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.

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.

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.

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.

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.

http://www.nytimes.com/2008/01/24/fashion/24skin.html?ex=1358917200&en=11ca054e9b8df617&ei=5124&partner=permalink&exprod=permalink

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 (www.aafprs.org) 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:  http://www.fda.gov/medwatch/safety/2008/safety08.htm#botox

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.

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.

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.

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.

We are often asked by patients whether nostril asymmetry can be corrected. This is something that often really bothers people a lot even though they know that noone else really sees their nostrils on a regular basis (except for maybe the family pet). The answer depends on the cause of the asymmetry. Much of the time, it is caused by asymmetry of the cartilages that make up the tip of the nose. You can be born this way but, more often than not, it happens from over-aggressive previous surgery. In this case, fixing the cartilage problems will go a long way towards improving nostril symmetry. You can see more results in our photo gallery. Sometimes, one nostril is just naturally smaller or shaped differently than the other one. The nostrils can be made to appear more similar in size and shape, but they may not be made perfectly symmetrical. This is usually cosmetically acceptable because noses and faces aren’t naturally perfectly symmetrical. So, the goal is to have every aspect of your nose look nice, natural, internally balanced, harmonious with other features and unoperated upon.When there is a major difference in nostril symmetry, such as in someone with a cleft lip and palate, deficient bone and soft tissue is often responsible. In these situations, we have to do a lot of work including grafting to get things looking more similar. But, even in these cases, improvements can be had. We encourage you to discuss your particular concerns with us directly, so we can evaluate you individually.                                                                This young woman was unhappy with the asymmetry of her nostrils that was also affecting her breathing. She also wanted her tip to be a little more refined and less boxy in appearance. In the 1 year postop view, you can see narrowing of the tip and achievement of nostril symmetry.

We see many patients of Asian or other backgrounds with the very same concerns you describe. There are a number of ways to build up your bridge and give your tip more projection.

The easiest way for a surgeon to do this is by using a prosthesis, usually made of silicone, to lay over the entire bridge in order to make the nose more prominent. This is a very common procedure, especially in East Asian countries. Sometimes, it works with success, but other times there are problems with these prostheses, such as infection, exposure, or movement as time passes.

For this reason, here at Profiles, we use prostheses as a last resort. Our material of choice is your very own cartilage. We usually take this cartilage from your septum (the midline wall deep within your nose) or sometimes from one or both ears. In either case, you won’t notice it’s gone and your ear anatomy will look the same.

By using your own cartilage, we are able to achieve a significant and natural-appearing nasal augmentation with almost no risk of rejection, infection, or other graft problems, even long-term. So, you can be reassured of a better chance at a great result.

We encourage you to contact us to discuss this and other approaches related to Ethnic Rhinoplasty. You can also read more about it in our online text on Modern Rhinoplasty.

It is true that your nose and chin are intimately related to each other on your profile view. In general, a small or retrusive chin can exaggerate the appearance of a large nose and vice versa.

The object of cosmetic plastic surgery is to bring all of these elements into balance so that no one feature is dominant. In Augmentation Rhinoplasty, if the nose is simply made ‘bigger’ all around, then your chin may appear smaller.

On the other hand, if your nasal tip is given more projection and refinement by very precise placement of grafts, instead of looking amorphous, all of your other features including your ckeeks and jaw line will appear more refined by association.

So, to make a long answer short, Augmentation Rhinoplasty can very well give all of your features the enhanced definition you desire. Please read more about this topic in our online Modern Rhinoplasty text, and give us a call to see if this procedure is right for you.