Non Surgical Rhinoplasty | Before + After | Nose Job

Posted on July 14, 2014 by Donald B. Yoo, M.D.
Before + After non-surgical rhinoplasty for softening and straightening profile.

Before + After non-surgical rhinoplasty for softening and straightening profile and dorsal hump.

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I’m really puffy below my eyes and I have deep tear troughs. Will lower eyelid surgery correct this?

Posted on March 19, 2014 by Donald B. Yoo, M.D.

Most commonly the puffiness under the eyes is a result of a forward outpouching (pseudoherniation) of the fat that surrounds your eye.  Normally this fat is contained around the eye (where it’s hidden) by a thin structure called the orbital septum.  It acts very much like a sheet holding the fat back.  As we age, this septum becomes thinner and weakens, allowing the fat to “pooch” forward.

In addition to the bags, with aging and gravitational changes, the volume of your cheeks and midface is being reduced and pulled downward.  This downward descent of the midface structures leaves a deficiency or hollowing under the eyes, resulting in a “tear trough” (nasojugal groove).

A lower eyelid surgery called lower blepharoplasty with fat repositioning is available to help combat these issues.  Lower blepharoplasty is performed through a hidden incision on the inner surface of your eyelid.  Through this incision the fat that is “pooching” is mobilized and moved to an area where it is useful – the tear trough, where there is volume deficiency.  This serves to move fat away from an area of excess and fill the area of deficit, smoothing the contour between the lower eyelid and the cheek.

Before and after lower blepharoplasty with fat repositioning.

Before and after lower blepharoplasty with fat repositioning.

Some bruising and swelling is expected after surgery, but most patients are out and about in 10-14 days.  Pain and discomfort is generally mild after surgery.

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On a few of my rhinoplasty consultations the surgeons mentioned a chin implant. Will it make me look weird?

Posted on March 14, 2014 by Donald B. Yoo, M.D.

Since it is located in the center of the face, the nose plays a crucial role in facial proportions.  An unbalanced nose can distort the perception of balance for the entire face, even when the other facial features are aesthetically pleasing.  Though it plays less of a role than the nose, the chin also plays an important part in determining facial harmony, especially from the profile view.

From the profile, a small chin gives the illusion that the nose is large and over-projected (pushed too far from the face) since the chin is “set back” relative to the nose.  A small chin can also cause the nose to appear too “long”.  There are 2 potential solutions for this during rhinoplasty surgery.  One is to account for the appearance of the nose in relation to the small chin, by reducing the size of the nose to match the chin.  For mild microgenia (small chin), this is a viable option.  For more significant chin disproportion, the more ideal option is to address the nose and chin, to harmonize the entire face.  Especially from the profile, this combination of procedures can deliver dramatic results.

When performed conservatively by an experienced surgeon, chin augmentation looks completely natural and undetectable besides a small incision hidden below the chin.

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How can nonsurgical rhinoplasty get rid of a dorsal hump?

Posted on February 28, 2014 by Donald B. Yoo, M.D.

Nonsurgical rhinoplasty is performed by using a dermal filler to augment or “build up” the nose.  Since volume and height can only be added, it can not actually remove a dorsal hump (bump on the bridge of your nose), but depending on how it is injected it can lessen the appearance of the hump.

The area of the bridge above the hump, connecting to the forehead, is referred to as the “radix”.  Sometimes this area is too low, causing the hump to look even larger than it really is.  When the area is augmented (built up and made higher), the result is a straighter profile and the appearance that the hump has been removed.  This does result in an overall taller and more projected nose, so it works best for patients with a deep, or low radix.

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What can I expect during my recovery after rhinoplasty?

Posted on February 5, 2014 by Donald B. Yoo, M.D.

Rhinoplasty, or a “nose job” as it is more commonly known, is one of the most frequently performed cosmetic surgery procedures today. If you are considering undergoing rhinoplasty it is important to consider all aspects of the procedure, including what you can expect during your immediate recovery period so you can make an informed decision.

In general, after rhinoplasty you can expect to experience some throbbing pain and headaches. Most patients who have undergone rhinoplasty only require a couple of days of a narcotic for pain relief. After that, most report that over-the-counter pain relievers such as Tylenol are more than sufficient to relieve their discomfort. The majority of patients are pleasantly surprised how the level of discomfort is less than expected. Most bruising and swelling will resolve within 7-10 days after surgery, and the majority of patients will take 10-14 days off from work or school.

