Archive for April, 2009
Is Latisse, the new prescription which makes eye lashes longer, safe?
Short answer is yes- when used correctly.
For those interested the more nuanced answer would still be probably yes but if used incorrectly or too much it may cause problems. A recent article which featured a number of different oculoplastic surgeons- specialists in reconstructive and plastic surgery around the lids found that a number of them felt that some problems may occur.
It should be noted that Latisse is and was first developed and promoted for patients who needed treatment for glaucoma because it lowers the intraocular pressure- the pressure in your eyes. Having noted that one of the “side effects” they noticed in these patients was increased eye lash length, Allergan subsequently patented the use of the medicine for this indication.
The most recent study by the company found good results and few side effects when Latisse was applied to the upper eyelashes, as 78% of the trial group found increased eyelash length after 16 weeks as opposed to only 18% when treated by placebo.(why the 18% placebo effect is interesting but a discussino for another time)
The important other points for this article were that the study specifically only tested the upper lashes in order to decrease the chances of this getting into the eyes and potentially causing any problems. SO what are those problems- possible inflammation and redness lasting days to weeks, skin discoloration, and changes to the color of your eyes (potentially darkening), not too mention decreased eye pressure.
Our point is simple, latisse is safe but use it as it was tested until more studies are done to check safety when applied to the lower lids.
No commentsHow we make your nose smaller
When you’re thinking about a nose job, you either don’t care how it’s done… you just want to make sure your surgeon can deliver the result you want and that’s it. Final. Over. Period. Or, you may join a growing group of people who want to research the procedure in detail to learn the pluses and minuses of open vs. closed rhinoplasty or Technique A vs. Technique B. If that sounds familiar, this blog is for you.
Most people have a hard time understanding nasal tip surgery. Taking down a bump on the bridge is easy to understand. A little shave here or there…it makes sense. But, it’s harder to wrap your head around how we make your tip smaller without removing a lot of cartilage and having it fall in over time.
Many plastic surgeons aren’t even comfortable working on your tip. For example, tip deprojection or bringing your tip closer to your face, is one of the harder things to do in rhinoplasty. Many plastic surgeons tend to avoid significant changes to the tip in favor of making the nose smaller by concentrating on that bump on the bridge (sometimes a little too much). So, one of the most common reasons both men and women want a revision nose job is that they think their tip is still too big.
So how do we do it? We use highly controlled procedures. One of our favorite techniques involves dividing the tip cartilage, overlapping the edges by a measured amount, and suturing it back together in a way that is stronger than it was at first (shown below). We can measure exactly how much we want your tip to move. And, depending on where along the cartilage we divide it, we can also change the angle your tip makes with your upper lip and correct any tip asymmetries without having to worry about it changing over time.
- Steps to making your tip smaller- Before (left) to After (right)
So, whether you’re considering your first nose job or a revision, you should know that these tools, if done right, can be a really powerful and predictable way to give you the smaller, refined tip you want like the one you see below. For more before and after photos of our rhinoplasty and revision rhinoplasty results, check out our rhinoplasty gallery.
- Giving a boxy tip more definition and refinement- Before (top) and After (bottom)
Tip Narrowing and Refinement
- Anatomy of a wide tip
The photo above gives you a peek inside at the anatomy of a boxy tip. For many years, the standard technique for tip narrowing was thinning of the upper edge of the tip cartilages, what we call a cephalic trim or cephalic margin resection shown below. When an excessively wide and thick tip cartilage is contributing to a boxy tip, this maneuver is helpful, but it’s very important that the surgeon doesn’t do so much thinning that the tip cartilages are destabilized.
The diagram below shows a reasonable amount of cartilage thinning (shown in red) that will preserve structural integrity and prevent collapse over time. This is especially important in thicker-skinned patients where stronger cartilage is necessary to support the thicker skin. Sadly, we continue to see potential revision patients every day where most or all of the tip cartilage was removed in this area resulting in predictable collapse over time.
Suture techniques for tip narrowing and refinement
You can see from the above real patient photos that these techniques can produce a dramatic improvement. We need to be careful to preserve just the right angle between these cartilages so that light will reflect favorably on your new tip. An inexperienced or careless surgeon may draw the cartilages too close together or may introduce asymmetries that show up later on, or he may not account for skin thickness and other factors. But, in the right hands, suture techniques provide a powerful way to safely provide the refinement and narrowing you are looking for without compromising breathing. In a future post, we’ll show you how we address tips that are too overprojected.
