Nip This Tuck That

Rhinoplasty 101 part three: Rhinoplasty healing times for a nose job or Rhinoplasty Surgery ( http://drfpalmer.com/Rhinoplasty.html ).  Well after Rhinoplasty 101 part 1 and 2, you should have some idea of what a Rhinoplasty Procedure is and what it can accomplish.  Now, for part three let’s talk about the healing time after a Rhinoplasty and what you can realistically expect after a Rhinoplasty Procedure.   

 Rhinoplasty healing should be considered in two separate categories, immediate surgical healing and the long term healing or how long until you see the final result from the Rhinoplasty Surgery.  First, the immediate surgical healing after a Rhinoplasty.  Typically, a Rhinoplasty will take about 1 hour for a Closed Rhinoplasty and about 1 1/2 to 2 hours for an Open Rhinoplasty…that’s my operating time which does not include the time to put you to sleep or to wake you up. 

 Having said that, there are obvious differences in the order of how things are done and performed within the Rhinoplasty Surgery between PLastic and Cosmetic Surgeons.  NEWS FLASH…not all Plastic and Cosmetic Surgeons are the same.  Plastic and Cosmetic Surgeons will vary in ability, aesthetic judgement, technical skill and experience.  Read my article on “How to choose your Plastic Surgeon” ( http://www.drfpalmer.com/choose.html ) to learn more.  Having said that, it will not come as such a suprise when I tell you that some Plastic and Cosmetic Surgeons are more effecient and more gentle, than other Plastic and Cosmetic Surgeons, when they perform Rhinoplasty Procedures.  Both time and the amount of surgical trauma play a major factor in the amount of post Rhinoplasty bruising and swelling.  The amount of bruising and swelling that does occur, after the Rhinoplasty, obviously directly effects the amount of time that is required to heal from the Rhinoplasty Surgery.

 In most instances, our patients, have some minimal swelling and brusing that has gone or is a slight yellow tinge at 1 week following the Rhinoplasty.  Things that may increase the amount of bruising and swelling, after your Rhinoplasty, are things that thin the blood.  Thin blood will create more bleeding during the Rhinoplasty (and all surgery) which is a bruise.  Remember, that a bruise is just blood that is outside of the vessels and percolates through the surrounding tissues.  Vit C, vit E, Aspirin, Ibuprofens, many homeopathic medications and herbs can thin the blood and increase your bruising and swelling.  Therefore, I typically recommend that youi avoid these things for 3-4 weeks before your Rhinoplasty and for 3 weeks following your surgery.

 Despite a quick, effecient Rhinoplasty and avoiding all the things that thin the blood, Rhinoplasty Surgery…like all Plastic and Cosmetic Surgery does cause some trauma to the tissues.  Ice therapy following the Rhinoplasty and limited physical activity for the first several days will help decrease the healing time.  But, you can count on about 1 week.  This will also coincide with the amount of time that you’ll have the plastic cast on your nose. 

 When the nasal bones are manipulated by rasping and/or reduction and in-fracture with a surgical chisel, a wafered plastic cast is applied to the nasal bones in order to offer temporary support.  This cast is removed at 1 week.  For an additional 3 weeks, the nasal bones are vulnerable as they are not completely healed and set.  Therefore, contact with the nose: bumping, twisting etc must be avoided or the nasal bones may shift position.

 Beofre we leave the issue of surgical healing following Rhinoplasty, I just want to add a note about Revision Rhinoplasty.  The nose, unlike other tissues that undergo Plastic and Cosmetic Surgery has a tendency to become much more difficult to elevate, manipulate and operate with each subsequent Revision Rhinoplasty.  And yes, the amount of swelling typically increases with each additional Rhinoplasty that is performed.  So if you’re having a Revision Rhinoplasty, plan on additional swelling during that 1 week and maybe a day or so longer.

OK.  Let’s talk long term results.  You can expect your nose to continue to change and improve for about 6 months.  This is for a first time Closed Rhinoplasty.  Since an Open Rhinoplasty has additional tissue elevation, over the nasal tip, the final result may take up to 9 or 12 months.  I have Rhinoplasty patients manipulate their nose according to very specific instructions that I give them at their 1 month post Rhinoplasty visit.  I have found these maneuvers helpful in eliminating post Rhinoplasty swelling and as a way to maximize the final aesthetic result.  

