Rhinoplasty (Nose Surgery)
Rhinoplasty, or nose surgery, is one of the most common plastic surgery procedures. During a rhinoplasty, the surgeon is able to reshape, reduce or augment a patient’s nose for cosmetic, and sometimes functional, purposes. A rhinoplasty may be performed to correct a birth defect, to repair an injury, to improve breathing or simply to improve a patient’s appearance.
Candidates for rhinoplasty should be at least 13 years old since it is important that patients have finished their facial growth before proceeding with this surgery. Patients considering rhinoplasty should be in overall good health, should not be smokers, and should have realistic expectations about the outcome. Rhinoplasty is usually an outpatient procedure performed under IV sedation or general anesthesia and takes from 1 to 2 hours. There are two methods for performing a rhinoplasty: open and closed. The surgeon will choose the appropriate procedure for each individual patient.
Immediately after surgery, the patient’s nose and eyes are usually bruised and swollen. Splints and some packing material will remain inside the nose for a few days. Most patients feel like themselves within a few days and are able to return to regular activities in about a week. During recovery, the rhinoplasty patient should refrain from strenuous exercise and showering, use sunscreen of SPF 30 or higher and avoid nose blowing, vigorous toothbrushing or any activity that puts pressure on the nose.
As with any surgical procedure, there are risks involved in a rhinoplasty, including excessive bleeding, adverse reaction to anesthesia, and localized pain, discoloration or numbness. Occasionally, a patient may be dissatisfied with the cosmetic results of the operation and a second surgery, called a revision rhinoplasty, may be desired. For most patients, however, a rhinoplasty is an uncomplicated procedure with pleasing results.
Revision rhinoplasty, also known as secondary rhinoplasty, is a complex procedure to reshape or resize the nose after the initial procedure. This surgery is performed on patients who are dissatisfied with the aesthetic or functional results of the original procedure and seek additional corrective surgery. Reasons for dissatisfaction with the original procedure may include a complicated pre-surgical condition, an inexperienced surgeon or a faulty healing process. Because of its complexity, revision rhinoplasty requires the skills of a highly trained specialist.
Reasons for a Revision Rhinoplasty
Problems patients complain of after the initial rhinoplasty procedure may range from minor cosmetic imperfections to serious medical problems and may include:
- Nostril deformities
- Nasal bone fractures
- Cautery burns
- Septal tears
- Breathing difficulties
Over time, gravity and sun exposure take their toll on the face and neck. Deep creases that run from each side of the nose to the corners of the mouth appear; the jawline slackens; and the neck develops loose folds and fat deposits. Rhytidectomy (facelift) counteracts these signs of aging by tightening muscle, removing fat, and trimming excess skin.
Rhytidectomy improves the look of the lower and middle areas of the face, and the neck. It is most effective for correcting the following:
- Mid-face sagging
- Deep creases under the eyes
- Nasolabial folds
- Sagging fat
- Loose skin and fat under the chin and jaw
Although rhytidectomy removes or reduces signs of aging, over time, they will gradually reappear. Rhytidectomy does not improve the look of the brow, eyelids and nose, and some parts of the mid-face. A patient who wants to improve those areas might combine rhytidectomy with a brow lift or eyelid surgery, and/or with injectable soft-tissue fillers, facial implants and skin resurfacing.
Types of Facelifts
Rhytidectomy is typically performed as an outpatient procedure in an office-based facility, surgery center or hospital. Patients may have a choice of IV sedation or general anesthesia. The procedure takes about 2 hours. The way a facelift is performed depends on the surgeon, the patient’s facial structure, and the extent of correction desired.
A traditional rhytidectomy is a “full” facelift that rejuvenates the face, jowls and neck, and includes sculpting and redistributing of fat; lifting and repositioning of muscle and deeper tissues; and trimming and re-draping of skin. The incision begins at the temples and travels down to the front of the ear, around the earlobe and behind the ear to the lower scalp at the hairline. Sometimes, another incision is made under the chin.
A limited-incision rhytidectomy improves the area around the eyes and mouth by reducing nasolabial folds and other deep creases. Short incisions are made at the temples and around the ear, and possibly in the lower eyelids and/or under the upper lip.
In both methods, incisions are closed with stitches or tissue glue. Scars are hidden in the hairline and natural contours of the face.
Blepharoplasty (Eyelid Surgery)
Blepharoplasty (eyelid surgery) is a plastic surgery procedure for correcting sagging or drooping eyelids.
