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.
I was pleased to see an article by me, that appears on page 120, of the recently published Fall Fashion 2011 issue of Genlux magazine. It is somewhat brief, but I discuss why nasal surgery is different and more technically challenging than other types of facial surgery. I will be posting this article in the near future.
This entry to my blog is more of a public service or “wake-up call” than informational, in an academic sense. I hear so many patients refer to doctors, who have operated on entertainers, as being the ultimate surgeons for that particular procedure. One has only to look at some of the celebrity plastic surgery websites or rating sites, such as RATEMDS.COM, to see that this is pure folly. While most of us, especially in Beverly Hills, have operated on TV, movie, musical and sports personalities, it has always been my understanding and hope that they found me by doing their “due diligence”. Having said that, it is unfortunate that many in the public don’t, but follow in lockstep like lemmings to an unfavorable result.
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 am frequently asked by patients to explain what a “mini-facelift” is. Obviously, this means something different to each surgeon. However, I think it would be logical to assume that a “mini-facelift” is anything short of what the surgeon would do in his “traditional” facelift. This could amount to just doing a rigorous facial procedure without the neck component or something quite minimal like slight skin undermining and excision, with or without fascial tightening. But it would seem logical to expect that a “mini” procedure will produce a lesser result than the “traditional” procedure.
I have just returned from an excellent conference in Las Vegas! It was the 7th Annual Vegas Cosmetic Surgery Symposium organized by The Multi-Specialty Foundation for Aesthetic Surgical Excellence.
In future postings, I will be discussing some of the newer advances that were presented. Invasive as well as non-invasive techniques for facial aesthetic enhancement were discussed, which included variations on traditional approaches. One such variation was the use of stem cells with fat transfer during facelift procedures. I have always advocated replacing the volume in the face which is lost with aging, since there is usually a deflation associated with the descent of the facial tissues.
Over the past year, I have been given the opportunity to co-edit a surgical atlas on Transsexual Surgery. The book is primarily aimed at teaching surgeons, who are interested in this field, the various techniques currently being used. It will cover, in detail, many topics including: feminization of the male face, voice feminization, body contouring and genital procedures including reassignment. I will post additional updates of this exciting project as they unfold.
Elf Ears There is a growing fad, of late, to produce elfin ears which are reminiscent of characters in Star Trek or Lord of the Rings. It appears to involve cutting the rim of the ear and sewing the edges of cut cartilage together to form a point. While it is true that trying to re-establish the exact pre-elfin ear is unlikely, if the person has “buyer’s remorse” following the surgery, it is still possible to produce a more normal, though smaller, ear by excising this area subsequently.
Another consideration which the prospective elf-to-be should consider is the possibility of chronic inflammation or infection of the cartilage. This is true because of the rather poor blood supply to cartilage and the fact that these operations seem to be performed primarily by non-physicians. Since most fads which produce a “cool, in” sub-culture become less stylish over time, it would be wise to pick one that wasn’t risky or didn’t leave a deformity when the “cool, in” crowd moved on to something else.
I recently vacationed in Asia and was struck by the wide variation in facial anatomy, especially nasal anatomy. These observations, coupled with my own extensive experience, reinforced my belief that a high, narrow bridge, a well-defined tip, obliquely rather than horizontally oriented nostrils and some degree of “nostril show” (where the columella between the nostrils is lower than the sides of the nostrils) looks better.
To this end, there are many approaches to accomplish this result. Obviously, the approach has to be individualized depending on the variations in anatomy and the patient’s wishes. Though nasal bridge augmentation in the Orient usually involves placing a synthetic implant with acceptable results, I have found them to be unsatisfactory. Besides being moveable over the bridge, many get infected or extrude. I generally prefer cartilage grafting, with or without a fascia covering. Sometimes it is necessary to fracture the nasal bones inward. Also, cartilage is usually needed to provide an angular defined tip, as well as structural support for the tip in the form of a strut. The strut is also useful in lowering the columella. And finally, the nostrils may be narrowed via tissue excision, suture cinching, wide undermining or a combination of these.
