Posts Tagged ‘reconstructive surgery’

Does Your Nose Grow with Age?

Thursday, March 8th, 2012

I’m sure you have heard the saying that your nose and ears continue to grow as you age. Let’s take a look at the facts.

How does the nose change with age?

Different areas of the nose change in different ways.  The nose is supported by an underlying bony cartilaginous framework.  The top part of the nose is supported by bone while the lower part near the nostrils is supported by cartilage.

nose with bones and carilages Does Your Nose Grow with Age?

A youthful appearing nose:

ideal nasal profile1 Does Your Nose Grow with Age?

Overtime, the cartilage becomes weaker and this causes the tip of the nose to droop, otherwise known as tip ptosis.  The bony part of the nose becomes weaker, but it does not move.

The skin of the nose actually becomes thinner, but the sebacous component of the skin increases.  The increase in the sebaceous skin makes the skin heavier and more vascular, which will cause the nasal tip to droop.

The bone that supports the nose from below, the maxilla, begins to reabsorb and shrink. This loss of support also contributes to tip ptosis.

Does the nose grow with age?

The answer to the question is both yes and no.  As one ages the nose does not grow, but it changes in shape, which often makes the nose appear larger.

As the support of the nasal tip weakens and the nose begins to fall, the nose appears longer from the side or profile view.  Additionally, it will make an existing nasal hump appear larger or cause a small hump to appear as the tip falls.

ideal nasal profile aging changes Does Your Nose Grow with Age?

The arrow pointing down shows the direction of movement of the nasal tip as we age.  The red line shows the outline of the anticipated appearance of the nose after the tip falls.  This illustrates how the nose is longer from the side view and appears to grow as we age.

Watch a video of me explaining the descent of tip of the nose with age.

How do these changes affect a rhinoplasty, also known as a nose job?

As a Charlotte nose job specialist, these changes are critical to understand.  A nose job performed on a patient that has a falling nasal tip secondary to the aging process is a very different operation than a young female seeking nasal refinement.    Generally speaking, a young patient with a large nose and hump will need the nose to be made smaller. An adult with a drooping tip which causes the nose to appear larger will need the tip lifted first to restore a youthful and refined appearance.  If additional changes are warranted, they can also be accomplished during surgery.  If the surgery were to be performed identically in both types of patients, the patient with the fallen tip could end up with a nose too small for their face.  As a Charlotte nose job specialist, I understand the anatomical changes of the nose as it ages and will tailor the operation to achieve the desired results.

Next read Major league baseball player gets nose job.

The Effects of Skin Thickness on an Ethnic Rhinoplasty

Wednesday, February 15th, 2012

All rhinoplasties and noses are not created equal. Caucasian nose jobs require different procedures and techniques than compared to all other ethnicities, such as those of African Americans, Asian, Indian, and Middle Eastern descent.  Even within each of these ethnicities there are cultural and anatomical differences that are taken into account during a nose job.  One common similarity in most ethnic rhinoplasties is the thickness of the skin covering the nose when compared to Caucasian nose skin. The skin in ethnic noses is much thicker than non-ethnic noses.  The nose is structurally supported by a bony  cartilage framework that provides the shape of the nose.  The skin drapes this foundation.  If the skin wrapping this framework is thin like a sheet, then you can see all of the curves, shapes, and forms of the underling framework.  If the skin that wraps the framework is a thick blanket and not at all like a thin sheet, as in ethnic rhinoplasty, it curves, shapes, and forms are blunted.  This prevents the appearance of a sharply defined tip of the nose, and as a result the nose is rounded and bulbous in appearance.

When I preform an ethnic nose job in Charlotte, I closely examine all features of the nose, including the thickness of the skin.  If my patient has thick skin, I know that I will have to do additional procedures to help define the nose, if that is the patient’s goal.  Additionally, there is a limit on the amount of definition that can be achieved with thick skin.  I make sure all of my patients understand this limitation before undergoing an ethnic nose job.