 Once again, Revision Rhinoplasty may take longer to see the final result.  I tell Revision Rhinoplasty patients that they should expect final results no sooner than 1 year after their Revision Rhinoplasty and in some specific Revision Rhinoplasty cases ( excess scaring, multiple previous Rhinoplasties, mutiple cartilage grafts used) it may take 2 years.

Tomorrow: Rhinoplasty 101..Realsitic Expectations and what you need to know during your Rhinoplasty Consultation!

Dr. Francis R Palmer, III

Rhinoplasty 101.  Let’s continue on yesterday’s discussion of Rhinoplasty Procedures ( http://www.drfpalmer.com/Rhinoplasty.html ).  There are two general types of Rhinoplasty Surgical Procedures: Closed Rhinoplasty and Open Rhinoplasty.  Let’s start with Closed Rhinoplasty.  Closed Rhinoplasty is a Rhinoplasty Procedure that has all of its incisions within the nostrils.  Offhand, you may assume that this wouldn’t make any difference when doing a Rhinoplasty, but that would be a false assumption. 

 Closed Rhinoplasty, in my opinion, is limited in certain clinical situations because of the fact that the central part of the nasal tip skin is not dissected and remains attached.  This means that the nasal tip cartilages can not possibly be viewed as they normally exist, within the nose, nor can they be sutured or manipulated in place.  They ( the nasal tip cartilages ) must be drawn down through one of the nostrils in order to access the center of the nasal tip cartilages during a Closed Rhinoplasty. 

 So, what’s the big deal you ask?  If you don’t have a nasal tip that is wide and boxy, asymmetric, or has had previous Rhinoplasty performed on it….it doesn’t matter because the chances are that the nasal tip cartilages will not require extensive manipulation and correction within this central cartilage region of the nasal tip…and that’s excatly the type of Rhinoplasty case when I use a Closed Rhinoplasty.  The noses that don’t require extensive and complicated sewing, shaping and/or placement of tip cartilage grafts (these require direct visualization and sewing in position) may have a Closed Rhinoplasty.  Oh, and of course in Revision Rhinoplasty where the nasal tip will require anything other than the most minor modifications along the superior aspect of the nasal tip and upper lateral cartilage junction.  In all other situations, in my opinion an Open Rhinoplasty is required.

 Now, you’ll see that I never mentioned removing a large bump, hump or otherwise manipulating the rest of the nose framework in my determination of when to perform an Open Rhinoplasty versus a Closed Rhinoplasty.  That’s because the rest of the cartilages and bone of the nose can be adequately changed, augmented and refined using either a Closed Rhinoplasty or an Open Rhinoplasty and since the Closed Rhinoiplasty has fewer incisions ( by just a bit), is easier to perform ( by quite a bit…even for someone like myself with over 16 years of experience of doing thousands of cases), takes less time to perform ( about 2 hours for an Open Rhinoplasty versus 1 hour for a Closed Rhinoplasty), and has quicker healing time ( a fair amount faster for a Closed Rhinoplasty versus and Open Rhinoplasty because less nasal tip skin is dissected)…I would use a Closed Rhinoplasty for any of those manipulations of the nose.

 The rub comes when a previous Rhinoplasty, or several previous Rhinoplasties have been performed, the nasal tip is wide and broad ( looks bulbous), or is really uneven and asymmetric…nothing, in my opinion, gives me the ability and the power to correct these things like an Open Rhinoplasty.  By making that small seemingly insignificant inverted V incision along the skin of the Columella and connecting that with incisions hidden within the nsotrils, I can now look at the nasal tip structures as they exist at rest.  No twisting, no distortion…it’s the way they are.  More importantly, I can manipulate, sew and modify these nose structures under direct visulaization.  That’s HUGE!

 When I combine the curved portion of the ear as a tip graft, I now have the ability to do or redo seemingly impossible nasal tips that are large, twisted, asymmetric or in some other way distorted.  Combine that ability with an onlay silicone graft to the nasal bridge and I have the right tools to tackle even the most challenging of noses…and man, I have seen my share of those. 

