February 26th, 2016
Review of Spreader Grafts by Dr. Vladimir Grigoryants
Spreader grafts are frequently used in rhinoplasty. Spreader grafts are strips cartilage made of patients own cartilage that are placed on each side of the septum ( between the septum and the side wall). Typically, the mid or lower portion of the septum is harvested to make spreader grafts. Other synthetic materials or other sources of cartilage (e.g ear cartilage) can also be used for spreader grafts. I prefers to use patient’s own septal cartilage to make the spreader grafts.
1. Why are spreader grafts needed?
Spreader grafts are very important to prevent midnasal collapse (also known as an internal nasal valve collapse or inverted V deformity).
The dorsal aspect of the septum (the top or the bridge) is naturally wider than the portion below it, looking like a letter T. The wider part of the T holds the side walls apart. This is the internal nasal valve. When the dorsal hump is removed that wide portion of the septum (horizontal part of the T) is removed in most cases leaving the narrow portion of the septum, looking like an letter I. Without reconstructing that wide portion of the dorsal septum, the side walls will invariably collapse causing nasal valve obstruction (breathing obstruction) and cosmetically collapsed nose, called an inverted V deformity. Therefore, in nearly all cases, when dorsal hump reduction is performed, spreader grafts should be used to prevent the sidewalls from collapsing. In some patients, with or without the dorsal hump, the wider portion of the T is naturally narrow causing nasal valve collapse on inspiration. Spreader grafts are used to reconstruct the internal nasal valve and improve nasal airway patency in these patients.
Furthermore, the spreader grafts also used close the open roof following dorsal hump reduction. Click on the diagram above to enlarge it.
So, spreader grafts support the sidewalls, preventing them from collapsing and maintaining or improving the internal nasal valve. Aesthetically, spreader grafts allow to produce smoother nasal contour line from the forehead to the tip on the front view, knows as dorsal aesthetic lines. The spreader grafts are not visible as they are placed between the septum and the lateral walls.
Please google Inverted V deformity in Google images to see what an Inverted V deformity looks like when spreader grafts are not used.
2. Will spreader grafts make the nose wider following dorsal hump reduction?
Patients with a wide dorsum (bridge) will have narrower noses following dorsal hump reduction, spreader graft placement and nasal bone narrowing via osteotomies.
Those patients with a narrow midportion of the bridge preoperatively will have a slightly wider midportion of the nose after spreader graft placement, which would be aesthetically more appropriate and better functionally.
Patients with an average dorsal width of about 7 -12mm will usually have about the same width after surgery as before surgery. It is possible for the width of the midnasal area to be slightly wider after surgery if the nose is significantly deviated and additional spreader grafts are needed to keep the nose straight.
It is very important to note that even 12 months after rhinoplasty there is still a small amount of swelling that takes years to go away. So, the nose may initially appear wider and continue to narrow during the first several years.
This patient underwent rhinoplasty almost three years ago. Her dorsal hump was removed and the tip and nasal bones were narrowed. Spreader grafts, septoplasty and turbinate reduction were performed to treat nasal airway obstruction. The bridge/midnasal area and tip appeared wide preoperatively. Spreader grafts allowed to produce smooth dorsal aesthetic lines (lines from the forehead to the tip on each side of the dorsum) and prevent nasal wall collapse. The midnasal area is narrower postoperatively.
To learn more visit http://www.vgplasticsurgery.com/los%20angeles%20nose%20reshaping(rhinoplasty).htm
Additional Patient Reviews with photos from Realself:
December 27th, 2015
The following instructions are given to Dr. Grigoryants’ patients after rhinoplasty. These instructions may be modified for each patient depending on what was performed during surgery.
First day after surgery: Keep you upper back elevated 30-40 degrees. Apply cold compress (cloth soaked in cold water or crushed ice in a glove placed over a cloth) during the first 24 hours. Avoid applying anything frozen directly on the skin. Start taking antibiotics (prescribed by Dr. Grigoryants) the same evening and prescribed pain and nausea medications as needed (read instruction labels on the medications).
Facial swelling tends to get worse during the first 3 days after surgery and improves by the fifth day after surgery. Call Dr. Grigoryants’ office to schedule your postoperative appointment 5-7 after surgery.
Starting day 3 : Start cleaning the bottom of the nose gently using cotton balls or facial tissue soaked in warm water. Apply Vaseline on the rims of the nostrils once a day. Do not put Q-tips inside the nose.
Day 5-7: Dr. Grigoryants will remove your splints and sutures if nostrils were narrowed. Having the nostrils lubricated with vaseline prior to the appointment makes suture removal less uncomfortable. Dr. Grigoryants does not use nasal packing.
