Facial Plastic and Cosmetic Surgery


RHINOPLASTY: PLASTIC SURGERY OF THE NOSE "NEW PERSPECTIVES AND NEW TECHNIQUES"


The nose is the most central and prominent feature of the face and one of the most significant anatomical features that contributes to facial harmony and balance. When the nose is even slightly out of proportion with other major facial features, it can greatly affect one’s self image and confidence. Nothing has a greater impact on how a person looks than the size and shape of the nose. Because the nose is the most defining characteristic of the face, a slight alteration can significantly improve one’s appearance.

Rhinoplasty improves the appearance and proportion of the nose, thus enhancing facial harmony. However, not all nose surgery is performed for strictly cosmetic reasons; rhinoplasty can correct structural abnormalities, such as a deviated septum. This condition can lead to breathing problems and other obstructive nasal symptoms.

RHINOPLASTY is one of the most commonly requested surgical procedures in America. Most surgeons agree that RHINOPLASTY is a surgical art form unto itself and undoubtedly, the most complex operation in plastic surgery. Since no two noses are alike, it is vital for the surgeon to have extensive knowledge and diverse experience in all aspects of nasal surgery in order to ensure that the procedure is designed to suit the specific needs of each individual patient.

Dr. Binder’s most frequently performed procedures are Rhinoplasty and Revision Rhinoplasty. Over 60% of the total number of nasal procedures currently performed in his practice are revision rhinoplasty cases. He has established his reputation in Beverly Hills and the Los Angeles Area and is recognized by his peers as the premier Rhinoplasty and Revision Rhinoplasty surgeon with the reputation as the "end-of-the-line" surgeon for severe, complicated cases requiring extensive reconstructive surgery. Dr. Binder has unique qualifications for performing rhinoplasty being double board certified in mastering the understanding of the functional and aesthetic aspects of Rhinoplasty.

Dr. Binder strongly supports the philosophy that nasal surgery must achieve consistent and natural-looking results. Dr. Binder believes that the surgeon who performs rhinoplasty must be acutely perceptive to the individual needs of each patient and have a strong three-dimensional understanding of not only the nose, but also, the patient's overall facial structure. This interdependent philosophy ensures a consistent, naturally-shaped nose that harmonizes perfectly with the rest of the face.

For almost three decades, Dr. Binder's dedication to this individualized approach to rhinoplasty has led him to pioneer the new "STRUCTURE" techniques of rhinoplasty, yielding more consistent results and rendering the pre-existing look of an unnatural nose-job obsolete.

  • WHAT IS AESTHETIC SURGERY OF THE NOSE?
    • Specific features addressed in cosmetic surgery of the nose include:
      • a. Nose size, width, and profile
      • b. Over and under projection of the nose
      • c. Nasal tip shape (i.e. too wide, bulbous, drooping, hooked or too upturned)
      • d. Oversized, wide, or flared nostrils
      • e. Nasal asymmetry
      • f. Limitations or advantages of skin type
    • FUNCTIONAL ASPECTS OF NASAL SURGERY:
      When there are functional problems in breathing either due to a deviated nasal septum, enlarged turbinates associated with allergy or a collapse of the nasal valvular (cartilage) structures, these problems can and should be corrected simultaneously with the aesthetic procedure. They most often go hand-in-hand because the aesthetic procedure commonly requires the same surgical technique that is often performed to correct the functional problems and vice versa.
    • OTHER CONSIDERATIONS IN NASAL SURGERY:
      • Facial Balance and Facial Harmony: Problems in the facial structure, especially a small chin and lower jaw or weak cheeks or midfacial bone structure may also contribute to imbalanced facial proportions. In these cases, surgery of the nose may be performed in conjunction with placement of facial implants or other procedures to achieve overall facial harmony.
      • At what age can nose surgery be performed? Surgery of the nose is best performed when facial growth is completed. This begins around age 15 for girls and the latter part of age 15 and 16 for boys.

      • THE CONSULTATION

      • There is no substitute for patient education. You should leave the consultation with a comfortable understanding of the procedure and its pertinence to your specific needs. Another purpose of the consultation is to ensure that you establish a rapport with Dr. Binder so that you feel comfortable coming back to ask additional questions if necessary. We feel it is extremely important to have all of your questions answered and thoroughly explained in a way that makes sense to you. No question is too simple or too complex.
      • The most common concern of a person seeking Rhinoplasty, particularly in the demanding geographical area of Beverly Hills, is "I don’t want to have that ‘NOSE JOB’ look". However, over the last 30 years, Dr. Binder has worked to eliminate this common concern through his sophisticated "structure" approach to Rhinoplasty.
      • The problems patients associate with the "bad rhinoplasty look" are universally the same (i.e. "I don’t want my nostrils showing; I don’t want my nose turned up or scooped out: I don’t want the nostrils margins flaring or I don’t want the pinched look"). Essentially, the patient desires a natural appearing nose as the final result….and should expect nothing less!