Nose Jobs (Rhinoplasty) In African Americans:How Augmentation Rhinoplasty Can Make the Nose Look Smaller
Many of our African American patients who present for rhinoplasty feel that their nose is too wide, “too big,” and undefined for their face. So you can imagine many of them become confused when we explain that they need to have augmentation rhinoplasty in order to make their nose look smaller.
While we recognize that there is tremendous variability in every parameter of the African American noses: including nostril shape and flare, nasal length, skin thickness, columella length, nasal projection, and bridge height; numerous studies have shown that African American patients, on average, tend to have:
1. Weak, Short Tip Cartilages- results in tip looking short and droopy
2. Wider, Bulbous Nasal Tips
3. Wider Variability in Nostril Shape
4. Greater Nostril Flare (bigger nostril curvature)- makes tip look wide
5. Acute Nasolabial Angle- again can make tip look droopy
6. Thin, Weak Septal Cartilage- harder to support and refine nose
7. Wider, Lower Nasal Bridges- makes nose look wide and washed out
8. Thicker Skin- makes it more difficult to add tip definition and refinement
9. Excess Tissue in the Nasal Tip- resulting in poor tip definition
With all of this being said, over the years we have found that the most challenging part in African American rhinoplasty is correcting the deficiency in tip projection in the face of a bulbous, amorphic tip with thick skin. In other words, the nose is at once short and wide.
As a result, in this type of nose it is important to build up and add to the tip structure in order to not only provide adequate support but also to give lasting tip definition and refinement. And at the same tip we must recognize that most of our patients are seeking a thinner, more refined nasal tip that is not built up too much. So as you can see in our example below a balance must be created between appropriate refinement without excessive projection.
This professional African American presented after noticing that over time his nose had started to droop and widen. You will note that even 3 months after surgery the improvement in tip definition and refinement is significant.
Should you choose open or closed rhinoplasty
This is a big question for people. There is a lot of fear about the open rhinoplasty incision. Will it be noticeable? Maybe you’ve seen examples of poor scars from an open rhinoplasty. The fact is poor scars happen when poor technique is used.
You should know that, in the hands of a careful and experienced open rhinoplasty surgeon, the open incision heals beautifully. Below is a typical example of how one of our open rhinoplasties looks before and after just 3 months. We hope you’ll agree that without showing you where the incision is placed in red, you’d have a pretty hard time finding it.
Now, many of you are probably saying to yourselves, ”Who cares how well it heals…why not have a closed rhinoplasty and not have to even think about the incision?” Worthwhile question. And, we have 3 main answers to that.
The first is that the access to your nose provided by the open approach is far superior to a closed rhinoplasty and therefore, diagnosis and treatment of tip problems can be far more accurate. A closed rhinoplasty may be good for taking down a bump on your bridge but does not allow the surgeon to see the tip cartilages nearly as well. As a result it is far more difficult to achieve symmetry in the tip and long term this can result in many more problems as the cartilage twists or buckles due to the asymmetry.
Perhaps most important for most people, the open technique affords a number of different techniques that allow us to reliably deproject (make the tip shorter), and thus the nose smaller. Doing these techniques via a closed technique is difficult if not impossible in most hands. As a result you find many closed surgeons end up producing noses that are scooped because they bring the bridge down trying to make the nose smaller since they cannot reliably lower the tip. Even more problematic are those surgeons who remove much of the tip cartilage in trying to make the tip smaller because in the long term this can and often does result in some form of problem.
The third thing to think about are the potential negatives from closed rhinoplasty incisions. Just because the incisions aren’t seen from the outside does not mean they aren’t there. Below you can see some of the different internal incisions (shown in red) that are often made in a closed rhinoplasty.
One or more of these incisions is made depending on how much work is planned for the tip. The incision on the far right also needs to be made if the septum is addressed as well. In contrast, work on the tip, bridge, and septum can all be accomplished in open rhinoplasty through the same external incision.
It’s not as important to understand the different incisions as it is to understand that the internal incisions made in closed rhinoplasty often pose real healing problems too. Some of these incisions are made near the narrowest part of your nasal airway so just a little bit of excess scar tissue can seriously compromise your breathing and potentially destabilize your tip.
Every surgical technique has advantages as well as potential downsides and trade-offs to consider. Don’t get too hung up on whether your preferred surgeon suggests an open or closed rhinoplasty for your nose. We like to say that far more important than how the surgeon opens, is what he does to the underlying structure once he’s there- that’s what in the long term gives you the beautiful, stable results we are all looking for. So, while we use both approaches, far more often than not we find that an open rhinoplasty is what it will take to achieve just the right change for you.
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