Beverly Hills Rhinoplasty Surgery Blog

Plastic surgery today has become widely accessible and more socially acceptable. The result has been a much wider public understanding and acceptance of plastic surgery across the spectrum, including the various ethnic populations that make up the world and, particularly, the United States. As a result we see patients from around the world that make up almost any ethnicity one could think of. The key to good outcomes for all of these patients is an individualized approach that seeks to identify the nose that would best suit each person’s unique face. In general, the traditional “reduction” rhinoplasty that is done for Caucasian patients is usually not best for many ethnic patients who have thicker skin, but for us this does not mean that the costs for this surgery needs to be more. Occasionally, anesthesia costs or facility costs may be higher, simply because it may take longer to harvest needed cartilage to build the bridge, but the difference in fees from standard rhinoplasty is generally nominal.

Is there a possibility that you may someday be able to have your botox without the annoying needles? According to one ongoing study, it may just be. Granted, the study looking at the effectiveness of a topically-applied botulinum gel, has only just finished a phase II clinical trial. But, the study’s lead investigator, Dr. Michael Kane, has reported that a large number of participants showed positive results. The final answer on this interesting question is not in, but we’ll keep you posted on this potential new formulation as we hear more.

We have recently heard from a couple of prospective patients who are concerned about having open rhinoplasty to narrow the tip and a nostril narrowing procedure (alar base reduction) at the same time. They had been to see other surgeons who had advised against this because of fear of risk to the blood supply of the nasal tip.

Quite frankly, we were a little surprised by this recommendation. The beauty of surgery is that it is not an exact science and there are many ways to arrive at the desired goal. However, the concern that tip rhinoplasty and nostril narrowing, when done together, might compromise the blood supply to the tip skin is really unfounded. In fact, most surgeons who make rhinoplasty a focus of their practice will tell you that they routinely perform these procedures together without issue. That has been our experience.

Some surgeons also advocate waiting to do nostril narrowing as a second procedure so that they can better assess how much narrowing is needed. To the contrary, we have found that we can very readily assess at the time of the initial tip work how much nostril reduction is needed if at all. To our minds, the initial surgery is the best time at which to make these desired changes to create a tip that is balanced and harmonious by reducing nostril width, flare, and asymmetry. We leave this part of the procedure to the very end so we can best determine how much nostril width and flare is still an issue after the other tip enhancements have been achieved. In experienced hands, the minimal swelling that occurs during surgery is not a factor.

There’s no real harm in waiting, of course, other than having to go through a second procedure later on. It can be done fairly easily under local anesthesia. In rare cases, when we feel that someone is very borderline in terms of need for nostril narrowing, we’ll wait. We almost always find later on that indeed it was not necessary. But, our overriding philosophy is that we want our patients’ first rhinoplasty with us to also be the last time they need anything done for their noses. So, when alar base reduction would be beneficial, we want to take care of it at the same time.

There was an interesting article in Science Daily reporting on the preliminary results of a combination therapy of LED lights and a cream with Green Tea Extract. LED lights have long been used for phototherapy to help heal any number of inflammatory skin conditions.

However, LED exposure, like any light energy exposure can also increase the production of free radicals that can injure the skin. Green tea was added to the mix because it contains a potent antioxidant that combats this harmful effect. The results? According to the German study, the same level of wrinkle improvement occurred in only one-tenth the time it took when treated with LED light alone. This underscores the importance of addressing inflammation and free radical injury as part of any effective anti-aging regimen.

We often see ethnic patients wanting a more defined nose. Many ethnic noses tend to have thicker skin. Achieving the definition, narrowing, and refinement you desire has everything to do with how that thick skin wraps around the cartilage structure underneath. If the cartilage structure is well-defined and well-supported, you can achieve excellent definition. If the cartilage lacks shape, your tip will look the same- bulbous, wide, full, and lacking in shape. On top of that, ethnic patients often have a thicker layer of tissue under the skin that lays on top of the tip cartilage. In these cases, it is necessary to carefully ‘thin out’ the thicker pad of tissue under your skin so that the newly-defined cartilage can show through.

Ethnic rhinoplasty depends more on cartilage grafting (using your own cartilage to create definition where it is lacking) than does traditional rhinoplasty. So, you should see a rhinoplasty expert who has experience in ethnic rhinoplasty to ensure your chances at a great result. We have found that a combination of tip cartilage suturing/grafting and soft tissue thinning, along with augmentation of your bridge and nostril narrowing, if required, can produce a beautiful and natural result. You’ll see some examples of the results you can achieve on our website.

