Archive for the ‘Rhinoplasty / Nose Surgery / Nose job / Nose Reshaping / Nasal Reshaping’ Category

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Solution for a person with large nasal skin envelope.

Saturday, April 10th, 2010

This is a patient that did not like the size of his nose and wanted it to be less wide and also wanted his tip to be less droopy and more elevated and smaller if possible.  This solution that I discovered avoids large incisions on the bridge of the nose or above and can lead to incisions that hide well inside the nose.  The below picture shows how we planned the alar resection next to the nostrils to make the nostrils smaller and the nose less wide (1st figure).  Now this was done with an open approach where we made an incision in the columnella.  This is  the structure that is made from the medial crus (take a look at our anatomy picture for a better visual on where the incision is made).  The columnellar incision is made on the inferior side between the nostrils and hides very well. I have a picture of this on my website on the rhinoplasty procedure page (Dr Young of Bellevue near Seattle Washington). There used to be a lot of fear of devascularizing the nasal tip by doing the rhinoplasty open and then also resecting the alae (see alar fibrofatty tissue on the nasal anatomy picture below 2nd figure).  We did this persons procedure below and was able to get an excellent result without causing any nasal tip skin loss.  More importantly, we had to figure out how to change the thick nasal skin on this persons nose.  I developed a way of taking away skin without making any incisions on the top of the nose where it is more visible.   The 3rd picture shows how we made the nose skin smaller by taking away skin from the bottom and within the nose.  I first made an incision down the middle of the lobule part of the nose just under the nasal tip and then made the corresponding angle part of the incision of the transcolumnellar scar that is like an inverted gull wing incision.  This was further taken to the soft triangle area where the wings of the incisions are shown in the third picture. The blue shaded area is where the skin was taken. When the incisions were closed they rested inside the nose so the scarring was all inside the nose hidden.  I judged how much skin to take by tensing the skin over the tip and determining how much tension was on the closure at the transcolumnellar site.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, WashingtonRhinoplasty

Posted in My Journey to Find and Attain Beauty, Rhinoplasty / Nose Surgery / Nose job / Nose Reshaping / Nasal Reshaping | Comments Off on Solution for a person with large nasal skin envelope.

Solution for the wide nose at the level of the nostrils through Alar wedge excisions, nostril sill excisions, VY advancements, and cinching procedures.

Saturday, March 27th, 2010

Have you wondered if you need to have the skin at the sides of your nostrils reduced or what it takes to make your nose less big at the base of your nose at the level of the nostrils through rhinoplasty (Dr Young near Downtown Bellevue, WA).  If you take a look at the first picture. The green arrow shows where the alae, the tissue that covers the nostril, attaches.  If the alae flares (at the blue arrow) greater than 2 mm than a significant amount of alar flare is present and a alar wedge excision would be an appropriate procedure to narrow the base of the nose which is shown in picture 2.  Do you have a wide nasal base in the first place?  Well if your nose at your base is bigger than the distance between your eyes, you could benefit from some modification of your nasal base. As described for the Alar Wedge Excision above.  The third picture shows the Intercanthal width which is the distance between our eyes by the green arrow.  The Yellow arrow shows the interalar width.  If the Interalar width, the distance between the outsides of the alae, are larger than the intercanthal distance (or the distance between the eyes), than you could benefit aesthetically from some form of treatment to make the nose narrower in the nasal base area ( measured by the interalar width).  When you don’t have alar flaring the excessive interalar width, is due to the lateral attachment of the alae (treated by VY advancement or cinching procedures), excessive size of the nostrils (nostril sill excision), or excessive tissue in between the alae (Cinching procedure, or treating the medial crura that makes up the columnella).   First do you have excessive nostril size?  If your nostrils are horizontally oriented and are wider than the width of the columnella a nostril sill excision would be a good consideration to narrow the interalar width.  In the fourth picture, The green bracket shows the width of the columenella while the yellow bracketing shows the width of the nostrils.  The green arrow shows the nostril sill area where the resection for the nostril sill should be in the horizontal portion as seen in the fifth picture. So in the fourth picture if the green bracket of the columnella is less wide than the nostril sill denoted by the yellow bracket, the nostril sill excision could be used to narrow the nasal base. If alar flaring and excessive nostril size are not present and you still have a wide nose as shown by the interalar width, you can then use VY advancements or cinching procedures to narrow the interalar width.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Alar FlaringAlar wedge excisionInteralar Width AnalysisNostril Sill 2Nostril Sill Reduction

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Asian Rhinoplasty Combination Techniques for both the Nasal Bridge and the Nasal Tip