– Irrigate the nose with saline spray (also known as Ocean spray). Apply Vaseline inside the nose at night for two weeks using a corner of an open paper napkin rolled into a cylindrical shape (Q-tips are too stiff and my cause injury ). Sutures and dry secretions/dry blood will come out. Breathing will improve.
– Tape your nose only at night. Although taping will not affect the final result, it will help minimize swelling that develops overnight during the early postoperative period.
– Avoid alcohol and blood thinners (aspirin, motrin, advil, excedrin, naproxen, ibuprofen, vitamin E, fish oil, omega 3 fatty acids, herbal supplements ) for 2 weeks after surgery.
– Showers, make up, facial creams can be restarted.
Nose blowing: Can be started gently 2 weeks after surgery.
Driving: You may drive when facial swelling is not impairing vision and you are no longer taking pain medications.
Exercises: Avoid bending for 2 weeks after surgery. Exercises can be resumed 1 month after surgery.
Swimming: Swimming with submerging head in the water can be started 2 months after surgery.
Sun exposure: You may be in the sun but avoid prolonged exposure. Use a hat to protect your nose.
Pore strips: May be resumed 3 months after surgery.
Unpleasant smell in the nose: May occur in some patients after rhinoplasty and will go away over time.
Stiff upper lip and smile: Usually resolves by 2-3 months after surgery.
Flying on airplanes: You may fly 7 days after surgery. Dr. Grigoryants will review special in-flight care instructions with you.
If you have additional questions, please contact Dr. Vladimir Grigoryants at 818 952-7070 or via email at firstname.lastname@example.org
March 6th, 2014
Instructions given to Dr. Grigoryants Patients
Walking – The next day after rhinoplasty
No bending for 2 weeks
Light running – 3 weeks after surgery
Weight Lifting- start gradually 1 month after surgery.
Swimming – 2 months after surgery .
February 25th, 2014
Noticeably different sized breasts is one of the many cosmetic issues that Beverly Hills patients are concerned with. It is a known fact that not every woman’s breasts are perfectly symmetrical breasts. The goal of breast augmentation is to personally transform the patient’s size, shape and volume with breast implants, but many wish to address asymmetrical breasts by altering one or both breasts to be even in appearance.
What Causes Asymmetry?
The case of asymmetrical breasts has no clear reason why one breast is smaller than the other. In most cases, the condition is simply due to genetics and inherited body type. Other possible factors that can be correlated with genetics, include:
- Weight gain
- Hormonal changes at adolescence
- Weight loss
The end result of these factors leaves one breast slightly higher or lower, shaped differently, or larger than the other breast. In some instances the patient’s nipples may be noticeably different in size or position. With the right approach, Dr. Grigoryants can correct these types of asymmetry to ensure that a woman feels confident with her feminine physique.
Uneven breasts can make a woman feel very self-conscious about breast appearance, in some cases the breasts are noticeably different by a cup size or more. This also makes women feel discouraged when it comes to finding the right bra or bikini top that fit and supports breasts correctly.
Depending on the patient’s goals, making breasts symmetrical can be corrected by breast reduction or augmentation. Breast implants can resolve the unevenness for women who wish to add volume to the small breast to match the size and shape of the larger breast. Patients dealing with asymmetry may also enhance both breasts by adding volume for smaller-breasted women. For this procedure, a smaller implant will be placed in the larger breast to match the larger implant for symmetrical results.
According to a study published in the Aesthetic Surgery Journal researchers found a significant increase in patients’ quality of life after having treatment for breast asymmetry. Measuring eight dimensions of health status, research revealed significant improvement in physical, social and psychological well-being.
No surgeon will ever promise perfection, but in the hands of an experienced plastic surgeon such as Dr. Grigoryants, breast augmentation can help you achieve fuller and even breasts suitable to your goals. If you are struggling with asymmetrical breasts, call now to schedule a consultation to have the figure you desire.
February 14th, 2014
Pollybeak deformity after primary rhinoplasty is defined by the appearance of a dorsal hump forms a nasal convexity that resembles a parrot’s beak. This occurs when the area above the tip of the nose on the bridge, known as the supratip, turns downward causing under-rotation. Unfortunately, not all rhinoplasty procedures go according to plan, and the plastic surgeon may not have been equipped for this complex nose reshaping. There are many conditions a revision rhinoplasty specialist has to deal with, one of them being pollybeak deformity. Here we will describe the steps taken by Dr. Grigoryants to resolve this issue.
How Does Pollybeak Occur?
