Read the article in full here.
Read the article in full here.
It is commonly said that we often don’t know what will make us happy. When we get what we want – especially something we’ve worked towards for a long time – it can sometimes fail to meet our expectations. On the other hand, life can equally be full of surprising joys. It’s hard to predict our happiness in advance. This is a fact of life that rhinoplasty surgeons are all too aware of.
Over many years we’ve developed increasingly sophisticated ways to simulate how a patient’s nose will look after a rhinoplasty procedure, to help us plan treatment with the patient and set expectations. Yet patients are still surprised by what they like about their nose after surgery, and the extent to which the procedure has affected their self-esteem.
It’s important to be in control as a patient because a rhinoplasty is no small investment. You want to know what to expect, and whether a rhinoplasty will be worth it in retrospect. But is there a way of predicting how you’ll feel, aside from travelling to the future to read your mind?
We may not have a crystal ball – but we do have the Face-Q scales.
How is this useful?
It is always useful for each patient to be able to compare how they felt before and after their rhinoplasty and see the difference it has made.
However, by looking at all of the questionnaires our patients have completed, we’ve started to spot trends.
For example, we now know that while rhinoplasty can make a huge difference in how you feel about your nose’s appearance. Dramatic improvements in your social confidence or general self-esteem are less common. We can work with you to set realistic expectations about your surgery and help you make a more informed choice about treatment.
The questionnaires also demonstrate how you feel about your nose before the procedure can affect how you’ll feel after the procedure. Body dysmorphia is a growing problem in the UK, and for some patients, rhinoplasty won’t provide a solution to problems with self-esteem. Using the insights from the Face-Q scales, we can conduct proper screening. This will ensure that we only recommend a rhinoplasty to patients who will really benefit from it.
Finally, there are many ways to carry out a rhinoplasty surgery, but so far we’ve been lacking knowledge on which technique really leaves our patients the most satisfied. The Face-Q scales show that the right technique actually depends on the patient and the problems they want to address. With this knowledge, we can tailor our treatments more effectively for all of our patients.
This is great news for patients, because in the past the decision to have a nose job was a bit of a leap of faith. Now, a good conversation with an experienced rhinoplasty surgeon can take away some of this guesswork and help you make the right choice.
Top Doctors UK Published: 11/02/2019
1. If your nose is bleeding heavily and it won’t stop.
How to stop a nosebleed:
If you sit down and firmly pinch the soft part of your nose for at least 15 minutes, then lean forward and breathe through your mouth. This will drain the blood down your nose instead of down the back of your throat.
2. You’re having difficulty breathing through your nose.
3. Your nose looks crooked or misshapen or you have a cut on the skin.
4. Clear fluid, like water draining from your nose.
First aid at home. Take painkillers, paracetamol will do, and apply a cold compress on the nose, this will help ease your pain and reduce the swelling of your nose.
You should see a doctor at your earliest convenience. You will be required to have an examination and evaluate the extent of your injury to your nose. It is also important to check the septum (this is the dividing space inside of your nose). Sometimes an x-ray or CT scan is necessary if there are any other facial injuries.
Surgical treatment may not be necessary if there is no misalignment.
You need to see a Nose Specialist 1-2 weeks after the injury to determine whether surgery is necessary.
Whilst a fractured or a broken nose will need immediate surgery, there are many people who don’t need an operation and will hugely benefit from a non-surgical procedure. For those people, we use a new generation of filler called Ellanse to help correct and disguise any small lumps, bumps, and depressions from older injuries. See our recent blog, Trauma To The Nose And Rhinoplasty where we discussed this more
From teenage boys with injuries from contact sports such as rugby, football or basketball. To young women with facial damage from hockey, lacrosse, netball, horse riding and trampolining. Through to professional sports people with previous injuries that perhaps weren’t repaired immediately.
Whilst a fracture or a broken nose will need immediate surgery, there are many people who don’t need an operation and will benefit from a non-surgical procedure. For those people, we use a new generation of filler called Ellanse. Ellanse helps to correct and disguise any small lumps, bumps, and depressions from older injuries.
This amazing 30-minute treatment involves a few small injections of gel – inserted with a fine needle, deep within the subcutaneous tissue, so it sits above the bone and beneath the skin, and muscle. Ellanse works differently to traditional fillers, improving the “scaffolding of layers” underneath the skin, helping to reshape and add volume in their areas of concern. It gives an immediate correction of lost volume, but also acts as a biostimulator, working with the body to trigger the formation of new collagen. Over time – skin thickness will improve, and elasticity will be restored. The results are gradual and soft and can last up to two years.
