Pollybeak deformity after rhinoplasty, or nose reshaping surgery, happens when the supratip or the area immediately above the tip develops excessive fullness hence the nose closely resembles the parrot’s beak.
While the supratip appears full, the actual tip meanwhile curves downward, further contributing to the suboptimal nasal profile.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that patients with notably thick and oily skin are in general susceptible to such risk, although there are certain ways to prevent or at least reduce its incidence.
One of the most critical steps to avoid pollybeak deformity and other types of aesthetic problems is to create a strong support to the bridge and tip. Doing so is also believed to slow down the aging process of the nose, making it less susceptible to tip drooping, which comes with advancing age.
Grafts are commonly used to produce a strong structural support. Dr. Smiley says the septal cartilage, which is derived from the nose itself—specifically from the wall separating the nostrils—is often the best material. However, an aggressive rhinoplasty may deplete it that should the patient need a revision his doctor may consider other donor sites such as the bowl of the ear or rib.
For ethnic patients who generally have thick skin, creating a strong underlying support is particularly important, says Dr. Smiley.
Thick skin is also susceptible to persistent swelling, thus some ethnic patients may even have to wait up to two years to see all the “details.” To accelerate healing, steroid [Kenalog] injection may be indicated.
Steroid injection is one way to address pollybeak deformity, particularly if it is caused by excessive scar formation in the supratip. While it can break up the scar tissue and lead to smoother, more natural nasal profile, it must be used conservatively—several weeks apart and in a highly diluted form—to avoid risk of soft tissue shrinkage and skin color changes.
Should pollybeak deformity after rhinoplasty is caused by excess cartilage in the bridge and/or tip, a revision surgery is clearly indicated. However, it is best performed once all the swelling has resolved and the skin has completely shrunk around the new contour; full healing may occur nine months to two years, depending on skin thickness and other underlying anatomies.
A revision rhinoplasty to correct pollybeak deformity often involves adding or removing tip cartilage or trimming the excess cartilage.
Lower facelift and neck lift: Are they the same?
Most Los Angeles plastic surgeons consider lower facelift and neck lift to be the same thing, hence the difference is nothing but semantics. In general, the incisions are positioned behind the ears to tighten the jowls and sagging neck skin.
Because each surgeon uses different surgical techniques and terminologies, a prudent patient should do her homework, which should always include ensuring that she only deals with a facial board plastic surgeon who performs facelift and its ancillary procedures on a regular basis.
Instead of the technical terms, what matters most is the “actual” effects of facelift. For this reason a lenghty, honest discussion is critical to produce the results that will make the patient happy with her new appearance.
Lower facelift or neck lift is a highly customized procedure to produce natural-looking results and to avoid surgical stigmata such as overly tight appearance. Nevertheless, women in general require more contouring along their jaw line than men.
With incisions behind the ears, the surgeon can remove the excess skin that contributes to the appearance of jowling and “fleshy” neck.
While a lower facelift may not always entail a small incision beneath the chin, most neck lifts require this approach to tighten the loose platysma muscle that contributes to the unsightly bands. To create a smooth chin-neck junction, this muscle is tightened and sutured in the mid line with internal sutures.
Meanwhile, it is not uncommon to combine standard facelift and neck lift to achieve more rejuvenating effects. This approach is particularly ideal for patients who need an extensive amount of work.
Any type of surgical dissection that aims to rejuvenate the face will not just depend on the techniques and the surgeon’s skill set. It is important to note that the patients’ underlying anatomies, particularly the quality of their skin, will have a significant impact on the final results as well.
According to California Surgical Institute website, patients with good skin elasticity and minimal facial fat generally achieve optimal results from facelift and neck lift.
Aside from proper skin care that should always include regular use of sunscreen and healthy lifestyle, keeping a stable, healthy weight is one of the most critical ways to preserve the results of facelift and neck lift.
A 360 degree liposuction is not just about eliminating the unwanted fat in the waist or torso, but more importantly, its goal is to sculpt multiple areas to create a smoother and more balanced appearance, as suggested by Los Angeles plastic surgery expert Dr. Tarick Smiley.
In his recent Snapchat video post, he was seen performing a 360 degree liposuction in which the patient’s flanks, lower back, and central abdomen were treated all at the same time.
Aside from producing a more proportionate, attractive result, Dr. Smiley said multiple liposuction areas may also allow him to collect more fats which could be later used in Brazilian butt lift, or medically referred to as buttock augmentation via fat grafting.
