Can you Spare a Rib?

Rib cartilage harvested by Dr. Yoo

The ribcage encloses important organs such as the lungs and heart and its bony structure provides support as well. In total, the rib cage is composed of 24 ribs attached to the 12 thoracic vertebrae. Costal cartilage is attached to each rib and the sternum and functions to help the chest expand during breathing. As people get older, costal cartilages are more prone to becoming calcified.

In dorsal augmentation rhinoplasties, the 6th or 7th costal cartilage can be harvested for grafting material. To harvest rib cartilage, a small incision is made beneath the breast and part of the ab muscle is cut through to reveal the rib cartilage. After the cartilage is harvested, careful measures are taken so that everything is closed securely. 

Rib cartilage provides an abundant amount of cartilage compared to ear cartilage or septal cartilage, especially for major reconstruction or structural support. Cartilage grafts are carefully crafted in the most perfect shape to construct a beautiful nose that caters to each individual. Book a consultation today to learn more about YOOur nose and work towards your aesthetic goals!

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It’s all sun and games, until…

How does the sun affect scar healing?

Although the skin uses sunlight to help formulate Vitamin D, it can also take major injury from the sun as well. Sun damage goes beyond just a typical sunburn. Over long periods of time, the sun causes gradual harm to the skin. Sun rays contain ultraviolet light and this type of radiation can cause DNA changes in the skin. There are two different types of UV light, UVA and UVB. 

UVA light affects skin at all levels and layers. Within these layers are collagen and elastin which affect the elasticity and tightness of the skin. UVB light affects the outer layer of the skin and damages DNA more so than UVA which can lead to precancerous and cancerous cells.

Scars are especially sensitive to UVA and UVB and more susceptible to damage. Sun exposure to scars can cause darkening of the skin (hyperpigmentation), lightening of the skin (hypopigmentation), thickening of the skin (hypertrophy), as well as cause blisters.

The best way to help facilitate scar healing is to avoid sun exposure during the healing period. If needed, wear clothes that cover the scarred area, or apply sunscreen with an SPF of at least 30. In combination with scar gel, this will assist scars to heal beautifully with minimal texture and color.

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Cute Skin with Vitamin C

In the 1930s, Vitamin C was discovered and researched as the remedy for scurvy. It was found to play a cofactor role in collagen hydroxylase as well as boosting the body’s immune system. The discovery of Vitamin C eventually led to research in its role in skin health. 

The skin naturally contains vitamin C which assists in stimulating collagen growth and antioxidant protection against UV sun damage.  Available evidence suggests that Vitamin C decreases signs of aging, improves skin color, lessens wrinkle depth due to increased collagen formation, improves skin tone, improves wound healing, and assists in the production of barrier lipids which aids surface roughness and dry skin.

Studies have shown that aged and photodamaged skin have lower levels of vitamin C concentration. To combat this, vitamin C can be applied topically on the skin. However, this is also dependent on the formulation of the cream or serum as Vitamin C is not easily permeable through the skin barrier. It is important to check if products contain ascorbic acid (vitamin C) and should have a pH lower than 4. A product we would recommend would be the skinceuticals C E Ferulic Acid Serum! Please contact our office for additional information or if you have any further questions.

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Can I pierce my septum after rhinoplasty?

The nasal septum is located roughly at the midline of the nose. It is composed of five structures such as the perpendicular plate of ethmoid bone, vomer bone, cartilage of the septum, crest of the maxillary bone, crest of the palatine bone with the cartilaginous parts located in the front and bony parts located in the back of the nose. The septum functions to separate the right and left nasal cavities as well as provide structural support for the nose.

In augmentation rhinoplasty, cartilage grafts are typically used and some grafts are placed next to the septum. For example, spreader grafts are placed next to the septum and can help widen the middle third of the nose, prevent depressions or concavity, as well as deal with asymmetries. Other grafts near the septum include a septal extension graft which is used to help with tip projection, shape, and rotation.

In general, it is recommended that you do not pierce your septum after rhinoplasty as this can compromise your cosmetic result. Some complications that may arise include infection, fracture of cartilage graft, unsatisfactory appearance, possibility of revision rhinoplasty, depression of nose, deprojection of tip, and asymmetries.

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Why is my rhinoplasty scar in a zig zag pattern?

The open rhinoplasty approach is widely accepted as the more beneficial approach, in comparison to closed, as it has been shown to have many advantages. Not only does it provide better visualization of nasal structures, but this also allows for better accuracy and any correction of possible deformities. One disadvantage that concerns patients is the external transcolumellar scar. However, studies have shown that most patients are not bothered by their scar or consider them to be barely perceptible.

So how does the scar become invisible? Although there are many different types of incisions that may be used during an open rhinoplasty (i.e. transverse, “w”, “z”, “v”)

The inverted V is the most popular. Many studies have compared the different approaches in incisions for open rhinoplasties, and have shown that the inverted V incision provided better scar formation as well as less notching (alar rim retraction). Some authors have also described that this pattern is less noticeable to the eye and helps reduce wound tension; therefore, showing less scarring. 

In combination with good aftercare of nasal incisions as well as the usage of scar gel, open rhinoplasties scars are usually minimized and are barely noticeable.

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Don’t Inject Yourself Dermarolling/Microneedling

Don’t Inject Yourself  Dermarolling/Microneedling 

Dermarolling or Microneedling has become a popular treatment in the aesthetic industry. It works by creating micro-wounds to the skin to promote skin rejuvenation. It triggers the body to create more collagen and elastin which are essential for tightening, lifting, and smoothing out the skin. 

