A great way to become more comfortable about undergoing a procedure is to understand the basic surgical steps involved in that procedure. Although there are some variations, rhinoplasty surgeons in Ontario, Canada, typically perform nose reshaping using similar techniques. Understanding the basics of this procedure can prepare you for your rhinoplasty consultation and your surgery.

Rhinoplasty consultations provide an ideal opportunity for patients to ask any questions they have regarding their surgery. Doctors should provide enough time to answer all of these questions and should present a general outline of what the surgery and recovery will be like.

Women and men who wish to restore facial symmetry through rhinoplasty typically require a reduction, reshaping or enhancement of the underlying nasal bone and cartilage. To achieve this, surgeons usually use one of two approaches:

• Internal Approach: Also called “closed rhinoplasty,” this method utilizes incisions inside the nostrils to avoid exterior scarring. The internal approach elevates the skin so surgeons can easily alter the nasal bone and cartilage.
• External Approach: The external – or “open” – approach, requires a minor incision across the columella, the small strip of skin that separates the nostrils. This incision allows the surgeon to make more significant changes to the structure of the nose, and most patients find that the incision is hardly noticeable after recovery.

The method chosen usually depends on the patient’s cosmetic goals and the preferences of the surgeon. I customize procedural techniques to match the needs of each patient and to create individualized results that naturally enhance a person’s facial contours.

Recovery time for rhinoplasty varies depending on the extent of surgery, but most people find they are able to return to work and other daily activities after 1 week. After 2 weeks, most physical signs of surgery should be minimal. However, changes in the nose continue for up to a year or more following surgery.

Baby boomers are those who were born shortly after World War II, when there was a dramatic increase in births. People in their 50s and 60s appear to be image-conscious and strive to fend off the signs of aging with cosmetic surgical procedures that rejuvenate the appearance. According to the survey, facelifts and cosmetic eyelid surgery tend to be the most popular among this generation, rising an astonishing 44% in 2009 over figures reported in the previous year. There was a 42% from 2008 to 2009 for cosmetic eyelid surgery.

However, noninvasive procedures that are designed to restore the youthful contours of the face experienced the highest increase. Dermal fillers that add volume and smooth out wrinkles experienced a 245% increase while there was a 157% jump in the numbers for Botox.

To be honest, the results of this survey come as no surprise. At our cosmetic surgery clinic in Toronto, our clients come from all walks of life and are from all generations. We have patients who are as young as 15 (usually for nonsurgical procedures such as laser acne treatment) and as old as 75 (liposuction). The most popular procedures for the baby boomer generation at Toronto Cosmetic Clinic are the following, in order of popularity:

1. Botox
2. dermal fillers, such as Juvederm and Restylane
3. facelifts
4.cosmetic eyelid surgery
5.laser skin tightening
6.liposuction (usually laser assisted)

Admittedly, most of our patients tend to be in their 30s and 40s, but this just goes to show you that just because you’re older, it doesn’t mean you have to give up the fight against the signs of aging! As long as you are relatively healthy, both physically and mentally, you can still be a candidate for cosmetic surgery.

Designed by LPG Systems of France more than two decades ago, Endermologie® was the first method approved by the FDA to temporarily reduce the appearance of cellulite without invasive surgery. It is a 35-45 minute procedure that is an essentially deep tissue massage which reduces subcutaneous fat viscosity in the target area and promote circulation. This allows trapped fluids and toxins to be released and facilitate lymphatic drainage. This deep tissue massage, performed by a device that gently kneads and suctions the skin in the desired area, is what assists the body to minimize the presence of cellulite. Typical of many nonsurgical cosmetic procedure, a series of sessions is required to achieve results. As the body reacts to treatment, results appear gradually.

There is no anesthesia or pain medication required during or following the procedure, although a body stocking, called Endermowear, is worn during a session for sanitary reasons and to provide a smoother surface for the Endermologie® device to operate.

For the best results, it is recommend that Endermologie® sessions are scheduled twice weekly. Patients should drink plenty of fluids throughout the course of their treatment to help the body eliminate released toxins.

A Note About Liposuction
Some still believe that liposuction can effectively remove cellulite. Unfortunately, liposuction is not an effective way to get rid of cellulite. Although some methods of liposuction, particularly those that are laser assisted such as Smartlipo, can tighten the skin and smooth it out, results may often be far from desirable. Currently, lifts and full tummy tucks are generally the most effective ways to reduce dimpled skin surgically.

