History of Nasal Reconstruction

The art of plastic surgery started over two thousand years ago in Ancient India.  In that time, shameful crimes such as adultery were punishable by amputating the convicts nose and/or ears.  The first nasal reconstruction procedures were most likely reconstructive rhinoplasties ( nose jobs ) to repair noses and ears that were mutilated after this form of punishment.    The art of nasal reconstruction was most likely further developed in the treatment of soldiers who lost body parts lost in battle.

Hindu surgeon Sushruta, working near the modern-day city of Varanasi described the “attached flap” method of plastic surgery in his 600 B.C.   The technique was described in his writings called the Sushruta Samhita. The procedure involves reconstructing the nose by cutting skin from either the cheek or forehead, twisting the skin skin-side-out over a leaf of the appropriate size, and sewing the skin into place.   The modern methods for nasal reconstruction were derived from these original descriptions, and really haven’t changed dramatically since that time.  To keep the air passages open during healing, two polished wooden tubes would be inserted into the nostrils. This method of nasal reconstruction became known as the “Indian Method of Rhinoplasty” and was kept secret for centuries in India.

Blog by Dr. Phillip Chang, MD:  Offices located in Fairfax, Loudoun, Winchester Virginia.

Blog By Dr. Phillip Chang:  Board Certified Plastic Surgeon with Offices in Loudoun, Winchester, and Fairfax Virginia.

According to the American Society of Aesthetic Surgery ( www.surgery.org , over 10.2 million cosmetic surgical and nonsurgical procedures were performed in the United States in 2008.    The Aesthetic Society has been collecting multi-specialty procedural statistics since 1997.  They state that the overall number of cosmetic procedures has increased 162 percent since the collection of the statistics first began. The most frequently performed nonsurgical procedure was Botox injections and the most popular surgical procedure was breast augmentation. Here in Virginia, in my offices in Loudoun and Fairfax, I have also seen this change, particularly after the introduction of silicone implants.

“For the first time in the twelve years these statistics have been collected liposuction is a runner up in popularity to breast augmentation. There is no doubt that this turnabout will generate discussions in the medical community and the public at large,” said Alan Gold, MD, Aesthetic Society president;  These statistics reflect that “changes in fashion, i.e. décolletage baring styles, might be a factor behind this change.”  Last year, there were 355,671 Breast Augmentation procedures.  Over the same period, 2,464,123 patients were administered Botox.

Although there are many patients who decide to have a breast augmentation when they are younger, the majority of patients decide to undergo a breast augmentation procedure to simply restore and rejuvenate their breasts after having children.  Most of these women would share that pregnancy caused their breasts to lose volume and sag a little or a lot.  Some would say that their nipple-areola complex also got larger.  These women simply want to return to some semblance of what they might have looked like before having children. 

Breast Augmentation

Breast Implant

Loudoun, Winchester, Fairfax, Virginia

Blog by Phillip Chang, MD:  Board Certified Plastic Surgeon with Offices in Loudoun, Winchester, and Fairfax Virginia

You might be thinking, “What does a plastic surgeon know about solving the health care crisis?’”.  Well, I happen to think I am well situated to have all ( ok… many) of the answers.  It may come as no surprise that a good percentage of my patients are overweight.  In discussing their lifestyles, I have given a lot of advice through the years on how to how to treat my patients surgically as well as on how to maintain their improved image after their procedures.  Often, this conversation begins with what are you doing for exercise, what kind of diet do you eat, and how much weight have you lost?  Believe it or not, I have a stake in having my patients maintain their appearances after a tummy tuck or liposuction procedure, or part of a Mommy Makeover.  I have found that most of my patients do what I call- Binging on Lifestyle Changes.  That is, they start an intense work-out regimen that is not sustainable ( for the average person )… or start a diet that is impracticable or unproven ( for almost anyone ).  They do this without the basic understanding that they would be better off by simply making minor lifestyle changes.

I recently posted a link to a Time Magazine article entitled “Why Exercise Won’t Make You Thin“.  ( http://www.time.com/time/health/article/0,8599,1914857,00.html ).  The article had the premise that exercise in and of itself is not the solution to weight loss.  50% of Americans are technically “obese”.  This article lead me to think about all the patients in my office who struggle with weight loss.  Contrary to popular belief, most women ( and men ) who come to my office don’t come in trying to use plastic surgery as a quick fix to weight loss.  My patients often struggle for years before they have the courage to step through my doors.   More often than not, they have joined gyms, hired physical trainers, bought treadmills, exercise bikes and/or  boxing gloves.  All to no avail.  At the same time, these patients, are also afflicted with busy lives which predispose to unhealthy lifestyles.  Many are stay-at-home moms who find it hard to lead active lives while they struggle with taking care of their families.  Others have stressful metropolitan jobs that don’t allow them to be active and encourage poor dietary habits.

