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Monday, November 23, 2009
before and after asian girls breast implant sugery
before and after pics galleries asian girls breast implants surgery
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Tuesday, June 9, 2009
The New Silicone Breast Implant News
The New Silicone Breast Implant News
After the moratorium in 1992 only patients who met the FDA’s criteria were candidates for Silicone Breast Implants. Some of these patients included women with chest or breast deformities, women undergoing breast lifts, women who already had silicone or saline implants and were having a problem and women who were undergoing reconstructive surgery after breast cancer.
Breast implants are the most studied medical device in the history of medicine. On April 14, 2005, Mentor Corporation, a leading supplier of medical products in the United States and internationally, announced that an advisory panel to the U.S. Food and Drug Administration (FDA) determined that the Company's silicone gel-filled breast implants are safe and effective for use in breast reconstruction and breast augmentation patients. This 7-2 recommendation for approval, with a series of conditions stipulated by the FDA's General and Plastic Surgery Advisory Panel, represented a significant step towards the current FDA’s approval of Mentor's silicone gel-filled breast implants in the United States. Silicone implants are preferred and used regularly in other countries but were under major scrutiny in the USA.
Limited right to choose
On November 17, 2006 the FDA agency announced that Silicone Breast Implants are once again available for cosmetic use in women over the age of 22 in the USA. After years of studies including information from doctors and patients using Silicone breast implants submitted to the IRB (Institutional Review Board) some women now have the right to chose what type of breast implant they feel comfortable putting in their bodies.
However not everyone will have the right to choose between silicone or saline. The FDA still does not allow patients less than 22 years of age to get silicone breast implants for cosmetic enhancement only. The same women are old enough to vote, drive cars, drink alcohol or smoke cigarettes that are proven to cause cancer, but they cannot chose between a saline or silicone breast implants.
Silicone
Saline Breast Implants are encased in a silicone shell. Almost all forms of implants or prosthesis are made of silicone and approved by the FDA. For example, cheek implants, chin implants, calf implants, nasal implants, knee prosthesis, hip prosthesis and testicular implants are all made of Silicone.
Why did it take the FDA 14 years to lift the moratorium on silicone breast implants? When men’s silicone testicular implants went up for the FDA’s OK they were approved in approximately 6 months with no age or physical restrictions qualifying patients.
Men now qualify for silicone breast implants
In the past men could use silicone testicular implants, but they did not meet the FDA’s approval list for silicone breast implants. After November 17th if a patient is a male/transgender patient who is seeking breast enhancement they now can qualify for silicone breast implants. Under the current FDA’s guidelines men now have the option for silicone breast implants if they are over the age of 22.
Some Grey Areas?
There still seems to be some grey areas in the category of who does and who doesn’t qualify under the FDA’s guidelines for silicone breast implants. What if a surgeon has a patient under the age of 22 who has a breast deformity with only one breast and wants both breasts enhanced? Is the surgeon only supposed to put the silicone implant in on the deformed side and a saline implant on the normal side? The rules are not always black or white.
Even surgeons with years of experience are calling the FDA and implant manufactures to ask about the guidelines in some gray areas of who qualifies for silicone breast implants and who does not.
Known for his expertise in breast surgery, Dr. Corbin’s practice also runs the full gamut of plastic and reconstructive surgery, and is not limited to cosmetic surgery. Regarding breast implant procedures, Dr. Corbin does approximately 450 implants per year, of which approximately only 20% involve the use of Silicone Gel implants. The latter category of implants was in the past reserved for patients who met the Adjunct Study Protocol established in l992, which included patients with reconstructive needs, included, without limitation, drooping breasts (ptosis), asymmetry, and patients that require replacement or revision and for whom saline implants were unsuitable (e.g., skin too thin, etc.).
Corbin says if he is in doubt he has called the implant manufacturers experts to advise him if a patient qualifies for silicone or not.
The right to choose
A Stage III invasive Breast cancer patient Lisa, chose silicone breast implants for her breast reconstruction with Dr. Corbin recently. She had the option of silicone or saline implants because she was a reconstructive patient. “I had a mastectomy on my left breast and went through 3 months of Chemotherapy. My hair was gone. My sense of self was forever altered. I was bald. My breast was gone. The loss of a breast is an extremely difficult experience for a woman to go through. Mind, body and spirit do not go unscathed. ” Lisa finds it interesting that a cancer patient whose immune system may be compromised or weaken by cancer can put silicone in her body and a healthy young woman may not qualify for silicone breast implants. “If silicone implants are safe for breast cancer patients why don’t all women have the right to choose them? I absolutely love mine. The new breast Dr. Corbin created for me looks and feels totally natural. I am so glad I had the choice to choose the silicone breast implants.’’
Ruptures
In its Nov. 17 announcement, the FDA recommends that women using silicone implants have their breasts checked by MRI (magnetic resonance imaging) three years after breast augmentation surgery and every two years thereafter for the course of their lifetime. The MRI is recommended to check for any ruptures of the implants. If a leak or break is detected in the prosthesis "the implant should be removed and replaced, if needed," according to the FDA.
With Saline implants ruptures may be more easily detected. Usually if a saline implant has a rupture it goes flat immediately like a tire would if it had a leak. In some cases however, a saline implant can have a slow leak and a deflation can occur over time.
The newer Silicone breast implants are manufactured differently today than they were in 1992. According to Fred Corbin M.D. he along with other experts toured the Mentor manufacturing plant in Texas recently. He saw first hand the care and precision it takes to make a silicone breast implant. According to Dr. Corbin, “The outer case of the silicone breast implants is thicker and provides a protective barrier also the gel substance inside the breast implants is “cohesive”. The new gel is like one solid unit unlike some of the older silicone gel breast implants where the silicone was more like a liquid. If you cut a new silicone breast implant in half it would not drip out of its case. The breast implant would remain as a cohesive unit. Some experts compare to the new silicone gel’s consistency to Jelly candy like a gummy bear. If you cut a gummy bear in half you have 2 separate cohesive pieces like the new silicone breast implants. If a silicone breast implant or saline breast implant ruptures there is no medical science that concludes a ruptured breast implant a danger to a woman’s health.
Safety
The prosthetic devices were pulled from the general marketplace in 1992 because of some concerns that they could rupture and endanger patients and possibly contribute to autoimmune diseases. After 14 years and many studies, no link to health problems was ever proven. According to Carla Peppler a Research Nurse with the Cross Cancer Institute in Canada she was apart of a clinical trial who researched the causes and treatments for breast cancer for over 20 years.” In the data we obtained and studied from my patients and NSABP there was no correlation between breast cancer and silicone breast implants.” In fact, when my daughter came to me before she had a breast augmentation with silicone implants and asked me if I thought they were a health risk I told her not based on any medical evidence I’ve ever seen.”
Beverly Hills plastic surgeon Dr. Corbin says,” I would feel totally comfortable putting silicone breast implants in my wife or daughters. In fact my wife has the new cohesive silicone implants” True to the Hippocratic Oath he took when he became a doctor, Corbin, also states , “I feel silicone breast implants are safe or I would never perform a single surgery using them on any patient knowing that it could harm them.”
Corbin educates his patients on all the risks and the benefits of breast surgery and according to him,” It doesn’t matter to me one way or the other if a patient who is a candidate for silicone chooses saline over silicone. I get beautiful surgery results with both types of breast implants. I inform my patients as much as I can and the ultimate decision I believe should be theirs.”
After the breast implant surgery is over it’s the patient who has to be happy with the implants they chose to live with and enhance their breasts with and not the plastic surgeons, politicians, lawyers, implant manufacturers or the FDA. Women rights have come a long way and all women and men should have the right to choose saline or silicone. The FDA’s recent ruling on silicone breast implants is a step in the right direction.
