Narrowing the bottom of the nose A frequent complaint in my office is that “my nose is too wide at the bottom”. The patient frequently refers to the nostrils (or more correctly the “nasal ala”) and wants these narrowed. This is possible with alar base reduction techniques. The first step is to determine if this procedure is indicated. The nose may be out of proportion due to a low dorsum, or disproportion of the nostrils with the other surrounding structures. The patient may require a different procedure to balance the nose and make the bottom of the nose “fit” with the face. If it is determined that the alar base is too wide, the next step is to determine the best method to narrow the base. There are a variety of procedures to narrow the base. Many different incisions may be used to place an incision in a place where it will be inconspicuous. However, all incisions leave scars. It is not possible to make an incision without leaving a scar. The skill involves placing the incision so the scar will be least visible. Only the most experienced surgeons in rhinoplasty should consider this procedure. The results can seriously deform a nose and after completion this is a difficult problem to correct. Alar base complications with complaints from patients having had this done is one of the commonest problems I see in the office. If not completed by someone with experience in this area the results can be very unsatisfactory. Frequently I counsel patients not to have this done since the initial diagnosis is not correct. Often a better solution to the aesthetic challenge the patient is facing will give them a result they will be happy with. Patient coming to my office after having this procedure looking for a revision are often unhappy to hear that I cannot improve the appearance. They will have to live with the result. All patients should be very careful in seeking to narrow the width of the nose with alar base incisions.

5 things that a rhinoplasty can change Rhinoplasty is the reshaping of the nose. It is a complex procedure and results can be variable. Experience and knowledge play an important role in consistently good rhinoplasty results. What are the things that a rhinoplasty can reliably change on your nose? My nose is too big The perception that a nose is too big is often incorrect. It may just be that the proportions are not balanced. “Make my nose smaller” is a common presenting statement for a patient. A rhinoplasty can “make your nose smaller”. This usually means readjusting the proportions of the nose for better balance. I have a large hump on my nose Nasal aesthetic surgery can remove bumps on the top of the nose. Dorsal irregularities are common and can be reliably improved with rhinoplasty. The surgeon must be very careful in patients with thin skin to smooth out all underlying irregularities to remove any bumps My tip is too wide A wide or boxy tip can be refined with a rhinoplasty. There are many tip refinement techniques that a modern rhinoplasty surgeon can employ to narrow the tip. Over-narrowing must be avoided; this may create a collapse of the tip supports and lead to cosmetic deformity and nasal obstruction. I have a twisted nose A curve to the entire nose is not uncommon. This can result from previous surgery, previous trauma or a natural phenomenon. This is something that is very hard to correct. The surgeon must always warn the patient that the curve may be improved but not eliminated. The methods to correct this may involve placing tissue on top of the curve or breaking the bones of the nose to reshape them. My nose is blocked Cosmetic nasal surgery always has a functional component. Unless the surgeon is skilled at surgery to improve the nasal airway this may not be appreciated. A person may have no nasal problems, but a cosmetic nasal procedure may alter the nose in such a way that a nasal obstruction results. If the surgeon is not aware of the nasal anatomy, they will not take the necessary steps to avoid this common post-op problem. All nasal surgery should preserve nasal function, maintaining breathing.

