How long has rib cartilage been used from rhinoplasty?

Posted on May 23, 2024 by admin

Somewhat surprisingly, the use of costal cartilage and rib cartilage in rhinoplasty and revision rhinoplasty has existed for more than a century. In an article published in Paris in 1904, French rhinoplasty surgeons describe harvesting rib cartilage and using it to repair the framework of a cartilage depleted nose during a reconstructive rhinoplasty. They obviously lacked the sophistication and precision of modern surgical techniques to harvest the cartilage in a minimally invasive manner, but nonetheless it is remarkable that they possessed the foresight to attempt such a surgery with the primitive instruments they had available to them despite facing incredibly high morbidity and the risk of disastrous complications.

Following the initial description, due to the complexity and inherent risks of harvesting rib cartilage, the use of costal cartilage for rhinoplasty surgery was largely limited to small subsets of reconstructive plastic surgery, and did not become widely utilized in the realm of cosmetic rhinoplasty surgery. Rhinoplasty surgeons such as Eugene Tardy, Jack Gunter, and later by Dean Toriumi, expanded the uses and indications of costal and rib cartilage in nose job surgery and began using it as the primary graft material in revision rhinoplasty cases where septal cartilage was not available, or insufficient. The acceptance of costal cartilage for use as a graft material in nose job surgery was gradual for the first 80-90 years since its inception, but in the last few decades has exploded to become the gold standard in revision rhinoplasty, and also in primary rhinoplasty cases where additional support or volume is needed. Korean plastic surgeons abroad, and plastic surgeons such as Donald Yoo and Charles Lee in Beverly Hills, California, have helped to spread awareness and widespread adoption of the use of autologous rib cartilage in primary rhinoplasty cases such as Asian rhinoplasty.

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Autologous costal cartilage and rib cartilage have proven to be reliable, permanent graft materials for use in nose job surgery that integrates seamlessly with the natural nasal framework. Autologous rib cartilage (cartilage from your own body) has the distinct advantage of being viable, living tissue and is intrinsically 100% immunocompatible with your nose, meaning there is no risk of rejection or resorption due to an immune response. Costal cartilage used as grafts obtains a blood supply from the nose, and becomes a permanent part of the nasal framework.

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What’s the best technique to augment the dorsum in Asian rhinoplasty or Asian nose job surgery?

Posted on May 18, 2024 by admin

The bridge of the nose, or the nasal dorsum, represents a subtle yet visually impactful component of the nose and of the face as a whole. The width, height and shape of the dorsum has an effect on the appearance of the balance of the face and especially in terms of the projection of the mid-face and cheeks, the appearance of the eyes and the area between them, and the side profile and oblique facial proportions. In Asian nose job surgery the dorsum of the nose is often low or wide, or a combination of both. Bone comprises the upper third of the bridge, while there exists an important “keystone” area where the bone interfaces with cartilage along the middle-third of the bridge. Critically, any surgical approach to augment the dorsum must preserve this connection, but also become integrated with it so as to provide a bridge that is solid and does not move, just as the original bone and cartilage do not. Any material that is placed on top of the natural bone and cartilage, but does not integrate with it, will be predisposed to migration and eventually extrusion through the skin.

The best material then, for creating a permanent change to the shape of the nose is material that will integrate and become 100-percent a part of your nose, and the only material that will do this is tissue from your own body. For this reason, the best Asian rhinoplasty surgeons have spurned the use of synthetic materials such as silicone, Goretex and Medpor in favor of cartilage from the ears or from the ribs. Depending on the amount of augmentation, and the concomitant changes to the shape of the nose with respect to the tip and ala desired, ear cartilage or costal cartilage may offer the superior option. For the greatest degree of tip-refinement and augmentation, rib cartilage offers the benefit of a plentiful volume of strong, straight cartilage to provide structural grafting.

