Nip This Tuck That

Rhinoplasty questions and answers continued from our Beverly Hills Surgery Center (Greater Los Angeles area):

1. What are the goals of Rhinoplasty?

I think there’s little doubt in today’s consumer, that all plastic & cosmetic surgery including Rhinoplasty should enhance one’s appearance in a natural yet beautiful manner. Gone should be the obvious “pinched”, “scooped” or “twisted” looking noses so common in the 1980’s and 90’s. The Rhinoplasty techniques have certainly evolved to create a more natural, refined looking nose but when it’s all said and done…it’s the aesthetic vision of the Rhinoplasty Surgeon that dictates how the nose will look after the surgery.

2. At what age should Rhinoplasty be considered?

In general , the nose should be fully grown before a Rhhinoplasty is performed. This is 15-16 yaers old for females and 16-17 for males.

3. How many times can the nose be operated upon?

Best case scenario, the Rhinoplasty would accomplish the desoired goals the first time. If additional work is required, the nose should be left to heal for a minimum of 6 months between surgeries.

Dr Francis Palmer
Beverly Hills Plastic and Cosmetic Surgery
What’s Your Number…the palmer code book

There seems to be many questions about Rhinoplasty (Nasal Surgery) and I thought that I’d start a series of information designed to address these questions:

1. How long does Rhinoplasty take?

Here in our Beverly Hills (Greater Los Angeles area) surgery center, the length of your Rhinoplasty may vary from about 1 hour for a first time closed Rhinoplasty to 2 hours for a Revision, or Open Rhinoplasty. This is my time and as variations exist between surgeons, you may have to ask how long your Rhinoplasty will take. I’ve had patients consult with me for Revision Rhinoplasty that told me their previous nasal surgery (performed elsewhere) took 4, 5, even 8 hours. I’m not sure why it would take that long, so be sure to ask.

2. What’s the recovery after a Rhinoplasty?

Typically, you will have minimal swelling and bruising the next day, tapering over 1 week. The amount of bruising is variable between patients and we ask our patients to refrain from all known blood thinners….including Vit C and E , aspirin, ibuprofen and homeopathic meds for 3-4 weeks prioir and 3 weeks after the surgery. It can take a full year to see the final result and the more that needs to be done to your nose, the longer the final result may take.

3. What are the typical costs of a Rhinoplasty?

Rhinoplasty costs will vary based on the difficulty of your Rhinoplasty with first time less expensive than Revisions…and Closed Rhinoplasty less expensive than Open procedures. Figure on spending $7,500 for a first time closed and up to $20,000 or more for an extremely complicated Revision Rhinoplasty. You may find cut rate prices for Rhinoplasty but remember…you get what you pay for. You will not get a top Rhinoplasty Surgeon for a cut rate fee. This fee is just the Surgeon’s fee and does not include Operating Room fees.

Dr Francis Palmer
Beverly Hills Plastic and Cosmetic Surgery
What’s Your Number…the palmer code book

Chin Augmentation is a plastic and cosmetic surgery procedure performed here in our Beverly Hills (Los Angeles area) that uses an implant designed to enhance the size and shape of the chin.

The chin should be evaluated by dropping an imaginary vertical line down from the lower lip, when the head forms a 90 degree angle with the neck. In a male, the chin should hit or approach this vertical line. In women, the chin should be about 5 mm’s behind the line. More information is available in my new book “What’s Your Number…the palmer code.”

If the chin is weak, after this analysis, then a chin implant maybe used to provide anterior (front) projection. The implant should not, in my opinion, be used to create elongation of the chin in the vertical plane. There are various sizes and shapes of chin implants with the most commonly used being the anatomical shapes in sizes small and medium. Anatomical means that the implant tapers in all directions and has a nice, feathered effect.

Chin implants come in various materials, including silastic (solid silicone), medpore, gortex but in my over 20 years experience using chin implants, I prefer the silastic ones. They are easilly removed and are the easiest to use…again, my opinion. The other materials may become attached to tissue or bone making them difficult or impossible to remove.

The surgery can be performed through the mouth (not recommended…more on that later) or through a small incision under the chin which is my preferred method. When performed through the mouth, the attachment of the mentalis muscle to the bone is severed in order to gain access to the required space where the implant is placed. This can create ptosis of the chin muscle later in life and the implant may move upward towards the inside of the mouth requiring it’s removal. When placed through an incision under the chin, these are not issues as the muscle attachment is not disrupted and the implant space is approached from below.