 So, the take home message in Rhinoplasty part two is simple:  both Closed Rhinoplasty and Open Rhinoplasty are valuable Rhinoplasty techniques and neither is perfect for all cases….so don’t let a Plastic and Cosmetic Surgeon tell you that he/she only does Open Rhinoplasty or Closed Rhinoplasty in every case.  You need a Plastic and Cosmetic Surgeon that can and does frequently use both Closed Rhinoplasty and Open Rhinoplasty in order to get the best possible aesthetic result from your nasal surgery (Rhinoplasty).

 Rhinoplasty part three:  healing time and realistic expectations….tomorrow!

Dr. Francis R Palmer, III

Rhinoplasty, Nose Jobs are Plastic and Cosmetic Surgery Procedures designed to make the nose more attractive.  The nose is made up of a skeletal structure that includes nasal bones ( the upper 25-50% ) and cartilage as the remaining component.  Over this basic structure are muscles, tissue and finallly skin.  Rhinoplasty Surgery is designed to adjust structure elements for a more aesthetically pleasing nose.

I want first to explain the basic aesthetics of the face so that you can place the proper aesthetic importance to the nose.  According to my “Palmer Beauty Principles”  ( http://www.drfpalmer.com/palmer-beauty-principles.html ) the top 3 aesthetic beauty features are the Cheeks, Eyes and the Lips that account for 75%, 10% and 7% of facial beauty respectively.  You may notice that the nose is not mentioned here.  That’s correct, the nose does make you more attractive however, your beauty may be diminished by the nose having characteristics that draw attention to it and away from the top 3 beauty features. 

 Rhinoplasty or a Nose Job is designed to remove those characteristics of the nose that may cause the observer to look at the nose instead of the Cheeks, Eyes and Lips.  Rhinoplasty Surgery should make the nose appear more sleek and streamlined without tell tale signs that a Rhinoplasty has been performed.  Rhinoplasty Procedures should not leave the nose looking scooped out or leave tips that are pinched.  Rhinoplasty should leave the nose looking natural.

Ever wonder how we perform Rhinoplasty through the nostrils?  The space seems too small to perform surgery doesn’t it.  Obviously it’s not too small and that’s exactly how a Closed Rhinoplasty is performed.  More on that later.  First, as the name Closed infers…there must be an Open Rhinoplasty and yes, that is the case.  So, there are two basic types of Rhinoplasty Techniques, Closed and Open Rhinoplasty.  What does this mean?

 Simple.  Closed Rhinoplasty refers to the fact that all the incisions, to perform the Rhinoplasty Surgery, are made inside the nose…inside the nostrils to be specific.  An Open Rhinoplasty, on the other hand, uses incisions that mostly are within the nostrils but do communicate across the skin of the Columella.  The Columella is that area of your nose that goes from the nasal tip to the upper lip.  An Open Rhinoplasty Procedure will have an inverted V incision placed mid way in the columella that then communicates with the rest of the incisions within the nostril.

Tomorrow….what Closed and Open Rhinoplasties are used to accomplish and when you should consider each of these Rhinoplasty Procedures.

Dr. Francis R Palmer, III

Minilifts, like our “Palmer Celebrity Lift”  ( http://www.drfpalmer.com/PalmerCelebrityLift.html ) are small but highy effective versions of Facelifts ( http://www.drfpalmer.com/FaceLift.html ).  Minilifts have shorter recovery time, smaller incisions and the benefit of being able to be done without general anesthesia.  In many cases patients can go out in a day or so with little or no bruising and swelling.  However, we are receiving questions from patients and the general public that indicates, to me, that there seems to be some confusion between Minilifts and suture suspension or Thread Lifts ( http://www.drfpalmer.com/ThreadLift.html ).  So let me clarify each and their differences and benefits.

 Minilifts are open procedures that allow tightening of the underlying muscle.  Once the muscle is tightened, the Minilift Procedure also allows for the excess facial skin to be removed.  On a typical face this amounts to 1 1/2 inches of skin from each side of the face.  This is typically the minimum excess skin that appears in the face of a 30 ish year old female having a Mini Lift.  This, because it’s an open procedure which allows muscle tightening and removal of the excess skin, is the most effective means of rejuvenating the face.  So, let’s say this is the gold standard and we place the benefits ( or result ) at 100%.  Then if a patient is, for some reason unwilling to have any incisions, I would have to offer them what I believe to be the another option.  The suture suspension or Thread Lifts are, in my opinion, ~ 50% as effective as the Mini Lift Procedure. 

