Sunday, November 30, 2014

What type of anesthesia is used for rhinoplasty?

Anesthesia for rhinoplasty or nose surgery is typically under general anesthesia. This means you will have a breathing tube and certain gas anesthetics are used to keep you under. The reason general anesthesia is used more often for a nose job and not twilight or conscious sedation is to protect the airway. With nose surgery, there may be blood that drains from the back of the nose and irritate the vocal cords or enter the airway. This can lead to significant coughing or even aspiration.

Local anesthesia is injected into the nose after you are under general anesthesia. This helps block pain receptors in the nose and limits the amount of narcotic the anesthesiologist needs to use. It also has a little epinephrine in it and constricts the blood vessels leading to less bleeding during surgery.

General anesthesia today is quite safe with close monitoring throughout the procedure. It is important to have a board certified anesthesiologist present during your rhinoplasty.

Dr. Funk is a nose surgery expert in Houston, TX.

Monday, November 24, 2014

Rhinoplasty and breast augmentation at the same time?

I have performed many a rhinoplasty or nose job concomitantly with other plastic surgeons who perform body surgery. The most common combination is rhinoplasty with a breast augmentation as these are the most popular plastic surgery procedures in the US.

There are a number of things that must be considered when having a nose job with breast augmentation. Nose surgery is considered a “dirty” surgery meaning it is not sterile as it is impossible to sterilize the inside of the nose where there are many normal living bacteria. Breast augmentation is not only a sterile procedure but one must maintain close sterility to assure that the implant does not get infected. It is therefore necessary to do the breasts first or redrape and sterilize things after doing the nose.

In addition, one must find surgeons that have privileges or the “right” to operate at the same surgery center or hospital. Just finding the best nose surgeon and best breast surgeon and expecting them to easily schedule your surgery may be difficult. Conflicting schedules and operative locations are things you must consider and accept to attain two surgeons.

Dr. Funk is a rhinoplasty expert in Houston, TX.

Monday, November 17, 2014

Do Facelifts Last?

Many of my facial rejuvenation patients may ask me how long does a facelift last? This is an excellent question but truly dependent on the age of the patient and more importantly, the type of facelift performed.

There are numerous types of facelifts and each require different incisions and different extent of dissections. The Mini lift or short scar facelift will only address minor jowls and the jawline and last only about 5 years. It does not address the neck.

A SMAS facelift is when the SMAS or fascia is suspended and excess skin is excised. The neck may be addressed during this facelift as well. This may last about 7-8 years.

The most involved facelift or face and neck lift is the deep plane facelift where the SMAS is cut and elevated and all the ligaments are released and then the SMAS is resuspended in a vertical direction. Of course, this causes a little more swelling and 3-5 days longer recovery, but I truly feel it is worth it as the lift is much more impressive, longer lasting, and natural. The deep plane facelift may last 10-15 years depending on the patient’s initial anatomy, skin laxity, and strength of tissues. For these reasons, I believe it is the best lift out there.

Dr. Funk is a facelift expert in Houston, Texas.

Saturday, November 8, 2014

Non Surgical Nose Job

I have many patients who may come in for consultation interested in non surgical rhinoplasty. They are referring to cosmetic changes to the nose that might be made with fillers such as Restylane, Juvederm, or Radiesse. As a surgeon, I am not a large advocate of non surgical rhinoplasty for a number of reasons.

The first reason is that what you have to understand about filler injection to the nose is that it will make your nose bigger. Most people who present for rhinoplasty want a smaller nose. Filler is typically placed above a hump between the nose and start of the forehead to give the appearance of a strong straight profile or bridge of nose. It can also be placed on one side or another to give the impression of a straighter nose. But this will also make the nose wider. If you are accepting of a bigger nose, then this may be a solution for you.

The inside of the nose is not a clean or sterile environment and if any filler inadvertently is injected or communicates with the inside of the nose, that area may get infected.

Non surgical nose job treatment with filler may lead to scarring under the skin making future surgery in the area more difficult.

Filler injection to the nose will not resolve any functional or breathing problems that surgery would.

Non surgical rhinoplasty with filler is temporary (duration dependent on type of filler injected).

You cannot do numerous things to the nose with filler such as rotate the tip, narrow the nose, refine the tip, narrow the nostrils, or bring down a hump.

I do feel that filler injection into the nose can help with patients who have already undergone rhinoplasty to assist with any minor depressions or irregularities.

Dr. Funk is a rhinoplasty or nose job surgery expert in Houston, Texas.

Monday, November 3, 2014

Does non surgical facelift work?

I have many patients that may come in asking does a non surgical facelift work? The answer here depends on who the patient is, what they are looking to improve, and what their expectations are. A non-surgical facelift is a broad descriptor of enhancing the appearance of the face without surgery. This may be done with a liquid facelift using injectable fillers or utilizing energy therapy to tighten the soft tissues.

Patients who have volume loss and not much descent of the soft tissues or laxity of the skin may be good candidates for a liquid facelift utilizing fillers such as Sculptra or Juvederm Voluma. This will help with their volume loss and provide a more youthful, healthy, and cherubic appearance.

Patients who are in their 40s and not quite ready for surgery may be good candidates for radio frequency skin tightening or Ulthera skin tightening using Ultrasound therapy. This will help with mild skin laxity, jowling, and enhance the jawline.

Ultimately however, most of those patients in their 50’s and 60’s will require facial rejuvenation with either a mini lift, a full facelift or a face and neck lift. It is important to be evaluated by a surgeon comfortable in all facial rejuvenation techniques.

Dr. Funk is a board certified facial plastic surgeon specializing in facelift surgery in Houston, Texas.