Nip This Tuck That

Beverly Hills Plastic and Cosmetic Surgery “Tip of the Day” from Dr. Francis R Palmer, III Beverly Hills Plastic and Cosmetic Surgeon.

I have a favorite saying “it is what it is.”  Simply put, certain things and situations are what they are and can’t be changed.  Rhinoplasty is similar and I’d like to put down some of the basic principles about Rhinoplasty and revision Rhinoplasty that I believe can’t be changed. I should be very clear that this is my opinion.

1. You will never be made gorgeous by having a perfect nose….a natural looking one without obvious serious flaws is all that’s required.

2. Rhinoplasty is the most technically challenging Plastic and Cosmetic Surgery Procedure performed.

3. In the most skilled hands, the nose may be improved about 2 points on a scale from 1 to 10 with 10 being perfect.  In other words a 6 can be an 8 (not a 9 or 10) and a 7 could become a 9 and so on.

4. There is no one right or wrong way to do a Rhinoplasty just the way that any particular Plastic and Cosmetic Surgeon can accommplish the desired results. 

5. Basically, an open Rhinoplasty should be considered when the nasal tip is very wide, very crooked, has grafts from previous Rhinoplasty or has been over-resected and has obvious loss of the normal tip cartilages.

6. A closed Rhinoplasty should be considered in all other scenarios and because this Rhinoplasty procedure takes less surgical time, has quicker healing and is less invasive, one should not opt for an Open Rhinoplasty unless they have one of the conditions mentioned above.

7. Things can be used to shape and or build up portions of the nose and these grafts, struts etc all have advantages and disadvantages…see more below.

8. Best material to use on the nasal tip is your own ear cartilage.  It’s soft enough for the tip area, won’t dissolve unevenly like bone or rib cartilage.  Septal cartilage is a bit too hard for this area and man made grafts like medpore and gortex may get infected for no obvious reason years later and extrude from the nose.

9. For the bridge of the nose….I like silastic straight grafts without the L configuration.  There is little chance for infection and extrusion along the bridge unlike in the tip area.  Rib grafts, ear cartilage, septal cartilage, irradiated cartilage and bone all have a nasty habit of dissolving irregularly some years later.  Medpore or gortex is an option here as well but like the tip area may become infected years later for no apparent reason, which in my opinion makes them less desireable.

10. Rhinoplasty should not be done any sooner than 6-12 month intervals as this may result in permanent damage to the nasal skin. 

There you have it…the 10 rules of Rhinoplasty…by Dr. Francis R Palmer, III

Beverly Hills Plastic and Cosmetic Surgery “Tip of the Day” from Dr. Francis R Palmer, III Beverly Hills Plastic and Cosmetic Surgeon.

Busy Monday as I am working on the following projects today:

1. Open Rhinoplasty with ear graft to nasal tip in the OR this morning.

2. Facial Liposuction and Radiesse Injections to shape the Cheeks, Mandibular Angle and the nasal bridge in the OR this morning.

3. Polishing up and putting the finishing touches on my new book.

4. In talks to outlets for Francis R Beverly Hills (R) my cosmeceutical line of skin care products. Read more here:

http://www.frbh.com

5. Getting ready to pitch a new, very cool, Plastic Surgery TV show.  You are going to love this show.

6. Ashton’s recording on two separate fronts….one is a hit song for an upcoming blockbuster movie and the other is a set of hip hop/R and B songs we can use to shop her to labels for a record deal.

7. Consulting on the cellulite treatment project that looks very promising in early clinical studies…and in early talks about 2 additional projects with the same think tank.

Dr. Francis R Palmer, III

Beverly Hills Plastic and Cosmetic Surgery “Tip of the Day” from Dr. Francis R Palmer, III Beverly Hills Plastic and Cosmetic Surgeon.

 Plastic and Cosmetic Surgery treatments and procedures to freshen up for Summer! 

Here’s a list of ways for you to look younger, fresh and more attractive for summer.

1. Restylane Injections to Plump up the lips and soften the folds of the face.  Quick, easy injection of this longer-lasting soft tissue filler will take years off your face with just 1 treatment.

2. For fuller, more attractive lips….think long-term.  Alloderm is perfect to fill out the lips and lasts about 7 years.  I have been using Alloderm for lips for over 12 years and the results are terrific.  Small little nicks in each corner of the mouth and the Alloderm is passed under the red portion of the lips.  The lips are fuller, soft, subtle and look very natural.

