Plastic Surgeon, Albany, NY - Deluca Plastic Surgery

Rhinoplasty (Cosmetic Nose Surgery) Basics

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What is a Rhinoplasty?

Cosmetic rhinoplasty is a surgery that reduces and repositions tissue in the nose for better aesthetics. This often involves straightening the dorsal profile, reducing dorsal humps, reshaping the tip, and possibly narrowing the width of the nose.

For a nose that is lacking projection and definition, grafting techniques may be needed to build up the projection of the tip and strengthen the dorsum.

The decision on the type of surgery, however, is based on the patient’s anatomy and patient’s preferences.

These are big movements that are often intended to create subtle, millimeter changes to the shape of the nose once it heals. The thickness of the nose skin can affect the overall result, however, an improvement can be obtained for most patients.

Anatomy of A Rhinoplasty

What is the recovery like?

The postoperative time for most rhinoplasty patients is often fraught with trepidation.

During a rhinoplasty, the skin and soft tissues are often completely separated from the underlying bone and cartilage framework. The framework is modified and the skin is laid back down. After rhinoplasty the nose swells from the trauma of surgery and the tissues become edematous. This makes the normally pliable skin firm and causes the nose to take on a “swollen” appearance in the first few weeks after surgery.

This swelling and firmness cause the tip to rotate, the dorsum to appear rounded, and the columella to swell and bow out from under the nose. As the initial swelling settles out over the first few weeks, the dorsum begins to settle, the tip starts to soften, and the columella swelling begins to dissipate.

The nose continues to settle over the next few months as the edema finally escapes and the soft tissues adapt to their new underlying framework. It may take 9 months to a year to see a final result.

Post-operative care after nose surgery helps patients achieve their optimal results. To encourage healing we utilize a unique regimen of post-operative care including icing, head elevation, supplements to decrease bruising, and silicone gel scar management.

Get more details on the management of swelling and scars in blog post: Post-Operative Care After Plastic Surgery.

What surgery is right for me?

A detailed examination will help delineate the best surgical treatment. The goal of a rhinoplasty is to create an aesthetic nose with the size, shape, and projection that is desired by the patient.

During your consultation, measurements of the nose are used as a starting point to recommend surgery. For some patients, digital computer simulations are used to help visualize the likely result.


Deciding On Your Best Option: Mid Facelift vs. Mini Facelift

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There are multiple types of facelifts; determining which procedure is right for you can be difficult. We want to help our patients make the right choices concerning their personal appearance, so we’re going to help you select a procedure that will benefit you the most. Specifically, let’s examine the differences between a Mid Facelift and a Mini Lift. These two techniques are somewhat similar, so distinguishing which one is for you will be dependent on factors unique to each individual.

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Nothing But Neck – Kybella vs. Liposuction To Treat Neck Fat

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Click here to contact Dr. Tauber to make an appointment for a free cosmetic consultation today!

Fullness of the neck due to excess neck fat can be treated with both invasive and non-invasive strategies. Reduction of this fat can give better definition to the jaw like and neck and make patients look younger and more fit.

Kybella

Kybella is a non-invasive injection that has been recently approved by the FDA to help improve the appearance of fullness associated with the submental fat of the neck in adults. Young adults, with a moderate amount of excess fat and good skin tone are usually good candidates.

During a office based Kybella treatment, the neck is first cleaned and numbed with topical lidocaine. A pattern is drawn on the neck and the product is injected into the fat of the central neck – dissolving the fat. The body then absorbs the fat over several weeks. There is swelling that occurs and may be bruising and some numbness in the area during this time. The injections are usually done once every six weeks and it usually it usually takes at least two treatments to achieve the desired improvement. (more…)


Do I Really Need A Breast Lift?

The decision to do a breast augmentation without lift versus a breast augmentation with a breast lift, however, is less based on patient preference and more dictated the saginess, the nipple position, and the ratio between the breast volume and the amount of excess skin that is present.

How Ptotic Are My Breasts?

The gold-standard method of assessing the need for a breast lift is the “pencil test.” Standing in front of a mirror, lift the breast and lay a pencil in the fold under the breast and allow the breast to settle over the pencil. Look at the position of the nipple in relation to the pencil.

Pencil Test For Determining Degree of Breast Ptosis
Pencil Test For Breast Ptosis

The lower the nipples and breast are below the pencil and the more excess skin you have, the greater the chance you will need a breast lift and the more of a breast lift you will need. If your nipple and a majority of your breast are at or above the pencil (Normal), you will likely get a great result from a breast augmentation alone. Larger implants can shift this equation slightly for patients that have borderline ptosis (Grade 1).

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Hollow Cheeks – Treatment with Implants, Fat Transfer, and Fillers

What Causes Hollow Cheeks

The aging, hollow face is typified by soft tissue decent and volume loss. These stigmata of growing older are manifest by the development of nasolabial folds, marionette lines, and jowls combined with a sunken mid-face and hollow cheeks.

In recent years, DeLuca Plastic Surgery has looked past skin tightening as the solution for all of these complaints and has recognized the role that volume loss contributes to the appearance of aging, hollow cheeks. This volume loss occurs as the soft tissue (and even bone) of the face resorbs over time as we get older or secondary to weight loss. To combat these changes we utilize a variety of techniques including several types of non-invasive facial fillers, fat transfer, and facial implants.

Facial Implants

Projection of the cheeks and mid-face is due to the interaction of the bones of the face and the overlying skin and soft tissue. Facial implants are used to add a more substantial foundation to hollow cheeks by adding projection to the bones of the face in patients that have experienced significant resorption as they age or who have always lacked projection.  Skeletal implants are powerful tools to modify the framework of the face and can produce dramatic results. In our practice, these implants are often combined with soft tissue augmentation, such as fat transfer, to treat hollow cheeks – restoring harmony and symmetry.

