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Reconstructive Surgery

Rhynoplasty(Nose)

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Surgery of the nose can accomplish a number of things. It can reduce the overall size, improve the tip, remove a bump, narrow or widen the width, or even improve the angle between the nose and the upper lip. Sometimes, breathing problems can be relieved. (in these cases, sometimes the procedure may be covered by insurance.) Generally, any or all of these changes can be made during one operation which usually takes from one to three hours. The procedure is almost always done on an outpatient basis, using local anesthesia with sedation.

Working from inside the nose, the surgeon carefully modifies and reshapes the bones and cartilage. A bump can be reduced or totally eliminated. The sides of the nose can be brought closer together to make the nose narrower. The tip can be made smaller and also lifted to enhance it appearance. When a large, oversized nose is made smaller, sometimes the nostrils also need to be reduced in size. Unbalanced, crooked or curved noses can be straightened and made more symmetrical.

After surgery, a splint is placed on the nose to maintain the new shape and to protect it. Often a nasal pack is inserted in the nose to support the inside. You'll be up and around a day or two after surgery, and any pain you feel can be controlled by medication. Cold compresses on your eyes can reduce swelling and bruising while you keep your head elevated. Within a couple of days the nasal packing comes out. The splint usually comes off within a week.

Bruising around your eyes starts to fade within a couple of days and disappears totally within a few weeks. Most people return to work within a week to ten days and makeup can be used to cover any bruises. You should avoid hitting the nose for at least eight weeks. There will be subtle swelling of the nose which subsides slowly over time. Your final result may not be realized for weeks or even months. Occasionally, additional changes and revisions require additional surgery.

The results will be immediate and dramatic if the nose was very large or if a big hump was removed. But usually, the changes are less dramatic. A slight hump or over-sized tip can be improved without attracting a great deal of attention. Friends may say that they don't see a major difference, but that's okay. Your surgery should improve your appearance without drawing attention to itself.

Remember the idea is not to create a new nose, but rather to improve and enhance the one you have. Your final result will be a permanent improvement which will last the rest of your life.

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Chin/Cheek Implants And Cheek Fat Pad Removal

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Ear Modification (Otoplasty)

Most people who are upset because their ears are too big are wrong. The problem usually isn't that their ears are too big, but just that they stick out. In most cases, pinning them back alongside the head solves the problem completely. It is a problem, especially for children. Ears that stick out make kids easy targets for teasing, jokes and derogatory nicknames. He may have had a more normal youth had his ears not made him feel self conscious.

That's why the sooner in life this problem is corrected the better. It can be done as early as the age of four or five and, of course, at any time for adults.

Though there are several different approaches to this procedure, the most common one involves reshaping or removing some of the cartilage behind the ear. After opening the back of the ear, the surgeon either removes some cartilage or folds it on to itself and sutures it together. This pulls back the ear, flat against the head. Since the work is done on the back of the ear, any scars are usually faint and can be hidden in the creases.

The procedure takes about one hour. After surgery, the ears are covered with a dressing. Usually, any discomfort can be controlled by medication. Within a couple of days, the dressing is taken off though some may wear a light head dressing during sleep for a few weeks. Most patients are up and around in a day or two after surgery.

This procedure offers immediate, dramatic results that will last a lifetime. It's a great example of the important psychological benefits that often accompany plastic surgery.

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Vaginal Labioplasy

click to read patient testimonial about vaginal labioplasty

Abstract
Many women are plagued by labia minora that are hypertrophic, protruding beneath their labia majora. They have no idea that this common nuisance can be dramatically improved with a relatively simple procedure.

Background
Patients have complained that grossly enlarged labia minora commonly interferes with intercourse, is a hygiene problem in terms of perpetual wetness and is frequently irritated by day-to-day activities 1-5. Some are self conscious that it is obvious in a bathing suit, ballerina tights and other form fitting attire. Women feel that such a malformation it is a problem both aesthetically as well as functionally both of which are unacceptable. Unfortunately many candidates are embarrassed to inquire about this personal surgery but we have had several patients through the years that have requested labia minora reduction. Every one of our patients has been delighted with the results. We had a bathing suit model that came to us and was very embarrassed about this problem and had never had a serious relationship until after this procedure. (Fig. 1) Shortly thereafter she sent us a wedding announcement to a Golf Pro. (Fig. 3) This is a procedure that is safe and easy to perform and provides universal satisfaction. Other surgeons have experienced similar success with the results of the procedure and, just as importantly, satisfaction of the patient 2-5. Without complication, a recent study has shown over 90% satisfaction in over 150 patients receiving vaginal labioplasty 4. Such a safe and effective procedure should be added to every surgeons arsenal and made more accessible to patients.

Materials And Methods
Anesthesia We use Valium and Ketamine sedation with local anesthesia 6.

Procedure
After the area has been prepped and draped (shaving is not necessary) the labia minora are injected with about 5 cc of 2% Xylocaine with Epinephrine on each side. The labium is gently retracted with forceps and a Kelly Clamp or similar hemostats may be used to cross clamp the labia in a gently curved path approximately parallel to the labia majora. (Fig. 2) No effort is made to remove all of the labia minora but only that which protrudes beyond the labia majora. After the clamp is in place for a minute or so, the excess labia is excised either with a curve scissors or a blade. It is rarely necessary to cauterize this area at all because the clamping leaves it relatively hemostatic. It is then possible to suture the internal and external edges of the labia with 5.0 Vicryl continuous locked stitches. No dressing is applied. A W-shaped incision may be used depending on the preference of the surgeon 5. The patient is instructed to shower daily and antibiotic ointment is applied to the suture lines.

Results
Over the years we have performed this procedure many times without a single complication and patients that are always delighted with the results. Both aesthetic and functional integrity are returned to the labia within a month experiencing only minimal discomfort for the first couple of weeks. All of our patients were delighted with the result and recommend the procedure to those in need. (Fig. 4)

Conclusions
Labia minora reduction is a safe simple procedure that can be performed under local anesthesia and as an outpatient with minimal sedation. The nature of the surgery has caused it to be less publicized than other aesthetic procedures leaving patients with this unnecessary crisis. Surgeons need to be responsible for making the option available as an independent procedure or one to be incorporated with other aesthetic surgeries.

References:
1. Kato, K., Kondo, A., Gotoh, M., Tanaka, J., Saitoh, M., Namiki, Y.: Hypertrophy of labia minora in myelodysplastic women. Urology I31: 294, 1988.
2. Alter, G.J.:A new technique for aesthetic labia minora reduction. Ann. Plast. Surge. 40:287, 1998. 3. Hodgkinson, D.J., Hait, G.:Aesthetic vaginal labioplasty. Plast. Reconstr. Surg. 74: 414, 1984.
4. Rouzier, R., Louis-Sylvestre, C., Paniel, B.J., Haddad, B.: Hypertrophy of labia minora: experience with 163 reductions. Am. J. Obstet. Gyn. 2000 Jan;182(1 Pt 1):35-40.
5. Maas, S.M., Hage, J.J. :Functional and aesthetic labia minora reduction. Plast. Reconstr. Surg. 2000 Apr; 105(4):1453-6.
6. Ersek, R.A.: Valium ketamine sedation for safety sake. In Press.