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Aesthetic Rhinoplasty

A beautiful nose participates to facial harmony and blends into the background. Whether before a full or partial rhinoplasty, all surgery of the nose should be preceded by functional examination. Customised rhinoplasty techniques allow us today to sculpt your nose à la carte and in harmony with your face. As with non-surgical harmonization, by Hyal-Sculpt® often the harmonious integration of the nose, implies an overall rebalancing of the face. This non-surgical rhinoplasty solves disgraces of many noses in few minutes by small amounts of hyaluronic acid, placed in strategic locations. To obtain the best results, it is important that these non-surgical treatments are performed by a surgeon expert in rhinoplasty and perfectly mastering the complex anatomy of the nose.

 

Rhinoplasty is a surgical procedure used to correct or reconstruct the nose. This may be needed to:

  • straighten the nose,

  • reduce a hump in size,

  • alter the tip or

  • correct any dips or depressions on the bridge of the nose.

  • abnormalities inside the nose causing twisting or blockage may also be corrected

 

The aims of surgery are:

  • to improve the nose cosmetically and to maintain or improve function

  • to produce a nose that is in harmony with the face

  • to produce a result that has a natural, non-operated appearance

 

APPROACHES:

Open Rhinoplasty
In an open rhinoplasty procedure, a small external incision is made on the underside of the nose between the nostrils. Additional incisions are made on the inside of the nose that cannot be seen. An open rhinoplasty fully opens the nose, providing improved visualization of the nasal structures and a more direct route for surgical manipulation. The small scar left at the nose base is barely visible after the healing process.

 

Endonasal rhinoplasty
In an endonasal rhinoplasty, also known as closed rhinoplasty, incisions are made inside the nasal passages. These incisions are hidden and are not visible after surgery. Endonasal rhinoplasty offers a limited view of and dissection of nasal tissues.

The rhinoplasty procedure is usually performed under general anaesthesia, with minimal scarring resulting. The specific framework for surgery is dependent on the individual and their desired results. For example, the nose can be reduced, reshaped, built up or even angled for a more youthful appearance.

 

We use VECTRA® 3D camera and Sculptor software to produces a three-dimensional photograph of the nose and face and able to simulate the expected average results of the proposed surgery.

 

What happens after the surgery?

A small cast/splint is applied to the nose for the first week post-surgery, and most of the swelling is improved by the time the cast is removed. Within two weeks, the bruising and swelling will be greatly reduced and can be hidden under makeup. Significant improvement and an 80% reduction in swelling are apparent after six weeks, 90% within three months and 95% within six months. The final cosmetic result is achieved after 12 months when the skin has conformed to its new framework.

ents.

As the nose matures, changes may occur in the elasticity of the skin and connective tissues that lead to descent of the nose over time. As the nasal tip falls, a hump along the nasal profile may be evident that was not observed at a younger age. The descended nasal tip may worsen the aged appearance of the nose but also often restricts nasal airflow.

 

Reconstruction of the nasal tip can serve to improve both nasal airflow and appearance. Often, in that situation simply lifting the nasal tip immediately improves nasal airflow. In that context patients can also use nasal devices like AIRMAX to improve their breathing.

Functional Septo-rhinoplasty

Rhinoplasty is a surgical procedure used to correct or reconstruct the nose. This may be needed to straighten the nose, reduce a hump in size, alter the tip or correct any dips or depressions on the bridge of the nose. Abnormalities inside the nose causing twisting or blockage may also be corrected.

The aims of surgery are:

  • to improve the nose cosmetically and to maintain or improve function

  • to produce a nose that is in harmony with the face

  • to produce a result that has a natural, non-operated appearance.

These aims are achieved through a careful assessment of the individual before the operation, to ensure that the surgical plan is tailored for each patient.

Fat Grafting

Volume loss to the face has become increasingly recognized as an important component to the aging process, which can be restored with either office-based fillers or facial fat grafting.

Modern fat grafting techniques have improved durability compared with older techniques that could compromise transplanted fat longevity.

Volume loss is particularly more pronounced around the eyes, cheeks, and jawline, where fat grafting can play the greatest role in creating a balanced and comprehensive rejuvenation strategy for the face that may include blepharoplasty (cosmetic eyelid surgery) and/or a facelift.

Fat grafting involves removing fat from one’s own abdomen or thighs to put into certain regions of the face that start to lose fat.

