Nip This Tuck That

 Rhinoplasty remains one of the most commonly performed plastic and cosmetic surgery procedure with hundreds of thousands performed each year in the US alone.  Such a common plastic surgery procedure, so why are there soo many unanswered questions about Rhinoplasty before and after the surgery?  Truth is, I’m not sure.  I’ve been performing Rhinoplasty and Revision Rhinoplasty for over 20 years now from the time of my residency at LA County USC Medical Center and into some 18 years of private practice in Plastic and Cosmetic Surgery in Beverly Hills and London (from 1994-2000).

I think several key points about Rhinoplasty and how potential consumers get their information about aesthetic medicine which includes treatments and surgery designed to improve the appearance, has something to do with the issue: (these are my opinions)

1. Rhinoplasty is the most technically difficult plastic and cosmetic surgery procedure performed in Aesthetic Medicine.

2. Aesthetic judgment of the plastic surgeon about what will and will not make the nose more attractive is key to success of any Rhinoplasty.

3. In the best scenario (highly skilled Rhinoplasty Surgeon, proper aesthetic judgment, great outcome) the nose will go up 2 points on a 10 point scale with 10 being perfect.  Yes, you heard me correctly.  A nose that ranks a 7 out of 10 could go to a 9 but won’t be a 10.  You get the point.  This is an important point…you do not need a perfect nose.  You should have a nose that appears sleek and unobserved.

4. Post Rhinoplasty healing can be prolonged and complicated and is negatively impacted by: thick skin, previous Rhinoplasty surgery or trauma.

5. Repeated Rhinoplasties to seek perfection are fraught with danger as the nose looses some of it’s ability to heal after each subsequent Rhinoplasty.

6. You must be realistic about expectations after a Rhinoplasty.  make your nose appear sleek and unobserved and then look at your Cheek, Eyes/Eyebrows and Lips as the defining facial characteristics that make a face look beautiful or handsome.

7. TV shows that talk about Rhinoplasty are able to just give you sound bites about the complexities of the procedure and all that’s involved.  Magazine articles typically give even less information and often are quite superficial in nature. 

 Some additional tips:

1. Never use price as a determing factor for a Rhinoplasty.  Experienced, well-qualified Rhinoplasty Surgeons don’t offer specials…trust me on that.

2. Find a Rhinoplasty surgeon that exhibits the type of facial aesthetics that make sense to you.

3. Experience is key….there is no substitute and Rhinoplasty experience takes 5-7 years minimum as a practicing plastic and cosmetic surgeon.

4. In some states dentists and other groups are now allowed to perform Rhinoplasty.  You may want to inquire about training and decide if this sounds right to you.

At the end of the day, your nose should fit your face and look natural.  If you follow this advice you are helping to make that a reality.  If not you could wind up looking worse as some of the celebrities that have recently made the news.

By Dr. francis R Palmer, III Beverly Hills Plastic and Cosmetic Surgeon

Beverly Hills Face Lift:

There are many different forms of Face Lifts available so how are you to know which one is best for you?  Let’s take a look at some basics regarding the different types of facelifts.

Traditional Face Lifts:  Here incisions are placed along the contours of each ear beginning in the temporal hairline, continuing around the front curves of the ear, behind the ear within the crease and then extending into the posterior scalp.  The incision is about  12 inches in length.  The skin is then elevated and the underlying SMAS muscle layer is lifted and the excess skin is trimmed and the incisions closed.  There are variations of the Face Lift incisions that go in front of the ears or the hairline but these are typically more noticed and therefore not desirable.  There are also variation of these traditinal facelifts that include only skin or that apply sutrures that fold or lift the SMAS layers.  In my opinion, the best method is to trim excess SMAS and then suture the SMAS into a higher position.

