— Dr. Kridel, Houston, TX

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

—- Dr. Kridel

http://archfaci.ama-assn.org/content/11/6/378.full.pdf+html

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

Answer:

If the dome cartilages under the nasal tip skin are large and rounded, then you are in luck in that these cartilages can be trimmed and then reshaped with sutures, giving you better tip definition. If on the other hand, the roundness to your tip is all due to thick skin and the cartilage underneath is weak, then there is less that can be done. Sometimes with thick skin, the tissue underneath can be thinned out, but this must be done conservatively and carefully. Some individuals with thick tip skin benefit from a tip graft that increases tip definition. Some lasers can thin overlying nasal tip skin and some medications can decrease pore accumulations and size. If you are going to have a rhinoplasty and you also have a dorsal hump, it would make most sense to have that addressed at the same time.

Dr. Russell Kridel, Houston, Texas

Russell WH Kridel, MD, FACS  is currently assigned as a co-author on two articles: Prerhinoplasty Facial Analysis, and Prerhytidectomy Facial Analysis in the following eMedicine book(s): Otolaryngology and Facial Plastic Surgery.

“Man has long tried to capture the beauty of the human face.  Praxiteles’ Aphrodite from 450 BC was considered a standard for artistic beauty for several hundred years. The Renaissance artists of the late 14th century furthered the ancient Greek canons of beauty and described a set of proportions known as the neoclassical canons of beauty. Our ideals of beauty have changed over the last several hundred years, but these concepts are built on the foundations of past artists and scholars, as well as innate aesthetic preferences. With the advent of modern media, our popular icons have shaped or have been shaped by our concept of beauty… Interestingly, homogenous opinions concerning beauty exist across cultures. Cross-cultural consistency results from an evolutionary process linking physically attractive features to biological or social fitness.”

Evaluation for any cosmetic surgery procedure includes clear communication and building an effective rapport with the patient, and is not complete without a thorough history, which begins with a discussion about the patient’s motivations. In addition, systematic facial analysis is critically important for surgical planning.

Numerous potential pitfalls can be identified and complications can be avoided by correlating the patient’s concerns with the individual’s facial anatomy in order to develop a realistic goal.

Properly motivated patients have a healthy self-esteem and seek restorative changes. Having realistic expectations of postoperative results as well as the postoperative recovery period is vitally important for the patient.

For rhinoplasty patients, specific techniques must be chosen and executed expertly, with the knowledge that each maneuver usually alters several characteristics of the nose at the same time. An appropriate marriage of analysis and technique yields the
greatest opportunity for achieving the most important goal of any cosmetic surgery: a satisfied patient.

You can read the entire articles here:

Prerhinoplasty Facial Analysis
http://emedicine.medscape.com/article/842545-overview

Prerhytidectomy Facial Analysis

http://emedicine.medscape.com/article/842489-overview

eMedicine is the most authoritative and accessible point of care medical reference available to physicians and other health care professionals on the Internet. eMedicine has a worldwide audience, including all of the 192 UN-recognized countries as well as other state s and territories. The site is part of the Medscape Professional Network which receives an average 1.5 million physician visits per month. The evidence-based content, updated regularly by some 8,000 attributed physician or health care provider authors and editors, provides the latest practice guidelines in 38 clinical areas. The eMedicine Clinical Knowledge Base contains articles on over 6,700 diseases and medical topics, and is richly illustrated with some 29,000 multimedia files. eMedicine’s professional content undergoes multiple levels of rigorous physician peer review, plus an additional review by a PharmD prior to publication.

In this issue surgeons explore special considerations such as preserving or modifying the facial features of different ethnic groups, and discuss the challenges and questions for these various concepts of ethnicity and of modern and changing standards of aesthetic beauty.

Rhinoplasty is currently the most popular facial plastic surgery procedure requested by Hispanic and African-American patients.  Traditional procedures and techniques have evolved to favor more ethnic preservation.

In two articles “African-American Rhinoplasty” and “Hispanic-American Rhinoplasty”, Dr. Kridel details how surgical planning shoud be sensitive to both individual and cultural differences in aesthetic perception and the patient’s expectations.

Kridel, RWH, Rowe-Jones J: Guest Editors. Ethnicity in Facial Plastic Surgery. Facial Plastic Surgery.  Thieme Medical Publishers, 2010; 26 (2).

Kridel, RWH, Patel, A. “African-American Rhinoplasty” In Ethnicity in Facial Plastic Surgery. Facial Plastic Surgery.  Thieme Medical Publishers, 2010; 26 (2): 131-141.

Kridel, RWH, Patel, A. “Hispanic-American Rhinoplasty” In Ethnicity in Facial Plastic Surgery. Facial Plastic Surgery.  Thieme Medical Publishers, 2010; 26 (2): 142-153.

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

Physicians from across the globe were in Houston through the weekend for Rodeo Rhinoplasty, a conference directed by Houston facial plastic surgeon Dr. Russell Kridel tackling all things nose jobs. 

Presentations at the meeting explained how the looks of Beyoncé and other people of color are changing global standards of beauty.

Discussants explained the fascinating connection between sexuality, self-image and snouts in Cindy George’s MedBlog at HoustonChronicle.com

A health and medicine blog with Cindy George and Todd Ackerman

Posted by Cindy George at March 12, 2010 01:09 PM
http://blogs.chron.com/medblog/archives/2010/03/sex_selfimage_a.html

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.)

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For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org.