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Dr. Denton's Plastic Surgery Blog for Vancouver BC
 

Tip Refinement and Deprojection During Rhinoplasty

These three sets of photographs show before and after images of a patient that underwent open septorhinoplasty to address several concerns she had regarding the appearance of her nose.  Specifically, she was unhappy with the appearance of the tip from all angles (boxy, over projected and long) and the height and irregularity of the bridge.  Thin skin also added further challenges to this case.

During open septorhinoplasty the bridge of the nose was reduced to give the nose a more feminine profile.  The tip was modified to make it more triangular and refined.  As is the case with any rhinoplasty I perform, as little cartilage and bone is removed as possible thereby maintaining the structural integrity of the nose.

Before & After Tip Refinement & Deprojection of the nose - Front View

Before and After Rhinoplasty*

Before & After Tip Refinement & Deprojection of the nose - Front View

Before and After Rhinoplasty*

Before & After Tip Refinement & Deprojection of the nose - Front View

Before and After Rhinoplasty*

Revision Rhinoplasty to Remove and Repair Damage from Silastic Nasal Implant

Nasal augmentation – essentially making the nose larger – may be indicated if the bridge of the nose is too low or the tip of the nose too short.  Generally, this is more common during Asian and African American rhinoplasty.  In many parts of the world, the augmentation is achieved by using a silicone or silastic implant.  These implants are inexpensive and readily available in a wide range of shapes and sizes.  They can be inserted quickly with immediate and often pleasing results.  So what’s the downside?  There are several as it turns out, however, the main issues with these implants is that over time, the implant can shift and distort the nose.  Also, if the implant chosen was too large to begin with, or the patient’s skin too fragile,  the implant can actually work its way through the skin of the tip of the nose.

When performing augmentation rhinoplasty, my preference is to use the patients own cartilage  where at all possible.   If a synthetic/man-made implant is required to augment the bridge of the nose, I prefer a custom carved ePTFE (Goretex) implant that is specifically designed for each individual patient.  At no time should the synthetic implant be allowed to contact directly the undersurface of the nasal tip skin.  The result is a long lasting and safe nasal augmentation.

Before & After Revision Rhinoplasty Nasal Augmentation - Front View

Before and After Revision Rhinoplasty*

Before & After Revision Rhinoplasty Nasal Augmentation - Side View

Before and After Revision Rhinoplasty*

Before & After Revision Rhinoplasty Nasal Augmentation - Underneath View

Before and After Revision Rhinoplasty*

Before and After Rhinoplasty – 5 year follow up

Before & After | 5 year follow up | Closed Rhinoplasty | Side View Before & After | 5 year follow up | Closed Rhinoplasty | Front View Before & After | 5 year follow up | Closed Rhinoplasty | Lateral View

Above are three sets of before and after photographs of a patient who underwent closed septorhinoplasty surgery 5 years ago*. Even though the closed rhinoplasty technique is not commonly used in my practice (mainly because the open approach provides superior access and control to the various nasal structures that require modification during complex rhinoplasty cases) this is an example of a great and long lasting result from a closed rhinoplasty.

In this case the objectives were to straighten the nose, narrow the tip, deproject the tip and rotate the tip – all of which were met nicely in this case. The one main advantage of closed rhinoplasty over the open approach is that the closed approach avoids the transcolumellar incision at the bottom of the nose. However, in my experience this is rarely if ever an issue.

Healing time generally is comparable between the two. Most patients will require 7-10 days off of work or school and two weeks off of the gym or other significant exercise.

Synergistic rhinoplasty with chin augmentation

Cosmetic nasal surgery – otherwise known as rhinoplasty – is the most popular procedure in my practice. Although the nose is a central feature of the face, it should not be a focal point of the face. Rather, it should lead the observers into the individual’s eyes, lips and smile. In other words, after a successfully performed rhinoplasty, the nose should actually draw less attention to itself than it did prior to the procedure. The key to this is balance among all of the facial features. When considering changes to the appearance of the nose it is critical to consider all of the other features of the face so that an optimal balance is achieved. In rhinoplasty, one of the most important related areas to consider is the chin. In this case, the patient had a prominent nose with an over projected and under rotated tip. The tip was full and asymmetric. Open rhinoplasty was performed to adjust these features. However, during the consultation, other features were recognized to be out of the balance. As a result a chin augmentation was performed concurrently. These procedures are considered synergistic – in other words they are together greater than the sum of the parts. The importance of chin augmentation combined with reduction rhinoplasty will be discussed in the next post.