Facial Implants Used in Treating The Thinning Face
Types of Facial Implants

Read: “Top Cosmetic Surgeries For Men”

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Current Trends in Labiaplasty – The Edge vs. The Wedge

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Women seek labiaplasty for many reasons ranging from discomfort with intercourse and pinching in tight clothing to purely cosmetic reasons. According to the American Society for Aesthetic Plastic Surgery there has been a significant increase in the number of these tissue reduction and restructuring procedures — an astonishing 48 percent rise in 2014 from 2013. Workout gear is becoming tighter and women are becoming more self conscious about how they look in lycra enhanced tight clothing.

Although there are variations in technique and equipment used, labiaplasty most often involves reducing the size of one or both of the labia minora through one of two basic techniques. Both techniques attempt to preserve the nerves to the skin within the mucosa instead of simply removing it. In addition,  both techniques can be extended to reduce some of the excess clitoral hood.

The first technique is a straight-line (trim) excision. It reduces the excess tissue in straight line front to back. This technique is more straightforward and has the added benefit of reducing the unsightly thickened free border of the labia. There are variations on trim that include the Lazy-S Labiaplasty and the Extended Excision Labiaplasty.

Labiaplasty Incisions
Labiaplasty Incisions

The second most common technique is the wedge excision. It reduces a pie-shaped wedge of tissue from the central portion of the labia. The remaining tissue at the front and back is then brought together and closed. This technique preserves the free border, however, it is more complex and requires additional incisions to reduce the dog-ear that forms. There are variations to the original wedge resection including the the Z-Plasty Wedge Labiaplasty, the Hockey Stick Wedge Labiaplasty, and the DOVE (Double Opposing V-Plasty with Extended Deepithelizing) Wedge Labiaplasty.

The choice of technique is based on patient preference and is tailored by Dr. David Tauber to each patients needs. A detailed examination will help delineate the best surgical treatment.

Get more details on the management of swelling and scars in blog post: Post-Operative Care After Plastic Surgery.


Botox and Facial Fillers – The Fountain of Youth (Without The Knife)

What Is Botox?

Botox is an injectable used to lessen the movement of specific muscle of the face in an effort to target wrinkles created by the contraction of facial muscle groups. The areas that are treated most often include the forehead, the area between the eyebrows, and the crows feet (on the side of the eyes). The goal is to soften these tell-tale stigmata of aging without leaving the face looking flat and emotionless. This can be a difficult needle to thread. If done correctly, however, Botox can make the face look younger, raise the eyebrows, and make the eyes look more open.

Botox Before and After
Botox Before and After – 7 Days (courtesy Allergan)

Botox is injected using a very fine needle into the affected areas. Most patients experience little discomfort and by the time they return home or to the office any redness or swelling has disappeared. The affect begins to be noticed over the next week and lasts for about 3-6 months until the effect, again, slowly fades out.

Read: “Botox Basics”

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Blepharoplasty with Fat Redraping – Solutions For Aging Eyes

Aging eyes are characterized by the development of wrinkles, fine lines, drooping skin, midface hollowing, and eyelid bags. These changes make patients look tired and angry. The bulging of the lower eyelids occurs as the tissue wall (orbital septum) that holds the fat in the orbit begins to weaken and stretch. Traditional blepharoplasty attempts to address this bulge by reducing the fat.

This approach to treating the aging eyes reduces the bulge, however, it can produce two unwanted effects. The first is an unmasking of midface hollowing that was masked by the fullness of the bulging lower eyelids. The second occurs as the face continues to age. Over time, the orbital fat begins to lose volume. This produces hollowing around the eyes. If the fat is reduced during a blepharoplasty, this hollowing is accelerated. This leaves the patient with a skeletal look that is difficult to correct.

Read: “Blepharoplasty (Eyelid Lift)”

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There is No “Right” or “Best” Age for a Facelift

Nice Face The facelift is experiencing a bit of a renaissance it would seem. I have patients of all ages ask about the surgery and whether or not they would be a “good” candidate for the procedure. It’s a good question.

Fifteen years ago, the average age of a patient was about 60 to 65 – today it’s closer to 45 to 50.

Why? Previously, patients were waiting until signs of aging had become extremely visible before opting to ‘turn back the clock’ 10 to 15 years (which is what a well done facelift can do). These days, patients are taking a more proactive approach in reducing the appearance of aging skin – and so are opting for less extensive lifts in their 40s and early 50s. That said, there’s absolutely no “right” or “best” time to undergo a facelift and if anything, having the procedure a little later on makes for an even more dramatic* result (because the face ages at a faster rate the older we get, so the difference between 30 years old and 40 is less than 40 and 50). (more…)


Rhinoplasty Recovery: What You See Right After Surgery is What You Get

Photo Of Doctor And Patient Discussing Plastic Surgery RecoveryI recently read a blog post by a plastic surgeon in Manhattan who specializes in rhinoplasty. The surgeon made a point that I have seen echoed by quite a few other plastic surgeons on RealSelf.com when answering questions from patients going through rhinoplasty recovery.

The question being posted across multiple online forums is: How different will the nose look 1 year after surgery as compared to 3 months, or 6 months? In other words, “If my nose looks great at 3 months, will it still look good a year from now? Or will it look overly defined and tight as more time passes?”

My opinion is this – there is no definitive answer. Each nose is different and no one can predict how your nose will change over time. However, one thing is glaringly clear to me about rhinoplasty recovery: If the nose doesn’t look good at 3 months, it isn’t going to look good in a year.
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