December 6th, 2011 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
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October 28th, 2011 Dr. Russell 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
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October 25th, 2011 admin
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
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September 28th, 2011 admin
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
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March 18th, 2010 Dr. Kridel
Rodeo Rhinoplasty Houston Texas 2010
“Lemme get a gander at that there schnozzle under your Stetson, partner” might be overheard this week in Houston during Rodeo Rhinoplasty, four days of physician training on every aspect of the nose job.
Houston’s racial and ethnic diversity — providing an international range of noses — makes the city an ideal location for a seminar exploring surgical techniques and modern beauty standards, said Dr. Russell Kridel, a Houston plastic surgeon who founded the annual conference last year.
“What we think is beautiful is changing,” he said. “We have to know that so we can achieve what that beauty is. You can’t think that everyone wants to have a long, thin nose.”
Read the story here: http://www.chron.com/disp/story.mpl/metropolitan/6909552.html
By CINDY GEORGE
HOUSTON CHRONICLE
March 11, 2010, 10:13PM
Rodeo Rhinoplasty Houston Texas 2010
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December 18th, 2009 Dr. Kridel
Dr. Kridel and coauthors congratulated for a landmark study
From this month’s 10th anniversary issue of the AMA Archives of Facial Plastic Surgery, editor Wayne Larrabee Jr, MD:
“Long-term Use and Follow-up of Irradiated Cartilage Grafts in the Nose epitomizes the meticulous clinical observation that we all should strive to achieve in our practices… Russell W. H. Kridel, MD and colleagues performed a meticulous study of 357 patients with a 24-year follow up. This study by Kridel, Ashoori, Liu, and Hart is important not only for the standard it sets in careful clinical evaluation, but also for the importance of the subject. Their results will cause many to reevaluate the role of irradiated cartilage in their practices.”
Rib cartilage from human donors is well tolerated as a grafting material in nasal plastic surgery and yields positive functional, structural and cosmetic results, even in complex cases.
Nov- Dec 2009
“The search for the ideal nasal implant remains an ongoing effort,” the authors write as background information in the article. “We desire a substance that is readily available in large quantities; resists infection and absorption; is completely integrated into host tissues; causes little patient morbidity [illness or injury]; and can be molded, shaped or carved with ease.” The patient’s own cartilage is often the preferred choice, but is sometimes too thin, there is an insufficient quantity or it may cause problems at the site from which it is removed. Irradiated homologous costal cartilage—donor tissue from human ribs that has been treated with radiation to decrease the chances of an immune response or resorption once placed in a donor—could serve as an alternative.
Russell W. H. Kridel, M.D., of the University of Texas Medical School at Houston and Facial Plastic Surgery Associates, Houston, and colleagues reviewed the surgery he performed on 357 patients who underwent primary or revision rhinoplasty (nasal plastic surgery) using autologous costal cartilage as the principal graft material between 1984 and 2008. The patients were an average of 37 years old and were followed up for an average of 13.5 years (and for a range of four days to 24 years).
(Arch Facial Plast Surg. 2009;11[6]:378-394. Available pre-embargo to the media at www.jamamedia.org.)
# # #
For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org.
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October 28th, 2009 Dr. Kridel
Revising Rhinoplasties (Re-doing your nose job)–Part One
-Introduction-
What patients often don’t understand is that all noses are different and so are the surgeons that operate on them. And, of all the surgeries in the discipline of facial plastic surgery, a rhinoplasty (the cosmetic reshaping of the nose) is the most challenging operation of all. On a national average, about 20 % of first time rhinoplasties undergo some degree of revision.
Noses are especially difficult because they not only have to look good but they also must breathe well. Making a nose too petite or defined may compromise how well one can breathe by decreasing the strength of the structures that keep the nasal airway open. Nose surgery is improving technically because facial plastic surgeons have learned that doing less is often preferable; over time noses change and a nose that looked good right after surgery may twist or heal irregularly with time, especially if structures have been aggressively trimmed.
The majority of surgeons will not leave the operating room until everything looks good. But no surgeon can control the healing process. When the nose is narrowed by bringing in the bones, one of the bones can settle more than another and the nose can look crooked. Or in the process of the bones healing, a bump can appear in the re-modeling process. Or the healing process can cause the tissue to contract unevenly and cause one side to look different than another. Or, if the nose was crooked to begin with, and even if the nose was straightened by the surgery, the cartilage can twist back because of intrinsic memory.
So, knowing that some noses will need revision surgery no matter how good the surgeon is, how do you improve your odds of getting a good result? Number one, we know experience counts. If you have to have heart surgery, you would want your surgeon to have done several hundred to thousand before he touches you. That desire should be even stronger for nose surgery (or revision nose surgery), since all noses are different. Choose your facial plastic surgeon well. Pick someone who also has ENT (Otolaryngology) experience as well so your breathing can be preserved or improved. And select a surgeon who performs revision rhinoplasties routinely, at least 40 or more per year. –End of part 1–
Please check back soon for part two! In the meantime, feel free to visit our website www.TodaysFace.com, or contact our office to schedule a consultation.
-Russell W. H. Kridel, MD, FACS
Houston, Texas
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