3. Radiesse Injections to fill out the Cheeks, Chin, Jawline and the folds of the face.  Radiesse is a long-lasting soft tissue filler that is injected.  Lasting 1-3 years, Radiesse can be used to accentuate the structure of your face similar to Cheek Implants, Chin Implant or Jaw Implants…but without the surgery, swelling and added expense.

4. Botox Injections are what I believe to be a liquid miracle.  Botox Injections can decrease lines and wrinkles of the face including those around the lip margins…be sure not to have full strength or too much Botox used…sssh (that’s my secret)..I have been injecting Botox around the lip for about 14 years with terrific results and without weakening the mouth.

5. The “Celebrity Lift”….if you have excess skin of the face and neck evidenced by Nasolabial folds (from the nose to the mouth) or Jowls (from the mouth to the jaw) this is the procedure for you.  Under local infiltration (you can go to sleep if you so choose) and through small incisions…the muscle layer of the face is trimmed and lifted…and here’s the part that separates it from threads or midface lifts….EXCESS SKIN IS REMOVED!   Patients go back to work in a couple of days and leave the house often the very next day.  Combined with Radiesse to fill out the Cheeks….you can look 10 years younger with this 90 minute procedure.

6.  Rhinoplasty…ever popular…it seems that more people want their Rhinoplasty Surgery in Spring and Summer.

Dr. Francis R Palmer, III

Beverly Hills Plastic and Cosmetic Surgery “Tip of the Day” from Dr. Francis R Palmer, III Beverly Hills Plastic and Cosmetic Surgeon.

The most popular Plastic and Cosmetic Surgery Treatments and Procedures here in Beverly Hills and I imagine everywhere else.  The latest trends in Plastic and Cosmetic Surgery.

1. Rhinoplasty (Nose Jobs) are still one of the most common Plastic and Cosmetic Surgery procedures performed in Beverly Hills “The Capital of Plastic Surgery” and I’m sure it similar elsewhere.  Before you have your Rhinoplasty read my blog and website and do pay for consultations with well trained experienced Rhinoplasty surgeons. 

 After over 20 years and having performed thousands of Rhinoplasty and Revision Rhinoplasty Surgeries, I can tell you that when it comes to Rhinoplasty here in Beverly Hills or where ever you are….there is no substitute for experience.  My office in Beverly Hills gets scores of e-mails with pictures each day from patients around the world asking for Rhinoplasty and Revision Rhinoplasty.

2. Facial Enhancements using Cheek Implants, Chin Implants or the newer longer-lasting soft tissue fillers like Radiesse to sculpt and shape the face.  Yes, I charge a bit more for my Radiesse injections but be clear what you’re paying for.  I’m the creator of the “Palmer Beauty Principles” that define facial beauty…do you really believe that any MD has the same aesthetic vision that I have?  Isn’t that what is really required for Radiesse injections to shape the face?  the material is the material but knowing where to place it…where and how much to inject to get the best aesthetic shape to the face…now that’s priceless!

3. Minimized face and neck lifts.  Look people….people….don’t be fooled there are no technologies or procedures out there that can magically deal with excess skin of the face and neck and if you’re someone that has excess skin…YOU DO NEED AN INCISION TO REMOVE THIS SKIN…PERIOD! 

 No lasers, no strings, no remote lifts are going to do the trick…none.  So, if you need to have an incision, why not get a very small one that’s curved around and inside the ear.  That’s our “Celebrity Lift”.  The “Celebrity Lift” was special enough to be featured on ABC’s talk show “The View”….quick recovery, look 10 years younger in 90 minutes or less without a general anesthetic.  Really!

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

4. Silicone Breast Implants for Breast Augmentation have really made a come back after the FDA relaxed the restrictions on these implants.  Women want larger, fuller breats and the current technology to accomplish these goals are Breast Implants for Breast Augmentation.

The latest trends in Plastic and Cosmetic Surgery from Beverly Hills Plastic and Cosmetic Surgeon Dr. Francis R Palmer, III.

Beverly Hills Plastic and Cosmetic Surgery “Tip of the Day” from Dr. Francis R Palmer, III Beverly Hills Plastic and Cosmetic Surgeon.

Cheek Augmentation using Porex or Medpore Cheek Implants versus Silastic Cheek Implants.

