436 N. Bedford Dr. Suite 105, Beverly Hills, CA 90210 Phone: (310) 271-7070 | Fax: (310) 271-7343
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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March 11th, 2009 Dr. Pincus
For patients who aren’t ready for a facelift or who may never want facial surgery, the Beverly Hills Necklift can give dramatic, rejuvenating results. As the skin loses its elasticity and starts to sag, the neck can suffer the most. Add an accumulation of fat underneath the jawline and laxity of the muscles in the floor of the mouth supporting the salivary glands and a full, sagging neck is the result.
The procedure is generally performed under intravenous sedation or general anesthesia. A small incision is made underneath the chin and incisions are made behind the ears. However, there are some patients with such extreme skin laxity that facelift incisions are also necessary. This is so because the skin has to be pulled superiorly on to the face as well as posteriorly behind the ears to accomplish the desired result. A small drain is usually placed over night and full recovery generally takes one week.
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March 9th, 2009 Dr. Pincus
There are many young patients who have never had a right angle under their jawline and would benefit from the Beverly Hills Necklift. Their full neck is primarily related to the orientation of the muscles that form the floor of the mouth and, to a lesser degree, fatty deposits and/or prominent salivary glands or hypertrophied muscle.
To correct this deformity, a combination of several techniques are used. Liposuction, creation of muscle flaps, excision of muscle, transection of muscular attachments, suspension sutures or partial salivary gland resection are the primary approaches. The procedure need not be performed with any additional facial surgery and can have a dramatic effect on the overall appearance.
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February 26th, 2009 Dr. Pincus
There are two different classes of patients seeking necklift surgery.
The first group consists of younger patients who have always had a fullness under their jawline. Their problem is more of an anatomical nature where the muscles that form the floor of the mouth are oriented obliquely downward rather than parallel to the jawline. This, in turn, is related to the position of the hyoid bone to which they attach.. Instead of being high and posterior under the angle of the jawbone, it is forward and low. Also, in some instances, fat may be present to further exaggerate the deformity.
The second class of patients are older and usually in their 40’s, 50’s or 60’s. With these patients we see excessive skin laxity coupled with fatty deposits. Lifestyle coupled with aging and genetics play the prominent roles here.
In both instances, a necklift can have a positive impact on the overall appearance of the face.
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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 27th, 2009 Dr. Pincus
The eyes are the first feature we see when we meet someone, and there is much to be learned from them. We can think that the person is tired, evasive, dishonest, energetic, sad, intense or even captivating just by looking into their eyes. So it is to one’s advantage to have good-looking eyes.
To this end, we like to see smooth skin without wrinkles or puffiness for both the upper and lower eyelids. There should be a crisp crease between the upper eyelashes and eyebrow, and the eyebrow should have a nice smooth arch about ½ inch above the bony rim. Obviously, allergies or any other inflammatory condition that affects the whites of the eyes would detract from an otherwise positive impression and should be corrected.
Generally, we like the outside corner of the eye to be slightly higher than the inside corner. The highpoint of the brow arch is most pleasing if it is somewhere between this outside corner and the iris or colored portion of the eye. Also, the eyebrow should start and end at the same horizontal level. We also like to see the distance between the two eyes approximately equal to one eye width.
Though many of us are born with naturally beautiful eyes, much can be accomplished with the appropriate use of make-up and the appropriate surgical procedure(s), if indicated.
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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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December 6th, 2008 Dr. Pincus
The topic of lip enhancement is very popular these days, especially in Beverly Hills and Hollywood. As a quick review of the various options available, I would like to separate them into surgical and non-surgical. In the non-surgical category, we have Juvederm, Restylane and Perlane which are naturally occurring substances (hyaluronic acid) that exist between the cells of your body. Also, there is fat, which requires minor liposuction surgery to obtain but no surgery to place. All of these fillers are placed via a syringe and needle and eventually disappear over several months. However, there may be some percentage of persistence with fat transfer. I do not use permanent fillers like Artefil or liquid silicone in the lips (or elsewhere) because I think they produce an unsusal “foamy” appearance in the lips, especially on animation. Also, because they depend on the formation of tissue reaction to produce the volume, there may be some asymmetries. Regarding surgical alternatives, the primary method that I use is mucosal advancement flaps from inside the mouth (V to Y advancements). This usually also requires fat as a spacer after the flaps are advanced. I also perform liplifts which shorten an elongated “white” lip and can pull up the “red” lip, if it is so desired. The final technique which I use in rare instances is direct excision of tissue around the red lip with mucosal advancement. This procedure is great for designing a new shape for the lips. However, it does leave a fine scar around the lips which, if obvious, can be easily covered with lipstick. The use of Verafil lip implants is another technique which I used more frquently in the past but less so recently because of the occasional problem with symmetry, palpation and volume maintenance.
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