Rugby star Ben Cohen was unhappy with the profile of his face. This was the result of having his nose broken more times than he can remember on the pitch. The bridge of his nose had collapsed, leading to a visible bump and his whole nose leaning to the side slightly. Ellanse was applied above the bridge and in the tip of his nose, in addition to a small amount of filler in his right cheek to correct a depression left by a fracture and some under his eyes to make them look less hollow.
I was terrified. I’ve never had a needle in my face, and I was worried I would come out looking worse. Aside from a few stinging moments, it didn’t hurt.Afterward , there was no swelling or pain. The result was subtle, and I’ve people telling me how well I look, which feels good considering what I’ve been through (on the pitch). Its been a fantastic experience and I couldn’t feel more positive about it
Ageing transforms the face to create a look that does not always reflect the person inside, but there are solutions to this
Maintaining a youthful appearance, for some, has a profound effect on self esteem and personal and professional
relationships. There are several non-surgical interventions available, but not all deliver high quality, long-lasting, natural results.
What treatments do you advise against? Well-known anti-ageing treatments are Botox and fillers. Whilst Botox can deliver fast-acting results, if the injections are not well-placed by an expert, the result can sometimes be a ‘frozen face’ appearance. Results from Botox injections also vary between people. There are a range of fillers available, each with varying results. Fillers are inserted under the skin, in different layers to improve contours, scars, folds and flaccidity. Common temporary fillers used today are hyaluronic acid (HA) fillers. Whilst long-lasting, due to their hydrophilic properties (their tendency to bind to water molecules), they can give an unnatural and over inflated look.
What do you recommend?
Newer generation polycaprolactone (PCL) Ellanse collagen stimulators are very effective in restoring volume and redefining contours. They are safe and temporary and require fewer touch-up procedures. Due to their biostimulatory properties, they are my first choice for natural facial rejuvenation and chronological ageing.
The process of rhinoplasty has advanced so much in just the past decade that many successful rhinoplasty procedures have been completed without the patient “going under the knife”. Non-surgical rhinoplasty is becoming more and more popular, especially here in the UK, and recently, this innovative procedure has made headlines in the national news.
Rugby Star Receives New Look With Non-Surgical Rhinoplasty
The Daily Mail recently printed an article about a non-surgical rhinoplasty procedure which was performed on ex-England rugby player Ben Cohen. Cohen’s bridge had collapsed as a result of his successful rugby career and, rather than undergoing a lengthy, not to mention risky, surgical rhinoplasty procedure, Cohen opted for a non-surgical nose rhinoplasty procedure performed by the experienced team at Rhinoplasty London.
The surgeons at Rhinoplasty London rebuilt Cohen’s profile with four injections which took just 30 minutes. The injections, which used a state of the art gel containing microscopic beads of plastic, was completed with a fine needle inserted deep beneath the skin. The microscopic beads were then placed between Cohen’s muscle and bone giving him his new look.
Cohen stated that the decision to have the procedure was not done strictly out of vanity, but for health reasons as well as he was constantly sick and his deformed nose didn’t allow him to breathe properly. He also developed a serious illness which he struggled to fight off and the rhinoplasty became a welcome “pick me up” when he was well again.
Non-Surgical Rhinoplasty
Non-surgical rhinoplasty is a safe and effective procedure designed to re-sculpt the nose and give it a more contoured look. The procedure is almost painless and it takes very little time to complete, with most procedures being completed in less than 30 minutes. The non-surgical nose rhinoplasty uses a botulinum toxin which is injected into the skin to weaken different muscles, thus creating subtle changes to the shape of the nose. Then, fillers of hyaluronic acid will complete the process giving the patient the look they want safely and quickly.
Contact Rhinoplasty London
To learn more about non-surgical rhinoplasty and how Rhinoplasty London can give your nose a new look and bring your confidence levels to new heights, contact them for a no-obligation consultation and let their experts show you what you could look like today!
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If you are considering rhinoplasty, there are some important factors that could help make your decision easier. You might have looked at some before and after images online to see just how dramatic the change can be for some rhinoplasty patients. If you feel ready to undergo the rhinoplasty because you wish to change the appearance of your nose, then the next step is to choose the right rhinoplasty surgeon.
