The Nose
A nose is not a nose is not a nose! It is a complex structure that can manifest with both functional and cosmetic concerns. The nose often defines a face and can be an aesthetic focal point. Rhinoplasty demands a plastic surgeon with special expertise, who understands its intricacies and the relationships to the rest of the face.
Dr Lukash has been performing cosmetic surgery on the nose for over 25 years.
Don’t judge a book by its cover. In this age of advertising and marketing, think of it as “buyer beware”; and the burden is on the consumer to seek out the qualified.
This is particularly true when it comes to nasal surgery. It is easy to believe that a surgeon is a master when shown selected before and after examples. Most surgeons can take the somewhat wide nose with the moderate hump and bulbous tip and perform a very adequate rhinoplasty (nose job).
That does not necessarily mean that there is an understanding or capability in dealing with a complicated nose, a disharmonious face, or a nose that has been poorly operated upon in the past, and requires restructuring.
How do you make the right choice? You must do your homework. Take nothing for granted. Ask to see many representations of the surgeon’s work, encompassing many different types of noses and faces. Ask to speak with more than one patient about their experience. Ask if the surgeon uses computer imaging. This will give insight into the thought process regarding your nose. Ask if the images shown are realistic of what can be done. Ask to see examples of imaged patients and comparisons to the final operated results.
Facial Balance: The Nose and the Chin
Historically, the nose job evolved as a way to reduce big bumps. Indeed, if the nose was made smaller it was a success. Many a pug or ski slope was made in the name of beauty. Today, there should not be an “in” or “vogue” nose. Not every nose requires the same operation. Each face should be carefully analyzed, and a treatment plan customized. A nose should be a natural complement to the face. The profile should be soft and straight; the tip refined, but not so overly sculpted that it screams “nose job”. There should, most of all, be a balance between the nose and the chin. In many surgeries it’s the melding of the slightly reduced nose and the slightly enlarged chin that brings out the hidden beauty of the face.
The Re-Do Nose Job (Secondary / Revisional Rhinoplasty)
There is an ironic twist to many of the people seeking plastic surgery today. They are in search of the most high tech ways to achieve a natural appearance. They ask about lasers, ultra-sonic liposuction, and endoscopic minimal invasive surgery. Yet many of these same people were victims of the all too obvious – they had a 1960’s type nose job. The nose is out of balance with the face: the profile is too low, the tip too thin or too thick, and the bones too narrow. In many cases the nose has been so overdone that breathing has become restricted.
This can be corrected. Essential building blocks of “like” tissues (cartilage and bone) can be borrowed from inconspicuous places such as the ribs or hips and utilized to reestablish nasal balance. Often once this has been done the function improves as well – breathing becomes easier.
Rhinoplasty Consultation
When you see Dr Lukash he will evaluate your nose as it relates to your face. He will discuss your functional concerns (breathing), if any, as well as your aesthetic issues. Dr Lukash utilizes computer imaging to give you and your family the opportunity to visualize the changes proposed.
If there is a functional breathing problem with your nose that aspect may have insurance coverage. Dr Lukash will evaluate that and his staff will help you find out about reimbursement.
Together a plan will be made to provide you with the facial balance you desire and deserve. Dr Lukash will advise you as to whether the surgery can be performed with closed techniques or whether an “open rhinoplasty” will be necessary. (The open techniques are most often utilized in complicated nasal tips, twisted noses and noses that are being re-operated on.) He will also render an opinion as to whether a chin augmentation will benefit the nasal-facial balance you are seeking.
The procedure:
Nasal surgery- even the most complex of cases- is performed as an out patient procedure. Since the face is where the action is, Dr Lukash is a very strong proponent of airway protection (general) anesthesia. If you are comfortable and safe, Dr Lukash can do his best work. Together with his anesthesiologist they will keep you pain free and without nausea.
The recovery:
Most patients go home within hours after surgery. The nose is rarely packed. The splint applied at surgery is removed in 5-7 days. Bruising is minimal around the eyes and often resolved by the time the splint is removed. Pain is likewise minimal and easily controlled with oral medication. Swelling decreases with time. Dr Lukash will see you often during your first year of recovery to answer any questions.
Chin Augmentation
In some situations it is the small, retruded chin that is creating an imbalance with the face. Many times it is part of a facial balancing surgery that includes a rhinoplasty. Other times it is the sole problem.
Chins can be augmented many ways. The bone can be advanced (sliding genioplasty); an implant can be placed (onlay, alloplastic surgery); or fat can be grafted into the area to create the shape and projection desired. The type of problem, age of patient and desire of patient all contribute to the technique used.
The procedure is an out patient one. The techniques of fat grafting and implants lend themselves to quicker surgery and rapid recovery. They can often be done under local anesthesia with light sedation.
Dr Lukash approaches the face as a total unit. He looks to provide balance and proportion to each individual. Therefore many of the old terminologies such as facelift (rhytidectomy), eye job (blepharoplasty), nose job (rhinoplasty), lasers - although familiar, may not be accurate in describing what is needed to optimize your face.
As we go through the many ways to solve the problems of facial rejuvenation, he will introduce to you the modern way of understanding and describing what you may need.
