Rhinoplasty (Cosmetic Nose Surgery) and related Cosmetic Surgery Topics

Can Medical Schools or Residency Training Programs Teach a Surgeon to Have an Aesthetic Eye?

No.  No.  In order for a doctor to go through medical school and get into good residency programs, he or she has to have a certain degree of intelligence.  This allows them to gather the material, digest it, learn it, pass examinations, and become a qualified physician.  Then, they can move on and take residency programs to learn the art of plastic surgery, cosmetic surgery, and a variety of other types of specialties.  Certain types of specialties and particularly that involving plastic surgery and cosmetic surgery require a talent that, in my opinion, is not teachable, and that is the aesthetic eye.  Intelligence and training does not teach something that, in my opinion, is genetic, and that is looking at features, not just one feature but the whole feature, and be able to discern what is beautiful, what is natural, what fits that particular individual the best, and symmetry.  It’s a certain way of looking at a patient, it’s an art, it’s a talent, and it is not teachable.  Talent is not teachable.  You can teach a person with talent to be better at their talent, but a person with no talent cannot be taught.  Therefore, when it comes to cosmetic surgery and the talent of the plastic surgeon, it is a genetic event, and either a surgeon has that genetic propensity to see beauty, see symmetry, see the whole and not just the part, and combine them all in order to make his form of surgery aesthetically pleasing to the eye and not appear to be operated, artificial, or look weird.

Therefore, to summarize this little writing, I feel quite strongly that talent and the aesthetic eye cannot be taught, and it is a talent.  If that person has that talent, then it can be tweaked further by proper training by other surgeons that have the same genetic propensity.

Newer is Better When it Comes to Cosmetic Surgery??

Certain new techniques have come into plastic surgery and cosmetic surgery over the years.  Many of them have proved to be unsuccessful and not worthy of further study.  Many lasers have come and gone, many new techniques for liposuction have come and gone, and yet the newer machines and the more expensive machines keep coming and coming and coming.  Occasionally, there is a new laser technique or machine that will work, such as laser hair removals and certain types of new lasers that can help rejuvenate the skin; however, we must not forget there are many much simpler methods to help rejuvenate the skin and give a better texture to the skin that avoid expensive lasers.  Simple things like trichloroacetic acid peels, or TCA peels, at a fraction of the cost of lasers can get a fine result for increasing texture on the facial skin and ridding it of very fine lines.  When it comes to certain types of surgical procedures, such as cosmetic nose surgery (Rhinoplasty), cosmetic eyelid surgery (blepharoplasty), and even face lift surgery, some of the newer techniques are worse rather than better.  The open nasal revisional surgery which has come to vogue and is extremely popular, in my opinion, is going backwards.  It is opening up the nose and causing tremendous trauma when all you have to do is make small incisions inside the nose, and you can get excellent results as long as you have a well-trained surgeon who is very familiar with this type of closed rhinoplasty/nose technique.  The same is true of face lifts.  Newer techniques for face lifts have been developed that, in my opinion, distort the face and cause a cat eye appearance, high cheek bones, pulled looks, and looks artificial.  The same for eyebrow lifts.  The same for certain types of blepharoplasty procedures.  The true art of plastic surgery is for one to look natural without pulled or artificial looks.  Some of the newer techniques, in fact, give artificial, pulled looks, which are far from improved.  Some of the older, more restrained techniques that are more conservative yet get great results are better than some of the newer techniques.  Reason -- they give more natural-appearing faces and looks without the pulled earlobe, retracted corners of the eye, or a variety of looks that look typically operated on.

Anesthesia Fear - Reason to Avoid Cosmetic Surgery?

One of the biggest fears that patients have to undergo any elective surgery, and particularly cosmetic surgery, is the fear of anesthesia and “going under.”  This fear, in modern day anesthesia, should be completely eliminated from the patient’s mindset.  The patient should be more concerned with the surgeon he or she goes to and the cleanliness of the facility and the surgicenter or hospital he or she actually attends rather than the anesthesia.  In competent hands, anesthesia is exceptionally safe.  It is a rare event when you hear about an anesthetic death following any type of surgery.  When this occurs, the vast majority of the time it is actually due to negligence and has nothing to do with some unusual drug reaction or something that just happens because of an unusual type of allergic reaction to a drug or a patient’s heart not working during the anesthesia.

New drugs and new ways of administering anesthesia are exceptionally safe.  I commonly tell patients that the risk of them driving to the office for a consultation is about 100 times or 10,000 times higher risk factor-wise than having anesthesia in a controlled environment.  Also, the new drugs and medication allow a patient to go under appropriate sedation so they are comfortable yet breathing on their own and in total control of all of their respiratory functions and yet have no pain or discomfort because of the use of local and regional anesthesia in conjunction with a qualified anesthesiologist and a qualified plastic surgeon, who work together as a team.  In fact, there are ways of doing anesthesia without the patient even requiring intubation, that is, tubes put down the patient’s throat to allow for proper airway.  Some procedures can quite safely be done without using intubation, or tubes down the throat, combined with a very qualified anesthesiologist, qualified plastic surgeon, and the proper use of certain medication.  Nausea postoperatively is a rare event and, in today’s modern anesthesia world, nausea postoperatively is exceptionally rare and, when it occurs, is usually avoidable had the anesthesiologist used a different drug or different medication.

Therefore, in summary, to avoid cosmetic surgery or any elective surgery for that matter because of the fear of anesthesia is a misguided thought.  There are a lot of reasons to avoid surgery, but certainly the risk of anesthesia is not one of them.

Revision Nose Surgery Using the Closed Technique - Can It Be Done?

Yes, in the general plastic surgical arena, many patients are told that revision surgery on the nose can only be done using an open technique in order to get ideal results. This is not true because in the hands of very fine surgeons that have used the closed technique for many years, they often have and can get very successful results using the closed rhinoplasty technique.

What are the advantages of closed versus open technique? The advantages are that the patient goes through much less trauma, much less scar tissue formation, no external scars, and a much faster recovery. It also allows for  further possible revision surgeries without the surgeon having to work through extensive scar tissue, which is produced by open techniques. In fact, many doctors who do open technique only cause tremendous trauma to the nose, which decreases the circulation and, in fact, makes revision nose  surgeries sometimes impossible. A closed technique is a harder technique to learn and, therefore, it is not as widely used because of the extensive learning curve required by the surgeon; however, after having performed hundreds of closed rhinoplasties, a competent surgeon can easily do revision surgeries closed, limiting the downtime, discomfort, and chronic edema and swelling that lasts for months following all open procedures. In addition, a major advantage is avoiding external scars. It is a fact that most plastic surgeons will mention to a patient that an open rhinoplasty technique is the only way to get a good result in a difficult nose. When the plastic surgeon has had extensive experience doing closed rhinoplasty, the end result can be exceptionally pleasing to the patient resulting in little discomfort and a faster recovery period. Testimonials to this fact abound on the Internet when patients realize the extreme benefits to closed procedures versus open rhinoplasty.