One of the most challenging – and satisfying – parts of a full rhinoplasty is adjusting the rotation of the nasal tip. Tip rotation is defined by the position of the nasal tip relative to the nasal dorsum (bridge) and the lip. The angle between the lip and the nose (the nasolabial angle) is smaller in an under rotated nose than it is in an appropriately or over rotated nose. Under rotation of the nasal tip makes a nose look long and droopy and it ages ones appearance as this type of nose is associated with an older individual. On the contrary, over rotation of the nasal tip makes a nose looks short and chopped and often results in the nostrils being overly visible from the front.
During your rhinoplasty consultation, tip adjustments are discussed and computer imaging is used to give an impression of the post operative appearance. The more substantial the planned changes are to the nasal tip, the more likely I am to recommend an open or external rhinoplasty. In my opinion, this approach allows better access to the tip cartilages and therefore allows a superior surgical outcome.
After surgery to the nasal tip, most patients will return to non strenous activites within 1 week and to normal activities in 2 weeks. 80% of healing will be complete after approximately 8 weeks but it may take as long as 12 months for the final appeaance to be achieved.
Front view showing favorable change 5 years following chin implant and neck liposuction surgery*
Profile view showing favorable change 5 years following chin implant and neck liposuction surgery*
Oblique view showing favorable change 5 years following chin implant and neck liposuction surgery*
Facial cosmetic surgery is all about balance which is superbly demonstrated in this series of before and after chin implant and neck liposuction surgery photographs. The face can be divided horizontally into thirds. The upper third extends from the hairline to the top of the nose, the middle third from the top of the nose to the bottom of the nose and the lower third from the bottom of the nose to the tip of the chin. In this example the patient was concerned with the lower third of the face and felt that it was short and poorly defined. In addition, she was unhappy with the contour of her neck and desired a sharper angle between the chin and neck. By performing chin implant surgery, the lower third of the face was lengthened and defined. Chin projection – which refers to how far forward the chin is positioned – was also improved. This is best appreciated in the profile and oblique photo sets. A small amount of fat was liposuctioned from the neck and area immediately below the chin. When performed together in an appropriate patient, these procedures are synergistic and the final result is greater than the sum of the parts.
In most cases I prefer to use a silastic chin implant placed through an incision on the inside of the lower lip – thereby avoiding a potentially visible scar under the chin. The liposuction part of the procedure is performed first through 3 tiny skin incisions which are not visible once fully healed. Recovery time is approximately 7 – 10 days with full return to normal activities by 14 days.
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