Archive for February, 2008

I read your recent blog about rhinoplasty in African American patients but I have a problem with keloids and was wondering how big of a problem this will be if I do have rhinoplasty.

Your concerns are valid and it is important to discuss your history of poor scarring whenever you undergo any type of surgery. You should note however that different parts of the body will heal differently. The simple answer is that keloids rarely develop in the central face and we here at Profiles have never seen a keloid develop after we have done rhinoplasty.

A more in depth explanation begins with an explanation of scarring. First, we need to help you in understanding the difference between a hypertrophic scar and a keloid. Clinically, hypertrophic scars are enlarged scars that stabilize or shrink with time. Keloids, however, initially develop as hypertrophic scars but later extend beyond the original injury area. They rarely regress on their own and have a propensity for recurrence after excision.

Keloids may affect virtually any surface on the body with the central chest, deltoid/shoulder region, and back having the highest frequency. And this has led some doctors to speculate that motion and tension play a large role in causing keloids to develop. While this may be true to some extent, the earlobes, which are one of the most frequent sites affected, are obviously subject to minimal motion or tension forces.

photos Before and After Earlobe Keloid Scar Excision

photo Before and After Earlobe Keloid Scar Excision

This African American patient demonstrates a typical example of a large keloid scar of the earlobe that was removed in one session with flap reconstruction of the back of the ear. The After photo to the right shows her postoperative result over 6 months after the procedure.

All this being said, while you should explore this issue with your doctor before surgery, you should feel some comfort in knowing that the nose is rarely a site for keloid development after rhinoplasty or nasal surgery. In fact, we did a literature review to check on your answer and were unable to find any papers which could point to a case of a keloid after rhinoplasty.


I had surgery with another surgeon and am not happy with my Rhinoplasty result after 1 month. What should I do? Can you help?

February 25th, 2008 | Category: Revision Rhinoplasty,Rhinoplasty Recovery

First and foremost, do not panic.

Early changes after Rhinoplasty are influenced by swelling and do not necessarily reflect the end result nor what was done during your operation. Trust your instincts and talk to your doctor about your concerns. There may be a perfectly good explanation for what you’re seeing. Sometimes, reassurance is all that is needed.

Once the cast comes off your nose, the natural tendency is to stare in the mirror for far too long- looking for the smallest of changes. This is precisely the most harmful thing to do because it will not change your healing and will only make you more nervous.

You will find that you are more swollen in the morning, when you are more active, or after lying down for long periods of time. This is because blood and fluid pools in the area of your nose and cheeks. Aside from that, healing happens in drips and drabs. You may not notice any changes for a few days, and then suddenly see a big reduction in swelling. There is a range of ‘normal’ healing. Don’t be alarmed if you are on the edge of that range. Your surgeon should let you know if anything unexpected is happening. If you are still unhappy at six months or a year, it may be time to talk about your options for improvement.

Your original surgeon is still the best place to start with this conversation, if he or she still has your trust. If not, consult a surgeon who has an experienced practice in Revision Rhinoplasty to see if this is a good option for you.

If you have any questions, please feel free to give us a call or send an email.

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Is it possible to ask too many questions before surgery?

February 18th, 2008 | Category: Rhinoplasty Philosophy

Have you ever noticed that when you ask a person regarding something they have a passion for, they will never tire in answering your questions? You almost will find a gleam in their eyes to show you why they have a passion for the subject. Well, at Profiles, Rhinoplasty and Revision Rhinoplasty are our passions.

We often have patients who have had a previous rhinoplasty or who have friends who have had rhinoplasty with less than ideal results. And many, if not all of our patients, have understandable concerns and are very good about doing their due diligence before proceeding with rhinoplasty.

At Profiles, we encourage our patients to ask any and all questions they have regarding their surgery and we take a great deal of time in the preoperative consultations in trying to assess your concerns and in helping you understand what the plan is. Because rhinoplasty and revision rhinoplasty are often elective procedures, we feel it is even more important that our patients feel comfortable with us and with the surgery we are suggesting.

