436 N. Bedford Dr. Suite 105, Beverly Hills, CA 90210 Phone: (310) 271-7070 | Fax: (310) 271-7343
September 23rd, 2009 Dr. Pincus
As a general rule, it is best to forestall any nasal surgery in children until they have stopped growing. This usually means waiting till after the puberty growth spurt. As a general rule, the nose stops growing when the individual stops growing in height. Though there are exceptions, it is around 15-16 years old for girls and 17-18 years old for boys. However, even after this final growth spurt, it has been reported that there can be some further septal growth up to the age 25, which could lead to late postsurgical distortions requiring possible revision surgery. But, I think, this would be rare.
There are several reasons for delaying surgery. The most important is that surgical intervention before the nose has fully matured can affect the growth centers within the nose. This could produce an infantile or stunted nose or asymmetries of the nose. Another reason for delaying surgery would be to allow an immature face to “catch up to” or “grow into” better balance with a nose that might appear too large. Exceptions to this rule might be acute nasal trauma, septal abscess, tumors, severe airway obstruction, significant deformities, as with a cleft-lip nose or significant psychological problems.
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June 11th, 2009 Dr. Pincus
Many patients present to me in Beverly Hills with asymmetric noses. Being centrally located, it is the first feature noted after initial eye contact. And because of its prominent location in relation to the other facial features, asymmetries are easily recognized. These may be developmental or from previous trauma.
When we evaluate nasal symmetry, we first check to see the overall facial symmetry. Since the root of the nose starts between the eyebrows and the base of the nose ends over Cupid’s bow of the upper lip, it would be impossible to straighten a nose if the centers of these two landmarks were not directly in line. However, through differential cartilage grafting, we can give the illusion of a straighter nose. Next we evaluate the upper, middle and lower thirds of the nose. The upper third is generally bony and can be straightened via various fracturing techniques. The middle third is mostly cartilaginous and may require cartilage repositioning, resecting or grafting. And, finally, the lower third involves the cartilage and soft tissue of the nasal tip and nostrils— either of which can be asymmetric or unequal.
There are numerous techniques for addressing deformities of these nasal structures. The tip cartilages can be equalized and re-positioned, if necessary, and the nostrils can be made more equivalent through techniques that raise or lower the rims and narrow or expand the openings.
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April 20th, 2009 Dr. Pincus
Nasal plastic surgery consists of both cosmetic and reconstructive techniques. Though the cosmetic procedures are widely discussed on these sites, very little is said about the reconstructive procedures. However, a truly good rhinoplasty surgeon is well versed in these techniques, as well. To understand the anatomy and external structure so that you can re-create what was lost from trauma or cancer surgery is the mark of a good rhinoplasty surgeon. The approach in reconstructive rhinoplasty involves creating a substructure, primarily of cartilage and occasionally bone, and a covering of skin and subcutaneous fat. The deeper structures are usually created with septal, ear or rib cartilage and occasionally cranial bone or hip bone. The covering is usually created from local, regional or distant flaps, skin grafts or composite grafts (skin & cartilage) from the ear. And though the exact underlying anatomy may not always be reproduced, the external appearance should very closely approximate a normal appearing nose.
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April 10th, 2009 Dr. Pincus
There is much confusion relating to the choice of “open” vs. “closed” rhinoplasty.
The main difference is an incision between the nostrils which allows for skin elevation off the underlying bony-cartilaginous framework. It is the technique most often employed when access through the top of the nose, as well as through the nostrils, is desirable. By providing this greater degree of visualization, asymmetries are more easily evaluated and graft placement and fixation are more exact. Finally, dissection through intensely scarred areas within the nose from prior surgery or trauma is made easier.
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March 30th, 2009 Dr. Pincus
Beverly Hills rhinoplasty has different endpoints depending on the gender of the patient.
For female patients, we aim to produce a very gentle slope over the bridge of the nose, ending in a defined tip which is the highpoint on profile. Additionally, the sidewalls of the nose are somewhat narrower in the midsection, producing a subtle curve or “C” shape. Extending this curve into the eyebrow produces a continuous convexity. Furthermore, the angle between the bottom of the nose and the upper lip is greater than 90 degrees or a right angle. In some cases, it may be as large as 105-110 degrees, producing more “nostril show” than we see in a man.