After the moratorium in 1992 only patients who met the FDA’s criteria were candidates for Silicone Breast Implants. Some of these patients included women with chest or breast deformities, women undergoing breast lifts, women who already had silicone or saline implants and were having a problem and women who were undergoing reconstructive surgery after breast cancer.
Breast implants are the most studied medical device in the history of medicine. On April 14, 2005, Mentor Corporation, a leading supplier of medical products in the United States and internationally, announced that an advisory panel to the U.S. Food and Drug Administration (FDA) determined that the Company's silicone gel-filled breast implants are safe and effective for use in breast reconstruction and breast augmentation patients. This 7-2 recommendation for approval, with a series of conditions stipulated by the FDA's General and Plastic Surgery Advisory Panel, represented a significant step towards the current FDA’s approval of Mentor's silicone gel-filled breast implants in the United States. Silicone implants are preferred and used regularly in other countries but were under major scrutiny in the USA.
Limited right to choose
On November 17, 2006 the FDA agency announced that Silicone Breast Implants are once again available for cosmetic use in women over the age of 22 in the USA. After years of studies including information from doctors and patients using Silicone breast implants submitted to the IRB (Institutional Review Board) some women now have the right to chose what type of breast implant they feel comfortable putting in their bodies.
However not everyone will have the right to choose between silicone or saline. The FDA still does not allow patients less than 22 years of age to get silicone breast implants for cosmetic enhancement only. The same women are old enough to vote, drive cars, drink alcohol or smoke cigarettes that are proven to cause cancer, but they cannot chose between a saline or silicone breast implants.
Silicone
Saline Breast Implants are encased in a silicone shell. Almost all forms of implants or prosthesis are made of silicone and approved by the FDA. For example, cheek implants, chin implants, calf implants, nasal implants, knee prosthesis, hip prosthesis and testicular implants are all made of Silicone.
Why did it take the FDA 14 years to lift the moratorium on silicone breast implants? When men’s silicone testicular implants went up for the FDA’s OK they were approved in approximately 6 months with no age or physical restrictions qualifying patients.
Men now qualify for silicone breast implants
In the past men could use silicone testicular implants, but they did not meet the FDA’s approval list for silicone breast implants. After November 17th if a patient is a male/transgender patient who is seeking breast enhancement they now can qualify for silicone breast implants. Under the current FDA’s guidelines men now have the option for silicone breast implants if they are over the age of 22.
Some Grey Areas?
There still seems to be some grey areas in the category of who does and who doesn’t qualify under the FDA’s guidelines for silicone breast implants. What if a surgeon has a patient under the age of 22 who has a breast deformity with only one breast and wants both breasts enhanced? Is the surgeon only supposed to put the silicone implant in on the deformed side and a saline implant on the normal side? The rules are not always black or white.
Even surgeons with years of experience are calling the FDA and implant manufactures to ask about the guidelines in some gray areas of who qualifies for silicone breast implants and who does not.
Known for his expertise in breast surgery, Dr. Corbin’s practice also runs the full gamut of plastic and reconstructive surgery, and is not limited to cosmetic surgery. Regarding breast implant procedures, Dr. Corbin does approximately 450 implants per year, of which approximately only 20% involve the use of Silicone Gel implants. The latter category of implants was in the past reserved for patients who met the Adjunct Study Protocol established in l992, which included patients with reconstructive needs, included, without limitation, drooping breasts (ptosis), asymmetry, and patients that require replacement or revision and for whom saline implants were unsuitable (e.g., skin too thin, etc.).
Corbin says if he is in doubt he has called the implant manufacturers experts to advise him if a patient qualifies for silicone or not.
The right to choose
A Stage III invasive Breast cancer patient Lisa, chose silicone breast implants for her breast reconstruction with Dr. Corbin recently. She had the option of silicone or saline implants because she was a reconstructive patient. “I had a mastectomy on my left breast and went through 3 months of Chemotherapy. My hair was gone. My sense of self was forever altered. I was bald. My breast was gone. The loss of a breast is an extremely difficult experience for a woman to go through. Mind, body and spirit do not go unscathed. ” Lisa finds it interesting that a cancer patient whose immune system may be compromised or weaken by cancer can put silicone in her body and a healthy young woman may not qualify for silicone breast implants. “If silicone implants are safe for breast cancer patients why don’t all women have the right to choose them? I absolutely love mine. The new breast Dr. Corbin created for me looks and feels totally natural. I am so glad I had the choice to choose the silicone breast implants.’’
Ruptures
In its Nov. 17 announcement, the FDA recommends that women using silicone implants have their breasts checked by MRI (magnetic resonance imaging) three years after breast augmentation surgery and every two years thereafter for the course of their lifetime. The MRI is recommended to check for any ruptures of the implants. If a leak or break is detected in the prosthesis "the implant should be removed and replaced, if needed," according to the FDA.
With Saline implants ruptures may be more easily detected. Usually if a saline implant has a rupture it goes flat immediately like a tire would if it had a leak. In some cases however, a saline implant can have a slow leak and a deflation can occur over time.
The newer Silicone breast implants are manufactured differently today than they were in 1992. According to Fred Corbin M.D. he along with other experts toured the Mentor manufacturing plant in Texas recently. He saw first hand the care and precision it takes to make a silicone breast implant. According to Dr. Corbin, “The outer case of the silicone breast implants is thicker and provides a protective barrier also the gel substance inside the breast implants is “cohesive”. The new gel is like one solid unit unlike some of the older silicone gel breast implants where the silicone was more like a liquid. If you cut a new silicone breast implant in half it would not drip out of its case. The breast implant would remain as a cohesive unit. Some experts compare to the new silicone gel’s consistency to Jelly candy like a gummy bear. If you cut a gummy bear in half you have 2 separate cohesive pieces like the new silicone breast implants. If a silicone breast implant or saline breast implant ruptures there is no medical science that concludes a ruptured breast implant a danger to a woman’s health.
Safety
The prosthetic devices were pulled from the general marketplace in 1992 because of some concerns that they could rupture and endanger patients and possibly contribute to autoimmune diseases. After 14 years and many studies, no link to health problems was ever proven. According to Carla Peppler a Research Nurse with the Cross Cancer Institute in Canada she was apart of a clinical trial who researched the causes and treatments for breast cancer for over 20 years.” In the data we obtained and studied from my patients and NSABP there was no correlation between breast cancer and silicone breast implants.” In fact, when my daughter came to me before she had a breast augmentation with silicone implants and asked me if I thought they were a health risk I told her not based on any medical evidence I’ve ever seen.”
Beverly Hills plastic surgeon Dr. Corbin says,” I would feel totally comfortable putting silicone breast implants in my wife or daughters. In fact my wife has the new cohesive silicone implants” True to the Hippocratic Oath he took when he became a doctor, Corbin, also states , “I feel silicone breast implants are safe or I would never perform a single surgery using them on any patient knowing that it could harm them.”
Corbin educates his patients on all the risks and the benefits of breast surgery and according to him,” It doesn’t matter to me one way or the other if a patient who is a candidate for silicone chooses saline over silicone. I get beautiful surgery results with both types of breast implants. I inform my patients as much as I can and the ultimate decision I believe should be theirs.”
After the breast implant surgery is over it’s the patient who has to be happy with the implants they chose to live with and enhance their breasts with and not the plastic surgeons, politicians, lawyers, implant manufacturers or the FDA. Women rights have come a long way and all women and men should have the right to choose saline or silicone. The FDA’s recent ruling on silicone breast implants is a step in the right direction.
Los Angeles Asian Plastic Surgery
Los Angeles Asian Plastic Surgery
At Enhance® Medical Center, Inc., Charles S. Lee, M.D. is a Los Angeles Asian plastic surgery specialist who aims to provide you with beautiful results and the care you deserve.