NeckLifts:  To remove excess skin and muscle pleats (”turkey neck”) a formal neck lift may be required.  This is often incorporated into the Traditional Face Lift and uses the popsterior ear crease and posterior scalp portion of the incision to access the neck.  The neck muscle (Platysma) is then tightened, the entire neck skin dissected, the neck muscles then pulled upwards and excess scalp trimmed within the posterior scalp.

Read more here: http://www.drfpalmer.com/FaceLift.html

Both of the above procedures are extensive plastic surgery procedures taking between 3-6 hours with recovery times of weeks to months.  In this fast paced society, the number of people interested in this amount of surgery or recovery time has drastically diminished in the past 5-10 years when they were the norm.  Today people are far more interested in versions of Face Lifts and Neck Lifts that are less invasive, with less surgery time, smaller incisions and of course rapid recovery.

“Celebrity Face and Neck Lift”:  I like to think of our “Celebrity Lift” (read more here: http://drfpalmer.com/PalmerCelebrityLift.html ) as a mini incision Face and Neck Lift.  It tightens the underlying Smas and removes excess skin of the face and neck with small incisions and limited skin dissection which means a very quick recovery….often the next day.  Combine this with Cheek Augmentation using Cheek Implants or Radiesse Injections and you have a powerful toool to make the face look 10 years younger in 90 minutes of surgery time, or less.  Now you know the secrets some of the celebrities have known for years.

 Francis R Palmer, III

 Ok, like this just is being noticed for the first time that some of the celebrities actually look worse after their plastic and cosmetic surgery or treatments.  The latest was a story about Priscilla Presley and industrial grade silicone injected into her face.  This isn’t something new and I’ve written about the danders of silicone injections for some time now.  People, including celebrities, are victims to the unrealistic scams that promise no surgery facial rejuvenation. 

   Read more here:

Posted Mar 24th 2008 11:15PM by TMZ Staff

TMZ has learned Priscilla Presley is the victim of a botched cosmetic procedure. What’s worse — it was at the hands of a gigolo who was sent to prison for perpetrating an injectable scam on Hollywood’s elite.

 If you are not fully educated on your options regarding facial and body rejuvenation…find out more before you become victim to just such a scam.  Siliocne can’t be removed or reveresed.  Better to have reliable fillers like Restylane, Radiesse or Juvederm….or proven procedures like Facelifts, Breast Augmentation, Blepharoplasty, Rhinoplasty, Botox, Cheek Implants, Chin Implants or lip augmentation using Alloderm.  These things work….no hocus pocus, just proven, highly effective plastic and cosmetic surgery procedures and treatments.  Don’t get taken in by scams….be an educated, informed consumer.

Dr. Francis R Palmer, III

I’ve been doing lots of Rhinoplasty lately which always includes open Rhinoplasty with cartilage ear grafts to re-shape the nasal tip and even some silicone straight grafts to build up the nasal bridge.  The later is very popular in non-caucasian Rhinoplasty as a way of increasing the height of the nasal bridge.

Read more about Rhinoplasty here: http://www.drfpalmer.com/Rhinoplasty.html

 Cheek Augmentation has always been one of my specialties and it seems that in the Celebrity, Hollywood and plastic surgery corners, I’m known as the “Cheek Guy”…that’s cool….  I use both Cheek Implants and/or Radiesse or even Perlane to shape cheeks.  Both Cheek Implants and the injected molded paste of Radiesse and Perlane give great looking cheeks.  Which one is right for you will depend on how much time you have for healing and what shape your cheeks are at the moment….and of course whether you want a permanent change or one that lasts about 12 months.  Implants are permanent but Radiesse and Perlane can be customized to each Cheek, something that isn’t possible with a Cheek Implant.