In recent years, the market has been flooded with advertisements of home or “DIY” dermarollers. These advertisements aim to target people who are looking for smoother skin without spending too much. Although everyone loves a good DIY, there are things that are better left to professionals. DIY dermarollers have needle sizes that average 0.1 mm – 0.3 mm in depth in comparison to professional clinical microneedling devices that have needle depths that range from 0.5 mm – 1.5 mm on average. Professional microneedling devices should only be used by trained medical professionals. DIY rollers are typically poorly manufactured and usually contain one needle head which is difficult to clean and sterilize with each use, increasing the risk of potential infections and skin damage. Not only that, microneedling may be fairly uncomfortable without numbing cream provided inside a medical office.

If used incorrectly, you may develop an infection, hyperpigmentation, scarring, or other serious damage. The risks far outweigh the possibility of an affordable at home project for nicer skin. It is important to discuss with a trained medical professional if you are considering microneedling or if microneedling is right for you.

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Is it in my blood?

Platelet Rich Plasma (PRP) is collected from a patient’s own blood sample that is centrifuged  to create a high concentration of platelets in a small amount of plasma. Platelets are made in the bone marrow and play an important role in blood coagulation. In recent years, scientists have discovered that platelets contain different factors (growth factors, cytokines)  that also assist in inflammation, neovascularization, stem cell migration, and cell proliferation.

PRP injections have frequently been used in musculoskeletal injuries. It has grown in popularity in this field as it increases the necessary blood and nutrients needed to regenerate damaged tissue. Besides orthopedics, PRP injections have also been used in fields such as ophthalmology, pediatrics, gynecology, urology, cardiac surgery, dermatology, and plastic surgery.

In aesthetic medicine, it has been shown that PRP is effective in increasing collagen and elastin production which can improve the overall quality of the skin. Topical application,  skin injections, or a combination of both PRP applications have been used for patients with facial wrinkles, sun damaged skin, atrophic acne scars, and depressed skin. Studies have shown that patients who received PRP treatment for these concerns noted a general improvement within weeks of their initial treatment. PRP can also be injected into sites such as the nasolabial folds, supraorbital grooves, forehead, temple, and glabella. However, PRP alone is not as effective in addressing deeper wrinkles in comparison to filler.

It is important to discuss with an experienced medical provider if PRP injections or topical application is the right option for you.

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That’s sNOrT a good idea

Nasal septum perforation is a condition where there is a full thickness defect (or hole) of the nasal septum. The nasal septum divides the inside of the nose from the left and right cavities. Septum perforations can be caused by a variety of different factors such as trauma, autoimmune disorders, infection, neoplasm, nasal sprays, or drug use.

Today, we will talk about cocaine and how this can lead to nasal perforations! Cocaine was popularized in medicine in the 1880s. In 1905, there was increased usage of cocaine recreationally and snorting cocaine became extremely popular. Hospitals started reporting cases of nasal damage caused by using this drug. 

Cocaine is a stimulant that causes blood vessels to constrict. When blood flow is compromised through continued use of cocaine, this causes lack of oxygen being delivered to the tissue.  As a result, the tissue lining the cartilage as well as the cartilage will begin to die. Since cocaine also has a numbing effect, most people may not even notice that this is occurring. Once a nasal perforation is present, it cannot heal on its own.

Damage to the septum can cause changes in the appearance of the nose such as causing the nose to look collapsed (saddle nose deformity). In addition, perforations can increase complications during and after rhinoplasty.  The size of the perforation and integrity of the septum are also factors which may affect the result of a rhinoplasty procedure. While this may sound discouraging, a safe rhinoplasty can still be performed for these patients by an experienced rhinoplasty surgeon. A consultation with an expert in advanced or complicated rhinoplasties would be best to discuss all possible options to achieve your aesthetic goals in a safe, predictable manner.

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Filler and Necrosis

I’m afraid to get fillers because I have heard about possible vascular obstruction and necrosis!

Vascular obstruction/occlusion can occur when blood flow has been blocked by filler which does not allow the surrounding tissue to obtain the necessary oxygen and nutrients it needs. In turn, this can lead to necrosis of the tissue if left untreated long enough.

Although vascular obstruction and necrosis is a severe possible side effect of dermal fillers, the incidence rate is extremely low. In medical literature, frequencies of vascular adverse events range from 0.05–0.01%.

Studies have found that experience, in terms of how long a provider has been practicing and how many procedures performed, affects the rates of occlusion. A more experienced provider will have a lower rate of occlusion, but even still, the rate is significantly low.

Some ways to prevent this include getting a full history from patients, choosing a reversible filler (hyaluronic acid), and good technique.

It is important to remember that any cosmetic procedure has its risks, but with the right care and medical provider, this risk is significantly reduced.

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The Dangers of Hyaluron Pens

Hyaluron pens are a needle free device that use pneumatic pressure to force hyaluronic acid into the skin. The FDA recently issued a warning on 10/8/21 advising against these devices, as they have been linked to serious injuries and irreversible damage. These pens are unpredictable because the levels of pressure distributed with each push are uncontrolled and uncalibrated pressure.

Some of the risks of using hyaluron pens for dermal fillers include:

  • Allergic reactions
  • Bleeding
  • Bruising
  • bacterial, fungal, or viral infections
  • the potential for disease transmission if shared with others
  • Blood-vessel blockage that can lead to necrosis
  • Blindness 
  • Stroke
  • Scarring 
  • Damage to the eyes from the device pressure
  • Skin lumps or discoloration.

Dermal filler is only FDA approved to be administered with a needle and syringe, and on occasions a cannula. It is important to consult with a trained medical provider to work towards an aesthetic goal that is not only beautiful but also safe.

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