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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

 

 

 

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.

Improve Facial Harmony with Rhinoplasty

Saturday, October 19th, 2013

Nose surgery (nose job) can produce a very pleasing  aesthetic  balance of the face especially in  patients with large noses preoperatively. Common changes performed in rhinoplasty in such patients  are reducing the dorsal hump, refining and possibly raising the tip, and shortening the projection of the nose.   In some patients, the size of the nostrils is also reduced.

Aesthetic benefits achieve with rhinoplasty are the following:

-Reducing the dorsal hump allows to accentuate the eyes and cheek bones.

-Decreasing the projection of the nose improves the balance between the nose and the chin ( and lips)

The angle between the columella and upper lip is considered aesthetically desirable  to be 95-100 degrees in women and 90 -95 degrees in men.   This results in a more youthful appearance of  the nose in patients with droopy noses preoperatively

 

 

These are general guidelines. Patients’ preferences need to be considered when formulating a rhinoplasty plan.  For example, some patients prefer to preserve ethnic or family features and may not wish to reduce the size of the nose much. A combination of surgeon’s recommendations and patients goals typically results in a better nose reshaping balanced plan.

 

Dr. Vladimir Grigoryants Plastic Surgery

Rhinoplasty to Improve a Facial Balance – Front View Analysis

Saturday, October 19th, 2013

 

Rhinoplasty requires  not just surgical skills but also understanding of facial proportions.  Preoperatively, patients frequently ask how narrow should my bones or tip be or how much will my tip be lifted.

The following are general observations of facial-nasal relationship found in models.

1.  The width of the nostrils is about the width of the vertical lines drawn from the inner corners of the eyes

2. Nasal bony base width is narrower than the alar (nostril) base width

3. Tip width slightly wider than the width of the filtrum (cental portion of the upper lip)

4. Position of the tip slightly higher than base of the nostrils

 

The front view of the patient below shows how nose surgery can improve facial-nasal harmony.  This patient underwent closed rhinoplasty.

Many patients, however, may have specific preferences as to how they would like their noses reshaped.  A detailed discussion between the patient and  nose surgeon  considering the  patient’s goals and reshaping suggestions from the  surgeon typically results a well thought out plan and best chances for a successful outcome.

To view more before and after photos of Dr. Vladimir Grigoryants patients, visit  our photo gallery

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.

Breath Better with Rhinoplasty

Tuesday, September 10th, 2013

Many people are unsatisfied with the shape of their nose and turn to rhinoplasty to promote balance and improve attractiveness. However, there are many people suffering because they have a defect in their nose that prevents them from breathing normally. After clearing your nose with nasal saline spray do you still experience problems breathing? Even after treating congestion problems does it feel like there is something still blocking your airways. There could be structural issues that have developed and are responsible for blocked airways. Fortunately rhinoplasty can restore normal function of the nose as well as enhance the appearance while balancing out your facial proportions.

Rhinoplasty, more commonly known as nose surgery, is a cosmetic surgery designed to reshape, restructure, and treat any nasal airway obstructions. Board certified plastic surgeon, Dr. Vladimir Grigoryants has mastered an effective rhinoplasty technique which offers his patients maximal results with minimal downtime. This technique allows him to reshape the nose without leaving behind visible scars or damage.

What Causes Nasal Obstruction?

There are many reasons why the nasal airways can be blocked, affecting a person’s breathing. A plastic surgeon is able to evaluate the underlying problems and create a plan of treatment to improve breathing and aesthetic appeal. Some common issues that can result in nasal obstruction are:

  • Deviated septum

  • Internal valve collapse

  • Enlarged turbinates

  • Nasal polyps

What are Signs of Airway Obstruction?

Nasal obstruction can affect a patient’s quality of life as it causes fatigue, poor sleep quality, loss of energy and snoring. Symptoms of airway obstruction include:

  • Nasal congestion

  • Mouth breathing

  • Dry mouth

  • Reduced sense of smell

  • Recurring sinus infections

  • Sleep disturbance

Treating Nasal Obstruction:

Patients can improve nasal airways with treatment from Dr. Grigoryants. He will correct a patient’s deviated septum through septoplasty. A hidden incision is made in the nose to straighten the crooked septum.