While there are many cosmetic surgeons in the UK, there are some factors that can help you choose one that is right for you. Let’s take a look at them now:
How To Find The Right Nose Surgeon:
Make sure the cosmetic/aesthetic surgeon is certified- a rhinoplasty surgeon should be a Fellow of the Royal College of Surgeons (FRCS). Certification to perform surgical procedures here in the UK. While some surgeons might be certified in other surgical procedures, you want one that specialises in cosmetic and aesthetic surgery of the nose. It helps if he/she are members of the Rhinoplasty Society of Europe and of the European Academy of Facial Plastic Surgery as well as belonging to Facial Plastic Surgery UK.
Does the cosmetic surgeon have rhinoplasty experience? Making sure that the cosmetic surgeon you choose has performed the rhinoplasty procedure before and has the experience needed to provide you with the results you want is important. Be sure to ask the surgeon these questions:
Look at their previous work- this can give you an indication of how your rhinoplasty will turn out. Every surgeon is different and each one is an artist with a different aesthetic sense. Choose the one that appeals to you by looking at before and after photos and focusing on previous patients with similar features as your own.
Visit the office and make note of the way the staff and the surgeon make you feel- if you get a good feeling from the staff or the cosmetic surgeon, chances are you will have a good experience at that office. Even the best cosmetic surgeons might not have the mannerisms that make you feel comfortable and you will have to decide just how much of a factor that will play in your procedure.
Can you trust the doctor to look after you? Can he/she fix issues if there is a problem?
Check the cleanliness and safety ratings of the operating facility- is the operating facility clean and well-staffed? Does it have the emergency life support systems needed in case there is a problem? These are important factors to consider. Be sure to ask about the anesthetist’s qualifications since much of your comfort during the rhinoplasty procedure is based on their work.
To learn more about how to choose the right cosmetic surgeon for you, contact Rhinoplasty London and let one of our facial plastic surgeon experts answer your questions today.
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Hot quotes:
-Hyaluronic acid is hydrophilic; it gives an unnatural overinflated look.
-Collagen contributes to the scaffolding and keeps the skin tight.
-With Botox, less is more!
Take home message:
Avoid getting rid of individual facial lines. Focus on appearing ‘well’ for the chronological age. With Botolunim toxin, avoid creating unnatural folds and a frozen face. Hyaluronic acid binds up to 1000 times its weight in water, it is a good lubricant ‘jello’ but when injected in the dermis it can cause pseudocysts and can give an overinflated look. The newer generation polycaprolactone based collagen stimulator restores volume and redefines contours making it the author’s first choice for natural facial rejuvenation.
Biodata:
Lydia Badia FRCS (ORL_HNS) was appointed as Consultant Surgeon in Rhinology at The Royal National, Throat, Nose and Ear Hospital (UCL) in 2001 after she finished her fellowship in Facial Plastic Surgery. Her main interest is in Rhinoplasty surgery and has always had a passion for facial aesthetics. ‘Patients who were happy with the nose result wanted more treatments’. She wrote a chapter for the latest edition of the textbook Scott Brown on non-surgical rejuvenation of the ageing face. She resigned her NHS post in 2012 to dedicate her time exclusively to private practice and together with Charles East founded Rhinoplasty London to promote excellence in nose surgery.
BEYOND FACIAL FILLERS; REJUVENATION THROUGH COLLAGEN STIMULATION
Ageing transforms the face to create a look that often does not reflect the vibrant person inside. Maintaining a youthful appearance can have a profound effect on self-esteem, and personal and professional relationships.
I would like to give an overview of the core of non-surgical interventions and focus on collagen stimulation products which I believe provide better longevity for rejuvenation and more natural results but also extremely useful for injured and scarred tissues after trauma.
The causes of ageing in relation to facial appearance may be intrinsic or extrinsic. Intrinsic skin ageing is caused by the same genetic pathways that lead to ageing of all the other organs of the body. Intrinsic ageing of the subcutaneous tissues is also highly relevant as bone resorption, muscle atrophy and variable atrophy of the fibrous layers leads to ptosis of the soft tissues, sagging, hollowing and rhytids. Extrinsic skin ageing is caused by life-style and environmental factors, which result in lines from loss of elastin and collagen fibres. The photoageing also affects the skin colour and tone.
Patients are typically concerned about looking fatigued, dull, angry, negative. If they have suffered injuries, they wish to improve the contouring. Most people want to appear “well” and optimum for their chronological age.