During our consultations we take and utilize your photographs to show you and to learn from you what the problem areas are that should be addressed. We then take the next step of using our state of the art computer imaging to give you an accurate idea of what changes we can effect with rhinoplasty. The process is detailed but we truly feel that when our patients are educated as to what we are able to do and when they understand what limitations their anatomy presents, our patients have real expectations that we know we can meet, and together we are able to achieve the goals they are seeking with rhinoplasty.

Moreover, here on our blog as well as on our website ( , you will find an extensive data base including a complete textbook written for you our patients (Modern Rhinoplasty). We encourage our patients to read as much as they want before their consultation but we go even further by providing you printed answers to all the most frequently asked questions regarding your rhinoplasty, including your preoperative and postoperative instructions as well as all the risks and benefits associated with surgery. We then will even suggest further specific pages in the online textbook to read for issues that specifically affect you and your surgery. And then we make a second visit before your surgery so that you can go and read as much as you want and so you can look at your images, so that during your second consult we can address any new or further concerns you have.

We welcome you to experience the difference. And we will do all we can to show you why we are dedicated to being the rhinoplasty and revision rhinoplasty experts.

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A recent patient who wanted to make her whole nose look smaller asked why plastic surgery does not allow noses to be made as small as people want?

We always appreciate patients who present to us having done some homework on their own because it lets us know that they are really preparing for their surgery and more importantly because it allows us to spend more time in really discussing the available surgical options.

We find a lot of our patients, men and women, present with exactly this question and the answer largely depends on each particular patient’s anatomy.

Sometimes, patients present with a large hump which makes their nose look large, and you will often see these pictures on people’s websites because in reality, though they are the most dramatic results, they are relatively easier to accomplish. Occasionally, these patients also have smaller chins and a chin implant goes a long way in balancing their appearance.

The more difficult cases are those patients who like the overall shape of their nose but feel like their whole nose is just too large. In these cases the tip, middle third of the nose and bridge all have to be reduced equally. While we can and often do exactly this procedure for our patients, it is important in these cases to be very cognizant of skin thickness. In those patients who have thick skin, we caution that while the nose can be made smaller, it should still maintain definition and refinement. In our patients with thick skin, we always let them know that if we attempt to make the nose too small the tip can lose its shape and appear amorphous. So while we make the nose smaller, we stress the importance of tip definition and refinement.

Finally, and perhaps most importantly, we must remember that the primary function of the nose is to help in breathing and this function is critical. Unfortunately, a lot of times with all the mass media exposure to airbrushed pictures, we are exposed to images of people who are not real and to noses that cannot be reproduced without causing problems in breathing. And its for this reason that at Profiles, we always admonish that Form must not supercede Function.

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I am considering rhinoplasty but don’t know whether I should tell my family and friends. What do you think?

February 15th, 2008 | Category: Rhinoplasty Philosophy,Rhinoplasty Recovery

We find that the decision to tell friends and family is a very personal one that largely depends on you and your relationships. For most of our patients we find the question of telling friends and family is very simple and they find that the added support helps in making the entire process easier.

Occasionally, however we have some patients who feel that they have family or friends who simply will not accept their decision to proceed with surgery. Occasionally, these patients want to remove some family defining characteristic such as a nasal hump that they feel their family would want them to keep. For other patients, especially those who are still in school, we will wait to have surgery over the winter or summer break so that changes are not quite so obvious to classmates. Overall, however we have found that the social stigma that used to be associated with plastic surgery is no longer really an issue and in general when our patients discuss their reasons for wanting to pursue surgery, their families and friends are generally much more supportive throughout the process than you may otherwise expect.

In those cases, when our patients are from out of town or when they do not have support, at PROFILES we have developed a comprehensive team and program to help take care of all your postoperative needs and to make you feel comfortable every step of the way.