I did my specialty training in facial plastic and reconstructive surgery with prominent rhinoplasty surgeons that specialized in ethnic rhinoplasty, including Dr. Paul Nassif (as seen on the Real Housewives of Beverly Hills).  Dr. Nassif has African American rhinoplasty and Asian rhinoplasty patients from all over the world.  After working with Dr. Nassif and learning his techniques, Carolina Facial Plastic Surgery Center will model his practice’s high level of specialized care.  I have two offices, one in Charlotte, North Carolina near Southpark Mall and the other Columbia, South Carolina near Columbiana Mall.  I look forward to seeing patients in the Irmo and Lexington regions of South Carolina, and the Ballantyne, Eastover, Dilworth, Meyer Park, Lake Norman and Huntersville regions in North Carolina.

The Doctor as the Patient: My Septoplasty for Nasal Airwary Obstruction Procedure

Friday, February 10th, 2012

You know how they say doctors never take care of themselves?  Well…. I am guilty as charged.  Although I exercise almost everyday, recently ran a half marathon with my fiancee, eat well, and try to get plenty of rest, I have never been able to breathe out of my nose properly, which I have ignored for quite some time. Eventually, I started to convince myself that there was a slowly growing tumor in my nose.  Physicians are also slight hypochondriacs, of which I am obviously also guilty, due to the fact that I started to truly believe I had a tumor in my nose.  A tumor would have been an extremely rare cause of nasal obstruction, but it is the most serious type.  I happened to be in the CT scanner room one day at my office, and I thought it would be good time to identify the cause of my deviated septum.

Dr. Jonathan Kulbersh’s CT scan:

ctblogpic 1024x577 The Doctor as the Patient: My Septoplasty for Nasal Airwary Obstruction Procedure

Deviated Septum Causing Complete Nasal Obstuction (Dr. Kulbersh's Poor Nose))

On a CT scan, the left and right side are switched.  The green diamonds represent the eyes and the yellow diamond is over the brain.  The blue arrow shows the open nasal passageway on the left side and the red arrow shows the deviated septum causing complete nasal obstruction (on CT scans black is air, grey is tissue, and white is bone).

A CT scan is an unnecessary test to diagnose a deviated septum.  A deviated septum is easily diagnosed by a qualified facial plastic surgeon.  I was relieved to know my deviated septum was the cause of my nasal airway blockage, and it was not blocked by a tumor. I was also relived to find out that my breathing could be fixed from a safe surgical procedure, septoplasty.  My first step to fix my deviated septum was to find a qualified cosmetic surgeon, Dr. Babak Azizzadeh. Even though I am a facial plastic surgeon specialist myself, I still had a consultation with my doctor.  We went over the risks, benefits, alternatives, and location of the septoplasty.  After gaining complete trust from a great first consultation with Dr. Babak Azizzadeh, I moved forward with the septoplasty surgery.

The septoplasty surgery was yesterday, and was my first time being on the “other side of the table”.  Even though I am a facial plastic and reconstructive surgeon and have done this procedure many times, I was still nervous before the surgery.  When I showed up at the outpatient surgery center, I was greeted with a very warm welcome, which eased my anxiety. I was taken into the bathroom, where I changed into a gown, socks, and put on a hat.  I was then placed in a patient room and welcomed by a very friendly nurse.  She asked me a variety of medical questions, and then placed an IV into my arm.  Unfortunately the first IV was not placed in the vein properly, and the anesthesiologist had to administer the IV in my other arm.  When the anesthesiologist placed the IV, he first numbed the area with lidocaine and this technique was much more comfortable.  After the painful experience with the first IV, I will now insist that all my patients receive lidocaine before their IV’s.  After the placement of the IV, my doctor came into the room to answer any of my last minute questions and concerns.  The anesthesiologist then gave me a medication, Versed, to relax my nerves, and I was taken into the operating room.  All I can remember is the anesthesiologist placing oxygen on my face, and then the surgery was over.  (I was told later that I was feisty waking up from surgery!)

