Happy New Year!
May you and your family’s 2012 be filled with great love, joy and new life experiences throughout the year.
I would also like to extend my personal gratitude to my loving family, my talented staff and my fabulous patients. Through all of your kindness and support, I enjoy the ability to follow my great passion for facial plastic surgery. Thank you.
— Dr. Russell Kridel
ANSWER: Rhinoplasty should balance form as well as function. A nose that looks good but doesn’t breathe well is not acceptable. Sometimes rhinoplasty techniques can decrease breathing if proper attention to the airway wasn’t taken at the time of surgery. However, sometimes breathing difficulty can be a result of nasal allergies, and no surgery can do away with allergies. With your post-operative description of air being real tight to get through your nasal passage, sniffing and use of a neti pot 2 times a day, dryness inside nose and worsening of allergic symptoms suggests allergy issues. First stop for you is a board certified otolaryngologist (ENT) or a facial plastic surgeon that is also board certified in otolaryngology because they have extensive training in both nasal anatomy, as well as aesthetics. You need a thorough evaluation of your airway and sinuses to see what the inside problem could be. It could be sinus disease, polyps, an empty nose syndrome, a deviated septum, a septal perforation, just plain allergy, etc. Also it could be a valve problem that will require grafting. Most insurance companies recognize nasal airway problems as medical in nature and not cosmetic if you and your surgeon determine that revision nasal surgery is required.
— Dr. Kridel, Houston, TX
Wrinkles around the eye area are one of the most common patient concerns in facial rejuvenation. The depth and extent of the wrinkles can vary and as a result the treatment options can vary as well.
When a physician uses any kind of laser, it (the laser) doesn’t automatically know what to do. Therefore, the doctor doing the procedure has to decide on what laser settings and how many passes over the treatment area to use. Extensive training, experience and skill are all important when you consider any type of laser treatment. However, there are also other variables in addition to the technical skill involved.
There are also variables in the type and strength of lasers. Exquisite care must be used to avoid injury to the eye itself. The Fraxel Dual (also known as Fraxel Re:Store Dual laser) is on the low side for obtaining wrinkle reduction in the eye area, as well as the face. A fractionated CO2 (carbon dioxide) laser is one step up (made by many companies) and then there is the fully ablative CO2 laser. All of these lasers have been shown to be effective. However, the rule of thumb is that the stronger the laser, the better the results in most cases, but the longer the recovery. The regular Fraxel requires a series of sessions, whereas Fractional and Full CO2 can be done in one session. Chemical peels are another treatment that can also be done and vary in strength and results depending on the chemicals used, their concentration and the skill of the physician.
— Dr. Kridel, Houston, TX
FPSA (Facial Plastic Surgery Associates) was one of the first plastic surgery practices in Houston to introduce laser hair removal over 10 years ago, but not since then have we been this excited about a new device for this procedure. The new LIGHTSheer™ Duet laser has advanced technology which has brought a major improvement in speed and comfort.
Now, with the new LIGHTSheer Duet, it takes less time to do treatments with a lot less pain. For example, a full pair of legs can take less than 25 minutes with the Duet vs. 3 hrs for other laser types and a full back can take less than 40 minutes with the Duet vs. 5 hours. And, with Duet’s increased comfort, most of our patients find that they do not need anesthetic numbing cream before their hair removal appointments. Plus, it is good for all skin types!
With the LIGHTSheer Duet, it will still take an average of six to eight treatments to get to the point where you do not have to worry about shaving, waxing or plucking. But with the new Duet, treatments are fast and virtually painless, particularly on medium and larger areas, so you are in and out of each treatment in no time.
If you have been thinking about having laser hair removal, you are not alone. Laser hair removal is actually the number one cosmetic laser procedure and is second to Botox in non-surgical cosmetic procedures in the United States. However, many patients have been reluctant to have the treatment because they have heard that it is painful and very time consuming. Just think, no more shaving and no more unwanted facial or back hair. So, if you’ve hesitated on laser hair removal in the past, hoping comfort would go up while treatment times went down, your time has finally come!
