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Archive for the ‘Rhinoplasty’ Category

Scarless Rhinoplasty (Closed rhinoplasty) Review by Dr. Grigoryants

Friday, September 1st, 2017

There are two ways to do rhinoplasty – closed rhinoplasty (sometimes referred to as scarless rhinoplasty) and open rhinoplasty. The main difference is that in open rhinoplasty, an incision is made across the columella and nasal  skin is lifted off the nose.  In scarless or closed rhinoplasty, all incisions are placed inside the nose.

Is scarless rhinoplasty truly scarless?   In my opinion, the term scarless rhinoplasty is a bit misleading because in many cases of closed rhinoplasty, the nostril base would need to be narrowed. It is done by placing a small incision in the nostril base groove on each side. This small incision heals well and very difficult to see in most patients. Not performing alar base (nostril base) reduction when needed will result in wide appearing nostrils and patient dissatisfaction.  In those patients who do not need alar base reduction, closed rhinoplasty will truly be scarless.

I prefer closed rhinoplasty for nearly all primary rhinoplasty and most revision rhinoplasty cases. Some difficult revisions, I perform using open rhinoplasty techniques.  Having performed numerous rhinoplasties and seen many patients that come to me for revision, I find that  open rhinoplasty scars  result in visible and indented scars with skin thickening in front of the scar  more frequently than thought. In my experience, closed rhinoplasty allows me to perform all the steps that I do in open rhinoplasty including septoplasty, nasal valve repair, dorsal hump reduction, bony base narrowing , and tip reshaping all under direct vision (as in open rhinoplasty).  Furthermore, not having the skin lifted off the nose, closed rhinoplasty allows me to get an immediate result of my nasal reshaping and produce more consistent and predictable outcomes.  Any patients considering rhinoplasty should make sure that his/her surgeon performs rhinoplasty frequently and able not only to change the shape of the nose but also  perform septoplasty when the septum is deviated, repair nasal valve to prevent collapse, reduce enlarged turbinates to open airways.

View our before and after photos here  – Dr. Grigoryants rhinoplasty

Learn about nasal valve repair here  –  Spreader Grafts

 

 

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

 

Rhinoplasty surgeon los angeles   rhinoplasty beverly hills

Physical Activity After Rhinoplasty

Thursday, 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 .

Will All Rhinoplasty Patients Experience A Voice Change?

Friday, February 7th, 2014

We have not observed any voice changes in our patients or received reports from patients that their voice changed  after rhinoplasty

Rhinoplasty: Choosing the Right Shape for the New You

Friday, 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:

  • Nostrils
  • Bridge
  • Septum
  • Nasal Bone
  • Cartilage
  • Tip

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.

Determining Shape

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.

When to Turn to Rhinoplasty for Traumatic Sports Injuries

Wednesday, December 4th, 2013

Physical contact is likely to happen in nearly any sport. Chances of injury rises without question, and when the face is exposed the nose is the most vulnerable to experience injury. What athletes are unaware of is the damage caused deep within their nasal structure. Many of us believe that simple home remedies of ice and heat applications can resolve the damage, but depending on the severity of impact there could be a need for corrective nose surgery, otherwise known as rhinoplasty.

After a broken nose, some men and women avoid the opinion of experts, and thus increase their risk for complications and crooked appearance.

Broken Nose Complications

The most common result of a broken nose involves a deviated septum, the wall that separates the two nasal passages. After the nose breaks, it can push the wall out of alignment. Limiting airflow for the individual because there is one narrow airway, making it difficult to breathe comfortably.

A broken nose can result in bleeding and when blood collects in the nostrils, one or both can become blocked. Leaving the injury untreated can result in long-term cartilage damage, blood clots and congestion.

Reconstruction and Functional Use

Upon correcting septum alignment and cartilage, rhinoplasty can reshape the nose. Nasal tissue plays an important role for everyone, acting as a filter for air before entering the lungs. Dr. Gigoryants and his staff will make corrections to deformities and rebuild broken nasal bones to become fully functional.

When to See a Rhinoplasty Specialist

Many people are still unsure when to come in for observation, but normally initial observation should come from a hospital emergency room. If the injury was unattended by a doctor for at least a week, then your nose should be evaluated by an experienced, board certified plastic surgeon. A broken nose can be repaired within the first two weeks from the day of the injury, waiting too long will push back the need for reconstruction to allow the bones to heal on their own.

We recommend anyone with a broken nose, who is unhappy with their appearance to seek the advice from our experienced plastic surgeon, Dr. Grigoryants. Those with permanent damage in nasal breathing and congestion are also welcome to determine their need for rhinoplasty. Traumatic sports injuries can cause severe damage to an athlete’s nose, book an appointment now to learn how to correct new or existing disfigurements with rhinoplasty in Beverly Hills.

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.

Friends Starlet Shares How Nose Surgery Changed Her Life

Wednesday, November 6th, 2013

Beauty, brains and friends are some of the most important things every young girl struggles with, even Hollywood actress Lisa Kudrow found herself as an outcast among peers. The former Friends star, known as Phoebe on the hit NBC show, revealed that she had undergone rhinoplasty, and celebrates her experience as a one that altered her life for the better.