The most uncomfortable aspect of the recovery is probably not being able to breathe through your nose during the first week after surgery. This is due to swelling from the surgery itself, and sometimes from small silicone splints that Dr. Yoo places inside the nose to aid the healing process.  Nose blowing should be avoided for the first two weeks, and instead nasal saline irrigation and sprays should be used to help keep the inside of the nose moist and clean.  As the swelling resolves, your breathing will be dramatically improved compared to before surgery.

Dr. Yoo sees patients the day after surgery, then one week after surgery.  At the one week post-op visit, the cast and sutures are removed and a light, nude colored tape is applied.  Light cardio exercise may resume 2 weeks after surgery, and full workouts may resume 4 weeks after surgery.

About 3-6 months after your surgery the vast majority of the swelling (60-80%) will have resolved, though your nose may still feel a bit numb.  Healing will continue for a full year after surgery, and up to two years after revision surgery.  Many patients enjoy seeing the subtle changes their noses undergo during the healing process as they reach their final aesthetic result.

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Why are silicone implants so popular in Asian rhinoplasty? Are there any downsides?

Posted on November 19, 2013 by Donald B. Yoo, M.D.

Common goals in Asian rhinoplasty include augmenting the dorsum (building the bridge), projecting and refining the tip (making the tip smaller and taller), and narrowing the nose. A variety of different techniques have been described to augment the dorsum, including using synthetic materials such as silicone or Gore-tex, and using autologous materials (from your own body) such as rib cartilage and diced cartilage wrapped in fascia (DCF).

Asian Rhinoplasty

Figure. 1

Silicone nasal implants have become a popular choice for dorsal augmentation because they are pre-formed in a variety of different shapes and sizes and are easy to place, thus greatly reducing operating time and complexity. Immediate results are also quite good, especially in patients with thicker skin such as Asians. Although Asian rhinoplasty with silastic implants is quicker and easier than surgery with autologous grafts (your own tissue), it does come with a number of downsides. Silicone implants never become incorporated into your nose and always remains as a foreign body. Thus, there is always a risk of migration, infection and extrusion. Even if an implant has been safely in place for ten years, there is still a chance for the implant to move out of position, or even thin out the skin to the point of poking through the skin (see Figure 1).

Dorsal augmentation with autologous grafts is a more technically challenging and far more time consuming surgery, but the results are natural, safer and permanent. Beverly Hills facial plastic surgeon Dr. Donald Yoo specializes in Asian rhinoplasty using autologous grafts because it provides the best possible aesthetic and functional outcomes. He is amongst a small, elite group of surgeons worldwide with extensive experience in using rib cartilage for Asian rhinoplasty. Instead of using a pre-formed silicone implant, harvested rib cartilage is finely diced and wrapped in fascia harvested from a hidden incision in the hairline (see Figure 2). This implant is custom tailored to provide the precise augmentation and bridge shape desired.

Silicone Implant for Asian Nose Job

Figure. 2 Removed silicone implant. Below: Custom-made diced-cartilage fascia (DCF) implant.

Unlike the silicone implants, diced-cartilage fascia (DCF) implants become fully incorporated into your nose so that it simply becomes a part of you. In addition, the DCF provides a very natural, aesthetically pleasing contour, unlike the very sharp and artificial edges of silicone implants. The result is a more beautiful you.

Before and After augmentation Asian rhinoplasty with DCF (diced cartilage fascia) and rib cartilage harvest.

Before and After augmentation Asian rhinoplasty with DCF (diced cartilage fascia) and rib cartilage harvest.

 

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What can you do to make surgical scars invisible?

Posted on December 21, 2012 by Donald B. Yoo, M.D.

Every surgery leaves scars, but the goal with any type of aesthetic surgery is to minimize the appearance of scars as much as possible.   The best way to minimize scarring is to avoid creating an unsightly scar to begin with.  Meticulous technique is essential, as it will provide the best chance of a scar to heal well.  Paramount to a successful closure is avoiding tension along the incision line, perfect approximation and careful eversion of skin edges.  Skin edges tend to pull apart as wounds heal and contract and if there is any tension on the wound a wide, unsightly scar results.

Proper technique is always important but most critical when an incision cannot be hidden and is in a highly visible place, such as with a male facelift patient who has experienced hair loss.  There are also instances where we can hide scars. For example, with a chin implant, the implant is typically placed through an incision through a natural skin wrinkle or skin crease located beneath the chin.  That way the resultant scar “hides” within this crease.  Hiding certain facelift scars is possible as well, as some incisions can be placed along the hairline and behind the ears.

