Beverly Hills Rhinoplasty Surgery Blog

You often hear that it can take a year or longer after a nose job before you’ll see the final result. Many of you may be skeptical and a small number of you probably roll your eyes when you hear a statement like this. Does it really take that long to see results or are surgeons just telling you that so they can buy time in case you’re not seeing what you want to see after surgery?

The answer is that surgeons aren’t just feeding you a line. It really does take time for the skin to shrink down and wrap onto the new structure underneath. That’s not to say that you’ll be miserable for months. Our patients generally bound into the office for their 3 month visit ecstatic about their noses. Still, when we take photos, we can see that there is still some swelling that needs to settle so that more definition can show through. The photos below are a perfect example of just how much your nose changes over the first year after rhinoplasty. In cases of revision rhinoplasty, thick skin, or when the nose has been deprojected or brought in significantly, this process happens even more gradually.

Looking at these photos, you can understand why we tell our patients that it matters far more to us how their noses look at 1, 2, or 10 years after surgery than it does at 2 weeks after surgery. At 2 weeks, your nose will look good but puffy. If a surgeon is showing you photos that look absolutely perfect 2 weeks after surgery, be very wary. You can bet that those same perfectly cute noses at 2 weeks will probably look scooped and overdone at 2 years once the skin contracts. It’s important to make sure your prospective surgeon is showing you long-term results.  

The young woman below underwent primary open septorhinoplasty with us at Profiles Surgery Center. Photos below (from left) show her pre-op, at 3 months, and 1 year after her surgery. Note how her 3-month photos still show some fullness and rounding while at 1 year we see a lot more definition.

Fat transfer has become more and more popular in the last decade  for restoring facial volume lost to aging and even as an alternative to breast implants. And why not? Fat is plentiful, easy to harvest, and it’s your own tissue so no need to worry about a reaction. And it works (well, mostly). The problem that has hampered fat transplantation from becoming universally accepted as the ideal volume procedure is that it can be hard to predict how much of it and how well it will last. That’s because the fat is being separated from its natural blood supply, is then transferred to a new area of the body, and is expected to develop a new blood supply that will allow it to survive. Sadly, not all of the transferred fat makes it.

In an effort to improve predictability of results, surgeons have tried all kinds of things to enhance extraction, handling, processing, and reinjection of the harvested fat. Still, even, with these precautions, about half of the fat that is transferred has a meaningful long-term survival and that’s about as good as anyone can get with traditional fat transfer. Thankfully for most patients, half of the transferred fat does very well and we have almost never had to repeat the procedure. Still, it would be nice to be able to offer an even more robust and predictable enhancement. And, that is the promise of stem cells.

In the last few years, scientists have discovered that fat contains a type of stem cell known as adipose-derived regenerative cells (ADRCs). These cells have shown the ability to improve long-term fat graft retention by secreting key growth factors that enhance blood vessel formation and promote cell survival. Cytori Therapeutics, a leader in the area, has developed technology that can isolate and concentrate these stem cells into a so-called cell-enriched fat transfer procedure.

In the latest article published in the February issue of the Annals of Plastic Surgery, the study of this technology in mice revealed after 6- and 9-month intervals that not only was the quality of transferred fat cells improved but the quantity and retention of fat cells had increased two-fold over controls. There is always a trade-off of course and, in this case, the procedure is expected to add about 90 minutes to surgical times along with increased associated costs. But, if studies in humans can match the findings in animals, this could prove to be a very valuable innovation on the horizon. The medical device technology is currently available in Asia and Europe but not yet approved for clinical use in the USA. We’ll keep you posted on the latest updates.