For questions or to book a consultation, please contact us.

rhinoplasty with balancing chin augmentation

Left view of patient’s before and after profile*

rhinoplasty with balancing chin augmentation

Front view of patient before and after surgery*

Before and After Open Rhinoplasty

The following is a series of three before and after photos of an open rhinoplasty procedure completed for a patient in our Vancouver plastic surgery clinic. The “after” photos were taken one year following the open rhinoplasty plastic surgery.

The goal of the rhinoplasty was to make the nose more feminine and balanced with the other facial features. Specifically, we lowered the bridge (profile), providing a subtle curve that was designed to complement the other facial curves – note in particular the curve of the forehead.  Changes were made to the tip of the nose as well.  The angle between the nose and the lip was increased (“rotation” of the nose) and the tip of the nose was shortened (“projection” of the nose).  Following these changes, the bridge flows gently into the tip with a slight change in angulation between the bridge and the tip known as a “supratip break”.  On frontal view, the bridge of the nose was narrowed and the tip was refined and given more definition.  Finally, the nostrils were found to be excessively wide – one more than the other – and changes were made to narrow the base of the nose.

There is a saying in rhinoplasty surgery that “the results of a good rhinoplasty are seen in the eyes”.  The nose will no longer detract from, but rather add to, the other facial features.  Eyes become brighter, lips become fuller and a smile becomes more engaging.

right oblique view of before and after open rhinoplasty in vancouver

Right oblique view of open rhinoplasty patient*. The goal of the surgery was to refine, deproject and narrow the tip and also to feminize and refine the dorsal contour.

frontal view of before and after photos of open rhinoplasty patient

Frontal view of an open rhinoplasty patient.*

right lateral view of before and after open rhinoplasty surgery by Dr. Andrew Denton

Right lateral view of and open rhinoplasty patient.*

Rhinoplasty – Dr. Andrew B. Denton

The following patient underwent rhinoplasty last year in Dr. Denton’s cosmetic surgery clinic in Vancouver. The post operative photographs of this open rhinoplasty procedure were taken one year following her surgery.

The goals of this type of rhinoplasty surgery were to: 1) remove the hump on the top of the nose and lower the nasal profile to create a gently curved and feminine contour to the dorsum (top) of the nose; 2) deproject (shorten) and rotate (move up) the tip of the nose; 3) straighten the nose when viewed from the front; 4) narrow the nose when viewed from the front; 5) narrow the tip and nostrils when viewed from the front.

Dr. Denton chose an open approach for this particular surgery. Surgery took approximately 2 hours and was performed using intravenous sedation for anaesthesia. The post operative course was uneventful and the patient returned to normal non-strenous activites after 1 week.

For more information on rhinoplasty surgery click the following link:

http://doctordenton.com/surgical-procedures/rhinoplasty/

Side View - Before & After Rhinoplasty Surgery - Dr Denton

During open rhinoplasty surgery, the dorsal hump (bump on the top of the nose) was reduced and the tip was rotated and deprojected.*

 

Side View - Before & After Rhinoplasty Surgery - Dr Denton

Following open rhinoplasty surgery, the patient’s nose is straighter and narrower. The tip has been refined and the alar base (nostrils) have been narrowed.*

 

Dr. Denton and Staff Would Like to Introduce Ms. Alannah Lane

     Dr. Denton and his Staff would like to introduce Ms. Alannah Lane to our clients.  Alannah is an expert esthetician with a particular interest in rejuvenative and restorative skin care as well as permanent make up and micropigmentation.

     Alannah will be available for skin consultations and peels as well as dermal needling and permanent make up procedures.  Alannah uses the highly regarded Environ line of skin care products.

