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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 natural result

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. 

In our clinic, every rhinoplasty or septorhinoplasty gets an endoscopic nasal exam, nasal valve assessment and 3D computer analysis.  

Scar Revision

A few common scars include:

Burn scars. Severe burns that destroy large sections of skin cause the skin to heal in a puckered way. As the skin heals, muscles and tendons may be affected in this “contracting” movement.
Keloid scars are a result of the skin’s overproduction of collagen after a wound has healed. These scars generally appear as growths in the scar site.
Hypertrophic scars, unlike keloids, do not grow out of the boundaries of the scar area, but because of their thick, raised texture, can be unsightly and may also restrict the natural movement of muscles and tendons.
Facial scars can be unattractive simply because of where they appear on the face, while others affect facial expressions.

Important factors to be discussed with your surgeon include:

  • The goal of facial scar treatment is to disguise the scar, relocate it, or minimize its prominence.

  • Skin type and color, ethnic background, individual healing rates, age

  • Different types of scars respond to different plastic surgery techniques. One must understand that there is no way of removing scars completely in facial scar revision.

  • Timing of surgery is another important choice. Some surgeons advise against any scar revision in cases of injury for a period that might extend up to a year after the injury. This interval allows the body enough time to heal fully.

SCAR REVISION SURGERY

Most scars can be treated with simple excision.

Contracture type scars generally involves removing the scar tissue entirely.

Complex excision and skin flaps may be necessary in some cases, 

Some scars on the face can be made less visible by scar reorientation or scar irregularization,

MINIMALLY-INVASIVE SCAR REVISION

With subcision one can use special Nokor needles to undermine a depressed or tethered scar, or even acne scars. The fibrous band under the scar is divided, allowing the skin to return to its normal position. Once undermined with the needle, one typically uses fillers or fat grafting.

 

Dermabrasion and laser resurfacing are methods a surgeon uses to make “rough or elevated” scars less prominent by removing part of the upper layers of skin with an abrading tool or laser light. Clearly, the scar will remain, but it will be smoother and less visible.

Typically early laser resurfacing allows to improve scar results and can be started at suture removal. Dermabrasion allows to flatten an elevated scar or helps a scar blend into the tissues and camouflage it better. Best timing for first dermabrasion is 6 weeks after injury.

Lasers that target blood vessels are commonly used for red scars, and ablative (destructive) and nonablative fractional lasers have advanced treatment substantially for some patients with traumatic scars, although multiple treatments are usually needed.

 

For pitted scars on can use chemical peels to reconstruct the pit by wounding in a procedure called TCA-cross.

 

Keloid or hypertrophic scars are often treated first with injections of steroids to reduce size. If this is not satisfactory, the scars can be removed surgically, and the incisions closed with fine stitches, often resulting in less prominent scars. Other options are a part from injected corticosteroids also topical steroids, injected chemotherapeutic agents (eg, fluorouracil), silicone gel sheeting, cryotherapy with liquid nitrogen, and irradiation.

 

Injections of fillers allow to improve depressed or atrophic scars.

 

Injections of botulinum toxin around the scar in certain areas of increased movement will allow to relax muscles around the area and in this way puts less strain on the healing scar.

Scar minimization is scar wound care, that keeps the scar moist and warm, which are favorable healing conditions. Effective early wound care are important to minimize scar formation. Physical therapy, pressure, and other treatments can help minimize contracture formation after injury.

Our cosmetic care consultant may assist with scar camouflage, either with cosmetics or dermopigmentation.

Skin lesions and Mole removal

Skin moles or benign skin lesions are common. They can be from birth or occur with age. Most of them are benign but there is a small risk of cancerous changes in some of them. Some moles do resolve but most stay the same or get larger with time.

The main reasons for removal are:

  • cosmesis – unsightly mole on the face or multiple mole

  • lesions are getting larger

  • they are suspicious looking – atypical naevi, spitz naevus

  • previous history of melanoma or skin cancer

  • repeated bleeding from trauma

 

REMOVAL MODALITIES

Moles, naevi or other benign skin lesions can be removed by different modalities:

-Cryotherapy (Liquid Nitrogen) – easy but a biopsy is not taken. Effective for solar keratosis and small superficial BCCs and SCCs in situ.

-Curettage with diathermy – the lesion is scraped and the defect is cauterised. This usually leaves a small contracted white scar.

-Radiofrequency (ELLMANN) removal. This is practically a scarless skin lesion removal and the indication is only for cosmesis. The wound is allowed to heal spontaneously. This may take up to 6 weeks. The deep aspect of the mole or lesion may still be present and may recur again.

-CO2 laser vaporization

-Shave excision – the lesion is shaved and allow to heal spontaneously. This may take 3-4 weeks. The deep aspect of the mole or lesion is still present and may recur again.

-Punch excision allows for skin biopsy or excision of very small lesions leaving virtually no scars.

-Surgery by excision. The type of excision depends on the type of mole or lesion, size, site, depth and patient skin characteristic and intent.

Anesthesia

Simple, superficial lesions can be treated under topical anesthesia. Local anesthesia is the procedure of choice. More complex cases can be are performed under local anesthesia with sedation or general anesthesia

Scarless Skin Lesion Removal

Scars begin to form when skin injury reaches about a third of the skin thickness.

So for many lesions scars can’t be avoided, but meticulous surgical technique, pre- and aftercare can minimize scar appearance. 

 

“Scarless” removal implies superficial controlled skin injury. This can be done by using Ellmann radiofrequency surgery and candidate lesions need to be evaluated on a case by case basis.

Excising of 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 surgical scar to heal more favorably:

-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 radiofrequency for cosmetic reasons and decrease the chance of a scar. Recurrence might also increase as a result of only partial ablation of the lesion 

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. 

It is an amazing technology which vaporizes tissue. Recovery is extremely quick and collateral tissue damage minimal.

Skin Cancer and Reconstruction

Skin and soft-tissue defects after skin cancer removal require reconstruction to give a result that is as inconspicuous as possible.

 

Reconstruction involves meticulous surgical technique, experience in closing facial tissue defects and judicious use of tools of scar minimization postopertively. 

Otoplasty

The correction of torn ear lobules is a common request.

We also do corrective surgery for congenital ear malformations, that may be covered by insurance.

Facial Reanimation for Facial Paralysis

Following facial paralysis, there are several interventions that can help the patient achieve more static symmetry in the face. 

Active reanimation may in volve facial nerve grafting or muscle transpositions. 

Many techniques aim to restore facial symmetry at rest. 

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