Cosmetic plastic surgery is unique in the field of medicine. By definition, the procedure does not need to be performed, it is purely elective. This central tenet means that the safety, quality and results associated with the procedure are of the highest standards and all pain minimized. Another unique aspect of cosmetic plastic surgery is often underappreciated. For a patient to undergo a surgical procedure with significant cost and some pain involved, they must perceive some benefit. In the case of a patient undergoing a cancer operation the benefit is clear, the surgery will save your life. In the case of a patient undergoing a procedure to repair a broken nose, the surgery will allow the patient to breathe. In the case of a cosmetic patient the benefit of surgery is more abstract. Cosmetic surgical patients are willing to undergo the cost, pain and time involved for a procedure because they hope to feel better after the procedure. The patient hopes to undergo a change in their state of mind based on altering their physical appearance. This is similar to when a patient goes to the gym to exercise or begins a diet regimen. The cosmetic surgeon is using surgical tools to affect a psychological state. A state of well being, improved self esteem, and confidence can all occur from cosmetic surgery. However, because cosmetic surgery in its essence changes a state of psychological being, patient selection is important. Certain patients may have psychological challenges that make cosmetic surgery not the best choice to address these concerns. How can the patient identify if they are probably not suited for a cosmetic procedure. All human beings are imperfect. It is natural to want to improve a flaw, but we all understand that we cannot change everything, we cannot improve everything. If you are spending a great deal of time looking and thinking about a certain imperfection or body part flaw this is a sign to pay attention to. If this perceived imperfection is changing the way you dress to conceal the flaw or the way you live your life, this is a warning sign. Patients should be very careful to consider the impetus for the cosmetic surgery. The best cosmetic surgeon is not going to help you save a failing marriage or revitalize a flagging career. The patient and surgeon should be honest about what the surgery can, and more importantly cannot achieve. The best way to address your concerns is to visit the surgeon and freely express your doubts and fears. The experienced cosmetic surgeon will be able to determine if cosmetic surgery is right for you or whether you may be best helped by other interventions. The surgeon’s primary concern is your psychological well being, if that is improved by surgery or some other means the surgeon will happily refer you to the most appropriate person.

This term refers to surgery of the nasal tip. This region is comprised of the lower nasal cartilages, skin and the septal support. The precise surgery performed will vary with the goals and the specific patient anatomy. Surgery of the nasal tip can be performed under local anesthetic and intravenous sedation. However, the tip has a profound effect on the appearance of the nose and the final result of a rhinoplasty. My personal preference is to perform tip surgery under a general anesthetic in most cases to ensure placement of tissues in the precise position for optimal results. Frequently surgery of the nasal tip is performed as part of a full reshaping of the nose: a septorhinoplasty. This may also include breaking of the bones around the nose to complete the reshaping process. It is best to contact an experienced rhinoplasty surgeon to determine if surgery on the nasal tip is all that is required or if another procedure may be of benefit.

Mentoplasty or chin reshaping is a procedure to change the profile of the chin. This procedure may be frequently combined with a rhinoplasty (nose reshaping) to enhance the patient profile. In order to understand if you could benefit from such a procedure you need to understand some basics of the science of how your teeth fit together (dental occlusion). When a patient comes to the office seeking a change in the appearance of the chin, the first step is to assess how the teeth fit together. The chin may be understood as the front part of the mandible, which holds the teeth. If it is in very forward or very retruded position, the teeth may similarly be placed in an unfavorable position. Depending on how unfavorable and any other dental issues, this may need to be corrected. If the dental occlusion is satisfactory and a cosmetic change in the chin is all that is required a chin implant may be a very effective method to improve the appearance of the chin. An incision is made either under the chin or inside the mouth and an implant is placed. If dental occlusion needs to be corrected or more major facial skeletal procedures are indicated, the chin can be reshaped using techniques to break the jaw and reposition the mandible. This is a much bigger procedure than a chin implant with the potential for more serious complications. Procedures are also available to slice some of the chin anteriorly, reposition it, and hold it in a new position. Consider a chin implant if you feel your chin is retruded, weak or asymmetric. Visit a facial plastic surgeon with experience in this procedure. After a consultation you will be able to determine if this is the best procedure for you.

Rhinoplasty in patients of African, South Asian or East Asian origin Rhinoplasty or nose reshaping is widely regarded as one of the most complex cosmetic surgical procedures. The surgeon must have sound surgical skills, a detailed knowledge of anatomy, and a wide range of techniques to treat various deformities. In addition to all these skills, a sense of artistry is needed to combine everything into a balanced aesthetic nose. Balance. Harmony. Proportion. These are the fundamentals of good rhinoplasty surgery. The nose of a patient of African, South Asian, or East Asian origin poses unique challenges to gain a superior result. Many of the analytic tools used to assess a Caucasian nose are not always useful. Typically the alar width (base of the nose) is wider resulting in a different shape to the ala and a wider tip. The nasal dorsum may not be a high as a Caucasian nose. The skin is generally thicker, and different techniques may be necessary to effect changes in the shape of the nose. These are just a few of the differences that must be clearly understood by the surgeon to achieve a superior result. The surgeon must completely understand this type of rhinoplasty and how to use the inherent characteristics of that particular patient and shape of the nose to advantage. It is best to choose a surgeon with extensive experience with this type of rhinoplasty. If such a surgeon is not available in your community, it may be best to search for a surgeon with these skills. Asking the surgeon to show you some of his patient results is the easiest way to determine his experience with this type of complex surgery.