Kudrow, 50, expressed no regrets for her decision in an interview with the Saturday Evening Post about her decision to have nose surgery at the age of 16. In her mind, she went from “hideous to not so hideous,” which made her feel the experience as “life-changing” as she transitioned through high school.

From Outcast Teen to Emmy Winner

A few of her childhood friends felt they needed to spare their friendship with Kudrow entering junior high school, leaving her friendless and disappointed. Being depressed going into high school with the same group of peers was no picnic either.

“For your own good, you need to see what would happen if we weren’t here,” said Kudrow about the experience of her friends evicting her. A difficult pill for her to swallow.

She took the initiative to gain a spark of confidence and had nose reshaping surgery during one summer and transferred to a new school. Only then was she able to feel the excitement about attending school and feel comfortable with her appearance. It turned her life around for the better, Kudrow said.

She dove deeper within academics and attended Vassar College in New York. She flirted with ideas of medical school, but it was then where she decided to get into acting. After her breakthrough role on Friends, she has become a highly requested actress, performing in about 30 films as well as many appearances on other television series, including her latest role on ABC drama Scandal.

Advantages of Rhinoplasty

In Kudrow’s high school days, teens were not frowned upon as they are now for undergoing plastic surgery. Surgeons express that maturity is a big concern for making the decision to get nose surgery, and in Kudrow’s case she understood the role rhinoplasty played. Photos of Kudrow before the surgery depicted a nasal tip that protruded and was bulbous in shape. Now the actress’s nose is shorter and smaller, which continues to prevent the hideous feeling that she once felt about her appearance. According to the American Society of Plastic Surgeons the changes of rhinoplasty include:

  • Corrections to nasal asymmetry and deviation
  • Reduction of wide, large or upturned nostrils
  • Adjustments to visible humps or depressions
  • Reshaping nasal tip that is bulbous, drooping or upturned
  • Promotes balance of facial features

Kudrow fans continue to show their praise for her performance on Friends. Her Twitter feed and Facebook display young girls who look up to her character. Kudrow expressed that it is a good feeling to be a role model for her fans beyond the end of the series. Her nasal appearance may have made an impact to her roles as an actress, but she feels that her procedure played an important role in her life. She was able to display her character with confidence, without having to worry about the overbearing and unbalanced features from her youth. Learn more about what rhinoplasty has to offer to help inspire a change in your life.

Even Iconic Beauties Can Benefit from a Little Nip/Tuck

Thursday, October 31st, 2013

Today when you look at Maxim magazine how many of the cover girls do you think had plastic surgery? It is not too shocking to learn that they had work done, but Marilyn Monroe on the other hand, was perceived as a natural beauty. A Southern California plastic surgeon claims to hold evidence proving that the legendary model and actress had cosmetic surgery. Monroe’s au natural presence continues to thrive well beyond her death in 1962, and now X-rays and doctors notes report that the icon had enhancements including chin implants and rhinoplasty.

Marilyn was constantly in front of the camera, so the fact that she had work done shouldn’t change her legacy. She wanted to maintain her appearance and be her best on the silver screen and in public. In the 1950s, the rise of Monroe’s career, there was not a presence of paparazzi that hounded their lives as they do today. Her surgical visits went unnoticed by the press. In that era plastic surgery was fairly new and kept under wraps if you were a public figure. Photos of her early days in modeling compared to work later in her career show differences in her chin and nose, which indicate surgical enhancements.

Did She or Didn’t She?

Monroe will forever remain a woman of beauty and her legacy will continue to thrive as a legend in the modeling and film industry, and evidence of surgery would only indicate that she was interested in keeping up with her appearance in Hollywood stardom. She may have been made over by Michael Gurdin in two procedures as early as 1946, coinciding with her name change and signing with Twentieth Century-Fox Studios. A chin augmentation, using bovine (cow) cartilage, would have filled her jawline out to give her a more distinct shape and improve facial proportion. Her nose was said to be fractured in the year of her death and the X-rays indicate that she may have had a nasal tip refinement.

Justifying Her Unveiled Medical Records

Much of society and public authorities are up in arms to the news that her medical records are going up for public auction. According to the Department of Health and Human Services, Health Insurance Portability and Accountability privacy act rules prohibit disclosure of medical records until 50 years after a person’s death. Many are unaware, but Marilyn passed away 51 years ago. The unveiling of her records is legal and her records are to go up for auction in November. The proceeds are to be donated to U.S. veterans in need of medical work.

Cosmetics and Beauty Today

Plastic surgeons of today strive to achieve natural beauty for every patient that improves their facial form and body contour as they see fit. Chin augmentation is no longer with the use of cow cartilage, but with FDA approved silicone implants. Aesthetic improvements for the nose are to improve shape and restore balance for a bulbous tip, improve breathing or reduce nasal humps.

Model or not, everyone has a fair share of aesthetic improvements they wish to achieve for their appearance. Plastic surgery only proves to show that if Monroe did in fact have the procedures done, without advanced technology of today, made her appear natural. Those interested in exploring options with plastic and reconstructive surgery can visit Dr. Vladimir Grigoryants in Los Angeles. He is a board certified plastic surgeon offering comprehensive treatment with amazing, natural appearing results.

 

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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