Meet Our Doctor
Our Los Angeles Asian cosmetic surgery specialist, Dr. Lee, is board certified by the American Board of Plastic Surgery (ABPS) and the American Board of Otolaryngology (ABOto). He has both the surgical knowledge and skills to provide you with a rewarding surgical experience.
Dr. Lee has taught many Asian cosmetic surgery courses for the American Society of Aesthetic Plastic Surgeons (ASAPS); his attendants are all board certified surgeons.
Procedures
Our physician specializes in a number of aesthetic procedures that can yield an impressive degree of facial rejuvenation:
Rhinoplasty:
In Los Angeles, Asian nose surgery specialist Dr. Lee performs a unique method of rhinoplasty that aims at making the nose larger as opposed to smaller. This has proven to be most effective amongst Asian patients.
Blepharoplasty:
Our Los Angeles Asian eyelid surgery expert has assisted many patients in achieving their goal of improved facial aesthetic quality. During this procedure, Dr. Lee will create more natural-looking creases in the eyelids of the patient.
Cheek Surgery:
With the aid of our Los Angeles cheek surgery professional, Dr. Lee, you can enjoy a refreshing facial image. Our physician understands that by reducing prominent cheekbones or evening out the cheeks, Asian patients will receive beautiful results.
Please contact our office at (310) 271-5954 to schedule a consultation with Dr. Lee today! You may also fill out our online contact form where you can ask a question or share a concern regarding Asian plastic surgery in Los Angeles. Be sure to view our before and after plastic surgery photos and our patient testimonialsto gain further insight into the cosmetic talent of our physician.
At Enhance® Medical Center, Inc., Charles S. Lee, M.D. is a Los Angeles Asian plastic surgery specialist who aims to provide you with beautiful results and the care you deserve.
Meet Our Doctor
Our Los Angeles Asian cosmetic surgery specialist, Dr. Lee, is board certified by the American Board of Plastic Surgery (ABPS) and the American Board of Otolaryngology (ABOto). He has both the surgical knowledge and skills to provide you with a rewarding surgical experience.
Dr. Lee has taught many Asian cosmetic surgery courses for the American Society of Aesthetic Plastic Surgeons (ASAPS); his attendants are all board certified surgeons.
Procedures
Our physician specializes in a number of aesthetic procedures that can yield an impressive degree of facial rejuvenation:
Rhinoplasty:
In Los Angeles, Asian nose surgery specialist Dr. Lee performs a unique method of rhinoplasty that aims at making the nose larger as opposed to smaller. This has proven to be most effective amongst Asian patients.
Blepharoplasty:
Our Los Angeles Asian eyelid surgery expert has assisted many patients in achieving their goal of improved facial aesthetic quality. During this procedure, Dr. Lee will create more natural-looking creases in the eyelids of the patient.
Cheek Surgery:
With the aid of our Los Angeles cheek surgery professional, Dr. Lee, you can enjoy a refreshing facial image. Our physician understands that by reducing prominent cheekbones or evening out the cheeks, Asian patients will receive beautiful results.
Please contact our office at (310) 271-5954 to schedule a consultation with Dr. Lee today! You may also fill out our online contact form where you can ask a question or share a concern regarding Asian plastic surgery in Los Angeles. Be sure to view our before and after plastic surgery photos and our patient testimonialsto gain further insight into the cosmetic talent of our physician.
Sunday, May 24, 2009
Asian Blepharoplasty (Double Eyelid Surgery)
We offer various cosmetic surgery procedures to meet
the unique needs of Asian ethnic groups.
Asian Blepharoplasty (Double Eyelid Surgery)
Although about half of the Asian population does have a fold in the area above the eyelashes, the other 50% of the population does not. For those without a fold, a blepharoplasty procedure known as Asian double eyelid surgery can create a natural-looking crease. Dr. Charles Lee skillfully performs Asian double eyelid surgery in Los Angeles, California.
Asian vs. Caucasian Eyelids
The difference between Asian and Caucasian eyelids is in the position of the eyelid fold. Asians who do have a crease above their eye have very different looking eyelids than Caucasians. The Asian eyelid typically starts at the crease very close to the eyelashes. As the crease gets further away from the nose, it gets larger and larger until the midpoint of the pupil, at which point the fold runs parallel to the eyelash origin.
A Caucasian lid crease is slightly different in both shape and size. It typically tapers closer to the eyelashes as the fold goes out laterally so that it is more of an upside-down "U" shape, rather than a parallel shape to the eyelash lid. The Caucasian lid crease is also about 20% larger than an Asian eyelid crease. When considering the blepharoplasty techniques that will be used to place a crease, it is important for both the patient and the surgeon to understand that the goal of double eyelid surgery is not to westernize an Asian face, but to create a crease that looks natural.
Asian Double Eyelid Surgery Methods
DST Double sutures and twisting method (DST) technique is the most sophisticated of the suture (non-incision) methods of double eyelid surgery. The traditional suture method has been criticized for its relatively high breakage rate and indistinct folds, which fade over time. The DST technique addresses these disadvantages while maintaining the benefits of a suture technique, such as the virtually scarless fold, a supreme naturalness to the crease, the potential reversibility and the quick recovery, which takes just a few days instead of weeks. In a suture method eyelid procedure, a crease is created by burying permanent non-reactive sutures (prolene, used in heart valve surgery) pinching a bit of the undersurface of the eyelid skin to the deep soft tissue of the eyelid.
An analysis of fold failure in such cases reveals that sutures do not usually break, but rather the sutures cheesewire through the soft tissue of the upper eyelid. The DST technique rectifies this problem by securing the sutures to firmer structures less likely to allow the sutures to tear through. This is accomplished by first securing one end of the sutures to the firmest structure of the upper lid, the tarsal plate, which is made of strong cartilage.
The other end of the suture is interlinked to an adjacent suture, much like two links on a chain. A bit of the underbelly of the eyelid skin is pinched into the suture before tying the knot. This results in a firm interlocked fold which is tremendously resistant to tearing through or breaking.
The published report for breakage or loss of fold is approximately one percent per year (ten year follow up).
This statement is remarkable for two reasons. One is that a claim of superior results has been supported by scientific data, a rare accomplishment in and of itself in aesthetic surgery. Secondly, an extraordinarily low failure rate has been established, comparable to an incision method. We hope to dispel some common misconceptions. First and foremost is the notion that the DST technique frequently fails or disappears over time. This has been repudiated by published study, our extensive personal experience with hundreds if not thousands of cases, and a reasoned explanation of why this procedure works. In anecdotal comments we have received, the most common source of misinformation has been in confusing the DST technique with traditional suture techniques that are unreliable.
Another misconception is that the DST technique results in more scarring than an open procedure. Because no significant incisions are made, there is virtually no scarring. This lack of scarring allows the procedure to be reversed by simple removal the sutures. In addition, we have confirmed during the occasional re-surgery that DST patients have much less scarring than those that have had prior incisional surgery. The ease with which re-surgery can be performed is reflected by the fact that we have always been able to revise DST procedures without difficulty.
As a practical matter the DST procedure continues to have tremendous appeal and secure reputation in the Beverly Hills and other Southern Californian communities. The majority of patients have referred themselves to our office after their friends have had the procedure done and have witnessed.
Fold failure after prior incisional surgery elsewhere (left) corrected with DST suture technique (right)
We consider the DST technique the procedure of choice for the ideal candidate, as described below. The best candidates for the DST technique have: A) thin skin that is not excessive and do not have a lot of upper lid fat, have not had prior eyelid surgery; B) whose brows are not low or heavy; C) who do not have complex eyelid problems such as ptosis ("sleepy eye") or retraction (overly pulled upper lid). Other candidates for the procedure include A) men, who generally cannot conceal the incisions with makeup, B) smokers (more than ten cigarettes per day), who are at higher risk of prominent scar. C) Patients with a fear of incisional surgery. D) Those in need of quick recovery period, who have a few days, not weeks.