As with other cosmetic rejuvenation treatments and procedures, Dr. Kridel is at the forefront and FPSA is the only plastic surgery or facial plastic surgery practice in the Texas Medical Center to offer the LIGHTSheer Duet.
Feel free to give us a call at 713/526-5665, and we can schedule an appointment, as well as, answer any questions you may have. Just think, no more shaving and no more unwanted facial or back hair!
Answer: Reviewing before and after photos is an important aspect in the process of selecting a qualified surgeon for a facelift and other cosmetic procedures.
There are two key areas that you should evaluate when looking at before and after photos. The first is the photography technique and the second is the surgical result.
When evaluating the photography technique, it is important that both the before and after photographs were taken at the same camera angles, with similar lighting and consistent head position. Do not be fooled by “tricks” some surgeons use, such as; if the pre-op photo has the head tilted down and the post operative photo has the head tilted up making the result look better than it is, or if the before photo is closer and the after photo further away from the lens making the patient look thinner.
A major surgical skill in facelift surgery is to make inconspicuous incisions that only the surgeon and a very observant hairdresser can see, because they are hidden in the hair and not visible. Some doctors will show facelift results where the photograph only shows the improvement in the neck and the face, but you can’t see the incisions because they have the patient’s hair pulled down to cover them. It is important to clearly see the front of the ear and behind the ear in all photos so that you can judge if you will be able to wear your hair up after surgery. The careful surgeon can hide incisions within the hair and will also preserve the hair so there is no loss of normal hair tufts.
Please look up this paper — Kridel RWH et al.: Techniques for Creating Inconspicuous Face-lift Scars: Avoiding Visible Incisions and Loss of Temporal Hair in Arch Facial Plast Surg. 2003; July-Aug; 5(4): 325-333 —for more in-depth information about our approach.
Also, here is a link to an abstract of the medical journal article:
\”Techniques for Creating Inconspicuous Face-lift Scars\”
— Dr. Kridel
ANSWER:
A Polly beak deformity is the appearance of a rounded fullness of the lower third of the nose that obscures any definition of the nasal tip. This nasal deformity can have many causes — including, from a previous primary rhinoplasty surgery or a revision rhinoplasty surgery — and therefore there are many different solutions based on the reasons that the Polly beak has formed. (1) If the tip of the nose has lost projection and now has fallen back closer to the face, it will appear as a Polly beak. The solution here is to re-project the nasal tip by giving it more support, usually through the use of a columellar strut and a tip graft. (2) If the roundness is due to there just being too much cartilage left on the lower bridge of the nose near the tip, simple excision can be done. (3) If, however, too much structure (cartilage) under the skin has been removed and the skin is thick, more structure will have to be added back to the nose to put the overlying skin on stretch so it has more definition; cartilage grafts to the bridge and tip may be necessary. (4) Sometimes the lower third of the nose looks relatively too full when too much has been removed from the upper portion of the bridge and then more cartilage needs to be added back. (5) A small soft tissue Polly beak caused by the formation of scar tissue can sometimes be helped with serial steroid injections to shrink the thick skin.
Revision rhinoplasty is a challenging surgery. Before having revision rhinoplasty, choose your surgeon carefully. Make sure the surgeon is a specialist in rhinoplasty and revision rhinoplasty, such as ABFPRS board-certified facial plastic surgeons. It is also important to find out how many similar procedures the surgeon has performed in the past two to three years.
—- Dr. Kridel, Houston, TX
Answer: When large quantities of cartilage are needed in Revision Rhinoplasty, rib cartilage can be the best solution. But, to avoid the scarring, pain, and possible lung puncture of harvesting your own cartilage, rib cartilage can be obtained from a tissue bank safely with no higher a complication rate than using your own cartilage and with the advantage of decreasing your operative and anesthesia time. Please look up this paper to see our experience with over 1000 such grafts with long term follow-up: Kridel RWH et al.: Long-term Use and Follow-up of Irradiated Homologous Costal Cartilage Grafts in the Nose in Arch Facial Plast Surg. 2009;11(6):378-394. Simply click on the link below to read the complete medical journal article.