Read more about Cheek Implants here: http://www.drfpalmer.com/CheekImplants.html

Read more about Radiesse Injections here: http://www.drfpalmer.com/radiesse-injections.html

Botox still is one of the most popular aesthetic treatments and I have done Botox Injections to soften unwanted lines and wrinkles for almost 20 years.  Whether you want the lines around the lips soften or you want to get rid of the Crow’s Feet or forehead lines, it’s tough to beat the fast, effective results that you get with Botox.  Obviously, you need to find a plastic and cosmetic surgeon well experienced in Botox Injections and be sure they use real Botox from Allergan and not a knock off brand that may be harmful.

Read more about Botox Injections here: http://www.drfpalmer.com/botox-injections.html

The “Celebrity Lift” which is a minimal incision Face Lift and Neck Lift, featured on ABC’s talk show “The View” http://drfpalmer.com/movie/index.html has continued to be a huge favorite in people seeking facial rejuvenation and why not…if you can look 10 years younger in 90 minutes or less with very small incisions, no general anesthesia and no sutures to be removed all with recovery that’s measured in hours, wouldn’t you be excited.  We have patients from all over the world having the “Celebrity Lift”… many fly home after 3 or 4 days.  With the full facelifts and necklifts it would be 10-14 days before they could fly and almost a full month recovery time.

 Read more about the “Celebrity Lift” here: http://www.drfpalmer.com/PalmerCelebrityLift.html

Spring’s just around the corner which means before you know it, you’ll be wearing a bikini and hitting the pool or beach.  This time of year many women turn to Breast Augmentation using either Saline or Siliocne Breast Implants.  Silicone Breast Implants are more available than they were in the past as the FDA has eased the regulations allowing women 25 or older to have this as an option for Breast Enlargement and Enhancement.

Read more about Breast Augmentation with Implants here: http://www.drfpalmer.com/BreastAugmentation.html

Dr. Francis R Palmer, III 

I’ve been writing more subject specific posts on the advice of the SEO company.  It seems the search engines don’t care about my feelings or take on things but want content rich and specific posts.  I did want to take a few minutes to catch up with my readers.

 1. I have a book agent and am working on a formal book proposal to garner a sale of my book.  the manuscript is already written but will need extensive edits.  No big deal…you will love this book.

2. I continue to be involved with VC companies and help develop emerging new aesthetic technologies in the plastic surgery and cosmetic medical field.  I love this work which allows me to look into the future for the next big thing.

3. Ashton’s happy in her second year at USC…my son, Evan will apply next year and hopefully he’ll be at USC as well.

 Everything else is great.  I just completed an italian tuscan style painting 4 X 6 feet in acrylics.  I haven’t done a painting in almost 10 years, so this was a pleasure.  My wife, Robyn has it proudly displayed in our home.

Dr. Francis R Palmer, III

Here’s some valuable advice when seeking plastic and cosmetic surgery procedures such as Rhinoplasty, Face Lift, Blepharoplasty, Breast Augmentation, Tummy Tuck, Liposuction, Brow Lifts, Cheek Implants, Chin Implants, Lip Augmentation, Botox Injections, Restylane Injections, Radiesse Injections, IPL treatments or skin care.

1. You, as the consumer have the burden of finding a properly trained plastic and cosmetic surgeon to perform your procedure or treatment.  You can’t rely upon TV, friends, radio or newspaper ads to do your work for you…as they don’t always have your best interest at heart.  Your family and friends do and this may be a good place to start but they don’t have enough knowledge about plastic and comsetic surgery to be sure the plastic surgeon that worked out well for them can do the same for you.  So you need to do your own investigating. 

How do you get started?  The internet is a great way for you to view the credentials and the expertise of various surgeons in your area and far away.  Be careful to separate obvious commercial sites where the content is written by sales people versus sites where the plastic surgeon writes the content.  The later is like speaking with the surgeon him or herself and far more valuable an insight into that surgeon.

You can read my 4-step article on “How to Choose Your Plastic Surgeon” here:

http://www.drfpalmer.com/choose.html

Do some basic research on the aesthetics of plastic surgery so that you become informed on what should make you look better…or worse.  This will become important when you have consultations or plastic surgeons suggest things that don”t sound logical…don’t sound like they would make you more attractive.  Too large cheek implants, or scooping out the nose…those sorts of things. 

