Rhinoplasty is a popular cosmetic surgical procedure used to improve appearance of the nose.
One may not like the size and shape of nose.
Modern surgical advances enable us to reshape the nose to make it look more pleasing thereby dramatically transforming facial features.
Being most prominent part of the face the nose has enormous aesthetic importance. There is huge ethnic, racial, regional difference and significance to its shape and size. Important determinant is the patient’s desire.
Broadly rhinoplasty can cover all problems related to nasal shape.
A large nose can be reduced in size; a small nose can be made bigger while the length and height of the nose can be adjusted to make you look good.
Rhinoplasty can also correct many functional breathing problems.
Any complaints about your breathing need to be discussed with your surgeon as many of them can be corrected in Rhinoplasty.
This is a procedure performed to reduce the size of the nose.
It may include reducing the height, removing a hump on the bridge or reducing the size of the nose tip and the width of the nasal bridge. These techniques alone or in combination can be performed to give a pleasing appearance.
The nose may be large, crooked, thick skinned and beaked and distorted in many forms; it is possible to get a better shape and size.
- The nose can be depressed and augmentation of nasal dorsum is one of the commonest requests.
- A variety of materials can be used to increase the height of the nose and fill up the depression.
- The best material for augmentation is autograft (your own body tissue) but it may require additional surgery.
- Bone or cartilage either from nasal septum, the ribs or the ear is used as filler.
- Silicone implants, Porex, and other synthetic substances are also used for this purpose.
- Fat Grafting & Fillers
a. Fat Grafting
- Fat grafting is a cosmetic surgery procedure wherein fat from one area of the body is transferred into another.
- With aging, parts of body begin to lose volume and other parts begin to accumulate it.
- Typically, areas like buttocks, thighs, lower abdomen have excess fat, while face loses it.
- Skin can be imagined as a cover or as an envelope, containing muscle and underlying fat.
- With aging, these contents thin out; the envelope becomes empty, resulting in sagging of the skin (typically the face) and wrinkling.
- We can restore a more youthful and attractive appearance by restoring fat in these areas.
Procedure involves harvesting fat from the ‘donor’ part of the body with a syringe and cannula. These fat cells are then processed and are injected beneath the skin into the target area.
The results of fat grafting / fillers are completely visible within a week or so.
The fat is preferably harvested from the abdomen, thighs and buttocks. The fat in these areas does not reduce significantly even after exercise. This kind of fat is therefore ideal for harvesting and transferring to another part of the body that needs it. Consequently, the results of fat grafting last for a longer duration.
Fat grafting is relatively safe, as it utilizes fat from your body.
Fat grafting is a good choice:
- To improve facial areas that appear wrinkled and sunken
- To improve body contour and revise scars
- For breast reconstruction, to fill in contour irregularities or hide obvious signs of breast implants
The benefits of fat grafting:
- No allergic reaction own, natural body fat is used
- Long lasting results
- Safe and cost effective
Downside of fat grafting-
One of the main possible downside of fat grafting is that the body absorbs at least some amount of injected fat. It cannot be predicted exactly how much fat will be absorbed. Therefore, it is a little difficult to predict the end result.
b. Fillers (Juvederm)
Fillers are used to replenish the hyaluronic acid that is lost with aging.
Once the skin starts losing the acid, its ability to stay moist and supple is decreased.
So, the skin loses its youthful glow and develops folds.
Juvederm is an injectable gel which contains hyaluronic acid that can restore the skin’s volume to smooth away facial wrinkles and folds.
It is especially useful for the wrinkles / folds around the mouth and forehead. Juvederm is thus filler that helps the skin in achieving a smooth and natural look.
The age of painful fillers is over.
- Long lasting results that stay upto 24 months with one single treatment.
- Minimal discomfort.
- Smooth and natural looking results.
- Ideal projection and lifting.
