Sunday, November 25, 2012

Rhinoplasty for Cleft Lip

Rhinoplasty or Septoplasty in a patient with a history of a cleft lip repair can be more tricky due to inherent asymmetry in the nasal tip cartilages and the septal cartilage. The nasal tip cartilage on the cleft side is typically depressed and leaning to this side. The nostril is typically more collapsed on the cleft side and the septum is typically deviated to the cleft side.

It is important to support this tip cartilage on the cleft side with strut grafts made from cartilage and suturing techniques. It is also important to center the cartilaginous septum which is typically tilted onto the cleft side obstructing the nasal airway on this side and leading to an asymmetric nostril.

Rhinoplasty can be difficult due to the lack of cartilage for grafting purposes. At times, ear cartilage may be necessary to reconstruct the nose.

Dr. Funk is a facial plastic surgeon and rhinoplasty specialist in Houston, TX.

Monday, November 19, 2012

Revision Rhinoplasty with Deviated Septum

Rhinoplasty alone is one of the most difficult operations in plastic surgery due to the need to shape a 3 dimensional object by carving, grafting, and manipulating cartilage, soft tissue, and bone. All the while, respecting or improving function or breathing is critical during this operation. Revision rhinoplasty is even more difficult as much of the remaining cartilaginous framework may be missing. Septal cartilage for grafting purposes may be missing. There is significant scar tissue under the skin making the dissection that much more difficult. Lastly, scar will be healing on top of old scar making the results not quite as predictable.

Revision septoplasty can also be quite difficult as there may only be fragments of septum remaining and the septal cartilage may be so warped or curved, advanced techniques may be necessary to straighten it. These include the use of spreader grafts, PDS plate, bone grafts from the bony septum to the cartilaginous septum, or ear cartilage. Sometimes the entire deviated septum needs to be removed, straightened and then replaced during revision septoplasty.

Dr. Funk is a Houston facial plastic surgeon specializing in revision rhinoplasty and septoplasty.

Monday, November 12, 2012

How to address a sagging neck

As we mature, there is loss of collagen and elasticity in our skin. Our neck is no exception. Not only does the skin begin to sag and wrinkle because of this, the thin muscle in the neck called the platysma begins to separate and loosen. This can lead to the “bands” we frequently see in the front of the neck from the chin down. Frequently, fat can herniate or fall between these bands of muscle to cause the fullness in the neck or “turkey” type appearance.

If we think of the neck as a hammock, as we mature, a hole develops in the base of the hammock. This is analogous to the muscle bands separating. Fat is falling through that hole. The first step in neck rejuvenation with a neck lift or facelift is to remove this fat and sew this hole back together. This addresses the fullness in the front of the neck. Now that the hammock is repaired, it still needs to be tightened to the trees as it has become loose over the years. The trees in this case are the bones and fascia behind the ears. The muscle is resuspended to this area creating a tight sling. Once the muscle is tightened, the skin will redrape over this muscle and the excess skin is removed behind the ears. This is essentially, a neck lift. It will also slightly enhance the jawline and jowls.

Dr. Funk is a facial plastic surgeon in Houston, TX who specializes in plastic surgery of the face and neck including many facelift and neck lift techniques.

Sunday, November 4, 2012

Am I Ready for Botox or Fillers?

Many of my patients have asked when they should start Botox (or Dysport) or fillers. The answer is that it depends. There are numerous factors to consider. The most important is, “How much do your wrinkles or folds bother you?”. Typically, if you are thinking about Botox or facial fillers, your wrinkles are likely a concern.

The next question is one that I would answer which is, “Am I a good candidate for Botox or fillers?”. An important factor to remember is that Botox or Dysport are used for active wrinkles, wrinkles that occur with motion, and is a medication injected into the muscle itself. Filler injection, such as Restylane, Juvederm, and Radiesse, on the other hand, are used for wrinkles and folds at rest (passive wrinkles), facial volume depletion of deflation, and are temporary injectable implants injected into the skin.

Some people have quite strong muscles and may develop these active wrinkles in their 20’s while others may not see them until their 30’s. Typically these wrinkles begin between the brows, the forehead, and the crow’s feet around the eyes. I have injected Botox and Dysport in women from their early 20’s to their 70’s. These medications have a preventative effect and can help assure that these active wrinkles that occur in motion do not become one’s seen at rest until much later in life.

Filler injection is typically reserved for patients starting in their 30’s when we begin to develop deep smile lines running from the nose to the corner of the mouth, hollows underneath the eyes, and downturned corners of the mouth. Restylane or Juvederm work well here.

Dr. Funk is a board certified facial plastic surgeon in Houston, Texas who regularly trains physicians and nurses throughout Texas on injectable fillers such as Restylane and Perlane and Dysport.