Asian Nose Job with rib cartilage and DCF

When using rib or costal cartilage in Asian nose job surgery, rhinoplasty surgeons may opt to carve a single piece of rib cartilage (en bloc rib cartilage) use diced cartilage which is glued together (diced cartilage glue or DCG) or dice the cartilage it and use fascia as a wrapping to create the desired shape (diced cartilage fascia or DCF). En bloc rib cartilage has the risk of warping and migration, as it is difficult for the solid block of cartilage to precisely adhere to the underlying bone and cartilage of a natural bridge. Contour irregularities are also not uncommon given the challenge of carving a solid piece of cartilage to mimic the smooth contours of a natural nose bridge. DCG eliminates the risk of warping, as the cartilage is diced. It also has a higher chance of incorporating with the underlying nasal dorsum, as the diced cartilage can easily accomodate the shape of the underlying nasal framework. However, given the tissue glue used in between pieces of diced cartilage, cobble-stone contour irregularities may result, and given the un-contained nature of the diced cartilage, the surgeon has less control with regards to where the cartilage ultimately resides along the dorsum. The DCF technique is also not without downside, as it is the most technically demanding to create a precise result, and also requires the most time in surgery to perform, as well has results in the longest recovery time to the patient. Fascia provides an exact shape for the diced cartilage to congeal and solidify into, while allowing the diced cartilage to become tightly packed to itself without the need for any tissue adhesives in between the pieces of cartilage. When performed masterfully, a nasal dorsum constructed from diced cartilage fascia will look and feel exactly like a natural nose bridge.

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What is the hardest plastic surgery?

Posted on May 17, 2024 by admin

Plastic surgery encompasses a wide gamut of surgical procedures from complex microvascular reconstructions to delicate cosmetic eyelid surgeries. As with all surgeries, plastic surgery requires a mastery of the anatomy and a profound understanding of the form and function of its component parts, but one distinct aspect that is somewhat unique to cosmetic plastic surgery is the way in which artistry and a keen aesthetic eye must accompany technical prowess for a surgery to be truly successful. Even in a highly complex and demanding surgery such as using tissue from a patient’s forearm to reconstruct a portion of a patient’s tongue that has been resected, there are certainly some judgements that have to be made with regard to appearance, but very much secondary to function. In this way the surgery becomes almost algorithmic, with success predicated more on the completion of each requisite step rather than a more holistic assessment of the outcome that places utmost emphasis on the beauty of the result.

For this reason, many plastic surgeons consider rhinoplasty to be the most challenging plastic surgery procedure. The nose has multiple core functions that must be preserved, and sometimes enhanced, during surgery including breathing, smelling, and contributing to the tonality of your voice. In addition to the critical functions the nose represents the central facial feature and must be cohesive and balanced with the rest of the face to optimize facial harmony. Perhaps the most challenging aspect, however, is to create a shape that is aesthetically pleasing not only when judged by “textbook” measures and standards of beauty, but to create a shape to the nose that blends and enhances the face when you as the patient look at it. As everyone has their own standard of beauty, influenced by personal bias, rhinoplasty surgeons have the task of understanding and incorporating their patients aesthetic ideals and biases to create the closest shape surgically possible with their unique anatomy, and the limitations this presents.

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What is Rejuran?

Posted on May 16, 2024 by admin

Rejuran is a recent K-beauty import that has taken the Korean aesthetic surgery market by storm as it is a novel filler product manufactured from purified polydeoxyribnucleotides (PDRN) that have been shown to promote wound healing by stimulating tissue repair. PDRN has been extracted from multiple sources, such as human placentas, but in the case of Rejuran it is extracted from salmon semen. Yes, you read right, salmon semen. While it may sound a bit extreme, this purified PDRN has been shown in several studies to accelerate the would healing process by influencing cellular growth pathways, such as initiating intracellular signaling through G-protein coupled receptors, which promotes anti-inflammatory effects and stimulates cellular repair.

PDRN has been applied to the clinical setting to help promote more rapid wound healing in the case of diabetic foot ulcers, and now more recently as a skin boosting treatment in cosmetic plastic surgery. The same anti-inflammatory and cellular proliferation effects are harnessed to provide quicker recovery from energy-based and laser-based skin toning and tightening treatments, and as a way to create a “boost” of skin recovery from accumulated damage from exposure to UV radiation from the sun and environmental toxins. Skin appears rehydrated and restored, for a more youthful appearance.