 When I consult with patients I am sure to put the options in just that manner.  An open procedure that allows for skin removal is always the most effective means of rejuvenating the face.  But if someone will not allow any incisions, that option is not possible and therefore, the Minilift can’t be done.  The effectiveness of the next best option, in my opinion, drops down from 100% to 50% and if patients truly understand this, we are happy to give them the second best option.  The confusion comes about because some people want to believe and hope that the Threads , Suspension Sutures, or some magical Laser Light will do the same thing to rejuvenate the face that a Minilift will accomplish and this logically, technically and physiologically just can’t happen.  Period!

Dr. Francis R Palmer, III

Botox and Restylane fakes and counterfeits are coming into the US from other countries and have proven to cause health risks for the unwary!  Botox and Botox Injections, asd I have stated frequently, are quite safe but you have to be sure you’re getting Botox from Botox Cosmetic which provides Botox from Allergan Medical Inc.  This Botox is proven safe and you don’t need to worry about the serious side effects that may occur if you get Botox from another source.

If you plan on having Botox Injections, ask the MD or PLastic and Cosmetic Surgeon if he/she is using Botox from Botox Cosmetic or Allergan Medical Inc.  Do be sure to avoid the cheap, inexpensive come-on prices for Botox and Botox Injections and treatments.  Well trained, experienced Botox providers will charge between $300 – $400 per area that’s trteated with Botox.  Be wary of prices that fall below this range as this may indicate less experience in doing Botox Treatments or perhaps they are paying less for bogus Botox that’s not from Botox Cosmetic and Allergan.  Either way, you don’t want any part of any of that scenario.

 Now for Restylane.  I have it from a good source that Restylane has been found in the US that was not distributed by the sole recognized source of Restylane in the US and that some of the captured Restylane had very similar packaging except it contained silicone instead of Restylane.  Once again if you are considering Restyalne Injections, be sure to go to someone experienced with Restylane Injections and pay the going rate.  For Restylane Injections, you should expect to pay between $500 – $650 per cc.  If you see a much cheaper price, you may want to seek a second opinion.

Had a great meeting with PMK PR for Ashton and Evan last night.  Have more meetings coming up about Ashton and her songs.

Read more about Botox here:

http://www.drfpalmer.com/botox-injections.html

Read more about restylane here:

http://www.drfpalmer.com/restylane-injections.html

Dr. Francis R Palmer, III

Botox ( http://www.drfpalmer.com/botox-injections.html ) and Botox Injections were in the news today!  Millions of Americans had Botox and Botox Injections, last year, to soften unwanted lines and wrinkles.  Botox has been proven to be safe and very effective when used by an experienced MD.  This is no different than any other Plastic and Cosmetic Surgery Procedure. 

But Botox Injections can do so much more.  Did you know that you can soften the lines around the lips…you know the ones that the lipstick goes into and drives you mad?  Well, an injection of Botox into that line wrinkle and it’s gone.  I have been using Botox Injections for this treatment for about 10 years but I use a special dilution of Botox from Botox Cosmetic so that when the Botox is injected around the lip…the lips still function properly.  W have patients that travel from all over the world for this 5 minute treatment.  The effects last for 4-6 months.

Botox and Botox Injections can also be used to raise eyebrows that are low.  A small amount of Botox Injected in just the right spot will allow weakening of the muscles that cause depression of the Eyebrows.  In so doing, the Botox allows the muscles that elevate the eyebrows to raise up the eyebrows into a higher, more aesthetic position. 

Botox can also be used to raise up the down turned corners of the mouth.  These are called Marrionette lines.  A certain amount of Botox Injected at just the right spot and the muscles that cause depression of the corner of the mouth are weakened and you guessed it…the muscles that elevate the corners of the mouth elevate to a more pleasing position.