Broadly speaking non surgical treatment modalities may be considered by anatomical layer depending on whether they address changes in the epidermis, atrophy and inelasticity of the dermis, dynamic facial lines caused by the pull of the underlying muscle, and loss of volume at sites of fat or bone resorption.
1.Topical treatments are popular among consumers seeking skin (epidermis) improvement because of their convenience, low cost and excellent safety profile. Whilst results may be modest, the marked is saturated with promise through non prescription topical products. Of the prescription products, retinoids are the most powerful, effective and evidence based topical anti-ageing products available. They should form the cornerstone of any topical rejuvenation plan. The profound biological effect of retinoids on the skin results from their direct action on a family of nuclear hormone receptors, the retinoic acid receptors (RAR) and the retinoid X receptors (RXR). These receptors are found in all cells, though the key targets are keratinocytes and melanocytes in the epidermis and fibroblasts in the dermis. Activation of retinoid receptors leads to a molecular chain of events that changes protein transcription and modifies cellular function. Histologically this leads to epidermal hyperplasia and impaction of the stratum corneum (producing smoother skin with a ‘glow’), increased dermal collagen type I, III and VII synthesis, reduced collaged breakdown and normalisation of elastic tissue organisation (improving coarse wrinkling and crepe-like skin texture), and a reduction in melanin synthesis and transfer of melanosomes to keratinocytes (improving solar pigmentation) [1]. Epidermal effects are seen within six months of use, while dermal effects may take a year or longer to become apparent. Treatment ought to be continued indefinitely for continued benefit.
A concentration of tretinoin of 0.025% is considered therapeutically effective whilst minimising side-effects. Chemical peeling is the topical application of chemical agents to cause controlled destruction of part of the epidermis. This leads to desquamation, liquefaction of the affected layers, followed by inflammation and finally regeneration. Glycolic acid and salicylic acid peels have a similar profile and are frequently delivered at two to four weekly intervals. Trichloracetic acid (TCA) has a higher depth of penetration and in high concentrations also a higher risk of scarring.
2.Botulinum toxin has been the most revolutionary anti-ageing treatment in recent years, two to five days after injection it produces muscle paresis and it therefore stops pulling on the skin. The subjective duration of action in a given patient seems to be stable, but there is great variability between different people. On the European Market, three different branches of BTX-A are off icially registered: Botox®/Vistabel® (Allergan), Dysport® (Ipsen)/Azzalure® (Galderma), and Xeomin®/Bocouture® (Merz). The units are not directly comparable. The products have different amounts of complexing proteins or are free of complexing proteins (ie, Xeomin®/Bocouture®). The diffusion of the different drugs seems to be dependent on concentration. BTX-A has an excellent safety profile and has been used extensively for facial rejuvenation with a focus on hyperkinetic wrinkles and to improve facial wound healing after surgery. [2] Microbotox is the injection of multiple microdroplets into the dermis with the intention of decreasing sweat and sebaceous gland activity and thus improving skin texture and sheen.
Autologous platelet-rich plasma injections (PRP) promote tissue remodeling by increasing the expression of Type I collagen in human dermal fibroblasts. [4]. This is the evidence for the “vampire facelift”.
The use of synthetic fillers for soft-tissue augmentation has increased dramatically in recent decades, progressively supplanting surgery as a result of the improved safety and efficacy, the short recovery time and the lower treatment costs. Different types of soft-tissue fillers can be distinguished: non-biodegradable (eg, polymethylmethacrylate (PMMA) and biodegradable (eg, hyaluronic acid [HA]) products. A newer generation of biodegradable products has emerged: the soft-tissue fillers, calcium hydroxylapatite (CaHA),poly-l -lactic acid (PLLA), and polycaprolactone (PCL) which possess biostimulatory properties.
Permanent artificial fillers are in my view no longer recommended, as the widely accepted long-term effect safety has not been established. Temporary fillers are metabolized by the human body and consist of different substances. Hyaluronic acid (HA) also known as hyaluronan or hyaluronate, is a carbohydrate, more specifically a mucopolysaccharide occurring naturally in the human body. It is the most common temporary filler used today. It has a high tolerability profile. Cross-linking gives HA fillers a life span of six to eighteen months. [5]. Although there is some evidence that HA stimulated new collagen, the main effect is from its hydrophilic properties. When not bound to other molecules, it binds to water giving it a viscous quality similar to “jello”. In my view this is the main drawback of HA, it can give an unnatural overinflated look. Figure 1. Shows a comparison sonogram between PCL and HA. [6] The HA produces multiple anechoic pseudocystic structures. The bright hyperechoic spots noticed in PCL represent microspheres with collagen stimulating properties. Collagen contributes to the scaffolding and keeps skin tight.