Risks of surgery Debate continues regarding the preference of incisional vs. suture method crease formation. Although suture techniques are sometimes disparaged as inferior surgery, patients resistant to the incision technique know something on an instinctive level - that the risks of an incisional surgery are more significant. The main risk of suture technique is fold failure. This is an annoying, embarrassing, but ultimately a readily correctable problem. The significant major risk of incisional surgery, on the other hand, is damage to the levator mechanism, which can result in ptosis (sleepy eye) or retraction (lid stare). Inexperienced surgeons can also create havoc by over removing fat and/or skin, resulting in an uncorrectable, permanent deformity. Finally there is on occasion the poor scarring and permanent puffiness of the upper lid, overwhelmingly which occur in smokers, cigarettes or otherwise.
Incisional technique The ideal candidate for Incisional technique include patients who are A) older than the latter 20's, B) have excess skin or fat, C) desire a larger, dramatic fold who have a preference for an Incisional technique. Some of the less ideal candidates for this technique include: A) Smokers (more than ten cigarettes daily), B) who will scar more prominently C) Excessively saggy brows or deep forehead wrinkles, whose correction would lead to too much removal of upper lid skin. D) Multiple prior upper lid surgeries, whose scarring results in limited eyelid function, and who probably should limit themselves to correcting eye problems related to function, not appearance enhancement.
Surgeons differ in two major areas: the crease markings which will determine the shape and size of the fold, and technique of surgery, namely which deep eyelid structure will the skin be secured to. Although many types of folds have been described, the most natural (hence, ideal) shape of the fold is a tapered fold and the parallel fold, referring to the shape in relation to the margin of the inner half of the eyelid. The ideal size of the fold allows 2 - 3mm of skin above the eyelashes to show on direct frontal view with the eyes open. This also usually corresponds to a crease set at 10mm from the lash line when the eyes are closed (with the skin on light tension). This height is modified based on whether the eyeball is slightly deep set (larger crease) or overly shallow (smaller crease). This height also corresponds to the size of the tarsal plate, the cartilaginous skeleton of the eyelid. Skin excision is usually needed, determined by the sagginess of the brow - more skin removal being required for saggier brows. Skin excision is limited to 3 or 4mm in order to maintain the naturalness of the eye area and prevent risk of dry eyes. Patients over age 40 and those who require more correction than this are strongly encouraged to consider a brow lift. An advantage of undergoing an evaluation from a plastic surgeon certified by the American Board of Plastic Surgery is that such surgeons are trained to evaluate and treat not only your eyelids but your face in its entirety, whether it is the eyebrows or the midface.
More dramatic folds result from an incisional “anchor” blepharoplasty with a brow lift.
Technical differences between surgeons involve the structure to which the eyelid skin-muscle is secured. One structure preferred by some surgeons is the septum, lying deep to the skin-muscle. The advantage of securing the fold to this structure is that there is minimal swelling due to the limited dissection. The disadvantage is that any excess fat, which lies just deep to the septum is not addressed. Also the limited dissection leads to a higher rate of crease failure. Perhaps the most popular technique today is securing the skin to the levator aponeurosis, the structure just deep to the fat and which is responsible for pulling the eyelid open. This technique, developed in the 1960's by plastic surgeon Leabert Fernandez, is considered the first modern technique for double eyelid surgery. Although probably used by more surgeons than any other, a drawback is the not-insignificant rate of fold failure and imprecision in the crease. This phenomenon is due to the fact that the levator aponeurosis is a structure with a glossy, teflon-like surface, necessary for gliding motion as the levator aponeurosis lifts and lowers the eyelid. This slippery surface, unfortunately, also can resist attempts to attach the skin-muscle to it when creating a surgical fold. This can result in imprecise folds that "slide" around. This also accounts for the occasional fold loss.
Prior incisional surgery with skin fixation to levator aponeurosis performed elsewhere resulting in multiple creases, indistinct fold, and left eyelid ptosis (droopage) (left photo).
Correction using anchor technique with fixation of skin to tarsal plate and correction of detached levator aponeurosis (right photo).
The most precise, permanent folds result from securing the skin-muscle to the tarsal plate, lying beneath the levator aponeurosis. Fat and other slippery soft tissues are removed to allow the muscle and skin to attach to the rough raw surface of the tarsus. The result is a secure permanent crease. This technique is known as an "anchor blepharoplasty". One drawback of this technique is the complexity of the operation which has limited the number of surgeons who feel comfortable with this technique. Performed properly, however, the procedure results in a highly stylized precise, permanent crease.
S = Skin
F = Fat
LA = Levator aponeurosis
TP = Tarsal Plate
In the “anchor” technique, the crease is secured to the Tarsal Plate rather than the Levator Aponeurosis resulting in a more secure fold. The levator aponeurosis has a slippery, shiny surface which is a less secure structure than the tarsal plate for suturing.
Medial epicanthoplasty The medial epicanthus (ME), or Mongolian fold, covers the inner corner of the eyelid. The degree of severity can be categorized as non existent or mild, moderate and severe, depending on how much of the caruncle (the pink "bump" inside the eye corner) is exposed. The severe cases should be corrected; for moderate folds, correction is optional. One popular technique for correction is to remove a crescent of skin along the ME. The location of the incision is parallel to the edge of the fold, in an attempt to hide it. Our observation is that this frequently leads to a widening of the scars due to the stretching forces resisting against the incision. In addition. the crescent removals are frequently performed as one long incision connected to the double-eyelid incision. We find that the continuous incision contributes to an undesirable appearance of the scar. Instead, our preference is what is called a "v-w plasty" in which incisions are placed not parallel but perpendicular to the edge of the ME. 7 sutures carefully placed with the aid of magnifying loupes usually results in barely detectable scars. However, we limit this procedure to non smokers.
Double sutures and Twisting (DST) method Asian eyelid surgery with v-w medial epicanthoplasty (ME)
For a technical description of the procedures described above geared to physicians, please go to: http://www.emedicine.com/plastic/topic425.htm
View Locations
BEVERLY HILLS CENTER
436 N. Roxbury Drive, Suite 207 Beverly Hills, California 90210
Tel: 310.271.5954
Fax: 310-271-0539
the unique needs of Asian ethnic groups.
Asian Blepharoplasty (Double Eyelid Surgery)
Although about half of the Asian population does have a fold in the area above the eyelashes, the other 50% of the population does not. For those without a fold, a blepharoplasty procedure known as Asian double eyelid surgery can create a natural-looking crease. Dr. Charles Lee skillfully performs Asian double eyelid surgery in Los Angeles, California.
Asian vs. Caucasian Eyelids
The difference between Asian and Caucasian eyelids is in the position of the eyelid fold. Asians who do have a crease above their eye have very different looking eyelids than Caucasians. The Asian eyelid typically starts at the crease very close to the eyelashes. As the crease gets further away from the nose, it gets larger and larger until the midpoint of the pupil, at which point the fold runs parallel to the eyelash origin.
A Caucasian lid crease is slightly different in both shape and size. It typically tapers closer to the eyelashes as the fold goes out laterally so that it is more of an upside-down "U" shape, rather than a parallel shape to the eyelash lid. The Caucasian lid crease is also about 20% larger than an Asian eyelid crease. When considering the blepharoplasty techniques that will be used to place a crease, it is important for both the patient and the surgeon to understand that the goal of double eyelid surgery is not to westernize an Asian face, but to create a crease that looks natural.