On the other hand, the angle for a man is around 90 degrees. The bridge tends to be straighter, which forms a “T” with the straight eyebrows above it. And we are generally more accepting of slight imperfections and a larger framework in a man.
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March 25th, 2009 Dr. Pincus
The term “septorhinoplasty” describes an operation that changes both the midline wall or septum within the nose and the outside structure or appearance of the nose. It implies that the septum is not in the midline, but rather in the direct path of inspired air. The septum is then classified as “deviated” and needs to be surgically corrected to improve airflow. This is called a “septoplasty”.
“Rhinoplasty” is the term we use to describe an operation that changes the appearance of the nose. When used in the context of improving breathing, it suggests a deformity that, by itself, is blocking airflow, as with a collapse of a sidewall or a deformity that contributes to the deviated septum, as may be seen in a nasal injury where deflected nasal bones are holding the septum in a displaced position. Hence, the term “septorhinoplasty”.
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February 6th, 2009 Dr. Pincus
One of the most difficult aspects of rhinoplasty is changing the shape of a nostril.. The main deformities that we see are the following:
1- The nostril is too wide or flared, with the long axis in a horizontal rather than a vertical direction.
2- The nostril is too narrow.
3- There is a notch or retraction along the superior border.
4- There is an overhang of tissue along the superior border
There are several approaches to each of these deformities, and these are usually performed at the conclusion of the operation..
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January 29th, 2009 Dr. Pincus
Working in Beverly Hills has given me the opportunity of operating on patients with various ethnicities. Though the majority of my patients are Caucasian, I still treat many who are Latino, African and Asian.
In most instances, their desire is to have features that more closely resemble the Western European ideals. However, one must be careful to preserve elements of the patient’s heritage so as to avoid a possible disharmony with the remaining features when performing a rhinoplasty surgery.
In general, one must approach each patient individually so as to determine how much of a change they desire. In the African and Asian patients, and to a lesser degree the Latino patients, the bridge usually needs to be augmented. This is most commonly accomplished using nasal septal, ear or rib cartilage which is diced and placed within a rolled covering of fascia taken from the temple. Although, in rare instances, a synthetic material like Gore-tex may be used. Also, because the skin in each of these ethnicities is usually thick, the nasal tip needs augmenting to produce a more projected, angular appearance. Once again, cartilage is used, in the form of a rigid strut placed between the nostrils. And finally, the nostrils have to be addressed. Though projecting the nasal tip may bring the nostrils in slightly, an additional procedure such as excising tissue or narrowing with cinching sutures may be needed.
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January 28th, 2009 Dr. Pincus
In contrast to the more common cosmetic rhinoplasty , which aims to improve the appearance of one’s nose, the reconstructive rhinoplasty attempts to restore it to a more normal or natural appearance.
It is a procedure which usually follows severe nasal trauma or surgery for nasal cancer. The aim of such surgery is to establish a nose which will appear relatively normal and not draw attention to itself. In many instances, the final product does not resemble the nose the patient had prior to his trauma or cancer surgery. However, most patients are accepting of this rather than be self-conscious with a severe deformity in the middle of their face.
The surgery aims to establish the appearance of a normal nose with normal airways. To this end, the underlying structures need not resemble the normal anatomy as long as the external appearance of the nose appears normal. Cartilaginous and ,occasionally, bony grafts are placed for support and form with external coverage using free grafts and/or flaps.
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January 24th, 2009 Dr. Pincus
The term “rhinoplasty” comes from Greek terminology. “Rhino” means “nose” and “plasty” means “to change”. Though most approaches to accomplish this end are surgical, there are some instances where a quicker, non-surgical method can be employed. The use of Radiesse is one such approach. Radiesse is a cosmetic dermal filler made of calcium-based microspheres suspended in a natural gel. It can be injected to create a bridge, lessen the prominence of a bump, fill in dents and depressions, help improve slight asymmetries and improve the angularity and aesthetics of the nasal tip. It lasts approximately 12-18 months and is performed while the patient is totally awake, which allows the patient some input as the procedure is progressing.
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