3. Lip Augmentation
Some people have very thin lips with no definition. Cause may be genetics, aging or smoking. Tissue deflates with aging and definition is lost over the years. Well defined, fuller lips which are smooth and wrinkle-free denote youthful appearance. Lip augmentation makes the lips fuller, plumper and reduces fine wrinkles that gather round the mouth. Lips are either injected with collagen or fat or Hyaluronic acid.
The collagen; a protein present in connecting tissues, the fat and hyaluronic acid are easily absorbed thereby having temporary effect and thus need a repeat treatment.
Fat and collagen injections are meant for those patients who find the idea of full lips appealing but don’t want to commit to it.
However, there are other options wherein are repeat treatments not required. For example, autologous dermis fat graft. Autologous dermis fat graft is easily accepted by the body because it is own tissue.
Normally, they have a pliable, natural feel. Implants are inserted by making tiny incisions inside the corners of the mouth.
Once it is in place it integrates with the natural tissues.
The filler is injected and implanted in the lips. Normally, 1 cc of filler is adequate for single lip to produce the desired outcome. Procedure requires 15 minutes. It is a quick and safe procedure with immediate results. However, it may be a temporary result depending on the type material used. So, injections may be needed to be repeated periodically.
- After the procedure is complete the recovery period is quite short.
- The patient can immediately return to daily activities or after a period of 24 hours in case the patient was put in a sedated condition.
- But this depends on the procedure and the materials used. For example, in case of surgical procedures the recovery period extends to a week.
4. Lip Reduction
Many people believe that their lips are too big/thick, and want them reduced.
Many younger patients are often conscious about having larger than average lips and are sometimes teased by their classmates.
Ethnically Indian population has lower lip larger than upper lip. Many people may not be happy with this trait.
- What Is Lip Reduction?
- Lip Reduction is the procedure to remove excess lip tissue to reduce the appearance of overly large lips. The procedure is performed under local anesthesia. The procedure takes only about 30 to 45 minutes and takes about one week to heal. Swelling can be an issue for 3 -6 weeks. This procedure really isn’t incredibly invasive but there are risks and complications.
- Procedure –
- Lip/Lips are marked and photographed. Once inside operation theatre, local anesthesia is administered and wedge shaped tissue and strip of vermilion (dry skin) is removed to give better shape and optimum size. Wound is sutured with absorbable material which gets absorbed within few days.
- Some swelling, bruising & pain will persist for 3-4 days. Medications for relief of pain and swelling are advised for 3-4 days.
- Cold Liquid/fruit juice/ milk is recommended for 2-4 days
- Every surgery has risks and complications. Apart from possible allergic reaction to the anesthetic used and infection, there is a chance of asymmetry, hematoma, and cyst formation.
- Numbness if any should usually subside within the first few weeks.
05. Chin Remodeling
A well defined chin helps give balance to the face and creates a major part of one’s profile.
But even though few examine their chins with the same discerning eye, having a weak chin is certainly not an asset.
Chin augmentation simply means a procedure to make the chin more prominent.
It provides balance to an otherwise less defined face or further augments existing chin structure. Surgery can be done along with other facial cosmetic surgery to achieve facial proportion.
Surgery can be done for reconstruction for birth defects and trauma deformity.
Now a days, surgery is done more and more for aesthetic reasons.
Surgery enhances a person’s chin or creates symmetry within the facial structure so as to transform face into a more aesthetically pleasing shape.
Like all cosmetic surgery procedures, goal should be realistic; typically to correct a lacking chin.
They are normally made from hard Silicone, expanded poly-tetrafluoroethylene (ePTFE), rigid polyethylene, hydroxyapatite/hydroxylapatite andMersilene mesh.
Solid implants can be fixed with screws to prevent shifting of the implant post-operatively.
The (ePTFE) implants are designed to be porous so that the tissues can attach themselves to the implant to prevent shifting.
Surgery can be performed under General anesthesia or local anesthesia with sedation. This procedure takes from 1 to 1 and 1/2 hours to perform. Incisions are placed as inconspicuously as possible. For chin implants the incision can either below the chin or inside mouth. Pocket of adequate size is created and implant inserted and fixed with screws.