Saturday, March 27th, 2010

I think that a combination of an implant for the nasal bridge and using your own tissues for your nasal tip is the best combination for Asian Rhinoplasty.  Through years of clinical results through patients and studies conducted by analyzing a different collection of studies have shown many things to us.  The dorsum or nasal bridge seems to be capable of accepting an implant that is made up of silicone porous polyethylene, or goretex. The areas that most likely have issues with alloplasts (foreign implants like silicone, porous polyethylene, and goretex, etc) is around the tip region where the distance from the implant to the environment is the thinnest.  What happens when you put alloplasts in the nasal tip is that the implant can get inflammed and extrude through the skin or inside the nose. This is the reason for using our own tissues in the nasal tip (also called autografts).  I use ear cartilage, or septal cartilage for the nasal tip.  I use my own approach for elevating the tip.  I use the patients own nasal tip cartilages but I use grafts from the septum or ear to prop their nasal tip cartilages into a more desirable position to make the nose look better.  The benefits are that you maintain the natural look of your own tip cartilages while using grafts to make the tip better.  I use the septum and grafts attached to the septum to project the nasal tip to a more pleasing position.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

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Rhinoplasty and the art

Friday, March 19th, 2010

Rhinoplasty (Dr Young Specializes in Facial Plastic Surgery and Rhinoplasties) is one of the hardest procedures that a facial plastic surgeon can do.  There are many steps in doing a Rhinoplasty and the steps you go through and the order is essential.  Many noses have a deviated component to it.  I usually try to make all noses straight first before doing additional work in the middle and lower part of the nose.   If you don’t make the nose straight all of the other moves that you do will further accentuate the deviation.  It starts with your septum.  You have to make sure that the septum is straight first before anything.  Sometimes this requires treating the nasal bones and shifting them to make them more in the middle as well.  Septum with all of these maneuvers the septum still doesn’t become straight. At this point, weakening the septum with 50% inferior cuts until it is allowed to come to the middle is needed.  In addition, sometimes it requires fracturing the septum higher up under the nasal bones to really weaken the septum and allow it to come into the middle.  Sometimes there are forces at the bottom of the septum near the tip that needs to be addressed including removing parts of the septum that are deviated or even shaping the spine that is at the bottom of the nose.  All of these things can be seen in the photo that is at the bottom of this blog.  Once the septum is straight then you can work on other things like the nasal tip, upper lateral cartilages to make the tip look the way you want.  I tend to do all of my rhinoplasties in the open approach and we have a picture of how that heals on our website.  This allows me to more accurately control things in the nose cutting down drastically my revision rate.  I also employ non destructive techniques for the best controlled long term solid results.  I never morselize, or weaken the cartilages to get results.  There is too much variables in healing that can lead to a bad result.  I hardly cut the cartilages and leave them to heal. They are always reconstituted and always done away from the tip area.  Sometimes in thin skin, I will crush cartilage to cover sharp edges on the tip areas or other areas to soften the results.  But the foundation is never crushed or morselized.  My order of rhinoplasty proceeds like this: markings, injections, open approach, address the nasal bridge first, if there is a deviation, treat the nasal bones through osteotomies to make the septum straight,  septal harvesting for grafts preserving 1.5cm of struts for ultimate support, septal restructuring to make sure that it is straight, further work on the nasal bridge, then proceeding to reconstituting the upper lateral cartilages to the septum,  then I start on the tip work including trimming the lateral crural cartilages, tip suturing (columnellar strut, medial crural sutures, transdomal sutures to narrow the tip domes, interdomal sutures to make the whole tip smaller, setting the tip’s projection, controlling the rotation through a tip rotation suture), then closure which includes closing the dead space.  Below is a picture of the anatomy of the nose.  The middle crura is in between the lateral and medial crura.  The middle crura cartilage and the junction with the lateral crura creates the tip highlight and the tip is mainly made up of the middle crura with the lateral and medial contributing to how the middle crura is presented on the nose.  The lateral process of the septal nasal cartilages are otherwise known as the upper lateral cartilages.  The lateral, middle and medial crura make up the lower lateral cartilages.

I hope that was interesting for you!

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, WashingtonNasal bones and anatomy

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What is the typical nose job recovery? How long do I need before I can go back to work?

Monday, March 1st, 2010

Rhinoplasty (Philip Young MD, Seattle / Bellevue WA) generally takes about a week recovery but subtle swelling can last for quite sometime.  And usually we say most people can go back to work in one week. Most of the swelling and bruising usually takes about a week to resolve. Sometimes the recovery is less and sometimes more depending on the person. It also depends on what was done.  If tip surgery only was done the recovery is a little faster.  But reduction of the tip can take a long time for the subtle swelling to go down.  The finer tip curves and smaller size can take months to go down and this can continue for up to 2 years or more.  When you break the nasal bones, this action can create more bruising and swelling that could prolong the recovery to more than a week.  In general, I tell patients that they should get 60% of their healing at 6 weeks, 80% at 6 months, and 88% at 2 years and it tapers off after that.  Major changes to the nose does take a little time to be fully realized in the nose.  The subtle changes over the years will show continued improvement.  This is good in the way, because people will not notice the big changes initially and the more subtle changes will slowly occur so that people will not be shocked at the major changes that can happen in your nose and its appearance.

