There is something magical about computer imaging.  The uniqueness is that the prospective patient can see their predicted result on a computer screen and immediately understand “what it is all about.”

The discussion of cosmetic procedures is often very abstract without some visuals.  The most powerful graphic they can have would be a computerized prediction of the outcome of whatever procedure they are considering, whether it is rhinoplasty, blepharoplasty, face and neck lift, chemical skin peel or neck sculpturing with or without chin augmentation. 

Previously all we had available to demonstrate to patients would be a magic marker to “erase” the bump on the nose.  We have used computer imaging in our practice since 1989.  Today’s technology, of course, is far advanced over those rudimentary computer systems we had and patients very much appreciate the chance to have that as an important part of their consultation.

In Hollywood, the home of the stars, we sometimes kid our patients who come from out of state to see us that “Welcome to Hollywood, now we will show your transformation to a Hollywood star!”

I have been thinking a lot about men’s rhinoplasty or cosmetic plastic surgery of the nose, the last several days.  In the last two days we performed nasal cosmetic and reconstructive surgery on two gentlemen.

The first was a middle-aged businessman who had difficulty breathing, but who also was motivated by the fact that he felt his “nose was growing”.   The nose, in fact, doesn’t grow, but the tissues within the nose, the loosen, the tip drops and the nose appears more bulbous and longer.  The gentleman’s motivation for that cosmetic enhancement was proper.  Likewise, the desire to breathe was very reasonable and the patient’s deviated septum and enlarged turbinates were causing blockage such that snoring and poor sleep quality was the result.  So it all made sense. 

In the case of that middle-aged gentleman it was very important to fully understand the man’s wishes.  He expressed on several consultation visits the need to have a natural looking nose that would not look artificial, “done” or drastically different from that which his face had carried for many years.  A surgeon needs to listen carefully to these words and understand the mission.  Any miscommunication could result in an unsatisfactory result and an unhappy patient.  That is not what a conscientious and competent cosmetic facial surgeon wants.

The second nasal case involved a young man who had had two prior nasal surgeries, one for breathing and one for appearance.  The former, the nasal septoplasty, was accompanied by reduction of the turbinates.  The turbinate reduction was quite satisfactory but the septum was still deviated to one side, meaning he had internal nasal blockage because of the shift of the septum which is the vertical partition that separates the two nasal passages.  Those “ revision septoplasty operations are not easy because typically some of the cartilage has been taken out of the septum and there is quite a bit of scar tissue underneath the internal lining of the nose.  It does call for considerable experience, expertise and judgment.

The young man’s other wish was to have his nose appear less long.  Indeed the nose was too long for his face and, as he ages, the length would have only increased.  Apparently the original operating surgeon did not heed the patient’s advice and the result did not match the patient’s wishes.

At this young man’s surgery, very conservative elevation of the nose was done such that it no longer looked too long as if it would touch his lip when he smiled.  And indeed, regarding smile, part of the problem was that he had a very strong muscle which, upon smiling, would depress the tip of the nose further.  The breathing problem was corrected by straightening the septum and some other relatively routine internal procedures, and we were able to lift the nose off the lip, release the muscle which had been exerting its downward force on the lip and give him a natural looking nose which was not radically different from what he had before. But certainly better and in keeping with his desires.

It is very important for surgeons to listen to patients, to get a good sense of what they want.  Also, in my opinion, it’s important have computer imaging available so that the perspective patients can see the predicted results of the procedure that the surgeon deems achievable and reasonable.  A meeting of the minds should take place at the computer imaging session such that the patient and the doctor are on the same page based on that computer visualization of the end result of the cosmetic rhinoplasty.

We have used computer imaging in our practice since 1989. It is helpful and important to patients who need the comfort of seeing the projected outcome.

The one great truism about cosmetic procedures is that surgery is incapable of removing wrinkles.  Surgery’s role is to correct sags and bags and reconstruct tissue.

Wrinkled skin is a matter of the skin’s deterioration.  A loss of elasticity.  The causes include too much ultraviolet light from years of suntanning, cigarette smoking, poor lifestyle including inadequate exercise and poor nutrition.  Think of wrinkled skin as having its tiny little rubber bands within it that has given its elasticity as having deteriorated and stretched out.  The skin no longer has the qualities of a new rubber band.