The eyelid, because its skin is much thinner than that in other parts of the face, is often one of the first facial areas to exhibit signs of aging. Eyelids that sag or droop can affect peripheral vision, making daily activities such as driving more difficult.
Blepharoplasty may become necessary when various factors, which include aging, sun damage, smoking and obesity, cause the muscles and tissue that support the eyelids to weaken.
Reasons for Blepharoplasty
Blepharoplasty tightens the eyelid’s muscles and tissue, and removes excess fat and skin. Blepharoplasty eliminates the drooping of skin into the visual field, greatly improving peripheral vision. It is also performed for strictly cosmetic reasons.
If the eyelids begin sagging into the field of vision, a functional blepharoplasty may be required. The procedure may be covered by medical insurance if it is deemed medically necessary. A determination of how much vision is affected is done by checking the peripheral visual field with an instrument called the Humphrey Visual Field (HVF) Analyzer.
Blepharoplasty can be performed on either the upper or lower eyelid, or on both, for cosmetic purposes. For a lower eyelid that needs fat rather than skin removed, a transconjunctival blepharoplasty is performed. During transconjunctival blepharoplasty, an incision is made inside the lower eyelid, so there are no visible scars, and the fat is removed. This procedure has no effect on vision, but results in a person’s looking younger and more refreshed.
It is important for a patient to have realistic expectations before undergoing cosmetic blepharoplasty. Although the procedure can enhance appearance and improve self-confidence, it does not radically alter the face.
The Blepharoplasty Procedure
Blepharoplasty is typically performed as an outpatient procedure requiring local anesthesia and sedation. General anesthesia may be used for anxious patients. Patients can choose to have this procedure on their upper or lower eyelids, or both. The procedure can take anywhere from 45 minutes to 2 hours, depending on whether both the upper and lower eyelids are operated on.
If the upper eyelid is being operated on, an incision is typically made along its natural crease. Once the incision is made, fat deposits are repositioned or removed, muscles and tissue are tightened, and excess skin is removed. For the lower eyelid, an incision is usually made just below the lash line so that excess skin can be removed.
After the procedure, the incisions are closed with sutures, tissue glue or surgical tape, and usually loosely covered with gauze so the area can heal.
A neck lift is a surgical procedure that smooths and tightens the neck’s skin, which can sag from aging or weight loss.
There are usually two components to a neck lift: cervicoplasty, which removes excess skin, and platysmaplasty, which removes or tightens muscles in the neck. A neck lift can be performed alone or as part of a facelift.
A neck lift candidate is in good physical and emotional health, and has realistic expectations about the outcome of surgery. The results of a neck lift can last up to 10 years.
Neck Lift Procedure
A neck lift begins with a small, inconspicuous incision directly below the chin (platysmaplasty) and/or in front of the ear lobes, looping behind the ears and ending in the scalp near the back of the neck (cervicoplasty). Sagging skin is trimmed away and lifted during cervicoplasty; loose muscles that cause the “bands” around the neck to be prominent are tightened during platysmaplasty. In some cases, it is necessary to perform only one of the two procedures. Liposuction is sometimes used to remove excess fat; if so, it is performed before the neck lift. Incisions are glued and/or sutured closed.
A neck lift usually takes 2 to 4 hours to perform, and the patient is given either general anesthesia or local anesthesia with sedation. Most neck lifts are performed on an outpatient basis. Bandages covering incisions are removed after a few days; sutures are typically removed after 7 to 10 days.
BOTOX® and Fillers
When you smile, laugh, frown, or look puzzled, you contract the muscles of your face. Over time, these contractions produce permanent furrows and deep wrinkles in the skin, especially around the eyes and mouth, between the eyebrows, and on the forehead. These lines can make you look older, sad, angry or tired. Soft tissue fillers can not only prevent you from deepening these lines during natural facial movements, they can also erase these marks of aging, leaving you looking younger and refreshed.
Soft tissue fillers are FDA-approved and safe for use by most patients. Many of the fillers are made from substances found naturally in the body, or synthetically made to mimic natural substances or stimulate collagen production. These fillers are injected directly into the skin of the targeted area to restore volume and reduce the appearance of fine lines and wrinkles. At Advanced Surgical Associates, we offer patients several different soft tissue filler options in order to provide the best possible results for their individual needs, including:
- Sculptra® Aesthetic
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