I hope that helps.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

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Can Facial Nerve Damage occur with Rhinoplasty and Chin Reduction Surgery?

Wednesday, February 24th, 2010

Facial Nerve Damage from Rhinoplasty (Aesthetic Facial Plastic Surgery, Dr Young Bellevue) and Chin Reduction Surgery (Philip Young MD, Bellevue, WA) is extremely rare.  From Rhinoplasty, Facial Nerve Damage would be something that you could report in the literature because it is extremely rare.  I have never heard of that ever.  So you worry about Rhinoplasty causing that should be lessened.  Chin Reduction surgery is a viable concern. When you do this type of surgery, you have to elevate the chin area.  Superficial to this elevation, you do have nerve fibers from the facial nerve that traverse this area.  If one were not in the right plane you could damage this nerve although this is still pretty rare.  Also with Chin reduction surgery, you need to tailor the skin envelope to accomodate the smaller chin after reducing the bone volume.  this tailoring can injure the nerve. One thing to remember is that, at that point you are dealing with end fibers of the facial nerve and likely regeneration will occur without any effects if it were to happen.  But more laterally when you do your reduction you need to be careful to stay in the right planes.  That might be too much information.  In general, the risk of facial nerve damage from either procedure is extremely rare!

I hope that helps.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Chin Surgery, Rhinoplasty / Nose Surgery / Nose job / Nose Reshaping / Nasal Reshaping | Comments Off on Can Facial Nerve Damage occur with Rhinoplasty and Chin Reduction Surgery?

What is a revision rhinoplasty and how is it different from a regular rhinoplasty?

Monday, February 22nd, 2010

Revision rhinoplasty is a cosmetic nose shaping procedure done after one has already been done before.  A revision rhinoplasty is just a procedure that is done to improve on the rhinoplasty that was done originally. This occurs at a certain rate with all surgeons.  Many surgeons use this as a gauge to determine how facile they are with rhinoplasties.  The lower rate of revision the better. No surgeon has a 0% rate of revision.  If any surgeon tells you that, he is most definitely not telling the whole truth.  Even the very best rhinoplasty surgeons I know, or at least are the deemed the best by their peers, have a revision rate that doesn’t get much lower than 10%.  Rhinoplasty is a very hard procedure and revisions are a necessary part of the process but vital in ensuring the very best result in the end.

I hope that helps.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

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Loss of fat around the eyes is not a commonly recognized risk from Rhinoplasty.

Monday, February 8th, 2010

Loss of fat around the eyes is not a commonly recognized risk from Rhinoplasty (Dr Young is in Seattle).  As the other doctors have answered this is not common.  It is a possiblity that some of the vessels around the nose could be affected with aggressive rhinoplasty (nose shaping, nose reshaping, nose plastic surgery, nose cosmetic surgery, rinoplasty, nose job) that could affect the blood flow to the parts of the eyes that are closer to the nose.  This could be the only possible way of losing fat around the eyes.  The other phenomenon that the doctors have mentioned could account for this sensation that you have lossed fat around the eyes.  One is that you tend to notice things more after you have had a procedure. Two, the swelling around the eyes from the rhinoplasty as it goes away could give the person the impression that they have lossed some volume around the eyes.

Hope that helps!

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

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Rhinoplasty requires careful analysis during the preoperative stages that the perlane could interfere with

Monday, February 1st, 2010

Rhinoplasty (Seattle) requires careful analysis during the preoperative stages.  You need to know exactly what you want to correct and hence having the unaltered preoperative state is essential with rhinoplasty.  If the perlane that you have in the nose and bridge makes a big difference it would be prudent to dissolve the perlane with hyaluronidase. This will allow you the ability to see the native anatomy better and hence your surgeon can come up with an accurate plan.  If it does not make a big difference the preoperative analysis may not be that affected.  If the perlane with in other larger areas of the face where the impact would be less, the need to remove the perlane would be less necessary.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Fillers / Facial Fillers, Perlane, Rhinoplasty / Nose Surgery / Nose job / Nose Reshaping / Nasal Reshaping | Comments Off on Rhinoplasty requires careful analysis during the preoperative stages that the perlane could interfere with

Tip grafts to define the tip in a thick skinned nose after 4 previous rhinoplasties

Monday, January 25th, 2010

Since you have had 4 rhinoplasties (Seattle), anyone considering your surgery will be very cautious.  That many procedures leaves the nose with low blood supply and hence more at risk for additional procedures.  Grafts in these noses have less blood supply and are more likely to have decreased volume and action that they were intended.  That needs to be understood.  Tip grafts can make your nose more defined but thick skin prevents the details from showing.  You can always make the skin less thick by reducing the fat underneath the tip but this can be risky but possibly the only way to define the tip in this situation in addition to the tip grafts.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Rhinoplasty / Nose Surgery / Nose job / Nose Reshaping / Nasal Reshaping | Comments Off on Tip grafts to define the tip in a thick skinned nose after 4 previous rhinoplasties

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