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Do Plastic Surgery Patients Really Come In Asking to Look Like Movie Stars?

February 13th, 2008 | Category: Rhinoplasty Philosophy

We recently read a Reuters report that said that Beverly Hills plastic surgery patients want the eyes of Katie Holmes, the lips of Angelina Jolie and Jessica Biel’s body. While the article goes on to say that patients do not ask for plastic surgery “to look exactly like a specific star,” it suggests they do want “to replicate a distinct feature of various celebrity faces and bodies.”

At Profiles, we wonder what the point is to an article that suggests that patients request the nose of “Grey’s Anatomy” star Katherine Heigl, Keira Knightley’s cheek, and skin like Paris Hilton. In most cases this is neither possible nor, even more importantly, desirable.

What is important for patients to know is that plastic surgery is not like sculpting; human bone structure and tissue is not like metal or clay that can be molded to any shape we desire. And even if it were, even Brad Pitt’s nose on David Beckham’s face can appear off-putting and abnormal.


Beckham with Pitt’s nose


The point is that in order to give you a beautiful and natural look, your surgery should be tailored to your individual facial characteristics. At Profiles, we think it’s important that we are honest with you regarding what is possible and that we help guide you in what is desirable. While we do appreciate patients who bring pictures that help show the characteristic they are trying to achieve, we find that our state of the art computer imaging allows us to better communicate what we can achieve with surgery and this, in turn, allows patients to fine tune the details that they want us to be aware of in doing their surgery.


As a result, we find our patients are well educated about what they can expect and come out of surgery happy knowing that we achieved what we said we could.

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Women, Plastic Surgery, And Ms. Natasha Singer

February 12th, 2008 | Category: Facial Plastic Surgery

We wanted to draw attention to one of the recent articles from Natasha Singer, a writer for the NY Times. We often find that her articles are very well informed and, unlike much of what we read about plastic surgery, are researched and well thought out.

In her most recent article, she draws attention to a self help book entitled “How Not to Look Old” by Charla Krupp. Interestingly, Ms. Singer points out that the book “offers a serious rationale for such vigilant attempts at age control, arguing that trying to pass for younger is not so much a matter of sexual allure as of job security.” In other words, she reports that women are increasingly turning toward plastic surgery in order to camouflage their age due to fears that they may otherwise not be able to get or keep a job.

According to the book jacket, “Looking hip is not just about vanity anymore, it’s critical to every woman’s personal and financial survival.”

Ms Singer argues that the success of the book indicates that popular culture is willing to buy into ageism as an acceptable form of prejudice.

We encourage people to read the article which goes on to connect everything from the book to Rush Limbaugh and Hillary Clinton to studies from MIT and Boston College regarding women and ageism.

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Botox Update- The Latest News

February 12th, 2008 | Category: Uncategorized


There has been a recent report of safety concerns regarding Botox.  The latest news is that the FDA is conducting a broader safety review of Botox and its uses.

Today, we received a media statement from our professional academy, the American Academy of Facial Plastic and Reconstructive Surgery ( that is copied below:

“FDA issued an early communication about an ongoing safety review regarding Botox and Botox Cosmetic. FDA has received reports of systemic adverse reactions including respiratory compromise and death following the use of botulinum toxins types A and B for both FDA-approved and unapproved uses. The reactions reported are suggestive of botulism, which occurs when botulinum toxin spreads in the body beyond the site where it was injected. The most serious cases had outcomes that included hospitalization and death, and occurred mostly in children treated for cerebral palsy-associated limb spasticity. Use of botulinum toxins for treatment of limb spasticity (severe arm and leg muscle spasms) in children or adults is not an approved use in the U.S. See the FDA’s “Early Communication about an Ongoing Safety Review” for Agency recommendations and additional information for healthcare professionals.

