Nip This Tuck That

Rhinoplasty continues to be one of the most popular plastic and cosmetic surgery procedures so I decide to update my readers with some Rhinoplasty and revision Rhinoplasty basics.

The purpose of your Rhinoplasty is to create a more refined, sleek nose. It is not to get a perfect nose.

There are many ways to refine the nasal tip, bridge and width of the nose from rasping the nasal bones, to placing sutures between wide layers of upper lateral cartilages, to removing excess subcutaneous tissue, shaving/removing cartilage and breaking the bones. Experience will dictate which the plastic surgeon chooses to apply in your particular Rhinoplasty.

Primary (first time) Rhinoplasty is easier to perform than a revision Rhinoplasty which has more tissue scar formation and the unknown abnormalities of the existing nasal anatomy resulting from the previous Rhinoplasty. Each subsequent Rhinoplasty creates more scar and further disruption to that nasal anatomy. This is why a Revision Rhinoplasty has a different set of goals (make the nose look normal first then more attractive if possible), has a greater degree of uncertainty (don’t know what was done to the nose during the previous Rhinoplasty surgeries) and is a quantum level more difficult to perform. Generally, this is not a time to be overly aggressive….which could lead to disaster.

Healing from a first time Rhinoplasty is something like this.
I don’t use any nasal packing. I frequently do use a nasal cast made of plastic and tape over the nasal skin. The first day post-op, I see the patients and clean out the nostrils using Q-tips and peroxide. I instruct patients to place ice over their eyes to reduce swelling and bruising, avoid strenuous activity and avoid taking Vit C, E, aspirin and other blood thinning agents and supplements. You should also avoid getting the cast really wet as it may come off.

Cast is removed after 1 week post Rhinoplasty and the skin of the nose is gently cleaned with alcohol. If a tip cartilage graft was placed during an open Rhinoplasty, reinforced tape is applied around the graft to further stabilize the graft. This is removed in another 3-4 days. The patient is informed that swelling can and will occur and it won’t be even from side to side or from top to bottom of the nose. Ice is used over the eyes and the sides of the nose and patients are advised to sleep on U-shaped pillows for 1 month. Once again, strenuous activity and direct contact (bumping, hiting) the nose is to be avoided for 1 month.

Patients are generally seen at 1 month post Rhinoplasty and are then instructed on how to manipulate the nasal tissues to remove residual swelling that can exist from 6 months (first time Rhinoplasty to almost 2 years in difficult revision Rhinoplasty). Patients are encouraged to be seen every month to follow their progress…and to intervene with kenalog injections if required to reduce the scar formation in the nose.

Full activity can be resumed after 1 month however, if it’s hot or you work out the nose will swell. Ice the nose and this typically resolves the following day. Swelling lessens over the months as does this tendency to swell after working out.

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

Dr. Francis R Palmer, III

The Minimal Incison Facelift…”Celebrity Lift” developed by Dr. Francis R Palmer, III is the next major advancement in facial rejuvenation.

If you have signs of Jowls, excess facial skin and sagging tissues…even at the earliest signs this equates to 2 or 3 inches of excess skin on each side of the face. The latest lasers used to shrink and tighten the skin will decrease this excess skin by 1 mm or maybe 2 ( there are roughly 25mm’s in an inch). That small amount of tightening does not compute with the sometimes outlandish claims made by some practicioners of lasers and deep chemical peels.

What this means, is that the excess skin will need to be cut and removed and this means an incision. The trick is to make the incision as small as possible and to hide it around the normal ear contour. This is the concept of the Minimal incision facelift “Celebrity Lift”.

Another significal advantage to this minimal incision facelift over skin lasers and peels is the ability to tighten the underlying muscle layer (SMAS layer) of the face. Tightening this layer by trimming the excess SMAS and then suturing the SMAS upward and backward allows the skin of the face to be redraped in a natural, more youthful manner avoiding the scary, windswept appearance tha makes us all cringe.

The “Celbrity Lift” may be performed without anesthesia because it was designed with minimal tissue dissection. This means a quicker, easier recovery. Most people return to work the next day. Combine Radiesse Injections to make the cheeks nmore full and youthful and the face can look 10 years younger. Why have an incision 4 times as large, with the old type face lift, if you don’t need it? The minimal incision facelift has arrived.

