Working in Beverly Hills has given me the opportunity of operating on patients with various ethnicities. Though the majority of my patients are Caucasian, I still treat many who are Latino, African and Asian.
In most instances, their desire is to have features that more closely resemble the Western European ideals. However, one must be careful to preserve elements of the patient’s heritage so as to avoid a possible disharmony with the remaining features when performing a rhinoplasty surgery.
In general, one must approach each patient individually so as to determine how much of a change they desire. In the African and Asian patients, and to a lesser degree the Latino patients, the bridge usually needs to be augmented. This is most commonly accomplished using nasal septal, ear or rib cartilage which is diced and placed within a rolled covering of fascia taken from the temple. Although, in rare instances, a synthetic material like Gore-tex may be used. Also, because the skin in each of these ethnicities is usually thick, the nasal tip needs augmenting to produce a more projected, angular appearance. Once again, cartilage is used, in the form of a rigid strut placed between the nostrils. And finally, the nostrils have to be addressed. Though projecting the nasal tip may bring the nostrils in slightly, an additional procedure such as excising tissue or narrowing with cinching sutures may be needed.
In contrast to the more common cosmetic rhinoplasty , which aims to improve the appearance of one’s nose, the reconstructive rhinoplasty attempts to restore it to a more normal or natural appearance.
It is a procedure which usually follows severe nasal trauma or surgery for nasal cancer. The aim of such surgery is to establish a nose which will appear relatively normal and not draw attention to itself. In many instances, the final product does not resemble the nose the patient had prior to his trauma or cancer surgery. However, most patients are accepting of this rather than be self-conscious with a severe deformity in the middle of their face.
The surgery aims to establish the appearance of a normal nose with normal airways. To this end, the underlying structures need not resemble the normal anatomy as long as the external appearance of the nose appears normal. Cartilaginous and ,occasionally, bony grafts are placed for support and form with external coverage using free grafts and/or flaps.
The eyes are the first feature we see when we meet someone, and there is much to be learned from them. We can think that the person is tired, evasive, dishonest, energetic, sad, intense or even captivating just by looking into their eyes. So it is to one’s advantage to have good-looking eyes.
To this end, we like to see smooth skin without wrinkles or puffiness for both the upper and lower eyelids. There should be a crisp crease between the upper eyelashes and eyebrow, and the eyebrow should have a nice smooth arch about ½ inch above the bony rim. Obviously, allergies or any other inflammatory condition that affects the whites of the eyes would detract from an otherwise positive impression and should be corrected.
Generally, we like the outside corner of the eye to be slightly higher than the inside corner. The highpoint of the brow arch is most pleasing if it is somewhere between this outside corner and the iris or colored portion of the eye. Also, the eyebrow should start and end at the same horizontal level. We also like to see the distance between the two eyes approximately equal to one eye width.
Though many of us are born with naturally beautiful eyes, much can be accomplished with the appropriate use of make-up and the appropriate surgical procedure(s), if indicated.
The term “rhinoplasty” comes from Greek terminology. “Rhino” means “nose” and “plasty” means “to change”. Though most approaches to accomplish this end are surgical, there are some instances where a quicker, non-surgical method can be employed. The use of Radiesse is one such approach. Radiesse is a cosmetic dermal filler made of calcium-based microspheres suspended in a natural gel. It can be injected to create a bridge, lessen the prominence of a bump, fill in dents and depressions, help improve slight asymmetries and improve the angularity and aesthetics of the nasal tip. It lasts approximately 12-18 months and is performed while the patient is totally awake, which allows the patient some input as the procedure is progressing.