Going to the tanning salon this week? Might as well skip it and take a little arsenic. That, according to the AMA, is because a recent meta-analysis of various studies on tanning beds has finally caused the World Health Organization to elevate UV-radiation emitted from tanning beds to their top cancer risk category. This lofty position is shared among the likes of arsenic, mustard gas, asbestos, plutonium and, yes, even tobacco and mixed alcohol.

WHO elevates tanning beds to top cancer risk

Studies show those who use tanning beds regularly are 8 times more likely to develop melanoma, the most serious type of skin cancer, and the risk of skin cancer is elevated 75% if the sun bed user starts before the age of 30. These findings come as no surprise to most people. My mom used to say even in the ‘80s that “those beds should be called cancer beds!” Moms are smart that way.

But, this news is important because, for years, proponents of tanning beds used the argument that the primarily UVA radiation emitted from tanning beds was less harmful than sunlight which has broader spectrum UV rays.

In fact, while we have long known that UVB rays are harmful, understanding of the harmful effects of UVA radiation has recently grown and is being reflected in changes in sunscreen formulations. So, while some in their invulnerable youths will continue to seek out the tans that only a UV bed can give (just as they’ll continue to smoke and do other things they’ll regret down the road), it can now officially be said that they were warned.

In general, we believe that there are good facial plastic surgeons and general plastic surgeons who do good rhinoplasty work. However, when it comes to functional problems it is important to understand that persistent congestion can be due to anatomical factors- deviated septum, valve collapse, polyps- that can be fixed with surgery or they can be due to systemic issues like nasal allergies and vasomotor rhinitis that are treated with medicine. So in these cases you would likely be better served in seeing a double board certified facial plastic surgeon since they are also trained in the treatment of these systemic problems.

Recently we came across a post from someone asking about the “nose huggie.”

Intrigued we looked it up and found what appears to be a modified hair clip being touted as a rhinoplasty alternative. Sadly, although it is true that the nose is made up of a lot of cartilage, you cannot simply mold the nose or its cartilage with pressure. In fact, when discussing rhinoplasty with our patients we go to great lengths to explain that cartilage and bone cannot simply be molded like clay.

So while there are occasional patients who we think can benefit from injection rhinoplasty, also called non surgical rhinoplasty- the nose huggie is not something that we frankly think works as a non surgical alternative to a real nose job.

We all know that public demand for non- invasive treatments for wrinkles is pervasive. And there are innumerable creams, lotions, injections, and lasers that claim to solve the problem. As the economy has slumped, even more people are looking to find inexpensive but effective means to make there wrinkles go away, especially if they are looking to land a new job.

What’s interesting is that most of these claims never have independent evaluation. However, recently a new paper published in the Archives of Facial Plastic Surgery attempted to independently verify whether “Frownies” actually work to remove those stubborn “11s” / frown lines or central forehead wrinkles.

The interesting thing is that the doctors evaluations found no improvement in either the frown lines or central forehead. However, many of the patients themselves perceived a slight improvement in their frown lines, and also stated that they saw a temporary reduction in their wrinkles in the first few hours after use of the frownies.

The final word: no independent improvement in wrinkles could be seen after one month use, but you may note some temporary improvement in the first few hours after use. So you decide if that’s worth your $19.95.

We are often asked how long it takes to heal after a nose job. Patients are suitably concerned about when they can show up back to work, go on a date, see friends, or worse, go to a family wedding or reunion, without looking alien.

We often tell people that within two to three weeks after surgery, no one but themselves and any one else in on the truth should know that anything happened at all. Most patients are comfortable returning to work even after one week. Bruising and swelling should be minimal if present at all.

But, there is still some healing to go after the first few weeks. If you read about healing after rhinoplasty, you will see the phrase 1 year often thrown around like some magic number. It’s not that you wake up on your 365th day after surgery and your nose miraculously appears different.

But, it really does take time for the skin to shrink down and wrap around the new structure underneath. For those with thin skin, this may largely happen within a couple of months. For some with very thick skin, revision patients, or if your nose was reduced significantly in size, it can sometimes take even more than a year. So, there is some individual variation in healing based on your skin type, healing characteristics, degree of previous nasal injury, and the type and amount of work done during your procedure.

If you don’t believe us , check out the photos below to see the progress of our recovery nurse after her revision rhinoplasty.

Our recovery room nurse is shown before (left), 10 days (middle), and 4 months (right) after revision rhinoplasty to treat a scooped out, overprojected nose. Notice how even at 10 days, she can return to activities without worry. But, you can see the reduction in swelling above and below the tip that continues to happen over several months after the procedure.