What is Asian blepharoplasty? How is Asian blepharoplasty different from a typical upper blepharoplasty or eyelid lift?

Asian blepharoplasty differs from other types of upper blepharoplasty in that it requires a slightly more complex surgical technique and vastly different aesthetic to create a naturally beautiful result. When upper blepharoplasty or eyelid lift is performed in an aging patient, the procedure will commonly involve removal of excess skin and perhaps removal of excess fat through an incision made along the pre-existing supratarsal crease. The upper eyelid crease, or supratarsal fold, does not need to be reinforced or recreated in most of these patients due to a strong connection between the skin and levator aponeurosis. In many Asian patients, the adhesions between the skin and levator aponeuoris must be reinforced with supratarsal fixation or “anchoring” sutures to create a crisp, defined fold. In cases of multiple folds, asymmetric folds or supratarsal creases that are lower than desired, Asian blepharoplasty is an effective way to modify and enhance the shape and appearance of the upper eyelids.

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What is a spreader graft in Rhinoplasty? What purpose do spreader grafts serve in the nose?

Spreader grafts were initially described in the ’80s by a rhinoplasty surgeon named Jack Sheen, who used them through an endonasal – or closed, scarless – approach to provide support in patients with short nasal bones, and to reconstruct the middle vault after dorsal hump reduction. Since this initial description and application, the uses of spreader grafts during nose job surgery have been expanded to include correction of internal nasal valve narrowing or collapse, adding additional support to the dorsal septum, straightening deviation of the dorsal septum, widening the middle third of the nose, to lengthen or counter-rotate the nose, and to create continuity of the dorsal aesthetic lines.

Spreader grafts can be carved from straight pieces of cartilage, most typically from that harvested from the septum or the cartilaginous rib. Tapering and chamfering the grafts allows for the optimum nasal contour during rhinoplasty and revision rhinoplasty by reducing any unnecessary bulk, and providing volume only in the locations where it will increase the cross-sectional area of the internal nasal valve, and/or provide necessary support for the nasal framework.

Spreader grafts carved to span the length of the middle vault, while transitioning seamlessly under the nasal bones, and tapered along the dorsal aspect to recreate and improve the dorsal aesthetic lines.

Before and after revision rhinoplasty with rib cartilage and fascia to restore stability and projection of the dorsum while counter-rotating and lengthening the nose with extended spreader grafts.

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What is a deep-plane facelift? How is it different from a SMAS facelift?

During a traditional SMAS facelift, the skin and subcutaneous tissue is elevated from an incision designed around the ear in a single layer. The layer deep to the skin and subcutaneous fat is the SMAS, or superficial musculo-aponeurotic system, a term coined by plastic surgeons Mitz and Peyronie in the 1970s to describe the anatomic layer investing the muscles of facials expression. For a traditional facelift, the SMAS layer is either plicated (oversewn) or imbricated (a small portion resected and the ends re-approximated) and the skin pulled along the incision to create a lift. This approach would distribute some of the tension of the lift along the SMAS layer, but a significant portion of this force vector would fall on the skin incision line itself.

During a deep-plane facelift, the skin and subcutaneous fat is elevated in one plane, and then as the dissection proceeds anteriorly towards the midline of the face and neck, the dissection descends under the deep-plane (SMAS layer) to create a thicker, more robust flap consisting of skin, subcutaneous fat and SMAS combined. The SMAS is mobilized and secured to provide the lifting for the facelift, with minimal reliance on the skin itself, thus allowing for a tension-free closure of the incisions. This results in a less “pulled” and more natural appearance, more durable, long-lasting results, and reduces the amount of downtime due to bruising and swelling.

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Where are the scars for a deep-plane facelift? How much downtime is there for a facelift?

The beauty of a well-designed and well-performed deep-plane facelift is that the result is youthful and natural, and the scar is virtually undetectable. The incision is hidden in the temporal hair tuft, along the back of the tragus, and in the crease behind the ear, outlined in red in the figure above. With meticulous, tension-free closure of the incisions, they become difficult to see by two weeks, and fade with each and every week of healing.

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Sutures remain in place for one week, and patients typically feel “restaurant ready” in two weeks.

Before and After deep-plane facelift with Beverly Hills Plastic Surgeon, Dr. Donald B. Yoo, M.D.

