Nip This Tuck That

Q. I had medium combination malar/submalar silicon implants placed. Three months after, the implants were removed because it was not the look I wanted, resulting in ROUND/FULLER CHEEKS. It has now been almost 3.5 months after removal and my cheeks still feel a bit puffy/round. Will the puffy/round cheeks go away over time?  Will the capsule created ever shrink and disappear enabling my cheeks to reabsorb to the bone? Will my cheeks sag faster as I age?

A. Yes, the implant capsule should absorb and after only 3-4 months was not fully formed to begin with IMHO.  The cheek shape should return to what it was before the Cheek Augmentation with Cheek Implants and IMO, the reason your cheeks are round and puffy at this time is most likely due to the swelling from the Cheek Implant removal.  These can be easily removed through a small incision on the inside of the mouth but does take some experience to avoid significant post removal swelling.  Your cheeks will not age any faster after having the Cheek Implants in and out in less than 4 months.

Q.  Can graphs make the nose appear larger? Why do they say that having strong nasal cartilage is so much better to have?

A.  Weak nasal cartilages are less likely to provide adequate support or create a defined nasal tip.  In a primary Rhinoplasty, with weak cartilages, there are two basic options on how to create both increased support/symmetry as well as a more tip definition.  Which one is appropriate, IMHO, depends on the angle of nasal tip rotation.

1. The nasal cartilages can be trimmed making the tip more refined and then the cartilage can be sutured together which creates added symmetry and support.
2. The nasal cartilages can be trimmed making the tip more defined and then cartilage graft(s), I prefer using conchal ear cartilage for tip grafts, can be placed to create added tip definition and strength.  Cartilage struts can be sutured inside the Columella (crural feet) for additional tip support if required.

 In Revision Rhinoplasty, much less cartilage trimming is typically called for since this was most often done during the previous Rhinoplasty.  The approach then becomes one of spot adjustments to make the tip appear defined, symmetric and natural in appearance using any and all of the techniques described above.  

 These options should be explained in detail, by the Rhinoplasty Surgeon, during the Rhinoplasty consultation.  The Rhinoplasty Surgeon must, IMO, understand and follow the proper aesthetics of facial (and nasal) beauty for the creation of a naturally more attractive nose.  Experience performing Rhinoplasty alone is simply not enough because using the wrong technique will not make the nose more attractive no matter how experienced the Rhinoplasty Surgeon may be.

Q. Which is better to build up the nasal bridge, rib cartilage, ear cartilage or banked cartilage?

A. IMHO after over 20 years of performing Rhinoplasty, I’d say none of the above.  Rib cartilage/bone from you or irradiated from donors or ear cartilage folded on itself because it’s curved not straight all have been shown to dissolve unevenly over time.  I do not use any of these for that reason and only use straight silastic dorsal implants.  These are reliable and will not dissolve.