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Rhinoplasty in Thick Skin Indian Nose

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Patients who have thick nasal skin can have Rhinoplasty to improve the shape of their nose but they should understand that there are limitations. Doing Rhinoplasty in oily, thick, bulbous nose is a challenge to any Rhinoplasty surgeon. Patients always come with unrealistic expectation which should be discouraged. The way a Rhinoplasty is performed is that the skin is raised off the bony-cartilaginous framework of the nose and the frame work is reshaped to give the desired external nasal appearance. In ethnic type noses where the thicker skin requires a different approach.

Defatting the nose during Rhinoplasty

Any changes to the under surface- the tip cartilage and bone is not as visible as it is obscured by the thicker skin. The significance to the thickness of the soft tissue enveloping the nose, in particular the skin and fatty layer is that it is more difficult to refine these types of noses.

Removing sub dermal fat and subcutaneous tissue must be done with care. This gives a narrow profile with sharp tip. The nasal skin is very delicate with critical blood supply.

However, for the nose to look good, the skin needs to fit tightly around the newly shaped framework. Because thick skin has flexibility and elasticity as thinner skin, it will not drape as well or fit as tight.

Cartilage grafts are harvested from septum and used because adding cartilage can help define the tip in patients with thick skin. Tip grafts and using sutures to bend the cartilages are more important then removing cartilage but other factors such as dissecting in the proper plane to avoid damaging the muscle and skin and creating more scar tissue is very important as well. Aggressive defatting can result in skin necrosis or loss of tissue and a very poor result

When we talk about defatting, it is a combination of removing some of the transverse nasalis muscle over the bridge of the nose and some of the fibro-fatty tissue over the nasal tip.

To get a narrow the tip or profile one can sew the cartilages together to create a more narrowed tip often in conjunction with cartilage grafts.

The type of thick skin nose that can be helped the most is one with a wide tip and decreased tip projection. By increasing the tip projection, tension is placed on the very tip causing it to get thinner and the flared side walls tend to straighten. Also, some of the bulk of the fat side walls where the walls meet the cheeks can be removed by taking out an alar wedge of tissue in that area and hiding the scar in the nose-cheek crease. This will make the nose look narrower and less bulky.

It is somewhat possible to thin out thick skin on a Rhinoplasty; however, the scar tissue can grow back. People who have thick, oily, olive skin tend to develop sub dermal keloids, hypertrophic scarring, and fluid retention in the supratip area of the nose. To help bring down the fluid retention, multiple cortisone injections during in the first three months in the postoperative phase may be necessary.


Hemifacial Atrophy and Cosmetic Surgery of Face

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hemifacial atrophy

Hemi facial atrophy, otherwise known as Romberg’s disease, is a disorder of unknown etiology. It is characterized by progressive wasting of skin, subcutaneous fat, cartilage, bone, muscle and hair. It was when first reported by Romberg in 1846.

The most common early sign is a painless cleft, the “coup de sabre”, near the midline of the face or forehead. A bluish hue may appear in the skin overlying atrophic fat.

The disease occurs more frequently in women and appears in the first or second decades of life. It progresses over a time course of between two and ten years, and atrophy appears to follow the distribution of one or more divisions of the trigeminal nerve.

When associated with inflammatory changes of the skin in other areas of the body, it is often diagnosed as scleroderma, and in reality they may be manifestations of the same disease.

Neurological abnormalities are common. Roughly 45% of people with Romberg syndrome are also afflicted with trigeminal neuralgia including the forehead, eye, cheek, nose, mouth and jaw and migraine.

hemifacial atrophy2Diagnosis can be made solely on the basis of history and physical examination in people who present with only facial asymmetry. For those who report neurological symptoms such as migraine or seizures, MRI scan of the brain is the imaging modality of choice. A diagnostic lumbar puncture and serum test for auto antibodies may also be indicated in people who present with a seizure disorder of recent onset

Management of hemi facial atrophy comprises of a long-term follow-up of somatic disorders, and prevention of psychological problems. Treatment is symptomatic and mainly consists of plastic surgery after the disease activity has stopped.

