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Archive for the ‘Revision Rhinoplasty’ Category

What are spreader grafts? Dr Grigoryants Reviews Spreader graft use in rhinoplasty

Tuesday, May 30th, 2017

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 Drawing

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.

 

Case Example

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.

Dr. Grigoryants rhinoplasty

 

 

To learn more visit  http://www.vgplasticsurgery.com/los%20angeles%20nose%20reshaping(rhinoplasty).htm

 

 

 

Dr. Grigoryants Reviews Post-rhinoplasty Instructions

Tuesday, May 30th, 2017

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  vladgrigor@gmail.com

 

What Is Pollybeak Deformity? Understanding Steps of Revision Rhinoplasty

Friday, 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.

Is Recovery Different After Revision Rhinoplasty?

Thursday, 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.

Revision Rhinoplasty for the New Year

Wednesday, December 18th, 2013

The holiday season is in full effect, and what a better time to talk about redesigning your nasal structure for the new year. You may be thinking of some of the flaws that occurred after recovery from your primary rhinoplasty and feel the need to correct them. While many of us attempt to resolve our nasal humps, uneven nostrils and saddle noses, there are also a number of issues that cause damage from your initial nose surgery. Plastic surgeons know how difficult it is to successfully complete a nose job, fortunately Dr. Grigoryants has years of experience in revision for patients with continuous or newly developed issues. Those in need of help turn to him for guidance around this time of year for correction of poorly executed rhinoplasty surgeries.

Revision rhinoplasty, or revision nose surgery, is offered to those who experience a need for repair or continued maintenance for a previous nose surgery. Patients are not always upset or accuse their previous plastic surgeons for botched nose jobs, rather they wish to receive a second helping of correction to maintain proper function and cosmetic results. Revision nose  surgery is performed for multiple reasons, including:

  • Correction of asymmetry or depressions
  • Replace implants or cartilage grafts
  • Restore normal breathing
  • Make the nose smaller and narrower
  • Correct droopy nasal tips

How Long Should I Wait for Revision Nose Surgery?

It is important for patients to know when to return or seek further assistance after primary rhinoplasty. About a whole year is required in order for a person’s nose to completely heal. The skin and softer tissues shrink down to size and swelling reduces after recovery. Roughly patients should consider waiting a minimum of a year to observe the outcome of their new appearance.

After a first rhinoplasty, the structure of the  face becomes altered and different than its initial shape. The nose now has scar tissue which may or may not have healed properly, which is why most all plastic surgeons urge their patients to wait before seeking a second nose surgery.

Common Mistakes to Avoid After Rhinoplasty

Nose surgery is not a one-size-fits all procedure, many precautions are taken by the plastic surgeon to avoid future issues from evolving. Many patients however fail to take care of their new nose after primary rhinoplasty. They turn to revision nose surgery for help because of their poor after care treatment. To avoid the need for revision they can commit to following a number of steps to ensure proper healing and shape, including:

  • Following plastic surgeon instructions carefully before and after procedure
  • Attending all follow-up appointments for healing progress
  • Avoiding incidental contact during recovery
  • Abstaining from sports and strenuous activities until permitted by surgeon

According to the American Academy of Facial Plastic and Reconstructive Surgery, careful consideration of your surgeon’s instructions and follow-up care are crucial to success in rhinoplasty. The surgeon knows what needs to be done to correct unexpected swelling, poor healing, and excessive bleeding. If a patient fails to meet with their surgeon regarding any of these issues then a patient’s appearance will fail to enhance without flaws.

A board certified plastic surgeon like Dr. Grigoryants will be able to give you the new look you were destined for. Book an appointment now for revision rhinoplasty to get the right look for the new year.

Common Reasons Patients Seek Revision Rhinoplasty

Wednesday, November 13th, 2013

Just as any other surgery, there are certain misfortunes that cannot be avoided. Rhinoplasty is probably one of the most difficult cosmetic surgeries and most plastic surgeons will admit to this. No one can claim to provide their patients with the perfect nose. However, years of experience, practicing up to date techniques and utilizing the latest technology will attempt to meet and surpass patient expectations. Revision rhinoplasty is called upon rare instances in which patients feel unsatisfied with their initial results and seek advanced aesthetic improvements. There are many reasons patients seek a secondary nose surgery, today we will discuss the common reasons why patients request secondary rhinoplasty.

Results of Initial Procedure were Undesirable

It is a rarity when the patient and the surgeon are not on the same page to meet expected results. This is when the need for thorough consultation with the surgeon is advised to avoid such outcomes. Careful planning and execution the second time will to ensure that aesthetic results match the patients’ preference.

Patients Experienced Unfavorable Healing

Following recovery many patients observe excessive scarring as a result of poor healing. The initial surgery was smooth and recovery may have gone well, but the nasal structure did not conform to its natural state. In this case revision may restore nasal shape and remove excess scar tissue.

Breathing Complications Arose

The patient’s ability to breathe comfortably following rhinoplasty is an important part of the procedure. In some instances, breathing issues develop. Revision for this complication restores the patient’s breathing while improving appearance to excess cartilage or bone previously removed.

Post Surgical Injury Affected Nasal Structure

The nose is the most vulnerable part on our face, and it is more likely to receive injury when objects strike the head. The sensitivity levels increase when the patient sneezes following rhinoplasty. Plastic surgeons always instruct their patients to practice safe habits to avoid injury, but we all know that accidents are bound to happen when least expected. Hold in sneezes and avoid blowing the nose until your surgeon allows full use after recovery.

Patients often worry that they may be going back under the knife too soon, so the ideal time to consider revision is after a full year following the initial procedure. This allows time for incisions to heal and allow the shape to conform with the face.