Learn more: https://www.halobeverlyhills.com/services/rejuran/

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How do I get rid of my under eye bags?

Posted on May 4, 2024 by admin

Before and after lower blepharoplasty with fat repositioning to eliminate under eye bags.

Lower eye bags or lower eyelid bags are often caused by pseudoherniation of orbital fat from under the eye forward into the cheek, where it is visible as a bulge or “bag”. The orbital septum, which contains the fat, can weaken and allow this forward protrusion of the orbital fat past the lower eyelid, creating an eye bag and also commonly a depressed area, or tear trough, immediately below it. While for mild cases undereye filler and hyaluronic acid filler injected into the tear trough can produce an improvement in the appearance of the undereye area by providing additional volume in an area that is deficient in volume, for cases where the lower eyelid fat is more prominent, the fat itself must be addressed to create the optimal cosmetic outcome.

For more information: https://www.donyoomd.com/services-lower-blepharoplasty.php

A hidden incision is made within the eyelid, so that no scar is visible. This scarless (transconjunctival) approach allows access to the bulging orbital fat, and it also allows access to the cheeks. After the fat is mobilized the soft tissue overlying the cheek bone is elevated down past the tear trough (orbito-malar groove) to allow for a pocket into which the mobilized fat can be re-positioned. Instead of excising the bulging orbital fat, which with further aging may result in a more aged appearance, the fat is re-positioned into the hollow of the tear trough, acting as a permanent filler to volumize this area. Sutures which remain in place for a week are used to secure the fat precisely in place, during which time the tissue of the cheek will incorporate the newly re-positioned fat. Foam bandages cover the cheeks for a week, and most patients feel comfortable returning to work or school in 2 weeks with their newly rejuvenated appearance.

What is the cause of Eyebags?

Orbital fat that normally cushions the eye, and stays below it, pseudoherniates forward into the cheeks and creates a bulge.

How can I get rid of Eyebags?

Lower blepharoplasty with fat repositioning is a scarless, straightforward way to eliminate the appearance of eyebags without any attendant change in appearance of the eyes.

Does lack of sleep cause eye bags?

Lack of sleep and too much work can definitely contribute to an increased prominence of eye bags. Some people, even with full rest and sleep will still continue to have a prominent appearance of their under eye bags.

Why do I have eye bags at 14?

Some individuals will have genetics and anatomy that predisposes them to having visible under eye bags at a young age. Getting plenty of sleep and rest can help reduce the appearance, but may not eliminate it completely if you are anatomically and genetically predisposed.

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What is the difference between blepharoplasty and Asian blepharoplasty or “double eyelid surgery”?

Posted on April 30, 2024 by admin

Blepharoplasty refers to any surgery that reshapes the eyelid, while standard upper blepharoplasty and Asian upper blepharoplasty require different techniques owing to some anatomic differences unique to Asian eyelids. For a standard upper blepharoplasty procedure, excess skin (dermatochalasis) will cause sagging and droopiness of the upper eyelid, creating a tired and aged appearance. During upper blepharoplasty an incision or cut is made through the skin where the eyelid crease is, and the excess skin is removed. Occasionally excess fat between the upper eyelid and brow will be removed or repositioned to reshape the appearance of the upper eyelid sulcus, though this is performed in the minority of cases. Once excess skin, and occasionally excess fat, is appropriately addressed, the skin is closed. In contrast, during Asian blepharoplasty specific attention must be directed at re-establishing the connection between the tarsal plate and/or levator aponeurosis to the dermis of the skin. This connection is responsible for setting the height and shape of the upper eyelid crease and is created by a surgical technique called supratarsal fixation, during which the operating surgeon precisely anchors the crease at multiple points to establish this connection. It is during this phase the surgeon can create an infold, or tapered crease that meets the corner of the eye, or an outfold or parallel crease that runs parallel with the eyelid margin and allows for space between the upper eyelid crease and eyelid margin for the upper eyelid to show (where eye shadow would be applied).