Asian Double Eyelid Surgery Methods
DST Double sutures and twisting method (DST) technique is the most sophisticated of the suture (non-incision) methods of double eyelid surgery. The traditional suture method has been criticized for its relatively high breakage rate and indistinct folds, which fade over time. The DST technique addresses these disadvantages while maintaining the benefits of a suture technique, such as the virtually scarless fold, a supreme naturalness to the crease, the potential reversibility and the quick recovery, which takes just a few days instead of weeks. In a suture method eyelid procedure, a crease is created by burying permanent non-reactive sutures (prolene, used in heart valve surgery) pinching a bit of the undersurface of the eyelid skin to the deep soft tissue of the eyelid.
An analysis of fold failure in such cases reveals that sutures do not usually break, but rather the sutures cheesewire through the soft tissue of the upper eyelid. The DST technique rectifies this problem by securing the sutures to firmer structures less likely to allow the sutures to tear through. This is accomplished by first securing one end of the sutures to the firmest structure of the upper lid, the tarsal plate, which is made of strong cartilage.
The other end of the suture is interlinked to an adjacent suture, much like two links on a chain. A bit of the underbelly of the eyelid skin is pinched into the suture before tying the knot. This results in a firm interlocked fold which is tremendously resistant to tearing through or breaking.
The published report for breakage or loss of fold is approximately one percent per year (ten year follow up).
This statement is remarkable for two reasons. One is that a claim of superior results has been supported by scientific data, a rare accomplishment in and of itself in aesthetic surgery. Secondly, an extraordinarily low failure rate has been established, comparable to an incision method. We hope to dispel some common misconceptions. First and foremost is the notion that the DST technique frequently fails or disappears over time. This has been repudiated by published study, our extensive personal experience with hundreds if not thousands of cases, and a reasoned explanation of why this procedure works. In anecdotal comments we have received, the most common source of misinformation has been in confusing the DST technique with traditional suture techniques that are unreliable.
Another misconception is that the DST technique results in more scarring than an open procedure. Because no significant incisions are made, there is virtually no scarring. This lack of scarring allows the procedure to be reversed by simple removal the sutures. In addition, we have confirmed during the occasional re-surgery that DST patients have much less scarring than those that have had prior incisional surgery. The ease with which re-surgery can be performed is reflected by the fact that we have always been able to revise DST procedures without difficulty.
As a practical matter the DST procedure continues to have tremendous appeal and secure reputation in the Beverly Hills and other Southern Californian communities. The majority of patients have referred themselves to our office after their friends have had the procedure done and have witnessed.
Fold failure after prior incisional surgery elsewhere (left) corrected with DST suture technique (right)
We consider the DST technique the procedure of choice for the ideal candidate, as described below. The best candidates for the DST technique have: A) thin skin that is not excessive and do not have a lot of upper lid fat, have not had prior eyelid surgery; B) whose brows are not low or heavy; C) who do not have complex eyelid problems such as ptosis ("sleepy eye") or retraction (overly pulled upper lid). Other candidates for the procedure include A) men, who generally cannot conceal the incisions with makeup, B) smokers (more than ten cigarettes per day), who are at higher risk of prominent scar. C) Patients with a fear of incisional surgery. D) Those in need of quick recovery period, who have a few days, not weeks.
Risks of surgery Debate continues regarding the preference of incisional vs. suture method crease formation. Although suture techniques are sometimes disparaged as inferior surgery, patients resistant to the incision technique know something on an instinctive level - that the risks of an incisional surgery are more significant. The main risk of suture technique is fold failure. This is an annoying, embarrassing, but ultimately a readily correctable problem. The significant major risk of incisional surgery, on the other hand, is damage to the levator mechanism, which can result in ptosis (sleepy eye) or retraction (lid stare). Inexperienced surgeons can also create havoc by over removing fat and/or skin, resulting in an uncorrectable, permanent deformity. Finally there is on occasion the poor scarring and permanent puffiness of the upper lid, overwhelmingly which occur in smokers, cigarettes or otherwise.
Incisional technique The ideal candidate for Incisional technique include patients who are A) older than the latter 20's, B) have excess skin or fat, C) desire a larger, dramatic fold who have a preference for an Incisional technique. Some of the less ideal candidates for this technique include: A) Smokers (more than ten cigarettes daily), B) who will scar more prominently C) Excessively saggy brows or deep forehead wrinkles, whose correction would lead to too much removal of upper lid skin. D) Multiple prior upper lid surgeries, whose scarring results in limited eyelid function, and who probably should limit themselves to correcting eye problems related to function, not appearance enhancement.
Surgeons differ in two major areas: the crease markings which will determine the shape and size of the fold, and technique of surgery, namely which deep eyelid structure will the skin be secured to. Although many types of folds have been described, the most natural (hence, ideal) shape of the fold is a tapered fold and the parallel fold, referring to the shape in relation to the margin of the inner half of the eyelid. The ideal size of the fold allows 2 - 3mm of skin above the eyelashes to show on direct frontal view with the eyes open. This also usually corresponds to a crease set at 10mm from the lash line when the eyes are closed (with the skin on light tension). This height is modified based on whether the eyeball is slightly deep set (larger crease) or overly shallow (smaller crease). This height also corresponds to the size of the tarsal plate, the cartilaginous skeleton of the eyelid. Skin excision is usually needed, determined by the sagginess of the brow - more skin removal being required for saggier brows. Skin excision is limited to 3 or 4mm in order to maintain the naturalness of the eye area and prevent risk of dry eyes. Patients over age 40 and those who require more correction than this are strongly encouraged to consider a brow lift. An advantage of undergoing an evaluation from a plastic surgeon certified by the American Board of Plastic Surgery is that such surgeons are trained to evaluate and treat not only your eyelids but your face in its entirety, whether it is the eyebrows or the midface.
More dramatic folds result from an incisional “anchor” blepharoplasty with a brow lift.
Technical differences between surgeons involve the structure to which the eyelid skin-muscle is secured. One structure preferred by some surgeons is the septum, lying deep to the skin-muscle. The advantage of securing the fold to this structure is that there is minimal swelling due to the limited dissection. The disadvantage is that any excess fat, which lies just deep to the septum is not addressed. Also the limited dissection leads to a higher rate of crease failure. Perhaps the most popular technique today is securing the skin to the levator aponeurosis, the structure just deep to the fat and which is responsible for pulling the eyelid open. This technique, developed in the 1960's by plastic surgeon Leabert Fernandez, is considered the first modern technique for double eyelid surgery. Although probably used by more surgeons than any other, a drawback is the not-insignificant rate of fold failure and imprecision in the crease. This phenomenon is due to the fact that the levator aponeurosis is a structure with a glossy, teflon-like surface, necessary for gliding motion as the levator aponeurosis lifts and lowers the eyelid. This slippery surface, unfortunately, also can resist attempts to attach the skin-muscle to it when creating a surgical fold. This can result in imprecise folds that "slide" around. This also accounts for the occasional fold loss.
Prior incisional surgery with skin fixation to levator aponeurosis performed elsewhere resulting in multiple creases, indistinct fold, and left eyelid ptosis (droopage) (left photo).
Correction using anchor technique with fixation of skin to tarsal plate and correction of detached levator aponeurosis (right photo).
The most precise, permanent folds result from securing the skin-muscle to the tarsal plate, lying beneath the levator aponeurosis. Fat and other slippery soft tissues are removed to allow the muscle and skin to attach to the rough raw surface of the tarsus. The result is a secure permanent crease. This technique is known as an "anchor blepharoplasty". One drawback of this technique is the complexity of the operation which has limited the number of surgeons who feel comfortable with this technique. Performed properly, however, the procedure results in a highly stylized precise, permanent crease.