Read the complete 2008 MedWatch Safety Summary including a link to the FDA’s Early Communication about an Ongoing Safety Review regarding this issue at:

While any serious complications from a medical treatment warrant thorough investigation and appropriate action, the important thing to understand is the context of the risks posed. Botox is a purified form of botulinum toxin and works by temporarily weakening the muscles into which it is injected. In small doses, such as those used for cosmetic benefits in the face, the risks are extraordinarily small. You have more chance of a serious reaction from a $4 bottle of aspirin.

The major risk arises when large doses are used in sensitive locations. Many neurologists are using Botox off-label to treat limb spasticity for cerebral palsy and other conditions. This can provide some relief for these very debilitating conditions. However, if very large doses are used, there is a small chance of overdose, causing symptoms similar to botulism. Also, Botox is blind to location and acts wherever it is injected. If large amounts are injected into muscles near the windpipe or esophagus, these structures can be affected, with potentially disastrous consequences.

For cosmetic uses, Botox remains one of the safest drugs around and has been used safely in literally millions of patients. But, we take these types of reports very seriously and will continue to update you as more information surfaces.

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After my rhinoplasty, when my surgeon removed my cast he found I had red, swollen skin with multiple tiny pustules. Is there anything I can do?

February 12th, 2008 | Category: Rhinoplasty Recovery

We recently received a question from a patient who had underwent rhinoplasty elsewhere and noted that a few days later her nose was very itchy. Upon removal of the cast she had red, swollen skin with multiple tiny pustules. She wrote to us in a panic wondering what had happened.

Of course without an evaluation, we told her that we would only be speculating. But we did note that on rare occasions, there are people who have allergic reactions to the adhesive on the tape that is used on the bridge of the nose after surgery. The tape and splint are intended to help keep pressure on the skin in order to help reduce swelling and to prevent the nasal bones from moving after surgery.

allergic skin

When an allergic reaction occurs, most patients generally report in hindsight that they noted some itchiness starting as soon as the day after surgery but that it only became intolerable after a few days. Of course once the tape is removed the allergen- the thing that is causing the allergic reaction- is gone but it generally takes days for the swollen, red, itchy skin to return to normal. The long term consequences of this are generally negligible outside of the transient initial itchiness and discomfort, but it does occasionally mean that it will take a while longer for you to see the final results of your surgery.

Depending on the severity of the reaction, some surgeons will provide anything from a topical to an oral steroid to help in treating your itchiness as well as in helping to reduce the swelling and inflammation. Hope this helps.

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How to Help Your Skin During the Windy Winter

February 11th, 2008 | Category: Facial Plastic Surgery

Blizzard SKin

Ok, so we may not live in NY, Canada, or the arctic, but it seems many people are finding that the blustering southern California winter air is now making their faces red, itchy and flaky. While it’s true that there are numerous beauty companies ready to sell you expensive, exotic solutions we thought, since gas prices are up and the economy seems to be teetering, maybe we should tell you about some less-expensive ways to protect the skin from winter air. 

Most of you know that it is not the cold itself, but rather the dryness of cold air, that dries out the skin, breaking down its natural protective layer of dead cells, called the stratum corneum. This layer of skin normally forms an oily coating that helps to keep moisture in the skin. When this layer dries out, the skin is more prone to flaking and cracking.

There are a number of ways to help retain moisture in the skin including humidifying indoor air, avoiding scalding showers and harsh soaps, and gently pat drying rather than rubbing the skin with the towel.

Beyond that you can use a host of well known moisturizers like Nivea Crème. If your going to be out skiing you can consider Vaseline, Kiehl’s Face Protector, or we’ve read of a product named Dermatone, which is made of beewax and lanolin.

As for your lips, stop licking them, it only dries them out more. And if the edges begin to crack and split, one doctor recommended covering them with A+D Original Ointment, a diaper rash cream made with lanolin that helps treat irritated skin. Hope this helps.

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