our patients that the vast majority of our patients experience minimal bruising and even those who do experience any bruising are almost always able to return to work at the 6 day point after surgery when the nasal cast is removed.No comments
A favorite question of patients looking to turn back the clock with a facial rejuvenation procedure is how much younger will they look? It’s a good question and one that’s hard to quantify. We know from quality-of-life studies, including one that we did, that facial rejuvenation surgery definitely helps improve quality of life and perceived satisfaction in many facets of life. But, it is hard to put a number on just how many years younger someone will appear after this surgery.No comments
The Profiles Perspective: Our Belief that Synthetic (Alloplastic) Materials Should Not Be Used in Rhinoplasty
At Profiles, we have always held the standard and belief that when doing rhinoplasty and revision rhinoplasty, there is a hierarchy we can follow when grafting material is needed. Ideally, whenever possible, we use septal cartilage. It allows us to replace any missing cartilage or to build support using tissue that is essentially identical to the normal cartilage we find in your nose. In some cases, the septal cartilage is too thin and flimsy and unsuitable for use; even in primary cases. And in revision rhinoplasty, the quantity and quality of remaining septal cartilage may be inadequate for reconstruction.No comments
If you are reading this post, you likely had previous rhinoplasty and have now seen a revision surgeon who has recommended that you have rib cartilage removed during your revision surgery. The use of rib cartilage in revision rhinoplasty has become increasingly popular over the last many years as revision rhinoplasty surgeons continue to seek out alternative sources of cartilage for grafts that are often necessary during revision.2 comments