Louisville Rhinoplasty
Part 3-  Mountain Climbing and Noses

What in the world does Rhinoplasty have to do with mountain climbing (besides frequent frostbite on the nose)?  Well, the different types of mountain climbing can illustrate the differences between types of rhinoplasty procedures.  Just follow me a bit...
"Alpine" style climbing is widely considered to be the purest form of mountaineering.  It involves simply climbing the mountain, without teams of people to help.  It uses the most direct route up a mountain.  It is the most difficult style and is difficult to teach.  Because there is no help, it has to use the quickest route to achieve the summit.  Summiting a mountain via Alpine-style climbing yields a different, and perhaps better form of success.  Few people are able to climb a mountain, Alpine-style.
"Expedition" style climbing is the more widely practiced form of mountaineering.  It involves a large support team to bring supplies and prepare the route up the mountain.  It often utilizes the easiest route (rather than the most direct) route to acheive the summit.  It is easier to utilize and teach.  Summiting a mountain via expedition-style is a success, but perhaps a different type of success than alpine-style. As we will see in the next few parts, Alpine mountaineering can be equated to Closed Rhinoplasty and Expedition mountaineering can be equated to Open Rhinoplasty.  More to come....


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Louisville Rhinoplasty
Part 2- History of Rhinoplasty

One of the earliest recorded surgical procedures, of any kind, was that of nasal reconstruction in India in approximately 800 BC.  During that time, removal of the nose was performed as punishment. Doctors then used the forehead skin to re-create the nose.  Amazingly, the same technique is still utilized today... or atleast last week for me.  After centuries of little recorded history, nasal reconstruction was reintroduced by the Italians in the 1600's.  They developed techniques utilizing movement of the skin from the arm to the face, in order to recreate the nose.  This too, is still occasionally used (2 months ago for me).  The Germans developed aesthetic rhinoplasty procedures in the 1800's.   All of these techniques have continued to undergo refinements, culminating in the modern rhinoplasty.
As with most of technology and medicine, there is a trend to develop more complex and invasive rhinoplasty procedures.  Although I perform these complex procedures in select cases, it is important to realize that the nose is not the same as an iPhone.  The nose is very delicate (so too is the screen of my iPhone).  The nose usually does not like extensive, complex procedures.  The nose follows a concept that I hold true too, "Just because you can do something, doesn't mean that you should." Many of the basic tenets of nasal surgery were developed thousands of years ago and those principles are still practiced today.  And unlike a new iPhone, new is not always better.  More to come.....

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Louisville Rhinoplasty
Part 1- Me and the Nose

The nose is why I am in Louisville.  The nose is what makes years of surgical training worthwhile.  The nose is what gets me out of bed in the morning.  I decided to pursue Plastic Surgery training in Louisville, KY to learn the art of Rhinoplasty under one of the masters, Larry Florman, MD.  I learned the subtle nuances of a beautiful nose.  I learned how to create a beautiful nose efficiently, with little patient "down-time".  I learned the importance of a patient, family, and close friends noticing a change in the nose, all without having an "operated-on" appearance.  I learned to respect the nose.

Rhinoplasty is often considered one of the most difficult procedures in Aesthetic Plastic Surgery.  The reasons are numerous, but most importantly is the need for patience.  The changes made in the operating room do not fully manifest for many months.  There are ways to make rhinoplasty easier, but they come at the price of longer procedures and external scars.  Unfortunately, the nose does not like scars or long procedues.  Hence the importance of efficiency and respecting the nose.

The subtleties of Rhinoplasty will be covered in depth in the next sections.  I hope at the end, one can have a healthy respect for Rhinoplasty and understand a little more why I love the nose.

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Louisville Forehead Lift/ Brow Lift
Part 2- Treatments

There are various options for treatment of the forehead and brow. The decision regarding the treatment depends on the exact problem.  A long forehead can be shortened (coronal brow lift), but a short forehead cannot be lengthened.  Eyebrows that are too low can be raised (coronal brow lift, endoscopic lift).  Deep wrinkles between the brows can be temporarily paralyzed (neurotoxins) or removed (limited incision muscle resection).  Deep horizontal wrinkles can be temporarily paralyzed (neurotoxins) or removed (coronal brow lift). Asymmetric brows can be brought into harmony (direct brow lift).

Coronal brow lifting is often considered the "gold-standard".  It has been performed for many years and gives predictable results, which are long-lasting.  Unfortunately, many patients are scared away when I tell them that it requires an incision within the scalp that spans from ear-to-ear.  I can honestly say that the scar can be barely visible, but by this time, some patients are already glassy-eyed.  For those willing to accept the minor scar, coronal brow lifting is often the best choice.

For those "glassy-eyed" patients who want to run out of the office at the thought of a coronal brow lift, endoscopic forehead lifting may be an option.  This utilizes small cameras inserted through the scalp, followed by lifting of the brows.  This is a reasonable option if the brow is too low, but it will not change the length of the forehead.  Although endoscopic lifts have been shown to provide long term lift of approx 5mm, I prefer to think of it as a method of keeping the brows from sagging any further, rather than long-term lift.

Neurotoxins (Botox, Dysport, Xeomin) have transformed the state of brow and forehead lift.  These neurotoxins can be used to temporarily improve wrinkles of the forehead and between the brows.  The use of neurotoxins avoids a surgical procedure and can be performed in a short period of time.  If more permanent results are desired, limited-incision muscle resection or forehead lifting may still be performed.  Neurotoxin use may also elevate the lateral brow, but will not dramatically change the brow position or the length of the forehead.

Overall, there are many options for forehead and brow rejuvenation.  The use of neurotoxins has changed the landscape- many are choosing to have an easy, temporary result  rather than a surgical, permanent result.  Because of the variety of treatments, forehead and brow rejuvenation can result in long-term, natural appearing results.

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