I believe many of the suggestions of this article are true.  Namely, I believe that rebound eating is a norm after “exercising”.  I see too many people trying to take an hour out of their busy days to exercise while the rest of their day remains sedentary.  I see even more people eat poorly throughout their days using the fact that they exercised as an excuse.   I have seen people diet only to fail in their diets because dieting ( which should not be confused with eating healthy in moderation ) is an unnatural behavior.  Researchers have pointed out that there is NOT A SINGLE DIET that has ever consistently lead to weight loss over an extended period of time.

The Time Magazine article suggests that Exercise in and of itself is not the solution.  There is the implication that increasing your normal daily activity as part of a lifestyle change is the solution.  Take walks, join a sport, ride a bike to work, take the stairs, etc.  Whether because exercise makes us hungry or because we want to reward ourselves, many people eat more — and eat more junk food, like doughnuts — after going to the gym. And don’t start the new fad diet.  Eat healthy, including proteins ( which decrease your appetite over time ) and decrease carbohydrates and oily foods.  But eat normal portions to prevent binge eating.

Reading this article and trying to relate it to my patients, I have developed some solutions to the health care crises.  These beliefs are based on the following facts:

1.  Americans live very unhealthy lifestyles compared to the rest of the world

2.  Americans are addicted to fast food and unhealthy processed foods  ( watch the movie Super size Me- its a classic )

3.  Americans live sedentary lives compared to the rest of the world

4.  Obesity predisposes to diabetes, hypertension, and further decreases in activity

5.  The problems with dieting and exercise are that they represent short lasting, self limiting activities that are often difficult to sustain.  For example, how often have you are people you know started on a diet or exercise regimen only to fail the first time the routine is interrupted )

Based on these principles, I believe that trillions of dollars could be saved if people simply walked to work and took the stairs, stopped smoking, stopped drinking, and ate healthy meals in moderate portions ( not dieting ).  I believe that millions if not billions of medical health care dollars should be redirected toward a national campaign to encourage healthy lifestyles; trillions of dollars could be saved.  Note that 75 percent of all health care dollars are now spent on treating hypertension, diabetes, cardiovascular disease, and lung diseases associated with obesity and smoking.  You might think that the national government would further encourage the cessation of smoking, and encourage lifestyle changes amenable to weight loss.  The present health care debate is misplaced and misdirected.  The answer is not in nationalizing the health care system.  Government run systems in general waste our tax base.  We already have two examples of nationalized health care in the United States; that is the Veterans Administration and the Military Health System.  Anyone who has used either system knows that both are inefficient bureaucratic behemoths.  We should be encouraging healthy lifestyles instead.  That is my two cents…. don’t even get me started on Tort Reform!

Antioxidant Fruits Fight Disease While Building Up Collogen

Blueberries , Acai Berries, Cherries, Pomegranates

It is a biological paradox that we breath in oxygen; our cells require it for metabolic energy, however, like the exhaust smoke that comes out of your car, the oxygen is broken into poisonous by-products call oxidants that poison the body unless is is broken down by “antioxidants”.  Antioxidants can both prevent the formation of these oxygen radicals as well as or dispose of their waste.

It appears that people who eat fruits and vegetables, which happen to be good sources of antioxidants, have a lower risk of some cardiac and neurological diseases, and even some types of cancer.   Other diseases which appear to be protected by antioxidants include macular degeneration,  immune deficiency diseases, and neurodegeneration.

Some Well Known Examples of Antioxidants include:

• -  Vitamin E
• -  Vitamin C
• -  Melatonin

Antioxidants also appear to increase collagen production and improve the quality of the collogen that already exists.  Collagen can be thought of as the resilient shell that surrounds the cells in our skin and organs.  With respect to aging, as the collagen breaks down, the skin loses its strength and elasticity— leading to loose skin and wrinkles.  Antioxidants theoretically increase collagen production and thicken the skin, making you look younger and healthier.