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Does scarless rhinoplasty or closed rhinoplasty have any limitations? Why wouldn’t you want a nose job with no scar?

Closed rhinoplasty or scarless rhinoplasty is an excellent procedure in the properly selected patient. Scarless rhinoplasty involves making incisions only within the nostrils, so that the scars are hidden and difficult to see from the outside. This does make the surgery faster, and swelling typically will be less than a comparable open rhinoplasty procedure. Scarless rhinoplasty and closed rhinoplasty work best in patients with:

  1. near ideal tip support
  2. near ideal tip aesthetics
  3. adequate dorsal height and projection
  4. thin to moderate thickness skin

Closed rhinoplasty and scarless rhinoplasty faces serious limitations in patients with:

  1. weak nasal tip support
  2. wide, bulbous or ptotic nasal tip
  3. lack of projection
  4. lack of dorsal height
  5. very thin, or thick, sebaceous skin

The best candidates for closed rhinoplasty and scarless rhinoplasty are those patients with near ideal tip aesthetics and seeking only a very mild change to the appearance of their nasal tip, but do want to address contours along the nasal dorsum such as a dorsal hump or wide lateral nasal sidewalls. Anything beyond a minor change to the tip of the nose often will be better served through an open rhinoplasty approach.

This beautiful patients underwent a previous scarless rhinoplasty with another surgeon with overall good results, but with some contour irregularities along the nasal tip and a lack of definition along the tip-alar transition. Using unified tip grafts crafted from her septal cartilage and cartilage from her ear I was able to create a smoother nasal tip contour and redefine the tip, ala and nostrils.

With proper incision design and execution, an open rhinoplasty will also leave a “scarless” appearance, with greater refinement and definition of the nasal tip complex.

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Considerations during Asian Rhinoplasty and Asian Nose Job using your own rib cartilage and DCF (diced cartilage fascia)

Asian rhinoplasty and Asian nose job surgery has enjoyed a surge in popularity as the interest in rhinoplasty surgery more broadly has also increased due to the wider social acceptance and emergence of techniques and surgeons capable of producing predictably beautiful results. While rhinoplasty as a general concept involves reshaping the nose, it’s far too broad a term to accurately reflect the enormous variation in terms of surgical technique and expertise demanded of rhinoplasty surgeons to modify an individual’s anatomy to create the specific aesthetic desired.

For Asian rhinoplasty more precisely, the challenge of creating definition in a setting where the pre-existing nasal framerwork and innate nasal cartilages are weak relative to the thickness and strength of the overlying skin, the rhinoplasty surgeon has the additional challenge of creating form by supplementing and enhancing the structure and integrity of the nose. The 1970s saw a rapid rise in China, Korea and Japan of using silicone implants to augment the nasal dorsum and bridge, and often project and define the the tip of the nose as well. Silicone provided a quick and easy way to add structure, and some degree of definition, to the nose in a way that was well tolerated for years, and sometimes even decades.

As time went on, however, the effects of having a synthetic implant – silicone, Goretex and Medpor – became clear in that they behaved like foreign bodies in the nose, always facing rejection and sometimes even extrusion or ulceration through the skin. For this reason, surgeons have sought out different sources from your own body to provide building blocks for reshaping the nose, including: septal cartilage, ear cartilage, fascia, rib cartilage, and bone.

For the safest, most permanent results, using 100% your own tissue is the best building block. Whether your surgeon uses ear cartilage, septal cartilage or rib cartilage is only one part of the equation for creating a naturally beautiful nose. While some sculptors may be able to turn a block of marble into a flooring tile, an expert sculptor with superlative aesthetics will be able to create Michelangelo’s David. In the same way, seeking a surgeon who uses your own tissue is the bare minimum, requisite first step to achieving successful results, while the more paramount requirement is having the skill and artistry to create the shape that you desire.

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Who is the best rhinoplasty surgeon in the world? Best Plastic Surgeon in Beverly Hills?