The Procedure
During laser tattoo removal, laser energy is directed at a tattoo for a fraction of a second. The laser sends short impulses of light through the top layer of the skin. The laser energy is absorbed by the tattoo pigment and breaks it up into smaller fragments so your body’s immune system can remove it naturally. The laser selectively targets the tattoo pigment without damaging the surrounding skin.

Laser tattoo removal does cause some discomfort but fortunately, each treatment session only lasts for a few minutes. Most of our patients say that laser tattoo removal feels like hot specks of oil landing on your skin (little specks!)

How Many Treatments Are Needed?
After the first laser tattoo removal treatment, it will take your body’s immune system around six to eight weeks to remove the ink that was exposed to the laser. The laser treatments must be repeated until the entire tattoo is gone. It may take up to 15 treatments for a tattoo to be removed completely.

There are several factors that can affect how you respond to laser tattoo removal and they include the type of ink used, the pigment colors of the tattoo, the depth of the tattoo, your immune functioning, and your skin tone.

People with lighter skin tones generally have more success with laser tattoo removal. Since everyone’s immune system is different, the time it takes for tattoo pigment to break down will vary from person to person.

Black pigment is the easiest to remove by laser because it absorbs all laser wavelengths. Red, dark orange and dark blue pigments also respond quickly to laser treatment. Green, light blue, purple, light orange and brown pigments require more treatment sessions to remove.

What to Expect Following Treatment
Following laser tattoo removal, the treated area will remain red and may even form a scab. After the site heals, the pigment of your tattoo will be barely visible or not visible at all. Some stubborn colors may remain but most of the pigment will be absorbed by your body.

Some people may get frustrated and impatient while they are receiving laser tattoo removal treatments because it is such a gradual process. However, it is important to remember that your body will respond differently to each treatment. To ensure the fastest removal possible, follow your physician’s instructions closely.

Sometimes, our Toronto rhinoplasty clinic has to turn away individuals because the procedure, and cosmetic surgery in general, is not a viable solution for their problem.

Here are 3 of the most common reasons why a responsible physician would have to turn a potential rhinoplasty patient away:

1.You’re doing it for some one else. All cosmetic surgery procedures are designed for individuals that primarily want to do it for themselves – not to please another person. Undergoing an invasive procedure like rhinoplasty just because your partner, friend, or other wants you to is destined to have a negative outcome. In most cases, you won’t be satisfied with the results but you’ will be the one who has to deal with it as well as endure the procedure. It’s better to address the true reason why your partner, friend or other wants you to have a nose job.

2. You’ve had a previous rhinoplasty, not once, but several times and you still aren’t happy with the results. Secondary rhinoplasty is for individuals who have had a previous nose job, whether it is for cosmetic or reconstructive reasons. However, if you’ve already had several nose jobs in the past, and the outcome is still not up to your standards, then you’ve got to re-examine what exactly you want corrected or re-think why you want to undergo the procedure in the first place. Perhaps your goals weren’t expressed accurately during the consultative process, your expectations are unrealistic or your desires are constantly changing. Regardless, chances are the next nose job you undergo won’t achieve results you’re going to be happy with.

3. You haven’t done your research. Someone who walks in without any knowledge of rhinoplasty is unprepared for the good and bad things that can be related to the procedure. Sure, the consultation is an opportunity to find out more information, however it’s up to the individual to explore other mediums. A ton of resources can be found quite easily, whether on the internet, at the library, or even just by chatting with friends. It’s vital you do your homework, since it will improve the level of satisfaction resulting from surgery.

Healthy pores are free of debris and fairly small, barely visible to the naked eye. However, when they become clogged with dirt and dead skin cells, they can grow in size and become breeding grounds for acne-causing bacteria. Enlarged and clogged pores detract from the beauty of your complexion, adversely affecting skin texture and quality resulting in roughness, breakouts and an undesirable shininess.

While the size of your pores are genetically predetermined, the gunk that clogs them can make them appear larger. Fortunately, there are a variety of treatments available that can remove the debris clogging your pores and improve the quality of the skin. At our cosmetic surgery clinic in Toronto, we offer a number of nonsurgical treatments that have been designed for this express purpose.

Pore Tightening Treatments

Chemical Peels performed routinely can help cleanse the pores and reduce their size. It can also brighten the complexion and target pigmentation irregularities. The procedure gently removes the damaged uppermost layers of the skin with an exfoliant based on one or more specific types of acid, such as trichloroacetic, glycolic or lactic. Once these layers are removed, the fresher, newer skin underneath is revealed in the days following. Sessions are generally about 30 minutes and scheduled on a weekly basis.