Pollybeak deformity can occur from a variety of causes. In today’s era of advanced plastic surgery however, the possibility of this reaction after primary rhinoplasty is becoming less common. Some of the best plastic surgeons cannot guarantee that it will be avoided, some of the causes of deformity include:
- Bone and cartilage were reduced from dorsal hump without reducing septum
- Unpredictable excess scarring in the supratip region
- Poor healing following primary procedure
- Patient has thick skin and soft nasal cartilage
Correcting Pollybeak Deformity
Every patient’s case is unique and Dr. Grigoryants applies custom treatment plans for every revision rhinoplasty patient. There are a few steps that are commonly utilized to correct pollybeak deformity. Some of the approaches to this procedure include:
- Injection of a steroid into excess scarring sites
- Trimming septum and cartilage in the bridge of the nose
- Adding or removing cartilage in the tip
- Support with dorsal grafts
Most plastic surgeons recommend on visiting your primary nose surgeon to seek revision treatment. However, it becomes difficult to achieve a good aesthetic result for some inexperienced with revision rhinoplasty.
If you decide you want to hire a new rhinoplasty specialist in the Los Angeles area to correct your nasal deformity, consider scheduling a consultation with board certified plastic surgeon Dr. Vladimir Grigoryants. His heavy background with revision rhinoplasty transcends patient expectations. Plan your visit for revision rhinoplasty in Los Angeles today.
February 7th, 2014
We have not observed any voice changes in our patients or received reports from patients that their voice changed after rhinoplasty
January 30th, 2014
Weight loss and healthier eating seem to be on the minds of nearly everyone in 2014, and if you are determined to stick to your New Year’s resolution we encourage you to work hard everyday towards your goal. However, successful weight loss is more than a resolution, for some people it is a committed lifestyle. There are still very many who feel that no matter what they do their figure cannot fully achieve what they are aiming for. If you have put the hard work in and are still unsatisfied with your midsection, then a tummy tuck may be the procedure that fine-tunes your New Year’s resolution.
There are many factors leading up to a person’s dissatisfaction with their abdominal section. The effects of dramatic weight loss, pregnancy, genetics and even aging can leave the stomach looking worn out and separate the abdominal muscles. Exercise and diet are a great to slim down, but the muscles need to be repaired to get rid of the distorted appearance. Most patients considering tummy tuck at this time of year want to get the best results that complement their weight loss achievements, a tummy tuck can restore the body by:
- Redefining body contour
- Eliminating excess and sagging skin
- Reducing fatty areas that exercise cannot remove
- Repairing and tightening abdominal muscles
A weight loss resolution is not an easy feat to accomplish for most people, but those who are successful have turned to tummy tuck and achieved a high rate of sustained weight loss. According to the American Society of Plastic Surgeons, overweight or obese patients who underwent tummy tuck reported long-term weight loss was sustained in 70 percent of the patients studied. Most patients declared that the reason for their successful long-term weight loss was due to the increase of satiety after surgery.
This study reveals that people who were once overweight have the ability to reshape their body without having to worry about putting the weight back. As long as they continue to follow a healthy lifestyle of eating right and exercising, long-term weight loss is sustained well after tummy tuck.
To get a better understanding of how to accomplish the best look for your body, schedule a consultation with Dr. Grigoryants in Los Angeles. Enhancing your New Year’s resolution results with a tummy tuck is the perfect solution to give you the tighter and slimmer abdominal section you deserve.
January 16th, 2014
Secondary nose surgery, or revision rhinoplasty, can involve similar motions that were administered in a patient’s initial nose surgery, but not everything will be the same. The goal for patients is to achieve better results than what they gained in their previous nose surgery, and many wonder if the recovery process is similar or different than what they experienced in their primary procedure. With the help of the latest technology, revision rhinoplasty specialists can help determine the accuracy as well as the road to recovery after surgery.
Following the plastic surgeon’s instructions for pre-operative care and postoperative care closely will help ensure the best possible results during the patient’s recovery. During consultation, the patient and Dr. Grigoryants reviews the overall aesthetic and functional goals of revision nose surgery and address the client’s need for revision. Since healing is managed differently with everyone, your plastic surgeon does his best to keep swelling and disrupting delicate areas to a minimum. After surgery Dr. Grigoryants will instruct you to follow his recovery instructions carefully. Utilize these simple tips for a healthy recovery period as follows:
- Avoid strenuous activity
- Use only prescribed medications allowed by plastic surgeon
- Rest and elevate the head as directed
- Reduce sun exposure
- Avoid smoking
- Do not harm or make abrasive contact with the nose until doctor’s approval
Depending on the outcome of the primary surgery and your plastic surgeon’s evaluations revision rhinoplasty may be the best solution to improve facial harmony. Your physician may suggest an alternative solution to correct your irregularities, so keep an open mind and explore the doctor’s options.
Dr. Grigoryants will be able to address your questions about revision rhinoplasty during consultation. He will help you explore the best solution to correct facial flaws from your initial surgery as well as predict your recovery process after revision rhinoplasty. Schedule an appointment with our professionals at your earliest convenience to achieve the look you really want.