There are two schools of thought at what level the chin implant should be placed. One , which I use, is below the bone covering. The other is above this covering within the deeper tissues of the chin….the problem with this approach is that the chin implant may always move and this can be upsetting to people.

The photo below is a model and not a patient of Dr Francis Palmer. The photo represents the profile view, of the face, that is used to evaluate the chin. No representation is made that the model has had chin surgery or any other type of plastic and reconstructive surgery and is included here for educational purposes only.

Learn what the celebrities have known all along…the best (top) plastic and cosmetic surgeons are in beverly Hills.

Dr Francis Palmer
Beverly Hills Plastic and Cosmetic Surgery
What’s Your Number…the palmer code book

chin uplift

Part One: General Overview

Step by step analysis of Nasal Surgery (Rhinoplasty) as performed in Beverly Hills (greater Los Angeles area).

There are several parts to the nose that can and are manipulated during a Rhinoplasty or Revision Rhinoplasty and include:

1. The Nasal Bridge. This is the height of the nose and is comprised of nasal bones at the upper most regions (by the eyes) to the mid nasal region and cartilage the rest of the way down to the nasal tip. This layer sits on the face like a pyramid with the base on the face. Underneath and inside the pyramid is the nasal septum which divides the space into right and left nasal cavities. This section of the nose can be reduced if the nose appears to large or bulbous. The nasal bones can be broken and narrowed if this area appears to wide from a frontal view.

2. The mid-nasal section: This area, composed of cartilage is just above the nasal tip and may cause the nose to appear wide. This area can be manipulated and narrowed through various techniques including, cartilage trimming, resection and sutrure placement to further thin the cartilages in this area.

3. The nasal tip: The tip is comprised of 2 cartilages, each shaped like a question mark without the period. The central regions of these two cartilages, when looked upon from below the nose, can be close together (narrow tip) or wider apart imparting a wider, more boxy-look to the nasal tip. These cartilages also have a width that can make the tip appear bulbous from a frontal view. The nasal tip cartilages maybe thin, moderate or very thick cartilage. The overlying skin maybe thin, moderate or oily/thick in nature. All things being equal, cartilage that is thicker, has more ability to support the nasal skin. The thicker, the skin, the less definition the tip cartilages appear to have. Then there is the issue of tip symmetry (right versus left tip cartilage shape, placement etc) and tip rotation as measured in degrees from a vertical line drawn through the plane of the tip cartilages. Typical ideal tip rotation is between 105 and 115 degrees.

Tips that have lower angles of rotation ~ 95 or 90 degrees appear long while those rotated at 120 degrees or more, appear short and over-rotated.

In each case, all of these nasal characteristics must be analyzed and factored into a reasonable, workable plan for your Nasal Surgery (Rhinoplasyy) to be successful….in other words for the outcome of your Rhinoplasty to be a naturally, aesthetically sleek and appealling nose.
Stay tuned for Part Two: Surgery of the Nasal Tip.

Dr Francis Palmer
Beverly Hills Plastic and Cosmetic Surgery
What’s Your Number…the palmer code book

Rhinoplasty, the plastic and cosmetic surgery procedure that takes a short time to perform but years to master. Nose Jobs remain the most technically challenging plastic surgery procedure and frequently top the list of the most popular plastic and cosmetic surgery procedure performed here in the Los Angeles area (Beverly Hills, Hollywood, Orange County) as well as around the world. It’s also the procedure that has the highest rate of patient dis-satisfaction and revision rate. Why? I believe it’s because both patient and surgeon lack the proper aesthetics to deal with this very complicated facial feature…called the nose.

Despite the nose’s popularity to be be surgically altered, it has mistakenly been given the power to somehow transform the face…a power it simply does not have and hence a source of dissatisfaction for the final result after a Rhinoplasty. If you look at your face, the most aesthetically important facial features, in declining order of poriority are : The Cheeks, The Eye Area followed by The Lips. The nose isn’t even in the top 3!