Aside from good surgical technique to minimize the appearance of scars, proper wound care is important as scars mature.  Keeping the incision area clean while healing is important as well, along with avoiding any strenuous exercise that may create tension in the incision area.  Sun protection with sunscreen of SPF 30 or higher is vital, as sun exposure will result in hyperpigmentation (darkening of the scar).   Close follow-up is important because even if you care for a wound perfectly, a scar may still form.  Scar formation can be modulated during the healing period using injections of a dilute steroid and 5-fluourouracil, as well as with laser treatments (pulsed-dye laser, fractional resurfacing laser).

Overall, there are many measures that can be taken both during and after surgery to minimize the appearance of scarring and leave the patient with a fantastic result.

Plastic Surgery Procedures

 

 

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What is fractional laser skin resurfacing?

Posted on December 19, 2012 by Donald B. Yoo, M.D.

For years lasers have been used to improve wrinkles, stretch marks, acne, surgical scars, uneven skin tone, and other skin conditions.  Lasers are well-suited to treat specific conditions because of their precision.  In the dark ages of laser resurfacing (1990s) the entire skin surface was ablated (removed) leaving a very large, raw surface area.  Undergoing laser resurfacing was a major ordeal, involving lots of preparation time for adequate pain control, and a prolonged recovery afterwards as the skin healed back over raw areas.

Enter fractional resurfacing technology.  Instead of removing the entire skin surface, columns of laser light in a honeycomb pattern treat 20-30% of the skin surface at a time.  These laser microbeams create areas of treated tissue surrounded by untreated tissue, allowing the skin to recover much more quickly and minimizing the downtime.    Side effects are minimized while healing and aesthetic outcomes are maximized.

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My surgeon recommended “fat grafting” to me. What does it involve and how long does it last?

Posted on December 17, 2012 by Donald B. Yoo, M.D.

Fat grafting or fat transfer has become a very popular stand-alone and adjunctive procedure in aesthetic plastic surgery.  The premise of fat grafting is to use your own body’s tissue as a volumetric filler instead of a synthetic material.  Besides eliminating the chance of any foreign body or allergic reaction, since it is your own tissue, fat has the added advantage of providing a longer-lasting, potentially permanent result.

Fat is first harvested by performing conservative liposuction to the abdomen, or flanks.  The technique used during harvest and fat preparation is critical to ensure the highest concentration of stem cells.  These stem cells are responsible for growing in the grafted areas and maintaining a long-lasting result.  I use the Adivive Lipokit system, which harvests at low pressure so as not to disrupt the fat cells, and filters and prepares fat to achieve high stem cell concentrations.

Once the fat is harvested and prepared, fat grafting and transfer is performed using a cannula.  Fat is commonly grafted to restore volume in the tear troughs, cheeks, smile lines (nasolabial folds), temples, brows, and around the eyes (peri-orbit).  In Asian and Korean plastic surgery patients, a common treatment area is also the forehead, to create a more rounded rather than flat appearance.

Approximately 30-50% of the initial volume remains as a lasting result.  Discomfort after the procedure is minimal, and bruising and swelling typically resolve within a week.

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Why is the revision rate so high for rhinoplasty?

Posted on December 12, 2012 by Donald B. Yoo, M.D.

In a recently published study, rhinoplasty surgeons across the country were surveryed on their rates of revision rhinoplasty.  That number is ~20%, meaning about 1 in 5 patients undergoing a primary rhinoplasty will undergo a revision surgery.  There are a number of possible reasons for revision rhinoplasty surgery.

Rhinoplasty is commonly called the most challenging procedure in all of surgery.  And while it can be a technically demanding procedure at times, the need to balance the forces of healing and the patient’s aesthetic goals with what is surgically achievable increases the difficulty level many-fold.  A fantastic result on the table will not always heal in predictable ways.

Besides unintended results, revision rhinoplasty can occur when there is a disconnect between the patient’s aesthetic and that of the surgeon.  In his/her eye, a surgeon may have performed an impeccable surgery and delivered a nose that is pleasing to him/her, but far from what you consider ideal.  Reviewing photo-imaging and photo-morphing with your surgeon prior to surgery is an excellent way to communicate your goals and to ensure you two are on the same page.  Looking at a surgeon’s before and after pictures is another great way to get a sense of your surgeon’s aesthetic.

Lastly, having realistic goals and expectations about surgery is critical before any procedure and especially for rhinoplasty.  Rhinoplasty is not about perfection, but about improvement.

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