—- Dr. Kridel
http://archfaci.ama-assn.org/content/11/6/378.full.pdf+html
Most traditional full facelifts generally keep you looking younger and refereshed for 7 to 10 years. You are always ahead of the game if skin has been removed and if muscles and fat pads have been re-suspended. I like to think of it as shifting the conveyor belt of aging by 10 years. Because alas, the aging process proceeds, and in every additional decade we age more.
What can be done before a second Facelift?
However, in the interim between lifts, laser skin resurfacing like Fraxel can reduce wrinkles and can tighten the underlying skin. Thermage (radio-frequency laser) might help shrink the tissues. Simple soft tissue fillers like Restylane, Juvederm or Radiesse can fill in folds and wrinkles.
—- Dr. Kridel
Answer:
Recently, I have been asked several questions about how a hump on the bridge of the nose can be reduced without changing the width of the bridge and if lateral osteotomies are necessary with Rhinoplasty or Revision Rhinoplasty surgery.
First, here is a quick clarification on lateral osteotomies. The term osteotomy is derived from Greek and is defined in the medical dictionary as a surgical operation in which a bone is divided or a piece of bone is excised (as to correct a deformity). Lateral, of course, refers to the outer sides of the nose.
The more you take down a hump on the nasal dorsum (bridge) by rasping or any other method, the wider the bridge will appear. Think of it as truncating a pyramid; the more you take off at the top, the wider the remaining structure will appear. For that reason, when taking down a large hump, lateral osteotomies are often done so that the bridge does not look wider than before the reduction.
This is one of the many reasons why I believe it is important for Rhinoplasty and Revision Rhinoplasty patients to have photos taken when they see me for a consultation. I have the photos computer imaged so that you can get an idea as to your goal for how wide you want your bridge following nasal surgery.
— Dr. Kridel
AN EVENTFUL STAY AT THE CITY BY THE BAY
From September 8-11, leaders from the field of Facial Plastic Surgery came together in San Francisco to educate other aesthetic surgeons. Doctors and guest faculty members were educated on the latest surgical techniques for facial plastic and reconstructive surgery.
Dr. Russell Kridel travelled to the 46th Annual Fall Meeting of the American Academy of Facial Plastic and Reconstructive Surgery in San Francisco, September 8-11, as an invited faculty presenter.
ETHNIC RHINOPLASTY:
Dr. Kridel gave two lectures focused on nasal surgery. In his first lecture, “How to Obtain Stable Results in Ethnic Rhinoplasty,” Dr. Kridel presented his published techniques for providing structural support when performing cosmetic rhinoplasty to help ethnic patients maintain positive surgical outcomes over time. Building dorsal height, achieving nasal tip definition amidst thick skin, and producing a more aesthetically pleasing alar base are the major challenges. He also reiterated to the surgeons in attendance that the definition of ethnic rhinoplasty has evolved as the population has become more of a melting pot. Dr. Kridel stated that surgical planning should be sensitive to both individual and cultural differences in aesthetic perception and expectations.
SEPTAL PERFORATION:
Dr. Kridel also presented a talk on “The Nose Inside and Out: Septal Perforations,” which was available for Continuing Medical Education (CMD) credit for attending AAFPRS member surgeons and AAO-HNS (American Academy of Otolaryngology, Head and Neck Surgery) member surgeons. Nasal septal perforations are holes in the septum that may be caused by trauma, nose-picking, previous nasal surgery and cocaine use. Dr. Kridel presented several case studies of recent septal perforation patients to demonstrate the surgical techniques he has pioneered. He has also written over 20 peer-reviewed medical journal articles on septal perforations and is considered one of the country’s leading experts on the procedure.
Over 700 facial plastic surgeons from the U.S. and around the world attended the conference to gain additional knowledge and training from guest speakers, such as Dr. Kridel, to take back to their practices.
To get more information on rhinoplasty or ethnic rhinoplasty, specifically, visit http://www.todaysface.com/
To get more information on septal perforations visit http://www.septalperforations.com/
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