It is of paramount importance, and cannot be overemphasized, the benefit of a personal in-office consultation. Every person is an individual – with individual problems to be solved. This site is a guide to help you prepare for your visit.
“When I think of the face I see it as requiring some or all of the basic R’s of rejuvenation: Repositioning, Revolumizing, Removing, and Resurfacing. Let us now go through the thinking in how to help you”. - Dr. Frederick N. Lukash
Facelift
The term facelift (rhytidectomy) familiarly hopes to inspire reviving youth in an aging face. Unfortunately it has been associated with pulling the skin very tight with complications and a long recovery. Many individuals today are frightened by the thought of a facelift because in brings to mind celebrities who have distorted their looks. As a result some have sought out media hyped “quick fixes”( “quick lift”, “s-lift”, “lunchtime lift”; “lifestyle lift”; “short scar lift”) that have gained attention in the press. What is needed is a clear approach to the issues of aging and sensible approaches to fixing the problems.
“I think that the term facial rejuvenation is much more valid and appropriate in helping to solve the problems of facial aging.”
The problem
As we age, many of the same things happen: the skin loses elasticity and tone and the face loses volume as our fat layer thins out. Add to this the environmental challenges such as sun exposure, and even smoking, and the oval or heart shaped “inverted cone of youth” is replaced by an elongation of the face. The middle portion of the face often hollows out and there is sagging around the eyes (hooding), mouth (nasolabial folds, marionette lines) and neck (jowling). These problems are universal but occur at different times and to different degrees to each person.
“When approaching rejuvenation I address the individual concerns of my patients and demonstrate to them what will provide the best overall balance and proportion. First I make my work plan and then I make my plan work” - Dr. Frederick N. Lukash
The solution
Through well placed and hidden (as much as possible) incisions, the facial skin is elevated enough to expose the deeper tissues that have also sagged. These tissues – the SMAS (covering over the muscles) and the platysma (neck muscles) are repositioned to lift the face and create a soft harmony with the cheeks and neck. Along with this some individuals will require removal of fat in their neck with liposuction and others will benefit from increased volume to the upper face with fillers – most often their own fat. Some patients will benefit from a light skin peel at the same time to enhance the quality of their skin.
The procedure takes 2-3 hours in time and is done either with local anesthesia and sedation or general anesthesia. (This decision is customized between patient, surgeon and anesthesiologist). It is an ambulatory procedure most often performed in his accredited surgical facility. Drains are rarely used. After a few hours of recovery most go home, alert and comfortable. If desired a member of our nursing team can stay the night. Some patients, especially those who have traveled far, may stay in a local hotel or overnight in the hospital. Discomfort is minimal and readily handled with oral pain medication. By one week the dressings are off, stitches out and bruising and swelling at a minimum. Most people can with makeup go back to work and resume their social life.
Brow Lift/ Forehead Lift
In many cases with the aging of the face, the areas around the eyes seem to be the first to go. As the eyebrows descend they crowd the eyes and make people look tired and even sad or angry. Many patients misinterpret the sagging of the brows for the need to have their “eyes done”. A thorough consultation will discern if a brow lift alone will rejuvenate the upper face or whether additive procedures such as a blepharoplasty will be part of the peri-orbital rejuvenation.
There are many approaches to brow lifting ranging from total open (coronal) lifting to endoscopic minimal incision lifting to lifting the outer third of the eyebrow to open up the corners of the eye. Brow lift incisions are usually hidden within the hair.
Brow lifts are straight forward procedures with dramatic results. The procedure takes about 30 -60 minutes when performed alone.
Eyelid Surgery (Blepharoplasty)
Blepharoplasty is a term often used to address the problems of aging around the eyes, implying removal of skin and fat. Modern blepharoplasty expands this original intent and looks at the entire upper face and other additive components to aging. To think that by removing skin and fat one can have youthful eyes may be misleading, and at times far from the whole story.
“I like to think of blepharoplasty in the larger scope of peri-orbital rejuvenation (around the eyes). Many factors have to be evaluated. Is their a sagging of the brows? Is their a hollowing of the eye area? What is the shape of the eyes? What is the quality of the skin? How good is the tone of the eyelids? What is the position of the eye ball with respect to the socket of the eye? Once a proper analysis is made then the appropriate recommendations can be made. Once again, make a work plan and then make the plan work."
For some just removal of extra skin will be most beneficial. For others it is the fat pockets that need to be tailored or repositioned. For others the corners of the eyebrows need to be lifted. Still others will require support to their lower eyelids (canthoplasty/canthopexy). And for others with hollow eyes, volume needs to be restored with fat grafting. There are individual who require some or all of the above.
Peri orbital rejuvenation takes 1-2 hours under local anesthesia and light sedation. It is performed in our surgical facility with patients ready to home after a few hours of recovery. The incisions are hidden within the creases of the eyelids and are closed with absorbable stitches – so there is nothing to remove. Home care is simple – rest and apply cool compresses to the eyes. Discomfort is minimal and easily handled with oral pain medication. Recovery is rapid, with patients returning to activities with in a week. Before any surgery of this type is performed all patients are evaluated by an ophthalmologist to insure that their eyes are in good health.
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