What is an otoplasty or ear reshaping, how is it done, is it effective Otoplasty refers to any procedure to reshape the ears. There are various techniques used to achieve this goal. An incision can be made behind the ear and sutures placed in the cartilage to reshape the ear. The cartilage can be incised or abraded to change the shape of the ear. This procedure is used for ears that are very prominent. The ear may be larger than normal but more often only appears prominent due to loss of some cartilage folding and a deeper central part of the ear (conchal bowl). An otoplasty reshapes the ear. It can be performed in a variety of methods ranging from incisions on the back of the ear to limited incisions in the front of the ear. Cartilage can be abraded, cut or sutured to recreate natural folds. The procedure may include a suture to decrease the distance from the ear to the side of the skull. It does not commonly result in major changes to the external canal which is responsible for allowing ear plugs or hearing aids to fit and any changes to the shape of the ear are unlikely to affect how headphones are worn. Ear reshaping is commonly performed on children around age four or five. This is a good time before classmates begin to notice the prominent ears which can lead to ridicule with the potential for psychological trauma. The procedure is also done on adults to correct similar deformities at any age. The procedure is usually very successful in repositioning the ear cartilage into a more favorable position and improving the aesthetic appearance of the ear. After surgery post op pain is usually mild, but not uncommon There are various techniques for the procedure of ear reshaping and it is best to discuss whether or not this procedure is right for you with the facial plastic surgeon.

Dermal cosmetic fillers have exploded in the field of cosmetic facial plastic surgery. Choosing the right filler and understanding the fillers is a complicated task, with new fillers arriving on the scene all the time.

How to choose a facial plastic surgeon Choosing a surgeon for facial plastic surgery can be a very difficult process. The internet has afforded the patient a myriad of choice to find a surgeon. However the patient is often confronted with an overwhelming amount of information. It may be difficult to filter conflicting reports and make a decision. A surgeon’s website may post a myriad of qualifications, beautiful before/after photos and great testimonials. These can all be misleading. How do I know what to believe and choose the best surgeon to perform my procedure? Word of mouth is one good place to start. If someone has had a procedure and been satisfied this is a good person to put on your list. If you have interacted with a surgeon and find that person fulfills your vision of a “good surgeon” this is also a good start. The appearance of a website is important in the sense that it should be professional. The most attractive website does not mean that the surgeon is the most suitable for you. Experience, training, integrity and a commitment to excellence are the most important qualities of the facial plastic surgeon. The most important and the most difficult to assess is a commitment to excellence. If the surgeon is dedicated to constant improvement, over time that surgeon will have consistently superior results. Integrity and honesty are important since not all surgeons do all procedures and it is important for a surgeon to state that they do not do something, and refer the patient to someone else. It is important to avoid a surgeon who will any and all cases. A good approach is to begin by comparing surgeons using characteristics of their practice that are hard to embellish or modify. How many years has the surgeon been in practice? This is easily searched from the governing body of the State (USA) or Province (Canada). Does the surgeon have any malpractice judgments against them? This may be available based on the laws in each State or Province. See if you can ascertain what procedures the surgeon is most skilled at performing. Do you know anyone who has had surgery from that surgeon? How did they find the experience? Remember that the surgeon may provide you a list of satisfied patients to contact, but this is a self selected list. Consider visiting a few surgeons, usually you will find one surgeon who you feel most comfortable with; this is the best surgeon for you. This does not mean they are the "best surgeon". The truth is there are many qualified surgeons skilled at performing the procedure you desire.