January 3rd, 2014
Your nose is one of the most definitive parts of your face, and its size is one of the first things people notice. Now that the new year is here you have considered taking the next step in altering your appearance, because the shape of your nose continues to make you feel self-conscious. There are plenty of options to consider during rhinoplasty, and Los Angeles rhinoplasty surgeon Dr. Grigoryants is available to show you the best shape for your nose.
Rhinoplasty is mostly an elective procedure that reshapes the nose for aesthetic purposes, but it is sometimes necessary to resolve functional issues that have been caused by injury of deformity. Being unhappy with the nose shape you were born with is a common feeling among many candidates considering rhinoplasty, so a consultation with your plastic surgeon will help you determine a shape that refines facial harmony.
The alterations made to a patient’s nasal structure considers all the components that make up the person’s nose. This includes:
- Nasal Bone
Depending on the patient’s goals and agreement with their surgeon all of these areas can be addressed during procedure. Results of nasal surgery are never hurried or drastic, which is why a skilled plastic surgeon attempts to bring out near perfect harmony and balance with their patient’s facial features.
During consultation is the best time to discuss the desired shape of the nose. Cosmetic surgeons agree that people should always strive for a look that is natural, so a female may consider more feminine results that include straight nasal bridge, slight lift and a nose that is not too long or pointed.
Many nose surgery candidates also consider the results of friends or celebrities who had a nose job. A plastic surgeon will remind their patients that a copycat or imitation nose surgery is not the best decision. Attempting to capture someone else’s look may appear artificial or out of balance with genetic makeup. However, this gives the surgeon an idea about how to achieve the shape for you, and the doctor can communicate the features that are achievable.
According to the American Society of Plastic Surgeons, a nose surgery candidate can expect to discuss their expectations and desired results from rhinoplasty during consultation. With respect to their patients’ desires, the plastic surgeon will determine the procedure’s reshaping of the nose as well as likely outcomes of nose surgery.
The goal of nose reshaping surgery is to make the nose as natural as possible. Dr. Grigoryants can show you the steps he takes to define your nose shape to restore facial balance and harmony. Then you can decide how beneficial rhinoplasty can reflect your appearance for the better.
December 27th, 2013
When it comes to breast augmentation, women are likely to ask how well their cleavage can be enhanced with breast implants. One of the reasons women turn to breast augmentation is because they desire flattering cleavage than before. In terms of breast augmentation we do not advise to place implants too close together on the chest, nor should they be placed far apart. The goals that breast augmentation meets first and foremost are improving the shape, volume and size of the breasts with respect to the patient’s body type.
A woman in search of more cleavage is attempting to close the gap between her breasts. What we typically view as attractive cleavage is narrow space of breasts naturally closer together. Depending on the patient’s anatomy, breast augmentation can close the gap slightly, but does not aim to fill in the gap completely. With respect to the patient’s natural distance between breasts and nipples, Dr. Grigoryants can place the implants slightly closer together for a natural cleavage appearance, otherwise the placing them too close will not achieve the patient’s results and may feel unnatural in the end.
When Breast Implants Sit Too Close Together
Some patients desire their breasts to be bunched closer together for a plunged effect, but it could only lead to a condition called symmastia, otherwise called the uniboob. This occurs when the breasts naturally sit close together, the implants are too close together or the implants shifted to the center after the procedure. The condition may also be a result from inserted implants that were too large.
Implants that Rest Too Far Apart
Lateral displacement is the opposite of symmastia where the breasts sit too far apart to produce a desired appearance of cleavage. Natural breasts sometimes position themselves farther apart than normal, and if implants are placed the final appearance may look too wide. Correcting this may be done to draw the breasts slightly closer together.
Best Approach for Cleavage Enhancement
Dr. Grigoryants is experienced with patients of both narrow and wide cleavage. Consultation will allow him to understand where to place the breast implants without causing the complications listed above. Every patient ends up with different cleavage depth and width after their augmentation. However, Dr. Grigoryants is able to predict the surgical outcome before procedure to match patients’ aesthetic goals as closely as possible.
According to the American Society of Plastic Surgeons, breasts change over time due to aging, weight fluctuations, hormonal issues and gravity. After breast implants are in place, they provide long-lasting results that can be changed or altered by your plastic surgeon in the future.
While it is a myth that breast implants create noticeable cleavage, some women achieve better cleavage if they had an average chest wall size before procedure. Anatomy varies in patients so cleavage is not a guarantee with breast augmentation. Patients are encouraged to bring in expectations and pictures of what they wish to achieve. In some cases improved cleavage is achieved after augmentation, and with proper bra selection a woman’s cleavage expectations can be met accordingly.