Hispanic, Asian, or African American patients who are active candidates for rhinoplasty or just thinking about having a nose job often have a similar complaint: My bridge is too low!
It is important to differentiate those ethnic rhinoplasty patients whose bridge and profile fit their other features and thus appear "natural" from those whose bridges are too low even for ethnicity. These latter patients' appearances can be greatly improved by augmenting or building up the bridge of the nose. Unfortunately, not every nasal surgeon is skilled at building the bridge up in a natural, long lasting, and attractive way. I often see ethnic rhinoplasty patients who have had surgery elsewhere and are not pleased with their bridge augmentation. Reasons range from visible or mobile implants, unnatural shaped implants, to poor bridge/tip proportion. It is very important to match the tip height (or projection) to the bridge height!
Revision rhinoplasty for ethnic patients can be complex due to the need to replace a pre existing implant, which may require dissecting through scar tissue around the implant. However, thick skin generally is a plus for allowing a smooth contour in the nose following the revision.
Silicone implants are a fairly common cause for revision bridge surgery in these patients. Silicone is difficult to sculpt, which can lead to noticable edges under the skin. In addition, it can sometimes form a capsule around itself, preventing the implant from sticking to the underlying bone and cartilage. Finally, silicone may occasionally extrude through thin skin especially if the implant is too long.
Endogenous cartilage from the nasal septum, ear, or rib can be used for bridge augmentation, however I have found gortex to be very useful in this capacity. Gortex tends to adhere nicely to the bone is very easy to sculpt and contour for a natural, long lasting appearance.
Thursday, September 24, 2009
Tuesday, September 8, 2009
"The Only Thing that Bothers Me is my Neck.."
Many patients come into our office and utter this phrase. Indeed, a "turkey waddle" (or is it "wattle"?) can be quite distressing for most folks. Even diehard naturalists who count on exercise and good nutrition thinking they can avoid the plastic surgeon will finally cave in when they see this develop under their chin. Often, they will tell me "I inherited this from my mother (or father)." While heredity can certainly contribute to the severity or rapidity of onset of an aging neck- we all get this to some degree or another.
Our necks start to "look bad" as we age for several reasons:
1) Sun Damage: UV rays directly damage the elastin fibers in our skin, causing a loss of "snap" and subsequent sagging.
2) Muscle laxity: the "bands" in our neck are the platysma muscle. This muscle extends from the collar bone to the jawline and into the cheek, and as it relaxes and loosens over time it separates from the underlying firm tissues and becomes visible under the skin- even when we don't flex it. (No, you can't fix this by flexing your neck.)
3) Fat: weight gain or cycles of weight gain and weight loss can eliminate the once youthful "90 degree angle" of the chin and neck.
4) Heredity: our underlying bones and cartilages provide the framework for our skin, fat, and muscles which can become loose. For example, a "low hyoid bone" can make it impossible for a patient to have a perfect 90 degree neck-chin angle-no matter what procedure is done.
So what can you do?
Most patients over 40 will require an actual neck lift. This involves repositioning and removing excess skin in the neck, in addition to muscle tightening and liposuction as necessary. This can be done with a short incision that is hidden behind the ear in the crease. Under age 40, most skin retains elasticity, and select patients can be treated with liposuction alone. This involves a very short incision below the chin.
The good news is a simple neck lift can be done with minimal anesthesia in approximately 45 minutes.
Liposuction is an approximately 20 minute procedure.
Recovery from these procedures is a matter of days to one week for most patients.
When patients complain about their necks, however, I always assess their jowls and cheeks as well. Occasionally, it is just not reasonable to correct the neck and ignore these other areas. Patients are then offered a mini facelift or a full facelift, depending on their needs and desires.
Our necks start to "look bad" as we age for several reasons:
1) Sun Damage: UV rays directly damage the elastin fibers in our skin, causing a loss of "snap" and subsequent sagging.
2) Muscle laxity: the "bands" in our neck are the platysma muscle. This muscle extends from the collar bone to the jawline and into the cheek, and as it relaxes and loosens over time it separates from the underlying firm tissues and becomes visible under the skin- even when we don't flex it. (No, you can't fix this by flexing your neck.)
3) Fat: weight gain or cycles of weight gain and weight loss can eliminate the once youthful "90 degree angle" of the chin and neck.
4) Heredity: our underlying bones and cartilages provide the framework for our skin, fat, and muscles which can become loose. For example, a "low hyoid bone" can make it impossible for a patient to have a perfect 90 degree neck-chin angle-no matter what procedure is done.
So what can you do?
Most patients over 40 will require an actual neck lift. This involves repositioning and removing excess skin in the neck, in addition to muscle tightening and liposuction as necessary. This can be done with a short incision that is hidden behind the ear in the crease. Under age 40, most skin retains elasticity, and select patients can be treated with liposuction alone. This involves a very short incision below the chin.
The good news is a simple neck lift can be done with minimal anesthesia in approximately 45 minutes.
Liposuction is an approximately 20 minute procedure.
Recovery from these procedures is a matter of days to one week for most patients.
When patients complain about their necks, however, I always assess their jowls and cheeks as well. Occasionally, it is just not reasonable to correct the neck and ignore these other areas. Patients are then offered a mini facelift or a full facelift, depending on their needs and desires.
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