I have had several patients recently that for one reason, or the other, didn’t like the Medpore (Porex) Cheek Implants that they had placed by other Plastic and Cosmetic Surgeons.  The patients wanted these Cheek Implants removed and replaced with other Cheek Implants of a different shape and material….mainly because I only use Silastic Cheek Implants for Cheek Augmentation.  Here’s the problem:

1. I spoke with a Porex company rep who told me that after 3-4 months, the Medpore Cheek Implant becomes integrated into the bone of the cheeks.  That means it can’t be removed!  It becomes part of your bone…there’s no longer a discernable separate implant but ratrher a fused cheek bone/implant complex.

2. So, what I think will need to be done, is I’ll use my Palmer Beauty Principles top guide what shape the cheek should be and I’ll have to use a nasal rasp to rasp down the Medpore Cheek Implant/bone complex to the desired cheek shape.

Just my opinion people….so you can take it for what it’s worth.  Silastic Cheek and Chin Implants may shift, although this is minimal in our hands but there is a definite downside to having an implant like Medpore that becomes integrated into the bone.  What happens 4, 6, 12 months or a few years later if for any reason you want the implant out, replaced or modified.  Silastic Implants are easy to take out and replace.  Medpore can’t be removed and require filing, rasping, or grinding down to reduce their size and shape…

Dr. Francis R Palmer, III 

Beverly Hills Plastic and Cosmetic Surgery “Tip of the Day” from Dr. Francis R Palmer, III Beverly Hills Plastic and Cosmetic Surgeon.

Midface Lifts versus our “Celebrity Lift”. (my opinion)

We have been receiving quite a few e-mails about the various types of minimized face lift procedures.  Let me share with you my thoughts after almost 20 years of performing Face Lifts.

1. Midface Lifts are performed at a very deep tissue layer.  Under the facial skin, muscles and nerves just above the facial bones.  This entire layer is lifted upward and backward towards the temple and uses incisions under the eyes, inside the temple hairline and inside the mouth (optional).  The tissues are sometimes secured using sutures, threads or fixation devices…some dissolve in a year or two while others are made from permanent material and never dissolve.

  It turns out that the tissue covering the facial bones, at which this lift is performed, is very adhesive and tends to stick tightly to the bone at the newly elevated position.  Some patients don’t like the tight look and feel that can result from this happening.

  The tissue, of the face, can build up over an area of the cheeks that aesthetically should be thin, resulting in an almost distorted wide-face appearance.  This can be avoided with proper patient selection and patients with full nasolabial folds or cheeks may wish not to have this procedure in order to avoid this occurrence.

 Although this seems like a minimally invasive procedure, it is not.  The extent of tissue dissection, the incisions and the depth at which the tissue is operated upon all cause prolonged hardness, swelling and tightness.  Some patients are reporting distortion of facial movements from the tissue shifting that does include the facial muscle….so their action of pull may be distorted.

This is a very difficult type of Face Lift to undo.  The tissue layer tends to stick very tightly and a complete repeat operation would need to be attempted to try and position the tissues in a lower more relaxed position.

2. Our “Celebrity Lift” is truly a minimized version of a full face and neck lift with all the benefits of these tried and true procedures but with none of the disadvantages.  Much smaller incisions, much less tissue dissection, tissue dissection above the sticky layer described above and a rapid very easy recovery with limited bruising and swelling.

  The Celebrity Lift relies more on aesthetic adjustments to your face that result in a soft, natural more youthful face and not a tight, drawn appearrance as can result from the mid face lift. 

   There are no incisions inside the hair which can result in hairloss nor are there incisions inside the mouth which can introduce bacteria into the surgical area and the tissues of your face.  The incision below the eyes which is required with the mid face lift and can result in pulling the eyes downward after the surgery is absent with our Celebrity Lift.

  With our Celebrity Lift, the cheeks are full and round in women or narrow and angular in men…not flat and tight as can occur with the mid face lift.

And finally, our Celebrity Lift can be done in 90 minutes or less without a general anesthetic unlike the midface lift which must be done under a general anesthetic and is typically a much longer plastic surgery procedure.  The healing and recovery time is a day or two with our Celebrity Lift versus many weeks or months with the mid face lift.

OK, I’ve given you the skinny on these face lift procedures.  Do yourself and your friends and family a favor and spread the word about our “Celebrity Lift”.  It so speciual it was featured on ABC’s hit talk show “The View”.  People write us all the time and say, “If I only knew about this procedure before….”.  Well now you do.

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

Dr. Francis R Palmer, III