S = Skin
F = Fat
LA = Levator aponeurosis
TP = Tarsal Plate
In the “anchor” technique, the crease is secured to the Tarsal Plate rather than the Levator Aponeurosis resulting in a more secure fold. The levator aponeurosis has a slippery, shiny surface which is a less secure structure than the tarsal plate for suturing.
Medial epicanthoplasty The medial epicanthus (ME), or Mongolian fold, covers the inner corner of the eyelid. The degree of severity can be categorized as non existent or mild, moderate and severe, depending on how much of the caruncle (the pink "bump" inside the eye corner) is exposed. The severe cases should be corrected; for moderate folds, correction is optional. One popular technique for correction is to remove a crescent of skin along the ME. The location of the incision is parallel to the edge of the fold, in an attempt to hide it. Our observation is that this frequently leads to a widening of the scars due to the stretching forces resisting against the incision. In addition. the crescent removals are frequently performed as one long incision connected to the double-eyelid incision. We find that the continuous incision contributes to an undesirable appearance of the scar. Instead, our preference is what is called a "v-w plasty" in which incisions are placed not parallel but perpendicular to the edge of the ME. 7 sutures carefully placed with the aid of magnifying loupes usually results in barely detectable scars. However, we limit this procedure to non smokers.
Double sutures and Twisting (DST) method Asian eyelid surgery with v-w medial epicanthoplasty (ME)
For a technical description of the procedures described above geared to physicians, please go to: http://www.emedicine.com/plastic/topic425.htm
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BEVERLY HILLS CENTER
436 N. Roxbury Drive, Suite 207 Beverly Hills, California 90210
Tel: 310.271.5954
Fax: 310-271-0539
asian rhinoplasty
asian rhinoplasty (asian nose job)
The same goal exists for rhinoplasty performed on Asians as for rhinoplasty performed on Caucasians, which is to build a natural-appearing structure that blends harmoniously with the face. As a group, Asians require augmentation of the nose to achieve this result, in contrast to Caucasians who usually require reduction. As with other types of surgery performed on Asians, successful surgery results in a feature consistent with the patient's ethnic identity. Thus, the goal of surgery should be an attractive Asian nose, not the creation of an attractive Caucasian nose on an Asian face. For more information on aesthetic medicine, including news and CME activities, visit Medscape’s Aesthetic Medicine Resource Center.
History of the Procedure
Previously, surgery has focused primarily on dorsal augmentation. Although still performed (especially by nonphysicians or those with limited training), injection of paraffin or liquid silicone has been replaced by alloplastic augmentation, most commonly silastic. Historically, the surgeon addressed the tip by augmenting it together with the dorsum in a one-piece, L-shaped implant with the bend of the L forming the new tip. Because extrusion at the tip remains an ongoing concern with implants of this type, the surgeon frequently protects the tip with cartilage from the ear, septum, or lower lateral cartilage.
The nasal tip and especially nasal tip lengthening vis-à-vis facial thirds remains the primary challenge of Asian rhinoplasty. The popularity of open rhinoplasty in the United States has led to an increased interest in applying this method to Asian rhinoplasty.
Nevertheless, due to the poorer healing characteristics of Asian skin, currently the author prefers the endonasal approach to Asian rhinoplasty.
Problem
Address the problem as isolated to the dorsum, tip, alar base, vertical dimension, or all of the above. The Asian nose shares similar ideal dimensions with the Caucasian nose but with emphasis on subtleness: the dorsum requires less height, the tip less definition, the alar base less narrowness. As in Caucasians, ideally the radix begins at or slightly below the lash line. The length, measured from the idealized radix to the base of the columella (subnasale), occupies the central third of the face. The tilt of the columella measures 90-115° from the vertical plane, with higher angulation preferred for smaller women.
Southeast Asians (Malay, Filipino, southern Chinese) typically require the most dorsal augmentation (4 mm or more), while northeast Asians (Korean, Japanese, northern Chinese) require less (1.5-2.5 mm) or none. It may be necessary to better define the tip and increase its projection. A deficient premaxilla may need augmentation, as evidenced by a retracted columella with deficient columellar show from lateral view. The nose may require lengthening as measured from the radix to the tip or from the radix to the base of the columella.
The need for alar reduction is frequent in southeast Asians but much less so in northeast Asians. In most cases, both the flare and width need to be corrected; this necessitates an incision into the alar groove.
Pathophysiology
Skin
Nasal skin's thickness better conceals the anatomic detail of the underlying nasal skeleton. This allows better blending of alloplastic or autogenous augmentation with native tissues. Nevertheless, do not use this as an opportunity for sloppiness in surgical technique, because in this patient population, expectations are exceedingly high.
Cartilage
The more delicate cartilaginous tissues of the lower lateral cartilage generally require reinforcement with autogenous cartilage from the ear or septum to obtain a desired result. Affecting a result with pure cartilage reshaping techniques is difficult and usually inadequate. Septal cartilage frequently requires two-layered reinforcement because of its thinness. When harvesting septal cartilage, preserve 1.5 cm of caudal and dorsal septum to prevent nasal dorsal collapse. In about 20% of cases, the septal cartilage is inadequate and additional cartilage from the ear is necessary.
Generally, the lower lateral cartilage is too soft and pliable to adequately support the tip. Such softness precludes the successful use of onlay grafts to the tip, except for the rare patient who has sufficiently strong cartilage (about 10% of patients). Currently, when the author performs an open rhinoplasty, preference is given to creating an anterior strut graft with ear cartilage. In the author's experience, even 2 layers of cartilage appear inadequate to maintain the projection beyond 2 years. While septal cartilage appears adequate for tip projection in closed rhinoplasty, the compromise of circulation at the tip when using the open rhinoplasty approach may contribute to long-term weakness, absorption of the septal cartilage, or both. Conchal cartilage grafts placed as a strut appear to have a more durable outcome.
When an endonasal approach is used, a 1-layered graft appears adequate to maintain durable tip projection.
When tip grafting, defatting should be limited in order to decrease the likelihood of graft visibility. This is particularly true in the open approach, as the 2-layered graft combined with a columella incision can lead to compromised circulation at the tip area and more significant scarring.
Nasal bones
The shorter and more delicate nasal bones place the patient at higher risk for internal valve collapse; consider spreader grafts in the rare patient requiring isolated dorsal reduction. Fortunately, alloplastic dorsal augmentation functions as a spreader graft, precluding the need for this as a separate maneuver in many cases.
Because of the shorter height of the nasal bones, the author finds that a curved osteotome provides a more consistent result than the percutaneous approach.
Indications
The indication for Asian augmentation nasal surgery is a patient with realistic expectations and mental stability. Asian male rhinoplasty patients appear to have a higher rate of dissatisfaction from nasal surgery. Careful screening is recommended, especially with regard to outcome and the likely shortfalls of the operation.
Relevant Anatomy
First analyze the nasal dorsum, which begins at or slightly below the eyelash line. A straight line drawn from this point to the supratip area determines the appropriate dimensions of the nasal implant. Because of the high visibility of implants ending in the mid dorsum, it may be necessary to lower the height of the dorsum to accommodate a longer implant, even if the dorsal deficiency appears isolated to the radix.
Next, assess the nasal tip for three characteristics: the need for increased projection, tip definition, and/or length from radix to tip. Because of their interrelationship, the need for improvement in any one of these aspects impacts the other two.
The resilience of the lower lateral cartilage determines the approach used to correct the deficiency. According to Millard-Sheen, a well-developed firm nasal tip may require nothing more than a suture-reshaping technique or a graft isolated to the nasal tip identical to a Caucasian rhinoplasty. More typically, a tip grafting technique is required. As the tip becomes increasingly delicate, construct increasingly substantial tip cartilage.