Many women actually like the shape of their face better in their early 30s because they have lost a lot of their baby fat and start to have more of a triangular heart shaped face. As one continues to age the loss of fat in the eyes, cheeks and jawline, including some weight gain in the lower face, neck, and jowls starts to invert the triangle so that the base of the triangle is now at the bottom of the face. Conceptually, the goal of facial fat grafting is to invert the triangle so that the heart shaped face of youth returns.

 

Volume restoration for the face also adds more light to the face, which in turn can make the skin look more radiant. Adding fat back to the face can even begin to help the skin texture and tone through what is thought to be a stem-cell response that the skin undergoes over areas of transplanted fat. This phenomenon is only speculated and is not conclusive but can be evident towards a year following fat grafting.

 

Fat grafting also appeals to many prospective patients, as it is minimally invasive and does not require any traditional facial incisions. With a global perspective on the aging process, fat grafting has assumed a more prominent role in our ability to combat the signs of aging.

Face and Neck Lift

Integrated Facial Remodelling offers a comprehensive approach combining liposculpture with modern repositioning techniques of the relaxed tissues. Following the global aesthetic analysis of your face, we propose to you the best suitable treatment plan.

Well hidden short scars, with minimal skin trauma, repositioning in the submuscular plane (SMAS facelift: superficial musculoaponeurotic system), sectorial mid-face repositioning and endoscopic brow lift, are the components of modern facelifts, with lighter operative surgical trauma, shorter social eviction, beautiful, natural and long lasting results.

 

Sometimes non-surgical treatments (Hyal-Lift®, lipomosculpture, facial laser treatments, etc.), can delay such a surgical facelift. In other situations, these same treatments can complete a facelift to get exceptional results. And, last but not least, all these techniques can improve, until a certain extent, aesthetic failures.


A facelift is also referred to as a Rhytidectomy or Meloplasty and can reduce the signs of ageing by:

  -Removing excess skin
  -Tightening the underlying muscles and soft tissues
  -Re-draping the skin around the neck and face
  -Get a Revitalised Appearance

A face lift is a safe, effective procedure performed to restore a more youthful appearance.

Benefits include:

  -Reducing the signs of ageing
  -Refreshing facial features for a more youthful look
  -Improving facial contours
  -While face lift surgery is effective in reducing the signs of ageing and in improving facial  contours, it does not stop the body clock or the natural ageing process. The most common age group is between 40-65 years, but often older or younger people may also consider face lift surgery.

 

Minilift

Indications include:

  -Mild to moderate face laxity – jowls
  -Mild upper neck laxity with facial laxity
  -Usually for a younger person, 40-55 yrs old
The least invasive option is where the procedure is limited to the face only. Variations include a mini-lift, minimum / short incision lift, S-lift or MACS lift (minimum access cranio-suspension).

During a MACS procedure an incision is made to the temple and in front of the ear allowing for the underling fat and SMAS to be tightened, lifted and re-sutured, with any excess skin removed.

These procedures have a short down time, low risk of complications and are suitable for mild to moderate facial laxity and ageing. These procedures are effective in younger age groups where people are not looking to obtain dramatic results, rather subtle changes and refreshed looks. Most people can return to work in 7-10 days.

Full face and neck lift

Indications include:

  -Moderate to severe face laxity – jowls
  -Moderate to severe upper neck laxity with facial laxity
  -Usually for more than 55 years old

Lips

The eyes and mouth are the cornerstone of face and expressiveness. A mouth which has became sharp, an elongated white lip, crowned by vertical wrinkles, will give to the face a sad and aged appearance before the age.
Treatments, often simple and leading to natural results, with limited social eviction, can be done nowadays.

Other times, younger people display a mouth that does not reflect their personality, or that disturbs by its asymmetry.
The Hyal-Sculpt® approach combines the expertise of the makeup artist with surgical know how and correct this situation with beautiful and natural results.

Lips are a dynamic structure, any modification will have to look natural statically and on smiling.

Lip augmentation

We do lip augmentations nearly exclusively with non permanent fillers (hyaluronic acid) and this gives the most natural result.

The end result achievable depend on the age of the patient. A natural result is the key.

 

Lips are very sensitive, so usually  we do lip injections after the application of local numbing cream and icing. Sometimes we also inject local anesthesia.

Lip reduction cheiloplasty

Reduction cheiloplasty is usually done under local anesthesia +/- sedation.

The procedure is usually done with a CO2 laser or with radiofrequency.

Lip lift

The aging lip becomes longer, thinner and loses volume.

The most frequent lip lift procedure is by direct excision of skin under the nasal base. This procedure is done under local anesthesia +/- sedation.