Immediately after waking up, I could feel slight pain in my nose.  I told the nurse about the pain, and she immediately gave my an IV pain medication that resolved the pain. Within one hour, I was feeling better and ready to go home.

post op The Doctor as the Patient: My Septoplasty for Nasal Airwary Obstruction Procedure

Dr. Jonathan Kulbersh with Nasal Bandage in Place

I am always honest with my patients, and I would say last night was uncomfortable.  I was not in pain, but I could not breath out of my nose because I have silicone nasal splints in my nose.  Therefore, I was breathing through my mouth, which became very unpleasant.  My nose slowly dripped small amounts of blood throughout the entire night.  If it says anything about the experience, I am writing a blog post about it the next morning!

Being the patient for a facial cosmetic plastic surgery procedure was a valuable experience.  As physicians, we are striving to understand our patient’s needs and concerns.  There were many little events yesterday that created a trusting environment that improved my surgical experience. The quality of the nurses, the doctor’s extra few minutes he took to answer my questions and the staff’s initial warm welcome got the day off to the right start.  For me, most importantly, I also now know the importance of the doctor spending a few moments with the patient before surgery for reassurance.  Additionally, my cosmetic surgeon called me the evening after the surgery to ensure I was doing well.  I learned many valuable lessons over my surgical experience that I hope to use to improve the experience for my patients in the Carolinas.

I am a facial plastic and reconstructive surgeon that trained in Beverly Hills.  I have two offices in the Carolinas, Charlotte and Columbia, serving the Dillworth, Ballentyne, Southpark, Meyers Park, Eastover, Lake Norman, Huntersville, Irmo, and Lexington.

New Medication Combination Reduces Nausea After Cosmetic Procedures

Thursday, February 9th, 2012

Dr. Kulbersh is always reading current litearture to stay on the cutting edge and improve the outcomes and experiences for his patients.  The most common unpleasant issue after facial cosmetic surgery is nausea or even vomiting. Dr. Kulbersh and his team take many precautions to prevent nausea in patients after surgery.  There was a recent study published that used a new combination of medication to dramatically decreased nausea after facial cosmetic surgery.  At Carolina Facials we will now be using this medication for our patients undergoing facial plastic surgery procedures such as rhinoplasty (nose job), blepharoplasty (eye-lift), facelift, necklift, or browlift in our surgery centers in Charlotte, North Carolina and Columbia, South Carolina.  Check out the article below:

http://journals.lww.com/plasreconsurg/Abstract/2012/02000/Aprepitant_plus_Ondansetron_Compared_with.39.aspx

 

Dr. Jonathan Kulbersh is a Board-Certified Head and Neck Surgeon and is fellowship trained in facial plastic and reconstructive surgery. His practice, Carolina Facial Plastics, has offices in Charlotte, North Carolina and Columbia, South Carolina, serving the Southpark, Meyers Park, Eastover, Ballentyne, Huntersville, Irmo and Lexington areas.

New Video About Blunt Cannulas for Injection of Facial Fillers

Thursday, February 9th, 2012

Dr. Babak Azzizadeh, my mentor in Beverly Hills, was featured on NBC news this evening on the use of blunt cannulas instead of needles to inject facial fillers.  This cutting edge technique, which I use in my offices in Charlotte, North Carolina and Columbia, South Carolina, causes less bruising and swelling, is safer, and is more comfortable.  Check out the link below!

http://www.nbclosangeles.com/video/#!/news/health/New-Wrinkle-Filling-Procedure-Has-Less-Side-Effects/138979099

Dr. Jonathan Kulbersh is a Board-Certified Head and Neck Surgeon and did his fellowship training in Beverly Hills in facial plastic and reconstructive surgery.  His practice, Carolina Facial Plastic Surgery, sees patients in his offices in Charlotte, North Carolina and Columbia, South Carolina.  These offices serve patients the Southpark, Meyers Park, Eastover, Ballentyne, Huntersville, Irmo and Lexington areas.

Why Do People Get Chin Implants/Augmentation and What is the Most Affordable Option?