      How can the patient be reassured that this will happen? "It’s very simple," says Dr. Binder. "Most of these untoward effects of Rhinoplasty result from older techniques, which were previously categorized as "reduction rhinoplasty". These techniques removed too much cartilage or bone, based on the theory of reducing size or "sculpting" the nose. This is what created most of the problems. In the mid 1980’s, those of us who became interested in revising and correcting these problems quickly realized that in order to accomplish this, we had to add cartilage back to the nose because too much had already been removed. The field of revision Rhinoplasty soon assumed a dimension of its own and different techniques were developed to prevent these problems from ever occurring. Hence, the term STRUCTURE RHINOPLASTY became the basis for performing what is today’s standard. Instead of removing, we reposition, identify, and reinforce weaknesses in the nose that contribute to problems in both structure and function. Dr. Binder’s philosophy is to create a nose that fits the face and remain in proportion with the other facial features. Every nose must be in balance with overall facial features, and breathing must never be jeopardized or compromised.

      Dr. Binder’s Structure Rhinoplasty techniques produce individual results that:

      • are characteristically subtle and natural
      • focus on strengthening and restructuring the cartilage framework of the nose, and
      • correct abnormalities caused by weaknesses in the nasal framework.

      The result is a completely natural looking nose. The patient never has to worry about ending up with the unappealing appearance of a "surgically-overdone nose." If the patient experiences breathing problems, the air passage can simultaneously be opened by either straightening the deviated septum and/or reducing structures inside the nose called turbinates, that become enlarged by chronic allergy or other nasal disorders.

      DIFFERENCES BETWEEN "OPEN" AND "CLOSED" RHINOPLASTY:

      To create that desired naturally balanced appearance, the entire procedure is performed from the inside of the nose (the closed technique), so there are no visible signs of scarring. The closed technique is performed without severing the columella, or delicate island of tissue between the nostrils. For surgeons, this technique requires a longer learning curve and is more sophisticated than the open techniques.

      • "NO SCARS ON THE OUTSIDE OF THE NOSE!" When asked whether to perform Rhinoplasty with a closed or open approach, Dr. Binder’s answer is: "I can perform Rhinoplasty either through a closed or open approach. However, I reserve the open Rhinoplasty approach for only very special circumstances. In most primary Rhinoplasty or majority of Revision Rhinoplasty patients, I believe that the experienced surgeon should have the capability to perform Rhinoplasty through the closed approach, which is how I perform the majority of my cases. I have seen too many scars underneath the nose that do not heal properly as a result of the open Rhinoplasty technique. If these scars do not heal well, it is extremely difficult to correct them and they can potentially remain permanently visible.

      So why are so many surgeons using the open technique in Rhinoplasty? Dr. Binder claims that the closed Rhinoplasty is nearly a lost art. It is significantly more difficult for the surgeon to learn and demands a steeper, longer learning curve than the open approach. Most training programs do not have sufficient case loads to teach both methods. Many new surgeons opt for the open technique to access the nasal skeleton for easy viewing. "In practicality, it can also be problematic, since the open technique can, in some cases, cause significantly more scarring, skin shrinkage, and long-term unpredictability than the closed techniques.

      Although comfortable with both approaches, Dr. Binder’s experience favors the the advantages of stable and more predictable results that reside with one’s ability to perform Rhinoplasty through the Closed Structure Rhinoplasty Approach.

      RHINOPLASTY – THE PROCEDURE:

      Structure Rhinoplasty can be performed with a local or general anesthetic, always under the strict supervision of a Board Certified Anesthesiologist.

      The length of time required to perform primary Rhinoplasty is usually between 1 ½ - 2 hours. For Revision Rhinoplasty, 2 ½ - 3 ½ hours is common. All incisions are made inside the nose. In the exceptional cases where wide alae require reduction in width, parts of the nostril can be removed, leaving a fine scar along the nostril base that is usually inconspicuous upon healing. Following surgery, soft packing placed inside each nostril is removed a day after surgery. A small comfortable splint is worn for 5 to 6 days to protect the nose and ensure rapid healing. The splint is not placed to retain the shape of the nose, but is merely used for protection and to minimize postoperative swelling. The day after surgery, the patient is up and about and within a few days, can usually perform most sedentary tasks. In our experience, the majority of patients who undergo Structure Rhinoplasty have only minor discomfort and stuffiness for the first few days postoperatively with minimal bruising and swelling. Proper follow-up care is an essential part of our overall philosophy. Following the procedure, we will observe and direct our patient's recovery process for 6 to 12 months to ensure that healing continues correctly.

      When the splint is first removed, most patients can see the visible signs of improvement right away. This is another advantage of the closed technique, which causes much less swelling postoperatively. It is important to realize that it usually takes up to six months before the nose assumes its new permanent shape. The Structure Approach to Rhinoplasty produces changes that not only improve function, but are so natural and balanced that no one will be able to visually recognize that a rhinoplasty procedure was ever done.

      NEW NOSE FOR THE NEW MILLENIUM:

      The new nose for the new millennium demands a greater level of sophistication. The results of Rhinoplasty should be substantial yet subtle and the patient should look like his or herself, only better!"

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