Nip This Tuck That

 Rhinoplasty or the re-shaping of the nose is the top or one of the top plastic and cosmetic surgery procedures perfomed here in Beverly Hills, across California and around the world.  I have written numerous articles on Rhinoplasty and what this procedure can and can’t do but I feel that people are not getting the message when it comes to ways to shape the tip cartilages and increase the height of the nasal bridge.

Lately, I’ve seen a wave of patients that underwent closed Rhinoplasty with placement of a silicone L-shaped graft to the nasal bridge to increase the nasal height.  The problem isn’t the dorsal segment of the graft but rather the vertical segment of the L-shape.  This short vertical segment is designed to go between the two sides of the tip cartilages and by doing so will logically increase…not decrease the size of the nasal tip.  The junction of the vertical and horizontal portions of the graft sits just above the nasal tip cartilages and can cause skin erosion and damage to the nasal skin.  Bottom line, patients have this L-shaped graft elsewhere and then come here to have it removed because they don’t like the aesthetics of what it did to their nose.

The graft can be trimmed leaving just the dorsal segment but typically the nasal tip cartilages must be repaired and the strengthened by using a conchal cartilage ear graft to the nasal tip all performed through an open Revision Rhinoplasty.  So if you are looking to increase the height of your nose and want your nasal tip smaller….you may not want the L-shaped nasal graft which, in my opinion, may require you to have another Rhinoplasty to deal with the issues this type of nasal graft can create.

  Francis R Palmer, III MD

 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