Microdermabrasion is another method that removes the skin’s superficial layers. Exfoliation is performed by a device that emits a steady stream of fine crystals which are then gently suctioned away, along with the dirt, debris and dead skin cells that they have helped to remove.

Laser and pulsed light technology, utilized in such treatments as laser resurfacing and photofacial rejuvenation, have also been clinically proven to help clear pores, thereby making them visibly tighter. These technologically advanced methods often achieve results faster, with the added benefit of stimulating collagen and rejuvenating the complexion.

By: Behnaz Yazdanfar, MD

Liposuction is one of the most popular treatments we offer at our clinic here in Toronto, but when prospective patients come in for a consultation about this fat reduction cosmetic procedure, recovery is usually their biggest concern. Like any surgical procedure, there are risks and side effects related to the surgery and anesthesia, both of which profoundly affect the recovery period. Needless to say, there are some individuals who prefer to avoid any type of surgery if they can help it. They don’t want to experience any “downtime,” regardless of how positive the potential results of liposuction may be. That’s why we offer the nonsurgical fat reduction alternative: UltraShape®.

No Knives, No Anesthesia

UltraShape is a fairly new procedure that reduces unwanted fat in a totally nonsurgical manner. Instead of cannulae and incisions, the treatment uses focused mechanical ultrasound energy that is emitted by a patented device and hand-held transducer. The licensed professional performing the procedure passes the transducer over pre-marked areas. The ultrasound energy passes through the skin to reach subcutaneous fat cells, disrupting their membranes and dispersing their contents. The contents are then carried away by surrounding fluids, to be processed in the same natural way as they would during weight loss. Therefore, while a single treatment lasts up to 90 minutes, you won’t see the results of a session right away. Results will appear as your body processes the dispersed contents of targeted fat cells, which is why appointments are scheduled a month apart.

The current UltraShape technology has been designed to specifically target the thighs, hips, stomach and flanks, with measurable results appearing in 3 treatments.

The good thing about this noninvasive body contouring technique is that there is absolutely no downtime after each session, there’s no pain associated with it (hence no anesthesia or pain medication), and clinical trials have shown measurable results in the circumference of a targeted area even after a single session (although 3 are recommended to achieve the ideal results).

It’s Not For Everyone

But while UltraShape doesn’t have the risks and side effects that are associated with liposuction, it’s not for everyone. You’ll still need a consultation prior to treatment to make sure it’s suitable. UltraShape is not appropriate for some individuals, such as those suffering from specific hereditary diseases or those who have high cholesterol.

By: Richard Rival, MD

How we look affects how people see us, and in recent months a few researchers have given us some interesting specifics on how even small changes to your facial features can dramatically impact what emotions your face communicates. One of the more recent studies by a research group from Yale looked at changes to the brow line, an area that treatments like BOTOX® Cosmetic, brow lift, and other Toronto facial cosmetic surgery procedures can affect.

Facial Features and Apparent Emotion: What We Know

Studies like the one at Yale typically show their participants photos of the same person, digitally edited to adjust the facial features, and ask the participants to identify what the person in the image seems to be feeling.

Not surprisingly, the photos showing someone with low brows or a wrinkled forehead were identified as showing anger or disgust, and saggy eyelids and wrinkles around the eyebrows created a significantly more tired expression. Interestingly, though, very elevated brows were seen as making a person look more, rather than less tired, and the photos that showed the most significant positive changes in mood showed adjustments to the curve, not the position, of the brows.

How This Information Helps You:

Studies like these underscore two important points about facial cosmetic surgery in Toronto:

• Moderate changes are best: Many people want to see big improvements to their features through a cosmetic procedure, but sometimes less drastic surgeries can produce more desirable results – this is especially true for facial cosmetic surgery. Toronto BOTOX Cosmetic patients, for example, sometimes think that good results need to create a completely smooth skin texture, but in reality a good facial plastic surgeon or nurse injector will know how to place the product so that the patient sees visible changes but still looks natural and retains a bit of the expressiveness that people expect to see. While the results will be less “extreme,” they will also give you a much more natural, approachable, and positive appearance.
• Great results match your facial features: Especially where a brow lift is combined with eyelid surgery, the line of your rejuvenated eyelid crease needs to match the line of your brows, and vice versa. After healing, you should not be seeing dramatic differences between the curves of your eyelid creases and the larger curve of your brows. While very high brows do emphasize the eyes, they can also communicate negative emotions like tiredness or surprise that compromise the benefits of the procedure. An experienced Toronto facial plastic surgeon ought to be able to work with you to tailor your surgical plan and make sure that your results accurately show who you are – and how you feel.