A variety of treatment techniques have been employed in an attempt to improve the atrophic deformity. These have included free fat grafts, dermis fat grafts, fascia, cartilage and bone for augmentation purposes.


(A case of hemifacial atrophy affecting an young female is shown here and the manifestations of this uncommon disorder is discussed. The various methods employed in correcting the facial deformity including rhinoplasty is being discussed.)

Indian Rhinoplasty: Before and After Pictures:25 Cases

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From Jubilee Hospital, Trivandrum, Kerala, South India.

Here I present few of my Rhinoplasty (Pre and Post Op Pictures) done in Jubilee Hospital Trivandrum, Kerala in South India. The Jubilee Hospital is a Christian Mission Hospital in the city of Trivandrum giving affordable treatment to everyone. Please note, the pictures are taken after the sutures are removed after 7 days and long term follow up is not practical in this part of the world.

Any one with realistic expectation to have their nose job done is welcome to this mission hospital. As it is not a corporate hospital, the cost is less, but don’t expect papering service and all.

 

For Rhinoplasty Videos:

http://www.youtube.com/user/drpaulose1

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Rhinoplasty Pictures from Jubilee Hospital Trivandrum India

Correcting Crooked Nose (Rhinoplasty) in Kerala India.

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Cosmetic Rhinoplasty is one of the most common procedures done in cosmetic surgery.

Rhinoplasty is a surgery done on the nose to reshape a crooked nose, to improve appearance, to improve breathing, to correct an injury or birth deformity. It is also called Nose Job or Nose reshaping. Along with Rhinoplasty, a septoplasty can also be done at the same time to open blocked nasal passages due to a deviated nasal septum (Functional Septo-Rhinoplasty).

The main goal in Rhinoplasty is to make sure that the new nose goes well with the remaining facial features which show patients’ ethnic origin.

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The Cosmetic Rhinoplasty is done routinely in Jubilee Hospital Trivandrum which is the capital of Gods Own Country Kerala in South India. Kerala is an established tourist destination for both Indians and non-Indians alike. Kerala is popular for her beaches, backwaters, mountain ranges and wildlife sanctuaries.

Pre and Post op Rhinoplasty Pictures (Patient No#49)

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(Pre op pictures)

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(post op picture 1 week-after stitches removed)

Jubilee Hospital Trivandrum being a christen mission hospital, gives affordable treatment for patients. The church has got a guest house in Kovalam beach where patients can stay for recuperation (Jubilee Animation Centre Kovalam).

(To see more videos of Rhinoplasty: http://www.youtube.com/user/drpaulose1 )

 

Samudrika Lakshanam and Cosmetic Surgery Nose

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Samudrika Lakshanam in Anga Sasthra is one of the most traditional techniques of predicting ones character and personality by their physical appearance. The Samudrika Lakshana is written by someone called Samudra Raja (King of the sea). Every part of ones body from head to toe has a definite and positive prediction to reveal about you.

Human face exhibits a lot of characters of that particular person. The nose, eyes, mouth and various other parts of the human face are just the reflection of the human being’s character. While this facial structure is permanent, and not totally changeable, it could certainly be modified and better presentation of yourself could be made for winning others and achieving your objective.

The inherent nature of a person’s character cannot be altered much by cosmetic surgery. But the self esteem and confidence level can be elevated to a great extent. The role of facial plastic surgery comes here. I do lot of Rhinoplasties to achieve a better nose for person who is not having a presentable nose. Being the most projecting part of the face, position and shape of nose is very important. In men the masculine features are shown in a prominent nose and it represents his virility. No wonder in olden days, amputation of nose who committed adultery was common thing and Master surgeon Sushrutha had the opportunity to carry out many cosmetic nasal surgeries. The Nose and female hormones are connected; changes in hormone level affect the nose as in menstrual time and pregnancy.