Collagen production unfortunately decreases with the aging process.   However, through a healthy diet of dark fruits which typically are rich in antioxidants, we can fight some of the effects of the aging process.   Fruits like blood oranges, cherries, blueberries and the acai berry are full of antioxidants which may which may slow aging and disease by lowering inflammation. Antioxidants also decrease the severity of rosacea.

At Aesthetica, I hightly encourage my patients whether they are coming fin for a tummy tuck or a facelift to eat healthy.  I believe that antioxidants have the ability to decrease inflammation and speed up the healing process by increasing collagen production.  I believe a healthy diet and a healthy lifestyle goes far beyond what I can do surgically.   The longer you look good, the better I look to you your peers.

Other examples of Antioxidant Fruits include:

• Blackberries
• Raspberries
• Plums
• Pomegranates
• Asian Dragon Fruit
• Kiwis

Blog By Dr. Phillip Chang, MD:  Board Certified Plastic Surgeon with offices Loudoun, Winchester, and  Fairfax Virginia

Volumizing the Brow with Hyaluronic Acid Fillers

The following is excerpted from the Press Release Center of the American Society of Aesthetic Surgery.

How do you judge a good nose job?  A good plastic surgery procedure is one that provides not only an improved appearance but one in which the rest of the world wouldn’t be able to tell that anything had been done. The surgeon that can provide this has to be a good artistic plastic surgeon and not merely a plastic technician. It upsets me when I walk through a grocery aisle and see the tabloid magazines pointing out how this celebrity or that celebrity had a bad cosmetic procedure- as if all plastic surgical procedures turn out badly. The way I respond to my patients is that the vast majority of procedures turn out fine, that they would be surprised how many of their neighbors have had procedures, but they might never know it because they turned out well.

A good example of what I am talking about is Ashlee Simpson. Simpson reportedly had a nose job in April 2006. When asked about it in an interview in May, Simpson neither confirmed nor denied it. In the May 2007 issue of Harper’s Bazaar, she said that she was not insecure about her appearance and had not been beforehand. She later stated that “as long as people have two eyes” they could determine for themselves whether she had a nose job.

Ashlee Simpson- Before and After

See My Before and After Pictures at :  http://fairfaxplasticsurgeon.com/rhinoplasty.htm

Here is a celebrity starlet who underwent the procedure for her own reasons… probably because she didn’t like the appearance of her nose. And regardless of the reasons for her procedure, some people needed to speculate whether she had the procedure at all. And finally, there is no doubt that the appearance of her “new” nose is attractive, natural, and improves her overall appearance. Kudos to her plastic surgeon.
Rhinoplasty procedures can be one of the most satisfying and life-changing procedures in cosmetic surgery. I have patients that range from 17 years old to 70 years old who come in with complaints about the appearance of the nose. The nose is after all, the central feature of your face.  Rhinoplasty procedures are becoming one of the most common procedures performed by plastic surgeons.  Typical complaints include:

• my nose is too large
• my nose is too small
• my nose has a bump
• my nose has a drooping tip
• my nose has a big tip
• my nose is too large
• my nose is crooked

What most people don’t realize without coming in for a consultation is that not all of these procedures require a surgical nose job.  Some of these issues can be addressed non-surgically.  I was one of the first plastic surgeons according to one of my filler representatives to use cosmetic fillers such as Radiesse, Juvederm, and Restylane to address the cosmetic appearance of the nose.  To some degree, all the complaints can be addressed with one of these fillers, without surgery, and no need for recovery.  Radiesse lasts between 1 and 2 years.  Juvederm and Restylane can last up to 1 year.

 At least half of my patients benefit more from a Surgical Nose Job.  The goals, of course are to provide an improvement that appears natural.   If you look at my before and after pictures on my web site ( www.GoToBeauty.com or www.fairfaxplasticsurgeon.com ), you will see that I attempt to provide my patients with an attractive appearance and an appearance of never having had a rhinoplasty.  I spend a lot of time performing revision rhinoplasties on patients from other offices where the results are not as natural.

 The first step is an initial consultation which is complementary.  During your consultation, we will discuss your image with some digital imaging software.  We will discuss your complaints and desires come up with a plan that fits your desired image and lifestyle.  Sometimes this means a non-surgical option, and sometimes it means a surgical rhinoplasty.

Blog by Dr. Phillip Chang, M.D. :  Board Certified Plastic Surgeon with Offices in Loudoun and Fairfax, Virginia.