As the nasal tip projection is increased with a graft, the nose rotates cephalically, shortening the radix-tip length. One way to offset this involves suturing the lower lateral cartilages to each other to prevent rotation; bolster this effect with ear cartilage two layers thick, or use a modification of Robert Flowers' toboggan-graft technique (a modified Millard anterior nasal strut). Secure a septal cartilage graft, two layers thick, to the base of the columella, with a buttress behind the graft at the tip if necessary to further offset the tip rotation.
As mentioned above, when using an open approach, the author prefers conchal cartilage, made 2 layers thick, to serve as an anterior strut graft. Perhaps owing to circulatory disruption, septal cartilage appears to weaken or resorb over time, resulting in the loss of tip projection. The endonasal approach preserves better circulation to the tip area, and this may explain the better survivability of cartilage tip grafts. Currently the author prefers an endonasal approach using a 1-layered conchal (cavum) cartilage anterior strut graft with minimal defatting to the tip.
Next, look for maxillary spine deficiency, as evidenced by a retracted columellar base and an acute nasolabial angle. The degree of deficiency may require a plumping graft of cartilaginous tissue. Finally, determine whether the alar base requires correction of width or flare. Increasing the projection of the nasal tip usually obviates the need for this in the northeast Asian population (Koreans, Japanese). More frequently, this procedure is performed on Southeast Asians such as Filipinos and Malay. When correcting the flare, the surgeon should avoid a pasted-on appearance of the nostril at all costs. This is done by preserving a slight curvature to the nostril when making the lateral incision.
Contraindications
Prior injections of liquid silicone or paraffin to the nasal dorsum predispose patients to infections when the nose is augmented with alloplastic material. The patient should accept the risk of infection rates, which border on 40% or more.
Rhinoplasty, Asian
Overview: Rhinoplasty, Asian
Treatment: Rhinoplasty, Asian
Follow-up: Rhinoplasty, Asian
Multimedia: Rhinoplasty, Asian
The same goal exists for rhinoplasty performed on Asians as for rhinoplasty performed on Caucasians, which is to build a natural-appearing structure that blends harmoniously with the face. As a group, Asians require augmentation of the nose to achieve this result, in contrast to Caucasians who usually require reduction. As with other types of surgery performed on Asians, successful surgery results in a feature consistent with the patient's ethnic identity. Thus, the goal of surgery should be an attractive Asian nose, not the creation of an attractive Caucasian nose on an Asian face. For more information on aesthetic medicine, including news and CME activities, visit Medscape’s Aesthetic Medicine Resource Center.
History of the Procedure
Previously, surgery has focused primarily on dorsal augmentation. Although still performed (especially by nonphysicians or those with limited training), injection of paraffin or liquid silicone has been replaced by alloplastic augmentation, most commonly silastic. Historically, the surgeon addressed the tip by augmenting it together with the dorsum in a one-piece, L-shaped implant with the bend of the L forming the new tip. Because extrusion at the tip remains an ongoing concern with implants of this type, the surgeon frequently protects the tip with cartilage from the ear, septum, or lower lateral cartilage.
The nasal tip and especially nasal tip lengthening vis-à-vis facial thirds remains the primary challenge of Asian rhinoplasty. The popularity of open rhinoplasty in the United States has led to an increased interest in applying this method to Asian rhinoplasty.
Nevertheless, due to the poorer healing characteristics of Asian skin, currently the author prefers the endonasal approach to Asian rhinoplasty.
Problem
Address the problem as isolated to the dorsum, tip, alar base, vertical dimension, or all of the above. The Asian nose shares similar ideal dimensions with the Caucasian nose but with emphasis on subtleness: the dorsum requires less height, the tip less definition, the alar base less narrowness. As in Caucasians, ideally the radix begins at or slightly below the lash line. The length, measured from the idealized radix to the base of the columella (subnasale), occupies the central third of the face. The tilt of the columella measures 90-115° from the vertical plane, with higher angulation preferred for smaller women.
Southeast Asians (Malay, Filipino, southern Chinese) typically require the most dorsal augmentation (4 mm or more), while northeast Asians (Korean, Japanese, northern Chinese) require less (1.5-2.5 mm) or none. It may be necessary to better define the tip and increase its projection. A deficient premaxilla may need augmentation, as evidenced by a retracted columella with deficient columellar show from lateral view. The nose may require lengthening as measured from the radix to the tip or from the radix to the base of the columella.
The need for alar reduction is frequent in southeast Asians but much less so in northeast Asians. In most cases, both the flare and width need to be corrected; this necessitates an incision into the alar groove.
Pathophysiology
Skin
Nasal skin's thickness better conceals the anatomic detail of the underlying nasal skeleton. This allows better blending of alloplastic or autogenous augmentation with native tissues. Nevertheless, do not use this as an opportunity for sloppiness in surgical technique, because in this patient population, expectations are exceedingly high.
Cartilage
The more delicate cartilaginous tissues of the lower lateral cartilage generally require reinforcement with autogenous cartilage from the ear or septum to obtain a desired result. Affecting a result with pure cartilage reshaping techniques is difficult and usually inadequate. Septal cartilage frequently requires two-layered reinforcement because of its thinness. When harvesting septal cartilage, preserve 1.5 cm of caudal and dorsal septum to prevent nasal dorsal collapse. In about 20% of cases, the septal cartilage is inadequate and additional cartilage from the ear is necessary.
Generally, the lower lateral cartilage is too soft and pliable to adequately support the tip. Such softness precludes the successful use of onlay grafts to the tip, except for the rare patient who has sufficiently strong cartilage (about 10% of patients). Currently, when the author performs an open rhinoplasty, preference is given to creating an anterior strut graft with ear cartilage. In the author's experience, even 2 layers of cartilage appear inadequate to maintain the projection beyond 2 years. While septal cartilage appears adequate for tip projection in closed rhinoplasty, the compromise of circulation at the tip when using the open rhinoplasty approach may contribute to long-term weakness, absorption of the septal cartilage, or both. Conchal cartilage grafts placed as a strut appear to have a more durable outcome.
When an endonasal approach is used, a 1-layered graft appears adequate to maintain durable tip projection.
When tip grafting, defatting should be limited in order to decrease the likelihood of graft visibility. This is particularly true in the open approach, as the 2-layered graft combined with a columella incision can lead to compromised circulation at the tip area and more significant scarring.
Nasal bones
The shorter and more delicate nasal bones place the patient at higher risk for internal valve collapse; consider spreader grafts in the rare patient requiring isolated dorsal reduction. Fortunately, alloplastic dorsal augmentation functions as a spreader graft, precluding the need for this as a separate maneuver in many cases.
Because of the shorter height of the nasal bones, the author finds that a curved osteotome provides a more consistent result than the percutaneous approach.
Indications
The indication for Asian augmentation nasal surgery is a patient with realistic expectations and mental stability. Asian male rhinoplasty patients appear to have a higher rate of dissatisfaction from nasal surgery. Careful screening is recommended, especially with regard to outcome and the likely shortfalls of the operation.
Relevant Anatomy
First analyze the nasal dorsum, which begins at or slightly below the eyelash line. A straight line drawn from this point to the supratip area determines the appropriate dimensions of the nasal implant. Because of the high visibility of implants ending in the mid dorsum, it may be necessary to lower the height of the dorsum to accommodate a longer implant, even if the dorsal deficiency appears isolated to the radix.
Next, assess the nasal tip for three characteristics: the need for increased projection, tip definition, and/or length from radix to tip. Because of their interrelationship, the need for improvement in any one of these aspects impacts the other two.