Any attempt at definitively and objectively determine who is the single best plastic surgeon, or rhinoplasty surgeon for that matter, is an endeavor fraught with subjectivity and destined for failure. Unlike other surgical specialities where outcomes and quality of treatment may be quantified, at least to a certain extent, with indicators such as rates of cure/survival, complication, infection, patient satisfaction, etc. in plastic surgery, relative success and failure is determined by each individual patient and not the collective of patients undergoing surgery by a particular surgeon. In the case of plastic surgery, simply choosing a surgeon who had success creating a wildly popular and sought after nose on a celebrity’s face such as Song Hye Kyo, Angela Baby, or Scarlett Johansson, is not a gaurantee to yield the same beautiful result. As a patient seeking out plastic surgery or rhinoplasty, be exceptionally wary of any surgeon advertising themself, or even self-describing themself on their website search results as “The Best Rhinoplasty Surgeon in Los Angeles” or “The Best Plastic Surgeon in Beverly Hills” as these are titles bestowed unto themselves.

When choosing a plastic surgeon, or rhinoplasty surgeon, the more important question to ask is: Is this the best plastic surgeon in the world for ME? This means the standard recommendations of vetting the doctor’s credential’s, training, reviews and expertise hold true. However, there is a very important distinction and caveat that can only be gleaned by careful review of this surgeon’s previous work, including before and afters and videos of previous patients. Has she/he operated on patients that have anatomy like mine? Has she/he produced beautiful results on other patients that look like me? HOw often does this surgeon perform this specific procedure? Does my rhinoplasty surgeon or plastic surgeon share my same ideals and biases when it comes to aesthetics and do we align in terms of the facets of my appearance I’d like to enhance and which I’d like to simply preserve? These are simply a few of the questions a potential patient should thoroughly consider before finding the “best” plastic surgeon for any kind of procedure.

In the end, the best plastic surgeon and best rhinoplasty surgeon is the surgeon who delivers the naturally beautiful results you are looking for.

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Time heals all wounds

When the skin goes through trauma it develops scar tissue to repair and protect the site of injury. There are a few phases to scar tissue formation. First is hemostasis where blood clotting begins and scab formation occurs. Next is the inflammatory phase where there is inflammation and edema. After that is the proliferation phase where collagen, elastin, and other components of granulation tissue are grown. Lastly is the remodeling stage where old cells are destroyed and new cells form. Errors in this stage can lead to excessive growth of tissue leading to hypertrophic scarring or keloids.

Keloids appear as pink, flesh, or red colored raised growths that can continue to grow larger. Growth can occur for months to even years. Hypertrophic scars are thickened scars that are more localized to the area of injury compared to keloids, are easier to treat, and can become less noticeable with time.

Ways to treat hypertrophic scars or keloids include steroid injections, dermabrasion, or lasers. It is important to discuss with your surgeon what options would work best for you!

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Mask of Pregnancy – Melasma!

Melasma is a condition where gray to brown patches appear on the face. It can occur in all skin types but more commonly on darker skin tones. Melasma occurs in 50-70% of pregnant women hence the nickname “pregnancy mask”. This skin condition is the most common cosmetic problem related to pregnancy. 

Although the exact reason why melasma occurs has not been discovered, there have been various factors that have been thought to contribute to it. Such factors include sun exposure (UV radiation), pregnancy, genetic factors, hormonal treatments and cosmetic products. Pregnant women undergo a variety of changes internally and externally, and it is believed that the main reason melasma occurs is because of hormonal changes.
The most effective way in attempting to prevent melasma is avoiding sun exposure and using sunscreen with high SPF during pregnancy. Hydroquinone is the most popular treatment for melasma after pregnancy. Laser treatments are also effective in treating melasma, specifically Picosure. It is the only laser that is FDA approved to treat melasma. Consult with our medical providers specializing in Picosure to discuss if this is the right treatment option for you.

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Can I wear lash extensions during surgery?

Got Lashes?

Can I wear lash extensions during surgery?

The short answer is preferably no. We recommend that our patients leave out their extensions mainly because it can interfere with surgery as well as cause an issue with sterility. For some procedures, we tape the eyes with a clear dressing to prevent the eyes from becoming dry and causing any corneal scratching. Lash extensions may be dislodged as we remove the tape. They may also fall off and fall into the eye which can increase your risk for corneal abrasions. 
When can I put lash extensions on again? After surgery, we recommend waiting at least one month! This is to allow all of the incisions to heal correctly and reduce the risk of infection. If you are still unsure about your aftercare instructions or what to prepare for before surgery, contact the office and we can answer those questions for you!

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