Understanding also that a wrinkle is the equivalent of a fault on the surface of the earth.  To some level, there is a crack in the tissues of the skin just under the surface.  Incidentally, wrinkles tend to occur more at sites of movement.  That’s why people have crow’s feet around the eyes from squinting.  They have deep vertical lines on the upper lip particularly from pursing their lips while smoking a cigarette.  So you have to look at areas of functionality and understand that usually those are the areas that begin to demonstrate wrinkling earlier in life. 

The neck skin is unique in that it is not as blessed as facial skin with respect to healing potential.  This is very important to understand.  We have very good success on the face.  We can remove wrinkles by using several techniques including deep chemical skin peeling and laser treatment.  These procedures are invasive although not surgical.  The chemical or the laser beam invades the outer portion of the skin causing the surface tissues to be erased and inducing fresh new tissue below the surface.  The new skin is indistinguishable from that of a younger person.  When the skin is injured, it knows only  how to regenerate brand new, fresh, younger tissue.

The neck has much less potential for healing because due to its unique anatomy and thinness, it cannot tolerate much injury.  If the skin cannot be subject to a controlled injury such as from the laser or chemical, it cannot be rejuvenated.

There are things that do make the neck skin look younger. Although not as successfully as the laser and chemical facial treatments.  Today, technology has delivered Intense Pulse Light and recently what seems to be a very promising technology, the second generation fractionated CO2 laser.  These procedures excel in removing brown spots, eradicating the red spots and erasing that long-term sun damaged look.  However, they are not as successful, at this point, as we would like them to be with respect to tightening the skin enough to make the wrinkles disappear.

But science never sleeps and technology continues to expand exponentially, we look for even better technologies and products coming down the line. 

We all read the in-flight airline magazines while traveling.  Personally, I find them always interesting and I particularly enjoy American Airlines’ American Way mainly because of the Mensa quiz.   Those are real brain-teasing questions and I always try to pit myself against the smartest people in the world.

I also enjoy the feature articles. In the February 15 issue, for an article entitled Vacationing for a New You, Dr. Stuart Linder and I were honored to be resources. The well-written piece describes the influx of patients, from throughout the world, to Beverly Hills for their cosmetic surgery.  I won’t steal the thunder of the article’s content but rather suggest that you follow the link to it.  I think you will find it interesting and enlightening.

Incidentally, Dr. Linder and I represent somewhat of a new wave or new trend in cosmetic surgery.  I see it as a very positive trend for the specialty.  Each of us is a superspecialist.  I operate only on the face and neck; Dr. Linder only operates on the body. While I perform facelifts, eyelid surgery, nose surgery — both for appearance and function — and procedures chin augmentation, neck sculpting and ear pinning, that’s the limit of my procedures.  No reconstructive surgery.  No cancer surgery, no accident surgery, no major reconstruction.

Likewise, Dr. Linder performs only breast augmentation and reduction, breast lifting, tummy tucks and body liposuction.

None of us can be experts in everything and typically the best results always come from those specialists who further refine their practice within a given specialty. Only via such narrowing of practice scope can they become what we in the medical profession refer to as master surgeons. That should be the goal of every surgeon in practice.

Neck wrinkle removal requires other procedures.  Some doctors would use a process involving chemical neck lifts but the opportunities for success are very limited.

Here in Beverly Hills, there have been several of us active in developing aggressive procedures to sculpt the neck.  Since 1980, my procedure has involved not only tightening the neck muscle, but taking out some of the excess fat between the neck muscle.  The weight of this fat often causes a “hanging neck” which people dislike.

The procedure is done through a fine, horizontal, hidden incision just below the chin.  Healing is quick and is aided by platelet-rich plasma which is sprayed into the wound before the wound is closed so that the tissues have minimal bleeding and, therefore, less bruising.  It also incurs rapid healing because of growth hormone which is present within the platelet-rich plasma.  We also use a very small suction drain tube which through its own force removes the excess fluid that might accumulate causing swelling.

Patients return to work and normal activities within a week to ten days and at that point may resume exercise.