Being a facial plastic surgeon who specializes in nasal surgery, I have been somewhat dismayed by the relatively recent increase in cosmetic as well as reconstructive procedures that are much more extensive than they need to be. This is not to say that the results aren’t acceptable or that it is being performed by inexperienced surgeons. However, one must always consider the associated morbidity or “collateral damage” that these procedures produce. When we consider cosmetic nasal surgery, especially revisional following prior poorly executed rhinoplasty, I am seeing many patients who come for second opinions because they were told they need a “rib graft”. While a rib graft may get the job done, it results in another operative site on the chest with its associated scarring, pain and risk of lung collapse. It is my procedure of “last choice” when there are no other alternatives such as nasal septal cartilage, ear cartilage or occasionally synthetic implants. And, to this date, I have never been disappointed in a result from the use of these materials in patients who were told that they needed a rib graft.
Regarding reconstructive nasal surgery following trauma or cancer surgery, I have seen a huge increase in the use of forehead flaps. These require an unsightly flap of tissue from the forehead attached to the nose for a period of three weeks, a second or more additional surgeries and resultant forehead scarring (which is usually acceptable). Once again, there are usually many alternatives like local flaps, skin grafts or composite (skin plus cartilage) grafts. Obviously, the main object of cancer surgery is complete removal of disease. However, it is still important to “factor in” the post-operative morbidity and, at least, to consider these other alternatives.
I recently did an interesting and challenging rhinoplasty on a patient in which I lowered and widened his nostril using an adjacent skin flap.
I will post the final results on a later blog.
I recently performed reconstructive surgery on a patient who had very large keloids of the ears secondary to ear piercing. Keloids of the ear are fairly common in African American patients, though I have removed keloids and reconstructed ears in Caucasian patients, as well. What distinguishes a keloid from a hypertrophic scar is its extension beyond the area of injury into adjacent areas.
When looking for a Beverly Hills plastic surgeon who specializes in facial surgery, it is important to do your homework. This means checking the doctor’s website and various doctor rating sites, speaking to professionals and ex-patients familiar with his work and, finally, having a consultation. While having a prestigious address in Beverly Hills and being affiliated with a University and various societies looks impressive, it is more important that you get a sense that the doctor understands what your goal is and that he can actually carry it out. Even if the doctor has operated on some celebrities, appeared on numerous talk shows or has edited a book on Facial Plastic Surgery (many recent grads seem to be doing that these days), it is important that you get a sense that he can deliver what you specifically expect. And don’t be talked into having a facial procedure, which you have not researched, added on to other procedures which you have. The facial plastic surgeon should be able to go over, in detail, what he would do to reach your endpoint and should be able to show you many “before & after’s” which exemplify his abilities to “walk his talk”.
I recently excised an aggressive skin cancer from a patient’s temple. It was complicated by the fact that it was right over a branch of the facial nerve that moves the forehead. Also, because of the limited mobility of the skin in this area, multiple small flaps had to be used to close the defect. Postoperatively, the patient was able to move his forehead, and the “pinwheel flap” produced an excellent closure. I will be posting the final result at a later date.
Recently came across a video, which was brought to my attention by a patient, which was made many years ago while a consultant for The Morrow Institute. Despite it being several years old, I think many of the points I bring out are quite relevant, so I thought I’d share it. Click on the link below or on the image to view the video.
I have just started using the Derma-Sculpt non-bruising, smooth cannulas (blunt needles) to inject Juvederm. They are truly amazing in that they do not leave any “black & blue” areas that usually result from tearing small blood vessels. As a result, patients can leave the office without the telltale signs of having had a procedure done.
So for patients who want to look rejuvenated before a big event, but were afraid of having embarrassing facial bruising, this is a great breakthrough. Basically, a small nick is made in the skin with a regular needle, and these special cannulas are then introduced in various directions to accomplish the augmentation. I am looking forward to using these cannulas for other fillers like Radiesse.
I recently performed a laryngeal shave, on a male to female transsexual patient (MtF TS), who was very self-conscious of the large, unfeminine protrusion in the front of her neck. The male larynx is not only bigger than the female larynx, but the angle of the front cartilages forms a 90 degree keel-shaped prominence (Adam’s apple). In contrast, the female larynx is smaller with a flatter 120 degree angle. During their transition, most MtF TS patients have reduction of their Adam’s apple to help eliminate the appearance of a masculine neck.