See more at:

https://www.donyoomd.com/services-surgical-asian-blepharoplasty.php

Before and after upper blepharoplasty (upper eyelid surgery)
Before and After Upper Blepharoplasty (Upper Eyelid Surgery)
Before and after Asian Blepharoplasty with supratarsal fixation double eyelid surgery
Before and After Asian Blepharoplasty (Double Eyelid Surgery)

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Considerations during alarplasty and alar base reduction

Posted on April 25, 2024 by admin
Alarplasty Nostril Reduction Before and After
Alarplasty by Rhinoplasty Specialist Dr. Donald B. Yoo

Alarplasty, alar base reduction and alar base modification refer to a surgical procedure used to reshape the ala and nostrils, alone or in combination with rhinoplasty, to improve and enhance the overall proportions of the nose. The ala and alar rims are the subunit of the nose that are commonly referred to as the nostrils. Skin and fibrofatty tissue comprise the ala and nostrils, and this nasal subunit actually lacks any cartilage. Given this, the size and shape of the ala is intricately tied to the patient’s skin thickness, as well as the anatomic configuration of the lower lateral cartilage (tip cartilage).

Alarplasty Alar Base Reduction Explained

During alarplasty, your surgeon will assess the proportions of your nose, in terms of the tip projection, tip width, length of infratip, length of columella, the width of the ala and nostrils, the flare of the ala and nostrils, and the size and shape of the nostril aperture. All these aspects factor into the placement and design of alarplasty incisions, with some incision placements favoring more reduction of width (sill incisions) while other incision designs (Weir incisions) will favor greater flare reduction. Preserving the natural curvature of the ala and nostril, while optimizing the proportions between the projection, width of the nose and the infratip:columellar ratio will ensure a natural appearing, successful outcome.

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Alarplasty Before and After Asian Rhinoplasty Specialist
Alarplasty Before and After

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FDA/CDC investigating outbreak of botulism type illnesses from possible Counterfeit Botox

Posted on April 23, 2024 by admin

One of the leading cosmetic injectables has recently come into the national spotlight after the Centers for Disease Control announced an investigation, jointly with the U.S. Food and Drug Administration, and several state and local health departments, into 22 cases over 11 states of people reporting harmful reactions after receiving botulinum toxin injections from un-licensed providers in non-healthcare settings such as spas. Harmful reactions from these unlicensed Botox injections have been reported in California, Colorado, Florida, Illinois, Kentucky, Nebraska, New Jersey, New York, Tennessee, Texas, and Washington.

Although the investigation is ongoing, the CDC has found that at least in some of these cases the botulinum toxin injected was counterfeit Botox, and in all cases the injections were performed by non-physician providers in non-healthcare settings such as homes and spas. The CDC went on to report that 55% of those harmed required hospitalization, with symptoms such as: blurry vision, drooping eyelids, difficulty swallowing, dry mouth, slurred speech, difficulty breathing, fatigue, and generalized weakness.

Counterfeit Botox Packaging

The CDC and FDA are instructing consumers to confirm with your health care professional that you are receiving a product from an authorzied source and to ask your health care professional if they are licensed and trained to administer the product. This may sound like common sense, because it is, and this represents the absolute minimum standard to provide cosmetic Botox and neuromodulator injections. As a consumer, the best way to ensure the safest and most beautiful results is to seek out a board-certified facial plastic surgeon, plastic surgeon or dermatologist’s office to ensure all providers have the adequate credentials, training and experience to perform cosmetic injections.

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How long does neck lift last?

Posted on April 22, 2024 by admin

The aging process is continual, and a neck lift is a surgical procedure to address and improve some of the signs of aging along the neckline and jawline. Typically the results of a neck lift will last ten to fifteen years, while maintenance with a good skincare routine and proper noninvasive treatments will help to extend this duration.

Neck lift and deep-plane facelift before and after
Neck lift and deep-plane facelift by Donald B.Yoo, M.D.

What is the best age for a neck lift?