By: Richard Rival, MD

Cosmetic nose surgery typically takes one of two forms: “open” (internal approach) rhinoplasty, or “closed” (external-approach) rhinoplasty. While some surgeons strongly favor one approach over the other, like most rhinoplasty surgeons in Toronto I base the choice of approach on each patient’s specific physical characteristics.

Last week, I outlined the advantages of open (external-approach) rhinoplasty (see last week’s post); this week I will be shifting focus to look at how closed (internal-approach) rhinoplasty works, and how it compares to the open approach.

Closed (Internal-Approach) Rhinoplasty:

How It Works: While open rhinoplasty requires the surgeon to pull the soft tissues away from the nasal bone and cartilage, closed rhinoplasty does not. Instead, this type of nose surgery in Toronto allows the surgeon to adjust the shape and appearance of the nose from the inside out, through incisions made within each nostril. Although closed rhinoplasty does not offer the same kind of visibility and direct access to nasal structures as the open approach does, it can still achieve very accurate results.

Advantages: Closed rhinoplasty generally requires less dramatic manipulation of the nasal tissues; it may therefore allow for shorter operating and recovery times. The incision sites are not visible from the outside, so although open-approach rhinoplasty scars are typically invisible, many nose surgery patients in Toronto still feel more comfortable with the closed approach.

Why This Approach Might Make Sense for You:

• You mainly want to correct a hump on the bridge of the nose and your nose is straight
• You only wish mild or moderate change to the shape or position of the tip of your nose

In most cases, I find that revision surgeries tend to require the open approach, simply because I need to understand as clearly as possible how the previous surgeon adjusted the tissues, but in some cases the closed approach will be equally as effective, depending on the kinds of improvements the patient expects to see. In the end the approach used is not nearly as important as the result you end up with. Your choice of surgeon should not be dependent on the approach he or she uses but the overall quality of the results he or she can achieve for you.

Further Resources:

• Read “Open vs. Closed Rhinoplasty: How to Decide, Part 1″ (Open Rhinoplasty)
• See open-approach rhinoplasty in 3D
• See real rhinoplasty patients’ results

By: Richard Rival, MD

Most of my nose surgery patients in Toronto are aware that there are two basic approaches to cosmetic nose surgery: “closed” (internal approach) rhinoplasty, and “open” (external approach) rhinoplasty. However, while most rhinoplasty surgeons will outline the differences between these two approaches, some patients undergo one or the other procedure without understanding why that approach makes sense for their specific case.

In today’s post I want to outline what open-approach rhinoplasty is, and give a few examples of situations where this approach might be the most effective for you. Next week’s post will do the same for closed-approach rhinoplasty.

Open (External-Approach) Rhinoplasty: The Basics

How It Works: In an open rhinoplasty, the surgeon makes a small incision across the columella, the soft tissue between the nostrils. The surgeon gently separates the surface-level soft tissues from the harder inner structure of the nose and pulls the soft tissues upward. The surgeon can then reshape the bone and cartilage of the nose before he or she re-positions and soft tissues and makes any necessary adjustments to the nose tip.

Advantages: This approach is popular with many rhinoplasty surgeons in Toronto because it allows for much greater visibility and control of the tissues during nose surgery. While both the open and closed approaches are equally precise in the hands of an experienced surgeon, for more extensive revisions many rhinoplasty surgeons in Toronto prefer the open approach simply because they can see everything much more easily. Studies suggest that this approach offers better results than closed rhinoplasty for reconstructive procedures, especially.

Why This Approach Might Make Sense for You:

• You want to make extensive structural corrections to your nose, such as reducing a large nasal hump, correcting a severely deviated septum, or reconstructing your nose after a previous rhinoplasty
• Your surgeon plans to adjust the position or width of the nasal tip, for example lifting a “drooping” nose tip or significantly augmenting or reducing the nasal tip’s size

Note that while many surgeons offering nose surgery in Toronto will lean heavily either for or against this approach, in my experience the patient’s nasal structure is the best key to planning an effective result. Learn more about how this approach compares to closed rhinoplasty in next week’s post on Open vs. Closed Rhinoplasty.

Further Resources:

• Read “Open vs. Closed Rhinoplasty: How to Decide, Part 2″ (Closed Rhinoplasty)
• See open-approach rhinoplasty in 3D
• See real rhinoplasty patients’ results