Enlarged turbinates can cause frequent nasal airway obstruction. They swell and shrink throughout the course of the day negatively affecting nasal breathing. It is initially treated with nasal sprays to reduce tissue growth, but for patients who are unresponsive to treatment, surgical intervention can definitively treat the enlarged turbinates. During surgery the turbinates are reduced to normal size, thus restore breathing function.

The internal valve area is located a little less than halfway up the nose, in the middle of the nasal bridge. This is a very sensitive area and the height or width of the bridge can affect the valve. Invisible spreader grafts and sutures reconstruct cartilage attachments and maintain good flow of air through this region.

Why Should you Correct Nasal Airway Obstruction?

The nasal airway plays a key role in bringing oxygen into the body. A damaged nasal passage will not perform its functional duties of filtering air pollutants and bringing in adequate amounts of oxygen. In Southern California quantities of pollutants continue to increase daily and is likely to affect those with nasal problems.

According to the American Society of Plastic Surgeons, nose surgery improves appearance and proportion of the nose as well as correct impaired breathing that was caused by structural abnormalities. Only the most experienced plastic surgeons are capable of achieving cosmetic improvements and enhance breathing function.

What to Expect After Rhinoplasty:

Patients may experience a few effects immediately after treatment, including swelling, discomfort, and pain. These side effects of the surgery will subside over time and airflow will gradually improve.

A well-planned rhinoplasty will alter the shape of the nose and improve the nasal passage for smooth and easy breathing. Dr. Grigoryants offers treatment options to correct airways for patients suffering from nasal airway blockage.

Discover how you can reduce signs of nasal airway blockage with the help of Dr. Grigoryants. His precision and accuracy will remove obstructions in nasal structures and patients can enjoy breathing freely. Open the airways to a healthy life with rhinoplasty in Los Angeles.

Dr. Grigoryants reviews safety of plastic surgery

Wednesday, August 21st, 2013

This post will describes what steps we take to ensure safety for our patients. When these guidelines are followed, plastic surgery can be performed with a very high degree of safety.

1. Patient selection:   Prior to surgery, patients are screened for any medical conditions and their ability to withstand surgery and anesthesia. For young and healthy patients, surgery is very safe. Older patients and patients with medical problems will need to undergo medical clearance by their primary care doctors or cardiologists. In certain cases, even stress tests will be ordered to evaluate the patients cardiac function. From time to time, we will turn down patients based on their age and/or medical condition.

2. Type of surgery performed: Certain procedures like (rhinoplasty, facelift, breast augmentation etc.) are associated with relatively little bleeding and little stress on the body. On the other hand large volume liposuction (over 5 liters) or tummy tuck with a large volume liposuction is more stressful for the body. When patients undergo combined surgeries or large volume liposuction, we recommend the patients stay in the hospital for at least 1 day for observation and intravenous hydration. During surgery surgery the patients vitals signs and fluid maintenance is very important. Dr. Grigoryants’ training and experience in Critical Care Medicine in addition to plastic surgery, allows him to take extra steps in ensuring intraoperative safety for his patients.

3. Duration of surgery: Most procedures in plastic surgery when performed by an experienced surgeon are relatively short. For example, Dr. Grigoryants’ rhinoplasty takes about 2-2.5 hours, breast augmentation 1.5 hours, and tummy tuck with liposuction 3-3.5 hours. Certain procedures can be combined safely. Although the relationship between the risk of complications and duration of surgery is not very clear, Dr. Grigoryants limits the duration of surgery to less than 6-7 hours when procedures are combined. When more extensive procedures are required, it is best to do them separately at different times.