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

Watch the “Celebrity Lift” showcased on ABC’s talk show “The View” here:

http://drfpalmer.com/movie/index.html

Dr. Francis R Palmer, III

Rhinoplasty do’s and don’ts:

I have performed many, many Rhinoplasties and revision Rhinoplasties over the past 20 years and I have written numerous scientific articles and blog entries on the subject. Yet, there are still soo many basic questions from blog readers about Rhinoplasty that I thought I’d write some basic helpful tips that I’ve learned over the years.

First the Do’s:

1. do your homework when seeking a Rhinoplasty surgeon. Look for training, years of experience (at least 7-10 in my opinion) of performing Rhinoplasty, longer if you have a complicated Revision Rhinoplasty as this is a quantum level more difficult to perform.

2. Do see a few plastic surgeons who fit the qualifications mentioned above for a paid consultation. remember, it’s expensive running a plastic surgery office and OR. They don’t make money giving away free consults and I personally don’t know any top plastic surgeons who do. Free consults are come ons to get you in and sell you something. A consultation should be a time to get an aesthetic opinion about you and whay may make you look more attractive.

3. Realize that you’re nose does not make up the vast majority of you’re facial beauty. read more here: http://www.whatsyournumber.com Your nose should be sleek, proportioned and natural in appearance.

4. There are many ways to perform a Rhinoplasty with a dizzying aray of grafts and implants and ways to reduce and thin the nasal tip. That’s what experience brings. Knowing when to use what. Ask specific questions during your consultation.

5. Look at real life pictures of before and after Rhinoplasty result….NOT AN IMAGING COMPUTER.

6. Expect to pay top dollar for a great job. There are no bargain basement discounts in the top 10% of plastic surgeons and thats what you want versus the bottom 50% isn’t it?

7. Be willing to travel to a different city or state to get the very best. It’s a week out of your life versus a lifetime of regret if you wind up with a nose you hate and have to have revision Rhinoplasty surgeires.

8. Go over normal post op Rhinoplasty instructions, limitations and general healing during your pre-Rhinoplasty and early post op visits. Don’t be afraid to call your plastic surgeons office and ask questions of the nurse and or plastic surgeon. Many times a simple answer will alleviate your fears and concerns.

9. Give yourself time to hael after your Rhinoplasty…typically 6 months for a first time uncomplicated Closed Rhinoplasty and up to 2 years for an open Revision Rhinoplasty with multiple grafts and implants.

10. Use common sense….after youre Rhinoplasty. Avoid strenuous activity, hitting or bumping the nose (sleep for a month on a U-shaped pillow).

Now the Don’ts

1. Don’t panic if your nose is crooked or swollen in the first few weeks.

2. Don’t have multiple doctors or surgeons giving you advice or treating you as this is often recipe for disaster. Stick with one doctor until you feel you need to change.

3. Don’t strive for perfection. The nose doesn’t need to be perfect…just sleek and refined.

4. Don’t have the Rhinoplasty until you understand what exactly the procedure will do to amke your nose and you look more attractive.

5. Don’t have a Revision Rhinoplasty for at least 6 months after the previous procedure. This obviously does not include emergency issues like an infection or bleeding which may require immediate attention.

6. Don’t decide to ignore the instructions of your plastic surgeon. You don’t have the knowledge to treat yourself.

Read more about Rhinoplasty and Revision Rhinoplasty here:

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

Read more about the Palmer Beauty principles here:

http://www.drfpalmer.com/palmer-beauty-principles.html

Dr. Francis R Palmer, III

Brad Pitt and Angelina Jolie named the newest Power Couple in Hollywood. Why not? Both Brad and Angelina are stunningly gorgeous and gorgeous offers a power that simply can’t be denied. Using my Palmer Beauty Principles, Brad and Angelina are a stunning 100 out of a possible 100 beauty points.

This beauty has earned them the admiration and attention of millions and millions of adoring fans worldwide. That is real power my friends…make no mistake about it. Don’t believe me? Would the press have offered the same title to Paris Hilton ( a 76 out of 100) and Borat ( a 60 something)? Doubtful!

Beauty is power and power makes fame and fortune…

All the more reason to understand my Palmer Beauty principles and my What’s Your Number system.