The best age for a neck lift is when laxity in the skin and soft tissue of the neck and face begin creating sagging along the neck line or jowling along the jaw line. The majority of patients will seek treatment in their 40s to 50s, though depending on genetics and lifestyle this spectrum may widen to include patients in their 30s as well.

Is a neck lift painful?

Neck lifts do create some discomfort initially due to the tightening of previously lax skin and soft tissue along the neck and lower face, but are generally not painful. Typically the discomfort will largely resolve within the first week as much of the swelling resolves, and most patients will be able to return to light exercise after two weeks.

Why are neck lifts so expensive?

The cost of a neck lift and face lift will depend on patient-specific factors such as baseline anatomy and aesthetic goals which determine the complexity and breadth of the surgery, and also on the experience and skill-level of the facial plastic surgeon.

Are you awake during neck lift surgery?

Neck lift surgery may be performed as an awake procedure under local anesthesia and sedation, or it can be performed under general anesthesia. For most patients, general anesthesia represents the safer and more comfortable treatment option, but some surgeons may be reluctant due to the more stringent requirements of a certified surgery center and the need for an anesthesiologist. Be sure to discuss the pros and cons of each with your surgeon to determine what time of anesthesia is best for you.

Can I tighten a saggy neck without surgery?

Yes! One of the marvels of modern medicine is the availability of nonsurgical skin tightening and nonsurgical neck lifting procedures to help address the signs of aging with minimal downtime and without any signs of surgery. Noninvasive and nonsurgical face lift involves the use of energy delivered to the deep layers of the skin and subcutaneous tissue to create tightening and re-organization of collagen and elastin. Some of the most effective devices in the market today include: Potenza, which uses RF (radiofrequency energy) delivered through an array of micro-needles, Ulthera, which uses high-frequency ultrasound, and OligioX, which relies on precise RF delivery to multiple layers of skin.

Nonsurgical Neck Lift with Potenza
Nonsurgical Neck Lift with Potenza

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What is a revision rhinoplasty?

Posted on April 19, 2024 by admin
Revision rhinoplasty with rib cartilage to create greater tip refinement and to eliminate a pollybeak deformity.
Before and After Revision rhinoplasty with rib cartilage with Dr. Donald B. Yoo to refine the nasal tip and to eliminate a pollybeak deformity.

Revision rhinoplasty is a nose job surgery performed in the setting of a previous, or multiple previous, rhinoplasty surgeries that have left a patient with aesthetic and/or functional issues. The aim of revision rhinoplasty and revision nose job surgery is to restore normal function while enhancing the shape and appearance of the nose.

Is revision rhinoplasty a good idea?

Appropriate candidacy for revision rhinoplasty or revision nose job surgery is best assessed by a rhinoplasty surgeon specializing in revision rhinoplasty surgery. The goals for a revision rhinoplasty must be congruent and attainable for a patient to be a good candidate for revision nose job surgery, which can only be determined after thorough evaluation and comprehensive consultation with an experienced revision rhinoplasty surgeon.

What is the success rate of revision rhinoplasty?

Multiple publlished stuides have attempted to determine the revision rate after rhinoplasty and revision rhinoplasty, and the revision rate typically ranges between 10%-20%. While the true number may be difficult to accurately ascertain, one thing is clear from these studies – the rate of dissatisfaction and desire for revision surgery is far higher for rhinoplasty and revision rhinoplasty than for the majority of other surgical procedures. This is partly due to the complexity of the operation itself, partly the expectations of highly motivated patients seeking elective cosmetic surgery, and partly the technical prowess of the surgeon performing the rhinoplasty. Paramount to success is careful patient selection by the surgeon, and careful surgeon selection by the patient, so that the patient’s expected idealized outcome is coherent with the rhinoplasty surgeon’s experience, technical abilities, and aesthetic eye.

Revision rhinoplasty with rib cartilage to straighten and symmetrize deviation and asymmetry caused by a previous rhinoplasty.
Before and after revision rhinoplasty with rib cartilage to create greater straightness and symmetry to the nose.

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