The resilience of the lower lateral cartilage determines the approach used to correct the deficiency. According to Millard-Sheen, a well-developed firm nasal tip may require nothing more than a suture-reshaping technique or a graft isolated to the nasal tip identical to a Caucasian rhinoplasty. More typically, a tip grafting technique is required. As the tip becomes increasingly delicate, construct increasingly substantial tip cartilage.
As the nasal tip projection is increased with a graft, the nose rotates cephalically, shortening the radix-tip length. One way to offset this involves suturing the lower lateral cartilages to each other to prevent rotation; bolster this effect with ear cartilage two layers thick, or use a modification of Robert Flowers' toboggan-graft technique (a modified Millard anterior nasal strut). Secure a septal cartilage graft, two layers thick, to the base of the columella, with a buttress behind the graft at the tip if necessary to further offset the tip rotation.
As mentioned above, when using an open approach, the author prefers conchal cartilage, made 2 layers thick, to serve as an anterior strut graft. Perhaps owing to circulatory disruption, septal cartilage appears to weaken or resorb over time, resulting in the loss of tip projection. The endonasal approach preserves better circulation to the tip area, and this may explain the better survivability of cartilage tip grafts. Currently the author prefers an endonasal approach using a 1-layered conchal (cavum) cartilage anterior strut graft with minimal defatting to the tip.
Next, look for maxillary spine deficiency, as evidenced by a retracted columellar base and an acute nasolabial angle. The degree of deficiency may require a plumping graft of cartilaginous tissue. Finally, determine whether the alar base requires correction of width or flare. Increasing the projection of the nasal tip usually obviates the need for this in the northeast Asian population (Koreans, Japanese). More frequently, this procedure is performed on Southeast Asians such as Filipinos and Malay. When correcting the flare, the surgeon should avoid a pasted-on appearance of the nostril at all costs. This is done by preserving a slight curvature to the nostril when making the lateral incision.
Contraindications
Prior injections of liquid silicone or paraffin to the nasal dorsum predispose patients to infections when the nose is augmented with alloplastic material. The patient should accept the risk of infection rates, which border on 40% or more.
Rhinoplasty, Asian
Overview: Rhinoplasty, Asian
Treatment: Rhinoplasty, Asian
Follow-up: Rhinoplasty, Asian
Multimedia: Rhinoplasty, Asian
Thursday, May 7, 2009
asian breast augmentation surgery
Home
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Patient Testimonials
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Featured Asian Beauty
Dr. Corbin's patient Grace Kim
Playboy Playmate November 2008
Asian Beauty Gallery
Breast Augmentation Patient Melanie
Name: Llorena
Bust: 34 C
Waist: 24
Hips: 34
Height: 4'11 1/2
Weight: 95
Personal Goals: To own and manage my own dance studio. To have a successful and fulfilled life. And to have a strong, loving, healthy marriage.
Pet Peeves: Dishonest people and people who are always late
Personal Style: Fun and sassy.
Hobbies: Dancing, shopping, traveling, spending time with my family and friends.
Three Most Important Things to Me:
Honesty,
Loyalty,
Respect.
Also My independence, my family, friends and happiness.
Testimonial: I was referred to Dr. Corbin by friends who are his patients. For years I went back and forth on whether I should have surgery or not. Finally, after a lot of thought, I decided it was a decision I knew I wanted to do for only myself. The experience, so far has been wonderful. It was not painful at all, in fact, within a day or two I felt ready to take on the world! I was always secure and confident, but surgery enhanced these qualities even more. I love how clothes fit and look on me more now than ever. The staff was wonderful and Dr. Corbin was amazing! Like anyone considering surgery, I was nervous and scared, but I knew Dr. Corbin and his professional staff would take care of me therefore, I was more excited than afraid. I would do it all over again in a heartbeat. My breast augmentation was one of the best decisions I have made.
Thank you, L.
Schedule your complimentary cosmetic consultation today! click here
Dr. Frederic Corbin
Beverly Hills Office
436 N. Bedford Drive, Suite 202
Beverly Hills, CA 90210
Phone: (310) 284-8384
Dr. Frederic Corbin
Orange County Office
400 West Central Avenue, Suite 101
Brea, CA 92821
Phone: (714) 671-3033
Fax: (714) 671-1231
Asian Breast Augmentation
Asian Women Breast Augmentation
Asian Breast Implants
Asian Breast Surgery
Asian Breast Size
Small Breast Augmentation
Asian Breast Implant
Asian Breast Enlargement
Asian Breast Photos
Asian Breast Enhancement
Asian Breast Augmentation
Asian Boob Job
Asian Breast Lift
Asian Breast Lift Beverly Hills
Asian Breast Lift Los Angeles
Asian Breast Lift Orange County
Breast Augmentation
Asian Breast Augmentation LA
Asian Breast Augmentation orange county
Asian Breast Augmentation beverly hills
Asian Breast Augmentation brea
Asian Breast Augmentation California
Asian Breast expert
The Asian Breast expert
Plastic surgery for asian woman
Asian plastic surgery specialist
Bigger breasts for asians
Dr. Profile
Asian Breast Augmentation Surgery
Asian Beauties Gallery
Before & After Photos
Patient Testimonials
Surgery Newsletter
Asian Breast Augmentation Resources
Contact Us
Featured Asian Beauty
Dr. Corbin's patient Grace Kim
Playboy Playmate November 2008
Asian Beauty Gallery
Breast Augmentation Patient Melanie
Name: Llorena
Bust: 34 C
Waist: 24
Hips: 34
Height: 4'11 1/2
Weight: 95
Personal Goals: To own and manage my own dance studio. To have a successful and fulfilled life. And to have a strong, loving, healthy marriage.
Pet Peeves: Dishonest people and people who are always late
Personal Style: Fun and sassy.
Hobbies: Dancing, shopping, traveling, spending time with my family and friends.
Three Most Important Things to Me:
Honesty,
Loyalty,
Respect.
Also My independence, my family, friends and happiness.
Testimonial: I was referred to Dr. Corbin by friends who are his patients. For years I went back and forth on whether I should have surgery or not. Finally, after a lot of thought, I decided it was a decision I knew I wanted to do for only myself. The experience, so far has been wonderful. It was not painful at all, in fact, within a day or two I felt ready to take on the world! I was always secure and confident, but surgery enhanced these qualities even more. I love how clothes fit and look on me more now than ever. The staff was wonderful and Dr. Corbin was amazing! Like anyone considering surgery, I was nervous and scared, but I knew Dr. Corbin and his professional staff would take care of me therefore, I was more excited than afraid. I would do it all over again in a heartbeat. My breast augmentation was one of the best decisions I have made.
Thank you, L.
Schedule your complimentary cosmetic consultation today! click here
Dr. Frederic Corbin
Beverly Hills Office
436 N. Bedford Drive, Suite 202
Beverly Hills, CA 90210
Phone: (310) 284-8384
Dr. Frederic Corbin
Orange County Office
400 West Central Avenue, Suite 101
Brea, CA 92821
Phone: (714) 671-3033
Fax: (714) 671-1231
Asian Breast Augmentation
Asian Women Breast Augmentation
Asian Breast Implants
Asian Breast Surgery
Asian Breast Size
Small Breast Augmentation
Asian Breast Implant
Asian Breast Enlargement
Asian Breast Photos
Asian Breast Enhancement
Asian Breast Augmentation
Asian Boob Job
Asian Breast Lift
Asian Breast Lift Beverly Hills
Asian Breast Lift Los Angeles
Asian Breast Lift Orange County
Breast Augmentation
Asian Breast Augmentation LA
Asian Breast Augmentation orange county
Asian Breast Augmentation beverly hills
Asian Breast Augmentation brea
Asian Breast Augmentation California
Asian Breast expert
The Asian Breast expert
Plastic surgery for asian woman
Asian plastic surgery specialist
Bigger breasts for asians
Sunday, April 26, 2009
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