So, why all the fuss, surgery and attention towards the nose. I believe it’s because the nose sits right in the center of the face and we tend to look at the eye area. As we do this, we see the nose as it sits in that same general vacinity. The truth of the matter, as revealed in my new book “What’s Your Number”…the palmer code, is that only when the nose has an exaggerated feaure like a wide/crooked/twisted/over-roated tip, wide/high/crooked/scooped nasal bones or something else that draws attention to the nose…and away from the top 3 facial features, does the nose exert some power over the beauty of the face. I feel, that this one factor has mistakenly led millions of people to have a Rhinoplasty for the wrong reason(s).

Rhinoplasty is designed to make the nose apper more sleek and refined in a natural-looking manner. If you want your face to be more ttractive, look elsewhere…starting with the top 3 facial features listed above…and if you want the best posiible results for your Nasal Surgery, you may have to travel to where the top (best) Rhinoplasty Surgeons are (Los Angeles Area). The cost of the trip will certainly be less than the cost of a Revision Rhinoplasty.

Dr Francis Palmer
Beverly Hills Plastic and Cosmetic Surgery
What’s Your Number…the palmer code book

Breast Surgery remains very popular including Breast Augmentation with Breast Implants (Silicone or Saline) and these are often combined when performing Mastopexy and Formal Breast Lifts for sagging Breasts. When the Breasts are too large, some women opt for Breast Reduction where additional scars are placed on the Breast and varying amounts of Breast tissue is removed to make the Breasts smaller…this is often combined with a Breast Lift.

Here in the Los Angeles area (Beverly Hills, Hollywood and Orange County), Breast Surgery has always been popular because of the nice weather all year-round and the emphasis on being outdoors. The presence of Hollywood with the glamorous actresses and starlets is another contributing factor. TV and movie execs have long realized the potential of full busted stars in their TV shows and movies. A fact that does not go unnoticed by the women who watch these shows and movies. Does this drive demand for Breast Surgery…it certainly is a contributing factor to the sustained popularity of Breast Surgery among women today. Like all plastic and cosmetric surgery procedures, Breast Surgery is an art requiring the proper aesthetic eye…be sure to fing a surgeon who has this vision.

Dr Francis Palmer
Beverly Hills Plastic and Cosmetic Surgery
What’s Your Number…the palmer code book

Doesn’t matter what you call nasal refinement: Rhinoplasty, Nasal Surgery or a Nose Job….the goal is to make your nose more natural looking and attractive. That could mean a more narrow and refined nasal tip, a more narrow nasal bridge..all with the goal of making your face more youthful and attractive.

Here in Beverly Hills (Los Angeles) Rhinoplasty is an art and if you are considering changing the shape of your nose, the trip here to the Los Angeles area and to Beverly Hills in particular could be well worth the journey. The most technically difficult plastic and cosmetic surgery procedure, Rhinoplasty can either compliment your facial features (when done properly) or can distract from them to such an extent as to make your look overall less attractive. The top, the very best Rhinoplasty Surgeons understand the aesthetics of the nose and how it plays into the overall appearance of the face.

Dr Francis Palmer
Beverly Hills Plastic and Cosmetic Surgery
What’s Your Number…the palmer code book

Facelifts have long been the workhorse of facial rejuvenation….the good news is recent advances in Face Lift procedure design has made the incisions smaller, the tissue dissection less invasive and therefore the recovery time shorther than ever. Our “Celebrity Face Lift” is a prime example and represents the culmination and pinnacle of over 20 years experience in Face Lift Surgery here in Beverly Hills (Los Angeles) and in London, England.

Face Lifts can remove 2, 3 inches of skin or more from each side of the face and as such are way more effective at skin tightening than and available Laser of RF procedure (that typically tighten the skin by several mm’s). The Face Lift also has the advantage of tightening the underlying muscle (SMAS) layer of the face and neck.

So, if you have Jowls, loose skin over the face and or neck…consider the “Celebrity Face Lift” a minimal incision Face and Neck Lift that can make you look 10 years younger in 90 minutes or less with or without anesthesia. Best news is that we send patients home to Asia, Middle East, Europe and all over the world days after the “Celebrity Face Lift” instead of the 10-14 day stay that’s often required with the older, traditional versions of Face and Neck Lifts.

Dr Francis Palmer
Beverly Hills Plastic and Cosmetic Surgery
What’s Your Number…the palmer code book