4. Surgical Enviroment: Surgical procedures with anesthesia have to be performed in the hospital or an accredited surgical center. These facilities will have the necessary equipment and medications to allow for safer surgery. For example, patients vital signs are carefully monitored before, during, and after surgery; warming blanket are used to keep patients warm; and sequential compression devices (SCD’s) are placed on all patients to minimize the risk of deep vein thrombosis.

To learn more visit our website http://www.vgplasticsurgery.com

Combining rhinoplasty with other surgeries

Saturday, August 17th, 2013

Rhinoplasty is frequently combines with other procedures in our practice.  Patients undergoing rhinoplasty will undergo another procedure such as breast augmentation, liposuction, breast reduction, lip augmentation, ear reshaping or labioplasty.  The advantage of combining surgeries is one anesthesia, one recovery period, and lower cost as compared to doing these procedures separately.  As long as the total duration of surgery is not excessive, the procedures can be safely combined.  The duration of surgery depends on the surgeon’s skill and complexity of surgical problem.   For example,  rhinoplasty and breast augmentation with Dr. Grigoryants takes about 3- 3.5 hours. Patients will return to work in one week and can resume exercises in 4 weeks afte surgery.  It important to have the procedures performed in a certified surgical facility (surgery center or  hospital).   Visit http://www.vgplasticsurgery.com/los%20angeles%20nose%20reshaping(rhinoplasty).htm to get more information about rhinoplasty with Dr. Grigoryants

Nasal taping after rhinoplasty

Thursday, August 15th, 2013

Dr. Vladimir Grigoryants removes the nasal splint 5-7 days after rhinoplasty. His  patients are instructed to tape the nose for at least  3-4 weeks every night. Although taping affect the final result, it will reduce swelling in the morning.  The nose, especially the tip of the nose tends to swell overnight. Having the tape minimize that swelling.  Our patients frequently report that when they do not tape the nose, they wake up with a thicker appearing nose.   A special light brown paper tape will be given to our patients when the splint comes off. We will also show how to tape the nose.  Some patients may develop irritation from the tape in which cases they will be instructed to stop taping.  Foods rich in salt, alcohol, and strenuous physical activity may increase swelling.

Visit our rhinoplasty page to learn more about rhinoplasty with Dr Vladimir Grigoryants.

Dr. Vladimir Grigoryants reviews swelling after rhinoplasty

Wednesday, August 14th, 2013

Patient undergoing rhinoplasty need to be prepared to experience different staging of swelling.
Unfortunately, there is no way to have rhinoplasty without swelling and take more time for swelling to resolve after rhinoplasty than after other plastic surgical procedures. Swelling after closed rhinoplasty tends to resolve faster than after open rhinoplasty.

1. Onset of swelling. Swelling develops around the nose and upper face day 1-3 after surgery and tends to look more pronounced during these first 3 days. This usually happens in patients who had work on the nasal bones.

2. Splint Removal . In our practice, the splint comes off on day 5-7 after surgery. At this stage, most of pronounced swelling around the eyes has improved. There may be swelling in the bridge of the nose, face, and upper lip. Noticeable facial swelling improves fast over the next 7-10 days. The upper lip may appear longer and the smile may feel stiff. This resolves gradually within 30-60 days. The tip may look more upturned and it will come down over the next 7-14 days.

3. Upper part of the nose. Although the entire nose will be gradually shrinking and softening, swelling in the upper part of the nose will be resolving faster. By 30-60 days after surgery most upper nasal swelling will subside and the skin will feel soft in the upper part of the nose.

4. The tip. Although one may read online that it takes one year for all nasal swelling to go away, the reality is that it takes several years for all swelling to go away before you can see the final shape. At the end of the first year after surgery, the patients are likely to see 85-90% of swelling resolution and by the end of the second year almost all of swelling will resolve. Patients with think nasal skin may take longer to heal. Once nasal tip swelling resolves, the tip feels softer and tip cartilages become more visible and easier to feel.

To learn more about rhinoplasty with Dr. Vladimir Grigoryants, visit our rhinoplasty page.

 

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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