Beverly Hills Rhinoplasty Surgery Blog

In many ways, the very challenging correction of the twisted or broken nose can be viewed as the final step in the mastery of rhinoplasty. It challenges the great surgeon to restore the various deformities present using a detailed understanding of both cosmetic rhinoplasty and functional reconstruction. This is because septal deviation or septal fracture is very common with twisted and/or broken noses and its correction, in large measure, determines the long-term success in treatment of the associated crooked cosmetic deformities. That is why oftentimes, people who have broken their noses and had them treated in the emergency room, long term end up with a still crooked nose- the bones were straightened but because the septum was not, over time the nose twists.

Oftentimes, surgeons treating the crooked nose fall into one of two camps, those who attempt to simply “camouflage” existing deformities and those who attempt to restore and reconstruct the pre- injury state. Rarely, following acute trauma where minimal or no functional problems are present, we can use cartilage grafts to restore the pre-injury straight appearance. These thin slices of cartilage are placed over areas of depression or curvature to hide the contour irregularities. The irregularities themselves are left uncorrected. However, while camouflage techniques preserve maximal support, they may lead to a nose that is overly prominent and wide. That is why, in general, we also do not use or recommend injection rhinoplasty in these patients- it can make your nose too wide.

For most patients presenting with broken or crooked noses there is a vague history of previous trauma, often during childhood, which was not treated and eventually led to a twisted nose. Oftentimes in correcting the twisted tip or asymmetric nostrils, we have found that it is the deviated or fractured septum that is the main cause and not the broken bones. Reconstruction provides optimal aesthetics in these cases because it not only allows us to make the nose look straighter but also to restore the underlying framework to its normal pre- injury positions. This approach is  balanced and allows us to address each cosmetic concern while maintaining and maximizing long-term support and function.

Correction of the Broken and Crooked Nose- Sports can lead to not only a crooked nose outside but also a crooked septum as well. Treatment of both is necessary to restore the nose to its natural pre- injury look

In December of this year, Botox will be celebrating its 20th anniversary on the market after approval by the FDA in 1989 for the treatment of eyelid spasm. While it has only been approved for cosmetic indications since 2002, Botox has long been a staple of plastic surgery and dermatology offices everywhere. In those 20 years, Botox has enjoyed a virtual monopoly with no competition in North America.

That is, until now. After recent years of obscene growth in popularity, the honeymoon will soon be over. Medicis, the makers of the wrinkle filler Restylane, has just announced FDA approval of their Botox rival, called Reloxin (already marketed in Europe under the name Dysport). The company is poised to begin marketing and distributing the product within the next several months.

Not much is known about the newest entrant into the wrinkle-relaxing field. There have been some conflicting reports about its effectiveness compared to Botox. One study suggested that, in a ratio of 3 units of Reloxin to 1 unit of Botox, the new product showed slightly faster onset and appeared to last longer. In another study, though,at a ratio of 2.5 units to 1 unit of Botox, its cosmetic effect appeared to wear off about a month sooner. So, clearly it will take a little tweaking to determine the equivalent dosing to what people are now used to with Botox.

Of interest to everyone, it is thought that Reloxin will be priced about 15% lower than Botox, an especially welcome turn of events in this sour economy. And, other potential competitors are quick on their heels with PurTox (Johnson and Johnson/Mentor) and Xeomin (Merz) on the horizon and predicted to reach market by 2011. While we’re sure there will be a small learning curve, if these products can equal the safety and reliability that Botox has boasted over the years, they will be a very welcome addition to the office-based cosmetic anti-aging market.