     For more information or to schedule a consultation and/or treatment please call the office at 604-879-3223.

Alannah Lane is an expert Vancouver esthetician

WE Magazine Reader’s Choice Award “Best Cosmetic Surgery”

best place for cosmetic surgery in Vancouver as voted in WE magazine

We were very happy to learn this week that we have been awarded a Reader’s Choice Award by Vancouver’s West Ender Magazine for Best Place for Cosmetic Surgery.  This type of recognition is always most appreciated and is testament to our hard work and efforts in making our facility a recognized leader in the field of Cosmetic Surgery in Vancouver.

Thanks again!

Dr. Andrew B. Denton and Staff

Facial Liposuction – An Option for the Heavy Neck

facial liposuction in Vancouver to reduce the look of a heavy neck

Before & After Facial Liposuction*

We often see patients in the office who are concerned with the contour (or lack thereof) of their neck.  With the ubiquitous cell phone camera constantly snapping us in unsuspecting and unprepared poses, we all see our profile much more often than we ever have in the past.  Unfortunately, it is not always as angular and defined as we had hoped or envisioned (mine included!).  Facial Liposuction can help.

The angle between the neck and the bottom of the jawbone is referred to as the “cervicomental angle”‘.  A larger cervicomental angle is considered less aesthetically pleasing whereas a smaller cervicomental angle (approaching ninety degrees) is considered more aesthetically pleasing.  Several factors contribute to the angle including skin, subcutaneous fat (fat below the skin) and the underlying anatomy of the neck.

Nothing much can be done about the underlying anatomy.  If you take your finger and run it back underneath the chin, you will eventurally meet resistance.  This is the hyoid bone and it defines the angle discussed above.  Regardless of how tight the skin is and how little fat is present, the cervicomental angle cannot be made any sharper or located any further back than this spot.

As we age, skin on the neck becomes lose and stretched.  In a previous BLOG post we discussed the isolated neck lift as an option in a case such as this.

Finally, in younger patients and in patients with good skin tone, excess fat may be present in the neck and under the chin, negatively impacting the cervicomental angle.  Fat in this area is stubborn and difficult to lose even in the presence of significant weight loss.  In the presence of a well positioned hyoid bone, a liposuction procedure can be perfored to remove this tisse and recontour the neck.  This type of surgery is performed using light sedation and the patient will typically return to normal activities within 7 days.

Challenging Double Eyelid Surgery (Asian Blepharoplasty)

Before and After Double Eyelid Surgery

Before and After Double Eyelid Surgery (Asian Eyelid Surgery)* – Dr. Andrew B. Denton, Vancouver, BC

This is a nice example of a double eyelid surgery. In this case the post operative photos are 5 months following the procedure. This young asian male patient had atypical upper eyelids. There was no crease at all on the right side and on the left, a pseudocrease was present quite high on the lid. Also unususal for a young asian eyelid was the absence of excess fat which actually made the eye look older than the patient’s 21 years (older eyes look sunken because of the loss of fat). The challenge in this double eyelid surgery patient was to create a natural appearing crease that was also symmetric between the eyes.

Just prior to the procedure, the anticipated and desired crease is marked. The resulting fold can be either “outside” or “inside”. This refers to where the crease/fold ends at the inner corner of the eye. In this double eyelid surgery patient the fold is “inside” which means that it ends on the inside of the epicanthal fold which if the fold of skin present at the inner corner of many asian eyelids. My preference is an “inside” fold because I feel that it appears more natural and ethno-appropriate. Once the excess skin has been removed – which is usually quite minimal in double eyelid surgery – a strip of muscle is taken which exposes the underlying fat pads and the levator aponerurosis – which is the structure that needs to be exposed in order to create the new fold. Once an appropriate amount of fat is removed, the skin is sutured to the exposed levator aponeurosis and the skin incsion is closed.

In one week the sutures are removed. During that period, the undersurface of the skin (the dermis) has become attached to the levator so that now, when the eyelid is opened, the skin also folds thereby creating an eyelid crease.

For more information on blepharoplasty click http://doctordenton.com/surgical-procedures/asian-cosmetic-surgery/