Figure 1. Comparison of sonographic morphology between
polycaprolactone versus hyaluronic acid. A, Polycaprolactone. The filler consists of a matrix with hypodermal hypoechoic deposits (*) that contain bright hyperechoic spots with mini-comet-tail artifact (arrows). B, Hyaluronic acid.
demonstrates multiple hypodermal deposits conformed by oval-shaped, anechoic pseudocystic structures. Notice that there are no bright hyperechoic spots within the deposits (o).
Ellanse®, Radiesse® and Sculptra® are particle based dermal fillers. The constitution of these fillers is mainly Carboxymethylcellulose solution, it acts as a carrier gel for the particles and microspheres. The particles of these three different fillers are the part of the filler that functions as a subdermal scaffold after injection and stimulates neocollagenesis around the particles.
Ellansé®, Radiesse® and Sculptra® are all made from resorbable materials. The particles/microspheres are made from:
ELLANSÉ®: Polycaprolactone (PCL): (C6H10O2)n
Radiesse®: Calcium Hydroxylapatite (CaHA): Ca10(PO4)6(OH)2 . 18 H2O
Sculptra®: Poly-L-Lactic Acid (PLLA): (C3H4O2)n
It has been well known that the surface morphology of implanted particles has an effect on the biocompatibility of the implant to the surrounding tissue. [7]. Smooth surfaces of implanted particles contribute to a gentle reaction of the body to the implant, without inducing an overreaction inflammatory response. Particle size distribution is also important after implantation. Particles smaller than 20 μm can be phagocytosed and transported to the lymph nodes.
Ellanse and Radiesse are very comparable based fillers and they are very different from Sculptra which contains large amounts of particles smaller than 20 um and many fragments are larger than 50 um. All three have biostimulatory properties but Radiesse lacks the long-lasting results,[8] and Sculptra the immediate effect [9].
Ellanse combines durability and immediate outcome. This unique product is composed of microspheres of a totally bioresorbable polymer, polycaprolactone (PCL) (30%), in an aqueous carboxymethyl cellulose (CMC) (70%) gel carrier.
The PCL microspheres are 25–50 μm in size and are thus protected from phagocytosis. They are totally spherical and perfectly smooth .PCL biodegradation and bioresorption occur via hydrolysis of the ester linkages, leading to the end products CO2 and H2 O that are totally eliminated from the body.[10-14]
The CMC gel carrier has the immediate effect and is gradually resorbed by macrophages in 6–8 weeks, the PCL microspheres stimulate neocollagenesis.[15,16] Deposition of newly synthesized collagen around the PCL microspheres was demonstrated by histological and histochemical analysis of skin biopsies from treated animals, showing that collagen type I becomes progressively predominant over collagen type III, thereby achieving earlier and superior qualitative results than other resorbable products with a long-lasting effect.[15 ] The collagen stimulatory effect has recently been confirmed in humans on skin biopsies from treated subjects.[16].
The PCL-based safety has been demonstrated in clinical studies and recommendation on injection techniques are provided for the upper, mid and lower face, and zone by zone for each of these areas. [17].
If you have just had any kind if nasal surgery, taking care of yourself at home is important to the healing process and it could actually speed up healing so you can feel better sooner. In fact, the first 2 days after your surgery are the most important and you should follow the instructions provided by the surgeon’s office.
Aside from the doctor’s instructions, there are some tips to keep in mind and that you should follow if you want to make your post-surgery experience a better one. Let’s take a look at some of them now and see how you can best look after yourself after your rhinoplasty surgery.
8 Ways to Look After Yourself After Rhinoplasty Surgery
What if your nose starts to bleed?
If your nose starts to bleed at all during the first two days post-surgery, sit up straight and do not tilt your head backwards or lie down. Hold a towel gently under your nose to catch any blood and spit out any blood that begins to drain down your throat. Do not apply pressure to your nose unless your doctor recommends it.
When should you call your doctor?
You should call your doctor if your nose bleeds for more than 10 minutes or if you have a temperature of more than 37.5 degrees Celsius. Also, if you are sneezing a lot or you have a lot of drainage coming from your nose, you should call your doctor.
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