Thursday, February 9th, 2012

When I look at a face, I believe one of the best compliments I can offer to describe it is harmonious.  There is not a single shape of a nose, eye, or chin that is beautiful, but the combination of all of the facial features together creates beauty. The chin is just one piece of the puzzle.  When examining the face, I look at the general overall features of the face.  Does the patient have large features, small features, angular features, or soft features? I will specifically look at the chin and jawline to see if it “fits” the face.  If the patient has larger features and a smaller chin or the face has a small chin in general, a chin augmentation is a great procedure that can dramatically bring the face into harmony. Another key feature that I will specifically look at when examining the face is the nose.  Many times, patients believe that their nose is too big. This can be true, but a small percentage of the time, the real reason the nose looks big is that the chin is too small.  Chin augmentation creates the illusion of a smaller nose.

The position of the chin has psychological undertones. Men with a large and angled jawline are considered powerful, intelligent, and strong.  Research shows that the majority of CEOs of major companies have strong chins.  The opposite is true of men with weak chins.  They can subconsciously appear as weak, less successful, and less attractive.  Chin augmentation in men can be used to improve aesthetic appearance and the subconscious opinion of others.  In women, it is more attractive to have a chin and jawline that “fits” the face.  Generally, the chin should not be strong or weak, but just the right size.

The chin may be augmented both surgically and non-surgically.  The surgical procedure is short and well tolerated, but there are also very tolerable non-surgical options.  The chin may be augmented with injectable facial fillers.  I am a Charlotte, North Carolina and Columbia, South Carolina based facial plastic surgeon.  I use two main types of fillers to augment the chin, HA fillers (Restylane, Perlane, and Juvederm), and calcium hydroxyappetite (Radiesse.)  Both of these types of fillers are natural products produced by the body.

At Carolina Facial Plastics we use nerve blocks and the needless filler injection technique to minimize any pain associated with the injection.  The chin is injected with the filler to create a larger, stronger, and more defined jaw to help fit the face.  Additionally, sometimes the muscles in the jaw may become tense and create excessive dimpling of the chin and cause the chin to be pulled up.  In these cases, I will use a small amount of a chemodenervator, Botox, Dysport, or Xeomin to relax these muscles.

Finally, the easiest and cheapest non-surgical chin augmentation is the growing of facial hair.  Hair covering the chin will give the appearance of a larger chin.  This may be a great option for some of our male patients, but for the females the transformation to the bearded lady may bring unintended consequence (invites to join the fair!).  A recent study shows that chin augmentation procedures are up 50% compared to last year.

Dr. Jonathan Kulbersh is a Board-Certified Head and Neck Surgeon and fellowship trained in facial plastic and reconstructive surgery.  His practice, Carolina Facial Plastics, has offices in Charlotte, North Carolina and Columbia, South Carolina, serving the Southpark, Meyers Park, Eastover, Ballentyne, Huntersville, Irmo and Lexington areas.

 

 

Will Injectable HA Fillers in My Face Look Different After a Couple of Days?

Monday, February 6th, 2012

The injectable HA facial fillers that are available in the Charlotte area, such as Restylane, Perlane, and Juvederm, are wonderful products that are temporary, reversible, and effective for taking years off your appearance.  These fillers require a minor procedure and patients can instantly see the difference after injection of the material.  The fillers are made of a material that is hydrophilic.  This means the injectable filler may slowly increase in fullness over a couple of days as it collects water.  I have found that Juvederm most commonly increases in size over a couple of days.  For this reason, I will not over-correct with an injectable filler.

For more information about Dr. Kulbersh’s needleless injection technique for injectable fillers, please visit the injectable page on his website.

 

Dr. Jonathan Kulbersh is a Board-Certified Head and Neck Surgeon and is fellowship trained in facial plastic and reconstructive surgery.  His practice, Carolina Facial Plastics, has offices in Charlotte, North Carolina and Columbia, South Carolina serving the Southpark, Meyers Park, Eastover, Ballentyne, Huntersville, Irmo and Lexington areas.