You can take our beauty quiz to test your aesthetic knowledge here:

http://www.drfpalmer.com/quiz.html

Read over the frequent Q/A section here:  http://www.drfpalmer.com/faq.html

Once you have completed this step, you are an informed consumer and ready to consult with experienced plastic and cosmetic surgeongs about how to make yourself more attractive.

2. Pay for consultations as free consultations are often given in an attempt to pressure you into buying surgery or services which you may or may not need or want.  Everyone deserves to get paid for their time and expertise…you don’t work for free, neither do top, qualified plastic and cosmetic surgeons.  Your consult is for the surgeons time to evaluate you….and your specific needs.

3. No matter what magazine articles have told you to do during your plastic surgery consultation…here is the real inside scoop of what to do and not do.

Do be yourself as an experienced plastic surgery staff will be able to tell if something is amiss and will somehow decline to take you as a patient.

Do remember that the surgeon-patient relationship is a two way street with the surgeon and his staff deciding if they want you as  a patient while you are deciding if you want to hire the surgeon to perform your plastic surgery or procedure.  Either one may decide to pass for any reason.

Don’t be overly aggressive, assertive or interview the plastic surgeon or the staff with the attitude that they must convince you why you should allow them to perform your surgery.  Such behavior, while appropriate in selecting a new stereo, is not appropriate for a surgical candidate and the plastic surgeon will most likely deem you not mentally ready to have the surgery or procedure.  That is most experienced plastic surgeons.  Remember the more experienced, busy plastic surgeons don’t want or need to talk you or any patient into having plastic surgery.  First of all that’s not the plastic surgeon’s job and second it’s not professional.   Plastic surgeons advise, we don’t pressure or persuade. 

Lastly and this is the most important take home message….if your gut tells you what to do, listen.  Never let money be the deciding factor to do or not do a plastic surgery or procedure.  People who paid less for second best…are never happy!  Hollywood celebrities have know this for years…and now so do you!

 Dr. Francis R Palmer, III

Silicone Breast Implants are once again very popular.  Since the FDA in the US lifted the restrictions on Silicone Breast Implants, more and more women are choosing Silicone Breast Implants for their Breast Augmentation and Enhancement.  Silicone Breast Implants have a higher specific gravity and are more dense which makes them feel more like breast tissue than the saline filled Breast Implants.  You can get more breast augmentation and enhancement in the breasts with a smaller volume of Silicone Breast Implants versus Saline Breast Implants.  I believe it’s best to have the Breast Implants placed below the muscle regardless of whether they are Silicone or Saline Breast Implants.  If the Breasts have sagged, a Crescent Lift performed around the upper border of the areolae will lift the nipple complex as well as serve as the incision through which the Breast Implants are placed.  The incision heals well and is closed using dissolveable sutures.

Shapely breats are an important aesthetic beauty feature for many women and Breast Augmentation and Enhancement with Silicone or Saline Breast Implants ranks amonmg the most common plastic and cosmetic surgery procedure for women.  Celebrities and madison Avenue has long known that women with full, shapely breasts sell.  They sell in movies, TV shows and in the print media.

Read more about Breast Implants here:  http://www.drfpalmer.com/BreastAugmentation.html

Dr. Francis R Palmer, III

If you’re looking to reshape the nasal tip without lots of healing and post Rhinoplasty swelling, then you should consider a Closed Rhinoplasty with a retrograde Tip-plasty.  In this technique, I make an incision inside the nose and back dissect over the top portion of the nasal tip.  The excess tip cartilage is removed and the incision is closed with dissolveable sutures.  This slick techniques has the following advantages:

1. Minimal dissection which means less bruising and swelling after the Rhinoplasty.

2. No cast is required or any sort of packing in the nose…in fact, I don’t use any packing in Rhinoplasty surgeries for the past 15 years or so.  It’s not necessary and is very uncomfortable for patients after their Rhinoplasty.