Read more here: http://www.whatsyournumber.net

Dr. Francis R Palmer, III

# 7 on the Holiday Glam list: Rhinoplasty and Chin Augmentation to balance the face and improve your appearance. Rhinoplasty should offer a more refined but not operated look to the nose. The various parts of the nose (tip, supratip, midsection and nasal bones) can be modified and refined using various plastic surgery techniques. This is however the most aesthetically and technically challenging plastic and cosmetic surgery procedure requiring years of training and experience to master. Rhinoplasty and the more technically difficult Revision Rhinoplasty continue to be one of the most popular plastic surgery procedure performed.

Ah, but what about the chin. The chin allows balance to the face on front and profile views and often is overlooked when analyzing the nose. If the chin is weak, on profile, it’s a good time to consider chin augmentation with a chin implant at the same time the Rhinoplasty is being performed. I prefer oplacement of the chin implant (I only use Silastic Implants) through a small incision under the chin and placement of the implant itself directly on the bone. I feel this gives the best results.

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

Read more about Chin Augmentation with Chin Implants here:

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

Read more about Radiesse Injection for facial shaping (including the chin) without an implant and surgery here:

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

Dr. Francis R Palmer, III

Scared of the knife? Pain free beauty

http://shopping.aol.com/beauty-health/skin-care?ncid=AOLCOMMshopDYNLprim0001

Read more about our own line of skincare products Francis R Beverly Hills(R) here: http://www.frbh.com Developed and formulated by Dr. Francis R Palmer, III.

# 6 in our top 10 ways to look fabulous this holiday season….Soft Tissue Fillers and Botox.
Have folds in the nasolabial, jowls or marrionette lines of the face? How about unwanted lines and wrinkles of the forehead, crow’s feet or around the lips? Well perk right up and try one of these great soft tissue fillers that’ll get you looking refreshed and more youthful in just a few minutes.

Fillers for that Fabulous look this Holiday Season!

Restylane, Juvederm, Perlane, Radiesse….Botox…oh my! So many choice of highly effective ways to make the face look more youthful and refreshed with no surgery and no downtime. So go ahead and plump up those lips, fill in those folds and shape those cheeks, chin and jawline for a fabulous new you for the new year. You can read more about all of these great soft tissue fillers at the links below.

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

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

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

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

Dr. Francis R Palmer, III

Full, plump, pouty lips can soften the entire face.  Forget the silicone injections that may migrate and cause health problems later….instead think about Restylane Injections to the lip borders or Alloderm Implants for a more permanent (lasts about 7 years) enhancement of the body of the lip itself.  I have done many of  Alloderm Lip Augmentation procedures over the past 15 years or so and have written several scientific papers on the subject.  I consider this to be the gold standard in lip augmentation.  Simple procedure done as an office procedure with or without anesthesia.  This makes #5 in our Holiday Glam list of must haves….because nothing beats a great set of lips!

 Read more about restyalne here: http://www.drfpalmer.com/restylane-injections.html

 Read More about Alloderm Lip Augmentation here: http://www.drfpalmer.com/LipAugmentation.html

Dr. francis R Palmer, III

Look Glam this Holioday Season cont’d:

 Continuing with # 4 in our top 10 ways to looks absolutely glamorous this holiday season.  Radiesse Injections can be used to shape the Cheeks, Chin and Jawline.  With this injectible paste, performed in minutes as an office procedure without anesthesia, the face can be molded, sculpted and shaped into a more youthful, attractive appearance. 

Minor swelling for less than 1 day and most people return to work at that time.  There’s no magic in using Radiesse…the real magic is the aesthetic, artistic eye and ability required to place the Radiesse in the right place using the proper amount. 

 The Radiesse will last for 12-18 months at which time it would need to be repeated.  We have patients that fly here to Beverly Hills from all over the world for this office procedure….and then leave the same day.  You could of course opt for a permanent solution with Cheek or Chin Implants for the facial Augmentation.  Don’t forget that Radiesse also works well for the nasolabial folds and softening the leading edges of the Jowls.

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

See Dr. Palmer and a Radiesse patient of his on ABC’s talk show “The View” here: http://drfpalmer.com/movie/index.html

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

Whichever you choose, you’ll be glam this holiday season with a more youthful appearance.

 Dr. Francis R Palmer, III

Dr. Francis R Palmer, III can be found in the latest edition of “Guide to America’s Top Plastic Surgeons” the 2007 edition of which is just out this month.

 http://www.consumersresearchcncl.org/Healthcare/plastic_surgeons/plastic_surgeons.htm