Injectable Fillers – Are They Used to Simply Fill Lines, Replace Lost Facial Volume, or Both?

Saturday, February 4th, 2012

The use of the facial fillers Restylane, Perlane, Juvederm, and Radiasse in the treatment of the aging face has exploded over the past 5 years in Charlotte and Columbia.  Restylane, Perlane, and Juvederm are composed of hyaluronic acid, while Radiasse is composed  of calcium hydroxyappetite (all of these products are natural substances made by your body).  All of these products have unique features that are explained on my website.  Fillers are now more popular than ever due to their ability to create a subtle refreshed facial appearance in a safe manner.

The loss of facial volume is one major contribution to an aging appearance of the face.  The loss of facial volume does contribute to the formation of wrinkles, but in my opinion, it more importantly changes the topography of the face.  A young face reflects light and has smooth transitions from one area of the face to another.  In an aged face, there are many “hills and valleys” that create many facial shadows.  The use of fillers in the face help create more highlights and smoother transitions from one area of the face to another, which will ultimately create a younger looking appearance.  The techniques to create this outcome are the “art” of facial plastic surgery and cannot be learned at a weekend course.  I believe the ability to analyze facial topography and the correct placement of fillers will differentiate good outcomes from great outcomes.

Fillers can also be used to simply fill deep smile lines and other wrinkles in the face.  This may be appropriate for some patients, but if that is the only technique of the injector, the patient is not going to get the full benefit of these products.  With two years of training in Beverly Hills, this skill and technique is one of the greatest differentiators between myself and other general plastic surgeons.

Carolina Facial Plastics has two offices, one near Southpark Mall in Charlotte and the other in Irmo, South Carolina.  I would love the opportunity to discuss the possible role of fillers in your personalized treatment plan.

Dr. Jonathan Kulbersh is a Board-Certified Head and Neck Surgeon and fellowship trained in facial plastic and reconstructive surgery.  His practice, Carolina Facial Plastics, sees patients in his offices in Charlotte, North Carolina and Columbia, South Carolina serving the Southpark, Meyers Park, Eastover, Ballentyne, Huntersville, Irmo and Lexington areas.

Options for Non-Surgical Brow Lift

Friday, February 3rd, 2012

The position of the eyebrow is central in facial expression, and its position is subconciously a strong non-verbal form of communication.  A brow located high towards the ear can make one appear surprised and a brow that is low near the nose can make one look angry or tired.  The proper position of the brow in women is just above the bony prominence, or supraorbital rim, just above the eye, and the brow should be right at the supraorbital rim in men.  A brow-lift surgical procedure requires only a week of downtime.  For the patient who wants lifting of the brow without surgery, a non-surgical brow-lift can be preformed with either Botox or Botox-like injections, fillers, or a combination of both, which requires no downtime.

The position of the brow is controlled by many forces including the pull of the muscles of facial expression.  The frontalis muscle, or muscle of the forehead, is the only muscle that raises the brow.  The muscle of the eye, orbicularis oculi, and the muscles over the nose, corregator supercilli, procerus, and depressor supercilli, depress the brow.  The muscles can be weakened with Botox, Dysport, or Xeomin, and the brow will rise.

As the face loses volume, the skin skin sags, just as if you slowly let air out of a balloon.  At the brow region, the loss of volume can create a ridge or depression above the eyebrow.  This can give a harsh and masculine appearance to the face.  With the addition of a hyaluaranic acid filler, Restalyane, Perlane, or Juvaderm to this depression, the brow will raise, and the face will have a softer appearance.

Dr. Jonathan Kulbersh is a Board-Certified Head and Neck Surgeon and is fellowship trained in facial plastic and reconstructive surgery.  His practice, Carolina Facial Plastics, has offices in Charlotte, North Carolina and Columbia, South Carolina serving the Southpark, Meyers Park, Eastover, Ballentyne, Huntersville, Irmo and Lexington areas.