Expect mild pain for 2-3 days.
Swelling and bruising may persist for 7-10 days and dissipates gradually after the first two weeks. Some amount of numbness may be experienced, which generally disappears within 1 to 3 months.
Many patients return to work within a week.
The sutures, if any, will be removed in approximately 3 to 5 days. Optimum result is evident as swelling subsides completely.
Risks/ complications –
- Hematoma (blood clots),
- Numbness from nerve damage and
- Hyperpigmentation (discolorations of skin) caused by the bruising
- Infection and implant exposure – implant removal may be needed
- Risk of implant shifting may need additional surgery to reposition the implant
Chance of asymmetry from tissues healing differently
There is the chance of your disapproval which may result in a re-do or removal
On similar principles, remodeling can also be done for
Nasolabial folds and nasal base
Tear trough deformity below eyes
06. Blepharoplasty & Browplasty
The procedure to modify eyelid is known as blepharoplasty.
Blepharoplasty reduces fat and removes excess skin and muscle from the upper and lower eyelids.
If the eyebrows are droopy, blepharoplasty alone will not correct deformity. Additional procedure of browlift will produce the best result.
Like any other cosmetic procedures, blepharoplasty can enhance appearance and self-confidence, but it won’t necessarily change your looks to match your ideal. It is very important to have realistic expectations.
Most patients are 35 or older, but if droopy, baggy eyelids are familial, surgery can be sought at younger age.
A blepharoplasty is a very individualized procedure.
Initial consultation is all about evaluation of face, including the skin and underlying bone, eyebrow position, frown muscles and hairline. Plan is formulated, discussed and agreed upon. Investigations for well being and anesthesia fitness are done.
Most eyelid procedures are performed under local anesthesia supplemented with sedation.
A surgery usually takes 2-3 hours, but the time required may vary considerably depending on the amount of work being done.
Incisions are made eyelid creases for upper lids and just below the lashes for the lower lids.
Extra, sagging tissue is removed and the incisions are then closed with very fine sutures.
Discharge can be processed after 3-4 hours of monitoring after the procedure.
There may be a little discomfort for 2-3 days. Swelling around the eyes may last for 7-10 days. Most patients are seen in 3-5 days post-op for suture removal. Do not expect to look or feel great right after surgery.
You are going to look much worse for several days. Regular activities can be resumed within a week. Lids heal quickly.
The scars are usually fine lines hidden in skin creases and rarely a cause for concern.
Expected results –
The goal of blepharoplasty is a more alert and youthful look. For many people, the results are long lasting.
Browplasty (Forehead Lift /Brow Lift)
A forehead lift is performed to treat changes associated with aging. Young adults who have a low brow or who already have deep frown lines due to stress or over activity of muscles may benefit from the Forehead Lift procedure.
Sagging or low position of the eyebrows, creating a tired or sad appearance
Deep horizontal creases across the forehead
Frown lines, or furrows, between the eyebrows and sometimes across the top of the nose
Incisions are usually placed in the hair-bearing scalp. Skin is undermined to required extent and the deeper layers of the forehead are ‘lifted’. The skin and deeper layers are then ‘fixed’ or attached to the bone.
07. Face Lift
Face lift is a surgical procedure performed to improve the looks of an aging face. It consists of lifting and relocating tissues of the face to their youthful position.
Skin laxity, deep folds on the face, jowls, marionette lines, hooded eyelids, drooping eyebrows, wrinkled neck with vertical bands can be corrected at once by means of surgery by surgery called a Face lift.
It is highly recommended to stop smoking well in advance of the surgery. Certain medications that increase the risk of bleeding such as Aspirin, non-steroidal anti-inflammatory medications, and some vitamins/homeopathic regimens should be discontinued prior to surgery.
The procedure is commonly performed under General anaesthesia
A well placed incision is taken in the hairline and in the skin fold going back behind the ear.
Excess lax skin of the face is removed.
The deep tissues like the SMAS and the fat pads are relocated and fixed in their proper position.