This procedure may help evert the red lip a little.

Smoker’s lines around the mouth

Vertical lines around the mouth are usually treated in a multimodal approach, combining

  • fractional laser CO2 resurfacing

  • ablative Erbium Yag resurfacing

  • fillers

  • botulinum toxin

  • mesotherapy

 

The use of full ablative CO2 resurfacing, dermabrasion or a deep peel are very effective in eliminating the wrinkles and lines, however these procedures are associated with longer down-time and a high complication rate (especially depigmentation of the skin)

Mouth corners

With age the corners of the mouth may droop and give an unintended sad look.

To correct this one can use a combination of botulinu toxin and fillers.

The botulinum toxin acts as a muscle relaxer and weakens the muscles pulling the down the corners. Fillers will then also help elevate the corners.

Otoplasty

Sometimes, their ungainly shape or simply a detached pavilion can generate a complex at all ages. They can be corrected by minor surgery. We prefer techniques that do not interrupt the delicate ear cartilage. With aging or simply wearing heavy earrings, the lobes may find themselves drawn and withered. Their filling by hyaluronic acid will plumps them immediately.

 

In a newborn with deformities of the outer ear one should consider a molding therapy for the first 6 weeks (like earwell) to prevent permanent deformity. During that time female hormone impregnation in the child from the mother will allow for the ear cartilage to be more flexible.

Protruding ears affect about 5% of the population and are an autosomal dominant trait.

There are many different techniques to reposition the ears, depending on the deformity. One can consider

The treatment of protruding ears, otoplasty, is a very rewarding procedure for both the surgeon and the patient, especially in children. Children with protruding ears are often teased by their peers which can lead to serious body image problems, or in extreme cases, psychological problems. Helping a young person feel better about themselves and improve their self esteem is a true pleasure. Dr. Niamtu will assist selected families that cannot afford the surgery.
The best time to correct protruding ears is before the child enters school. The ear develops to its mature size early in childhood and most children can have corrective surgery between 5-7 years old.

Depending upon the procedure, recovery is usually several days. The patient will wear a tennis type headband for several days and at night for another week. Female patients can hide the ear with long hair and return to work in as little as 48 hours. Generally patients will refrain from strenuous exercise for 2 weeks. Again, depending on the procedure some patients will have sutures that are removed 14 days after surgery.

 

 

Surgical technique

For most cases, the incision is made near the fold of the ear joining the head. An elliptical or dumbbell of skin is removed, ensuring that any scaring remains hidden. The cartilage is then sculpted creating a more natural looking shape and stitched into place, or alternatively, a portion of cartilage may be removed and the ear folded back to its new permanent position.

Surgery lasts 1-1 ½ hours and stitches along the incision line will be either dissolvable or removed in 7-10 days. Patients are normally ready to go home after a few hours. Young patients must stay with a responsible adult for 24 hours if discharged on the same day.

Big ears (macrotia)

The reduction of big ears can be done surgically by chondrocutaneous flaps (Antia-Buch procedure).

This procedure can also be done to symmetricize ears.

Ear lobule rejuvenation

Ear lobules seem to elongate with time and are a manifestation of loss of volume.

One can correct deflated ear lobules with fillers.

Big deflated ear lobules can be reduced surgically.

Torn ear lobules

The correction of torn ear lobules is a common request.

Ear lobule reduction

Ear lobules seem to elongate with time and are a manifestation of loss of volume.

One can correct deflated ear lobules with fillers.

Big deflated ear lobules can be reduced surgically.

Eyelids

The eyes  they are one of the most important features of your face.

Having a blepharoplasty procedure (eyelid surgery) can help restore a youthful and less fatigued look, by correcting droopy eyelids and reducing puffy bags. Blepharoplasty is performed for medical or cosmetic reasons, with the aim to improve the aesthetic appearance of the eye, while retaining natural shape and function.

Why people choose to have Blepharoplasty

Remove excess droopy skin from the upper or lower eyelids
Reduce fatigue from heavy eyelids
Enhance youthful appearance
Reduce puffiness under the eyes
Tighten the underlying muscles and soft tissues
Remove excess fat ´bags´ from under the lower eyelids or in the upper eyelids

Chin

This base of the face is an important part of its balance. Injections with hyaluronic acid can easily correct it. This approach can also be a preliminary step before a definitive surgical advancement, ie genioplasty or mentoplasty. The oval, when a bit unstructured, can also be corrected by such injections. Finally, the neck at a moderate stage of relaxation, can be improved by combining various non-invasive techniques, such as radiofrequency, hyaluronic acid and notched threads.