Plastic surgeons never admit to performing the perfect treatment. They provide their patients with accurate expectations and will make corrections that achieve balance with facial features. Every rhinoplasty procedure is different for every patient and it is not a failed surgery if expectations are not met or complications follow, it is a part of the cosmetic process. If you feel that your nasal appearance is unrealistic or unsatisfactory, schedule an appointment to discuss revision rhinoplasty with board certified plastic surgeon Vladimir Grigoryants in Los Angeles.

Reasons Why People seek Revision Rhinoplasty

Thursday, September 19th, 2013

Nose surgery offers results that can significantly improve your overall appearance. Helping you understanding what the surgery can and cannot do is part of the consultation with the plastic surgeon. Before the patient and surgeon commit to the procedure, predictions of results will settle patient’s expectations. Rhinoplasty is a complex, custom-fit operation that offers substantial aesthetic improvements, but there are occasions where patients are left with imperfections. When deformities and flaws are dissatisfying, revision rhinoplasty may be appropriate and necessary.

Revision rhinoplasty can be done to correct functional or aesthetic issues not addressed or brought about by a previous rhinoplasty procedure. Surgeons advise a revision surgery for patients who developed breathing issues and cartilage loss. Patients also seek revision after initial nose surgery to correct aesthetic flaws that their first surgeon failed to correct. Dr. Vladimir Grigoryants is visited often to treat patients for revision rhinoplasty in Los Angeles. Many of his patients will seek his attention to correct flaws from previous surgeries and he achieves success from the closed rhinoplasty technique.

Closed rhinoplasty allows the nose to be reshaped from the inside. Incisions are not made across the columella and lift the skin as it is in open rhinoplasty, instead the dorsal hump and tip is reshaped from incisions inside the nose. In rare instances where patients received open rhinoplasty, Dr. Grigoryants would resort to the open technique to correct scarred tips.

How Long Should I Wait Before Undergoing Revision Rhinoplasty?

After the initial rhinoplasty procedure the patient may see results within the first few days, but the face needs to adjust to the enhancement for a few months and allow the swelling to subside. Most surgeons advise to wait a minimum of six months to a year before considering revision rhinoplasty.

It is necessary to wait to allow the face to heal and allow scar tissue to mature. This permits the surgeon to perform revision rhinoplasty with healthy scar tissue and achieve better results.

Reasons for Revision Rhinoplasty

Patients undergo revision rhinoplasty for a number of reasons. The most common reason Dr. Grigoryants comes across is the disappointment from the outcome of their initial rhinoplasty procedure. The patient’s nose is now too small or still too large, the shape looks crooked, or the patient is suffering from nasal obstructions. Naturally, aesthetic flaws leads to cosmetic dissatisfaction. Such flaws may include:

  • Displaced implants or cartilage grafts that look round and bulbous
  • Too large, small or wide in appearance
  • Inadequate tip projection, droopy tip
  • Asymmetrical appearance

Functional problems that develop as a result of a primary rhinoplasty procedure that led to nasal obstructions making it difficult to breathe or constantly feeling stuffed up can lead a patient to seek revision rhinoplasty.

According to a study from the American Society of Plastic Surgeons, most secondary rhinoplasty cases are considered appropriate to correct new developments or unresolved conditions from initial procedures. There were 150 participants seeking revision and 90 percent of those patients were determined as acceptable candidates. After revision, 97 percent of the patients treated were satisfied with the outcome.

Candidates for Revision Rhinoplasty

Secondary rhinoplasty may be appropriate to fulfill patient expectations that primary procedures could not reach. Candidates for revision should be in good health and present valid reasons of dissatisfaction of results. They must possess realistic expectations for results of treatment.

Patients must wait a minimum of six months for the site to fully heal before secondary surgery. Depending on the body’s healing abilities, patients may need to wait longer than six months to obtain revision. Scar tissue must be healed and healthy before the surgeon can treat the site properly.

Schedule a Consultation

Dr. Grigoryants plans a custom revision rhinoplasty to treat the needs of his patients. He considers the details changed from previous surgeries and applies precise techniques to correct new developments or untreated aesthetic flaws. Book your appointment in Los Angeles for revision rhinoplasty, you can still achieve the results you deserve. If you are dissatisfied with your initial rhinoplasty discover the quality results of revision rhinoplasty with Dr. Grigoryants.

 

Dr. Grigoryants Los Angeles cosmetic surgeon provides plastic surgery services throughout Southern California including Glendale, Burbank, Pasadena, Los Angeles, Encino, Huntington Park, Studio City, Arcadia, Montrose, Hollywood, La Crescenta, La Canada Flintridge, Valencia, Monrovia, Eagle Rock, Altadena, San Marino, Sherman Oaks, Thousand Oaks, North Hollywood, Long Beach, Beverly Hills, Van Nuys, Santa Monica, Calabasas, Palmdale, Fresno, Northridge, and Westlake Village, and Simi Valley.

Our Plastic Surgery center in Glendale, Los Angeles, California specializes primarily in Cosmetic Plastic Surgery inclding breast enlargement, breast augmentation, breast implants, liposuction, tummy tuck, abdominoplasty, cosmetic facelifts, rhinoplasty (nose surgery, nose job), Forehead Lift, Eyelid Surgery and other body contouring procedures. The center led by an expert Los Angeles Plastic and Cosmetic Surgeon. As a board certified Los Angeles plastic surgeon, Dr. Grigoryants is dedicated to providing high quality yet affordable cosmetic plastic surgery options to Los Angeles patients and being the best plastic surgeon in Los Angeles, Glendale, Pasadena, Beverly Hills.

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