The wrinkled, dark skin of the eyelids is trimmed. The eye bags in the lower lid are corrected.
The eyebrows are lifted up.
The scars are very well concealed.
The procedure can take upto two to three hours to complete. Precise meticulous repair is carried out.
The fatty neck, double chin and neck folds are all addressed at the same time.
For Men and Women the procedure will vary to take care of beard area or the side burns.
You can be discharged the same evening. If the procedure is extensive, overnight stay may be required. Expect swollen, puffy, bruised face for upto a week to ten days. The swelling is maximum on second or third day and decreases rapidly. Ice packs are applied on the face to control swelling and bruising. Facial movements including chewing may be difficult for a week or so. Some pain, more like discomfort is expected. Sleeping with head elevated position will help control the edema.
First follow up visit is scheduled on 3rd day and all dressings are taken off. The drains if any are removed. Shower and head bath can be taken after this visit. The stitches may require removal and it will be done at eight to ten days. The sensation on some skin areas may be decreased or absent. Sensations generally improve over next few weeks.
The scars mature over a year and may look red for a while.
Avoidance of factors that could reduce the benefits of the surgery, such as excessive unprotected sun exposure and cigarette use is very important.
08. Dimple Creation
Dimple on Cheek/Chin
More & more young females & males are requesting for creation of dimple on face to enhance the looks and beauty.
Location, number & size of dimple can be decided as per patient’s choice.
Once aesthetic attributes are decided to patient’s satisfaction, patient must understand the procedure, its benefits risks.
Dimple surgery is Day care procedure done under local anesthesia. After marking and administration of anesthesia, small incision is give on cheek mucosa. Cuff of muscle and fat is scraped off. A double suture of nylon is put through skin and mucosa to develop dimple and tied over bolsters which remain in place for 1 week.
Post procedure –
Except some bruising and swelling for 2-3 days.
Ice packs can be used for 2-3 days for swelling. Patient can resume normal diet.
Excessive facial animation is advised to expedite resolution of edema.
Dimple will appear at rest & in animation for 6 to 8 weeks,then gradually disappear and only present itself thereafter naturally during facial expression.
- Persistent swelling
- Abscess formation because foreign body reaction to knot of suturing material and scarring
- Knot may not work & dimple disappears, can be corrected surgically.
- Very rarely, Facial nerve weakness or paralysis
09. Ear lobe Repair
The ear lobe has a special importance among facial structures as it is a common practice in many parts of the world to pierce it in order to wear ear rings.
The ear lobe consists of only skin and fat and no cartilage.
Hence, it is easy to perforate an ear lobe.
Few ear lobe tears may heal with time, but most require repair. Ear lobe repair is needed due to tears caused by wearing heavy ear rings or other such jewellery for long periods.
In some cases, it may be because of someone (mostly a child) tugging on the earlobe / ear ring.
Earlobe tears can be partial, multiple or complete tears.
Mostly, earlobe tears are repaired under local anesthesia. Sometimes, a second procedure may be needed to correct the defect.
Complications after earlobe repair include keloids, hypo/hyper pigmentation and suture dehiscence in some individuals.
10. Scar Revision
Scars are marks of injury and once formed will remain forever.
Scars are formed as a result of deep injury to the skin, either due to accident or because of surgery.
It is important to understand there are either good looking scars or bad looking scars.
Healing of scars can be affected by preexisting conditions like diabetes, systemic diseases or a predisposition to hypertrophic scars or keloids.
There are many options available to treat scars. Even if scars don’t disappear completely ugly appearance of scars can be minimized.
Options for the treatment of scars include injectible fillers, light and laser therapy, chemical peels dermabrasion and surgical revision.
Deeper scars usually can be treated only by surgery.
Method of choice for the scar treatment depends on the severity of the scar, location of the scar and the age of the patient.
Scar revision surgery, LASERs and topical creams play a very important role in improving the overall appearance and quality of the scars.
Scars mature over time and it is important to have patience.
Scars can dramatically improve over a period of six to twelve months.