Botox and soft tissue fillers can do remarkable things, but they are not..at present a suitable replacement for Facelifts ( http://www.drfpalmer.com/FaceLift.html ) and our newly designed Mini Lift (Mini Facelift) the “Palmer Celebrity Lift”  ( http://www.drfpalmer.com/PalmerCelebrityLift.html ) These lifts are capable of removing sagging skin and loose muscle that soft tissue fillers can’t logically remove.  So, while I consider Botox to be a true marvel in the realm of Plastic and Cosmetic Surgery…Botox and soft tissue fillers like Restylane ( http://www.drfpalmer.com/restylane-injections.html ), Radiesse ( http://www.drfpalmer.com/radiesse-injections.html ) and others can not accomplish tightening and removal of aged and sagged tissue.  This still requires removal of tissue with the state our current technology.

Dr. Francis R Palmer, III

 Millions…somewhere around 5 million of Botox Injections…Botox Treatments ( http://www.drfpalmer.com/botox-injections.html ) were performed in the US alone last year.  Tens of millions of Botox treatments and injections have been performed over the past 12-15 years, yet some people are still afraid of Botox.  I have performed Botox Injections to soften unwanted lines and wrinkles for over 12 years and I consider Botox and Botox Injections to be safe and highly effective.

 People, People, what’s all the fear about.  Botox, Botox Cosmetic and Botox Injections as treatments have proven highly safe and effective as a means of reducing unwanted lines and wrinkles.  Yes, you must get an experienced Plastic and Cosmetic Surgeon to do your procedure…but that’s not a news flash.  If you want Botox, see a well qualified and experienced MD…better yet, see an experienced Plastic and Cosmetic Surgeon and stay away from discount Botox or bootleg Botox…these are the ones that you need to fear.  Botox sold by Botox Cosmetic is safe….go ahead, get rid of those lines and wrinkles…and don’t be afraid of Botox any longer.  In fact, I have used a special dilution method with Botox from Botox Cosmetic that I feel makes it more effective…I can even use it to soften lines and wrinkles around the lips without effecting the movement of the mouth….the Botox is Injected and the line is lessened…right before your eyes.  patients fly here from all around the world for that 5 minute treatment and get right back on the plane and leave, no one the wiser.

 More difficult Revision Rhinoplasties ( http://www.drfpalmer.com/Rhinoplasty.html )and more and more Radiesse Injections ( http://www.drfpalmer.com/radiesse-injections.html ) to shape the cheeks and chin.

 PR meetings next week…have a great weekend.  Will keep you posted.

Dr. Francis R Palmer, III

 Plastic and Cosmetic Surgery by definition is the improvement of your appearance!  In that persuit, a complete and thorough understanding of the aesthetics of beauty…is not an option…is a must have requirement for your Plastic and Cosmetic Surgeon.  Whether you are considering Botox Injections ( http://www.drfpalmer.com/botox-injections.html ) to soften lines and wrinkles; Radiesse ( http://www.drfpalmer.com/radiesse-injections.html )  shape the Cheeks ( http://www.drfpalmer.com/CheekImplants.html ), Chin ( http://www.drfpalmer.com/ChinImplants.html ) and Jawline; Rhinoplasty Surgery ( http://www.drfpalmer.com/Rhinoplasty.html ) to improve the apperance of the nose; Facelifts ( http://www.drfpalmer.com/FaceLift.html ) or minilifts ( http://www.drfpalmer.com/FaceLift.html ) like our “Palmer Celebrity Lift” ( http://www.drfpalmer.com/PalmerCelebrityLift.html ) that can make you look 10 years younger in 90 minutes or less without a general anaesthetic; or Breast Enhancement and Augmentation with Breast Implants ( http://www.drfpalmer.com/BreastAugmentation.html ) the aesthetics of beauty will dictate what should be done…and more importantly what shouldn’t be done in order for you to be more attractive!  THIS IS AN FACT!