3. This technique will thin the nasal tip without the risk of making the tip too small, pinched, or over-rotated.

I’ve done this Rhinoplasty technique on TV stars that were able to return to work, on the set, the following week without anyone knowing they had a Rhinoplasty.  Now you know the secrets, the Celebrities know.

 Read more about Rhinoplasty here: http://www.drfpalmer.com/Rhinoplasty.html

Dr. Francis R Palmer, III

Nasal Surgery also called Rhinoplasty…by Dr. Francis R Palmer, III…Beverly Hills Plastic and Cosmetic Surgeon and World Renowned Rhinoplasty expert.

 I still receive the vast majority of questions and concerns, on this blog, related to nasal surgery, nasal refinement otherwise called Rhinoplasty.  From Beverly Hills, to London, Tokyo, Miami, Dallas and points in between it seems people are more and more confused about Rhinoplasty and the post op course the nose often takes once the Rhinoplasty has been performed. 

Let’s all take a deep breath and try and make sense of all the madness. 

1. Rhinoplasty done the first time is called Primary Rhinoplasty and is the easiest Rhinoplasty to undergo.  This is because the tissues are not scarred, the cartilages that make up the nasal tip and mid nose section have not been previously resected and the skin has a health blood supply that’s so very crutcial to post Rhinoplasty healing. 

2. Rhinoplasty can be performed as a Closed Rhinoplasty where all the incisions are hidden inside the nose.  This type of Rhinoplasty is, in my opinion, best suited for everything but very wide, downward rotated, very asymmetric/crooked, or previously operated nasal tips.

3. Open Rhinoplasty combines similar internal incisions with a very small inconspicuous inverted V incision mid way on the columellar skin.  This is best for the Revision tip, crooked tip, asymmetric tip, very wide or severly downward rotated tip (looks like the nasal tip touches the upper lip).

4. Healing after a closed Rhinoplasty is typically shorter (3-6 months) than after an Open Rhinoplasty.  The lymphatics of the nasal tip area can take up to 6 months for an Open Rhinoplasty before the shape of the nasal tip begins to become smaller and more refined.  This process may continue for 12 months or longer, especially in Revision Rhinoplasty cases.  If the nasal tip has been re-built with ear cartilage grafts, the process of healing may be extended. 

  In Rhinoplasty and Revision Rhinoplasty cases, the expertise of the plastic and cosmetic surgeon performing the Rhinoplasty is key…including the surgeon’s post Rhinoplasty healing instructions.  Every one of my Rhinoplasty patients are instructed, at 1 month, post Rhinoplasty on how to manipulate (massage) their nose in order to remove post Rhinoplasty swelling.  By reducing the post Rhinoplasty swelling the amount of scar formation is redued and the aesthetic enhancement of the nose is increased.  These manipulations can be done in less than 5 minutes a day and should be performed for at least 6 months.  I follow my Rhinoplasty patients at monthly intervals, for those that are not out of country, to monitor the post Rhinoplasty swelling and healing.  I intervene with Kenalog 10 injections if needed.

So, as you are deciding who should perform your Rhinoplasty take all these things into consideration.  There is a reason some higly skilled and experienced Rhinoplasty surgeons, such as myself, charge more than other plastic surgeons performing Rhinoplasty.  Remember, you get what you pay for and there are no exceptions to this rule.  Celebrities and the rich have known this for years and yes this means that you may need to fly to Beverly Hills for your Rhinoplasty but ask yourself this: “which is less expensive…a trip to Beverly Hills for my Rhinoplasty or a Revision Rhinoplasty if I’m not happy”?

Read more about Rhinoplasty here: http://www.drfpalmer.com/Rhinoplasty.html

 Dr. Francis R Palmer, III