Beverly Hills Rhinoplasty Surgery Blog

LaRoche, the drugmaker responsible for Accutane, has been slapped with a $25 million judgment against it for inadequate labeling of its popular acne drug. This is the latest in a series of personal injury judgments against the embattled manufacturer blaming them for chronic ailments such as inflammatory bowel disease suffered after using the oral drug. While Accutane, or isotretinoin, was highly effective and often used as a last resort in treating patients with severe acne who failed to respond to other treatments, it also had significant potential side effects requiring frequent monitoring. In addition to being associated with birth defects, there were other serious effects that apparently were not spelled out clearly enough by the manufacturer according to these juries. Reportedly, Accutane has been unavailable from LaRoche as of last year.

This is yet another example of what we believe will be a backlash against drug manufacturers who today advertise directly to consumers day and night while paying little attention to properly educating them as patients. As for acne, all but the most severe sufferers can benefit from daily topical treatments that include exfoliants, topical retinoids (vitamin A derivatives), and other effective ingredients that do not carry the risk for these types of systemic side effects. See our post on JolieMD or our JolieMD site for more details on effective skincare.

Because our practice focuses heavily on rhinoplasty and revision rhinoplasty, we see many patients every week who are unhappy with their previous rhinoplasty result. One of the greatest sources of unhappiness is a poorly performed nostril reduction. Nostril reduction or narrowing is a relatively common procedure performed along with rhinoplasty and, done well, it often is a really nice finishing touch to a great nose job. See our blog of Dec 08 to get a sense of how we do alar base reduction differently.

Problems usually occur after nostril narrowing because of poor technique and especially overaggressive removal of nostril tissue. This can lead to the typically triangular, pinched, tethered nostril appearance, a dreaded look that should really never happen. We’ve also seen this problem occasionally after lip lifting procedures where tissue is removed from the bottom of the nostrils across the columella to try to pull up and show more of the upper lip. Sometimes, the lip is not lifted so much as the base of the nose is pulled down. We’ve blogged before about how to prevent nostril narrowing problems. But, what can you do if you’re already there?!?

The answers are unfortunately not simple nor perfect but, there is some promise of help in many cases. In our experience, there are a few reliable ways of getting some degree of improvement in this situation depending on the severity. If the problem is merely poor scars, this can be pretty readily treated with resurfacing techniques such as chemical peels, laser, or dermabrasion. If the problem is mild notching or tethering of  the nostril, this can sometimes be improved with what is called a V to Y advancement. See the diagram below to get a picture. Essentially, when the scar is revised, some tissue is ‘borrowed’ from the cheek/lip area where it meets the nostril edge in order to elevate the nostril attachment. The downside of this approach is that it leaves a vertical scar along the upper lip although every attempt is made to hide it in the natural crease in this area.

When the situation is more severe, there is no choice but to return some normal tissue to the area where too much nostril tissue has been lost. As shown in the diagram below, the nostril scar must be opened and some skin (usually taken from behind the ear or some other non-visible area) must be placed into the area to try to recreate the normal curvature of the nostril.

This can produce a very nice result but it does create some potential headaches of its own because of visible scars and possible skin color matching issues. Obviously, the absolute best result is achieved by getting it right the first time. If it’s your first rhinoplasty, don’t let posts like this discourage you…just find the right rhinoplasty specialist for your procedure.