 You may assume that all Plastic and Cosmetic Surgeons are equally well versed in the aesthetics of beauty because after all that’s their business….ah, but you would be utterly incorrect in that logic.  It may come as a shock to you but the aesthetics of beauty are not taught to Plastic and Cosmetic Surgeons as part of their training.  Now, some may disagree and show you a myriad af angles and proportions taht we all learn as part of Plastic and Cosmetic Surgery but nowhere does anyone tell us what makes a face female or male.  What makes a face more youthful and attractive.  Or how about what is the most important beauty feature of the face?  None of these are part of Plastic and Cosmetic Surgery training.  The answer, according to my “Palmer Beauty Principles” is the Cheeks..that account for 75% of what makes a face appear male, female, young, old, attractive or less so.  Important stuff to know and understand?  Yeah, you bet!  I know because I had to come up with these “Palmer Beauty Principles” on my own….over 12 years ago.

 You, as a consumer seeking Plastic and Cosmetic Surgery as a possible way of making yourself more attractive must understand the aesthetics of beauty in case your Plastic and Cosmetic Surgeon does not.  If all Plastic and Cosmetic Surgeons understood the aesthetics of beauty equally, why do some people look worse after their Plastic and Cosmetic Surgery?  Answer: because the wrong aesthetic judgement may have been used in the first place!

 Read and fully understand the aesthetics of beauty as I have outlined in my “Palmer Beauty principles” http://www.drfpalmer.com/palmer-beauty-principles.html and use these to arm yourself with the knowledge you need when seeking to improve your apperance.  If you have a consultation with a Plastic and Cosmetic Surgeon and he/she suggests sopmething counter to those principles…..you may want to stop and think about the situation.  In the end, it’s you body/face and your decision….I just want you all to make the correct aesthetic one!  Visit my website to learn more http://www.drfpalmer.com

Dr. Francis R Palmer, III

Wow…this is the summer of the tough Revision Rhinoplasties.  I’ve done tons of these very difficult cases but sometimes even I say an extra prayer to God….this was just such a Revision Rhinoplasty.  I open the nose up and there staring back at me was a mess of scar tissue and nothing…I mean nothing that even remotely resembled the normal structure of the nasal tip. 

 Can you imagine the pressure that I felt at that very moment.  I am in charge.  It’s up to me and no one else to move this surgery forward and I need to keep moving…the patient is under general anesthesia and the nose will start to bleed like crazy after about 2 hours, so the clock is ticking…and ticking…and ticking!  What to do?  Where to start?  There is so much wrong here that needs corrected…I have to act and act right now!

 These are the types of cases that separate the men from the boys!  The experienced form those less so!  I’ve been here before, in similar cases hundreds if not thousands of times.  I took a deep breath and started taking stock of the situation.  Rule # 1…do a thorough assessment of the situation, but do it quickly.  After that was done, I addressed the most pressing issue….Rule # 2…start with the most important aesthetic issue or area and start to make improvements there….

 Once that was done things were looking much better.  Mutiple sutures here to sew bits of tissue and cartilage fragments together…like some distorted zig saw puzzle…but it was taking shape.  Next, I fashiond the ear cartilage into the proper sized tip graft and glued it into position using tissue glue.  Now things really looked 1000 times better..more symmetric and normal in appearance.  Then I went to my rule # 3:  know when it’s good enough…or another way to state this is “the enemy of good is better.”  

 Experience has taught me when things look great and the case is over…..trying to get it to look better may actually undo what I spent all this time creating….and I definetly don’t want that.  So I place the skin back over the newly created nasal tip and sew things back together….tape the outside of the skin.  At this point, I can take a deep breath…a sigh of relief and a quick thankful prayer to God for the wisdom, guidance and courage to complete the case.  Just another day here at the office….doing what I am trained to do…living with the stress, the joy and the wonder of it all!

 I have often said that a gifted Plastic and Cosmetic Surgeon must posess:

 ”The eyes of an artist”

 ”The hands of an angel”

and….”The heart of a lion”….to do what must be done.  True words for this Revsion Rhinoplasty!

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

Dr. Francis R Palmer, III

Ashton’s at orientation for USC this week getting ready for her college experience.  Meanwhile, she’s getting mutiple auditions for feature films and TV roles.  I’ll keep you posted.

Both Evan and Ashton are ready for new head shots….will get those next week.  Getting ready to put together a reel of Evan’s appearances on “Unfabulous” over the past 2 seasons.

Ashton is set up with several meetings about recording…..more on that later.

I have a development meeting with a large production company about Plastic Surgery Show ideas….