Chin augmentation (to correct a receding chin)

Chin surgery is minimally invasive and can change the shape of the chin to reduce a prominent chin or extend the chin from the face. The contour of the chin can be reshaped to be smoother, or more angular in appearance thereby creating or enhancing a better profile. Often a small, weak chin can make a nose appear larger so patients are sometimes advised to have chin surgery in conjunction with rhinoplasty to create a better balance of features. Patients can also have neck liposuction to remove excess fat from under the chin to redefine the chin line. Chin augmentation can make a major difference to the overall appearance of the face.
To correct a receding chin either an implant can be inserted or the chin bone can be moved forward to a more normal position. For a prominent chin the bone can be reduced and re-sculptured to a more acceptable size.  Chin Surgery can be performed to:

  -Add definition to the jawline
  -Correct a receding chin line
  -Create a stronger looking chin
  -Balance out facial features
  -Enhance a profile

Chin surgery is normally performed under general anaesthesia or local anaesthesia with IV sedation and takes 45-60 minutes depending on the extent of the surgery to be performed. We use VECTRA® 3D camera and Sculptor software to produces a three-dimensional photograph of the chin and face and able to simulate the expected average results of the proposed surgery.

 

We make an incision in the natural crease line under the chin or inside the mouth where the lower lip meets the gum. An implant (the size of which has been predetermined at previous consultations) is then inserted into the created space and fitted into place. The incision is closed with fine stitches. The sutures on the inside of the mouth show no visible scarring. Sutures along the chin crease will hardly be noticeable. The implant is usually Silastic with Gortex ePTEF covering (Composite).

 

Chin Reconstruction Surgery (To Correct a Prominent Chin)

In surgery for chin reduction we make a small incisions either inside the mouth or under the chin and sculpt and reposition the facial bones to create a more harmonious look.

Scarless Skin Lesion Removal

Excising skin lesions with a surgical blade invariable will result in a scar, but this partly depends on the depth of injury of the skin with the blade (eg a scratch does not produce a scar). When more than about a third of the depth of the skin is injured, a scar will result.

Each person scars differently and some people have a tendency towards unfavorable healing (large scars, spread scars, atrophic scars, white scars etc)

 

There are many technique considerations that will allow for a scar to heal more favorably. These include:

Meticulous surgical technique, picking a favorable incision location and scar orientation, as well as good suturing techniques are primordial.

 

Postsoperative wound healing and dressings are also very important to help minimize the scar.

 

Sometimes one can choose to remove skin lesions with lasers of radiofrequency for cosmetic reasons and decrease the chance of a scar. Recurrence might also increase as a result of only partial ablation on the 

The Surgitron® Dual RF redefines our surgical results with two distinct frequencies – 4.0 MHz (Monopolar) and 1.7 MHz (Bipolar) – for outstanding surgical precision and control.

We use it for scarless removal of skin growths, warts, moles, seborrheic keratosis

 

What had to be done by the blade, scissors and knives earlier can now be done with this amazing technology which vaporizes tissue. Hence, recovery is extremely quick and collateral tissue damage minimal.

Skin Resurfacing

Skin resurfacing can be achieved by means of

  -chemicals (chemical peels),

  -mechanical procedures  (microdermabrasion, dermabrasion)

  -or through the use of heat (lasers).

It consists of removing a variable amount of superficial skin layers that then has to regenerate during the wounding phase. Skin resurfacing can have varying effects on deeper skin layers, like increase production of collagen, depending on the wounding mechanism.

BEFORE RESURFACING: SKIN PRE-CONDITIONING

Before a resurfacing procedure skin pre-conditioning may be recommended to help

-avoid excessive melanin production after wounding,

-optimize wounding results and promote faster healing after treatment.

-accelerate wound healing,

-evaluate skin tolerance and treatment compliance of patients

-detect allergies and measure skin tolerance

Skin conditioning consists of sun protection + retinoids or alphahydroxy acids for more even penetration of the chemical peel + a skin bleaching agent to minimize pigmentation problems + an antiviral to prevent herpetic outbreaks.

The start date depends on your skin type and the intended injury.

NEW SKIN FORMATION

After controlled injury to your skin with a resurfacing procedures, new skin forms. Some signs are expected side effects after skin resurfacing procedures and are not considered complications, such as:

1.      transient erythema and flushing,

2.      increased temperature,

3.      pruritus,

4.      oedema,

5.      milia and acne

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