The aspiring facial plastic surgeons may learn more about this interesting topic- the Sumudrika lakshana sasthra.

Cosmetic Surgery Nose-Tip Rhinoplasty in Trivandrum India

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Tip Rhinoplasty refers to shaping of the nasal tip. These can include asymmetry of the tip, droopy tip, hanging columella, bulbous tip, wide tip, M tip etc.

Most tip sculpting procedures are best done through an open (external) approach where the surgeon can three dimensionally see the cartilage frame right before his eyes .I always do by an external open approach.

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Having a bulbous tip means it looks like your nose has a ball on the end. This can be due to the shape of the underlying structure, or just thick skin, but regardless of the cause, this nose type looks bottom heavy and draws attention away from the eyes. To refine the tip of the nose, the cartilage is narrowed. Tip Rhinoplasty relies less on removing cartilage and more on strengthening existing cartilage or adding additional cartilage for support in order to improve definition. Other procedures can also be performed to improve breathing like septoplasty and turbinate reduction.

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Endosnasal Rhinoplasty Pictures:

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Rhinoplasty Pictures Before and After-Trivandrum India

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Jubilee Hospital Trivandrum, Kerala India.

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Pre op and Post Op Pictures 2

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Pre and Post op picture 3

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Ear Nose Throat Disorders-On line Email Consultation from drpaulose.com

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As you can imagine I am very busy to send reply to all the emails which I am getting every day. I know most of them are from genuine patients seeking medical advice on line. But few are wasting my time.

I would like to help you so I have introduced Email Consultations; this allows you to receive my medical advice from the comfort of your computer/mobile instead of waiting for an appointment with a specialized doctor and waiting in the queue to see the doctor.

It’s a small donation towards charity mainly orphanages and food for the hungry (Anna Daanam).

For USD 30 or more you get 3-4 replies and payment can be made thru Paypal (Click Here).

Those who are in India can contribute Rs 1500 or more for 3-4 replies to the Account as given below.

CHARITY Ac No. Dr.K.O.Paulose FRCS

SB Ac No.32518883582

MICR.695002039 IFSC. SBIN0013313 SWIFT Code: SBININBB398

(Bank: State Bank of India (SBI), Branch: Panavila, Gr floor, Kasthurbham commercial building ,Trivandrum, Kerala. Tel 2332155)

You may also pay directly to the following charitable organization I support-

Name: Employee’s fellowship

Bank: Catholic Syrian Bank, Palayam, Trivandrum, Kerala, India.

Ac No: 096 -1207090 -190001, IFSC code:CSBK0000096

Or

Name: Lourdes Matha Care

Bank: Catholic Syrian Bank, Palayam, Trivandrum,Kerala, India

Ac No.0096-01208751-190001

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Nasal Septal Perforation-Surgical Repair

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In the days of SMR operations, the iatrogenic septal perforations were very common. But after the septoplasty procedure came into being, the incidence of septal perforation is much less.( Iatrogenic means caused by surgeons). The next common cause is trauma, after septal hematoma. Nasal Septal Perforation is defect in the nasal septum which is the […]

Revision Rhinoplasty in India.

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Rhinoplasty – Cosmetic nose reshaping is also known as Rhinoplasty. The procedure can reduce or increase the size of the nose, narrow the span of the nostrils, change the angle between the nose and upper lip, and change the tip or bridge of the nose. It can also correct some breathing problems. Revision Rhinoplasty Rarely […]

How Vit D Deficiency Affect Your Sleep ?

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Vitamin D deficiency and insufficiency is now a global public-health problem affecting millions of people world wide. Every one talks about it these days, its indeed a hot topic. The most well-known consequences to not having enough vit D or the “sunshine” Vitamin was associated with bone diseases like rickets, osteoporosis etc,. But these days […]

The post How Vit D Deficiency Affect Your Sleep ? appeared first on Dr Paulose.

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