While some patients can achieve good results from central abdomen liposuction in which the four quadrants of the tummy are treated, individuals whose fat deposits are around their waist can achieve a smoother result with a 360 degree or circumferential approach.
To further achieve a smoother torso, Dr. Smiley said that some patients might need their outer thigh and hips included as well.
Aside from proper patient selection, another way to achieve impressive results from liposuction is to conduct comprehensive physical exam and lengthy discussion in which the patients share their personal preference and cosmetic goals with their doctors in the most accurate manner, said Dr. Smiley.
During consultation, the patient must understand the “overall aesthetic problems.” For instance, some women are just concerned about the appearance of their large thighs without realizing that ignoring their overly wide hips altogether will most likely lead to suboptimal, disproportionate results, he further explained.
Other commonly combined treatment areas include abdomen-hips, hip-flank, and upper-lower back, he said.
While liposuction uses a flexible tube to suction the fat out of the body, in one of Dr. Smiley’s Snapchat video he said it is critical to leave behind some fat beneath the skin to avoid contour irregularities and unnatural appearance.
To avoid inadvertent over-correction and its suboptimal effects, Dr. Smiley said he uses microcannulas or flexible tubes that have a narrow body, as opposed to large cannulas that remove fats quicker but in larger chunks.
To further achieve a smooth appearance, the leading liposuction surgeon said the quality of skin, particularly its elasticity and “shrinkage,” must be taken into account prior to surgery.
Rhinoplasty supratip break. Does it look good on most patients?
The rhinoplasty supratip break refers to a slight projection of the nasal tip. When looked closely, it also appears that there is a very small indentation in the lowest bottom of the bridge, before it extends into the tip. The consensus is that it creates a more feminine appearance.
In male rhinoplasty, meanwhile, the supratip break is generally avoided since it can look out of sync with the masculine features.
While it may be surmise that most female patients could benefit from supratip break, women with long face and are rather tall can tolerate a straighter, somewhat longer nasal profile. Nevertheless, several studies have suggested that female noses that are deemed attractive by many appear shorter and have more angle of tip rotation than men.
Female noses with an angle of rotation that is between 95 and 110 degrees are believed to be the most attractive, while in male noses ideally it should be 90-95 degrees, which in turn leads to a longer, straighter profile.
To create the appearance of supratip break, which must be subtle for a more natural result, leading Beverly Hills plastic surgeon Dr. Tarick Smiley says it is critical to slightly raise the tip of the nose over the bridge with the use of grafts.
Dr. Smiley, who has performed more than 2,000 rhinoplasties, says it is equally important to preserve the structural integrity of the nose, particularly its tip to achieve long-lasting results and to avoid the drooping appearance or breathing problems down the road.
Despite being an “aesthetic standard,” Dr. Smiley says that a good rhinoplastic surgeon will nonetheless ask for his patient’s specific goals since the supratip break appearance may not appeal to some individuals. For this reason, he highlights the importance of an honest, lengthy discussion between a doctor and his patient.
In the initial healing stage, the residual swelling may conceal the appearance of supratip break. In fact, it could take up to a full year to see the final results, with the tiniest details only becoming visible after the skin has fully redraped to the new contour, says Dr. Smiley.
Meanwhile, pollybeak deformity is arguably the opposite of supratip break. This occurs when there is an excessive fullness right above the nasal tip before it curves downward, leading to the appearance of a parrot’s break.
To avoid pollybeak deformity, Dr. Smiley says it is crucial to use a strong supportive graft along the bridge and tip and to avoid/treat excessive formation of scar tissue in the supratip area.
Otoplasty procedure, or more commonly referred to as ear pinning surgery, is performed on patients with protruding ears. According to leading Los Angeles plastic surgeon Dr. Tarick Smiley, it could performed in children as young as four; in fact, they enjoy unique advantages because their cartilage is more supple and easier to work with than adults’.
In Dr. Smiley’s recent Snapchat video, he showed before-and-after photos (viewed posteriorly) of a male patient who had good results from otoplasty procedure.
In the “before” photo, it can be seen that the patient’s ears protruded too far from the head, prompting Dr. Smiley to use a technique that allowed him to position them closer to the sides of the head.
Depending on the amount of correction needed, Dr. Smiley says the surgery can take between one and two hours.
He explains the three most common techniques used in otoplasty procedure; the ideal method will depend on the patient’s underlying anatomies and whichever can deliver the “best” results in terms of the ear position and shape:
- Skin removal
- Cartilage scoring. It uses incisions behind the ear to manipulate the cartilage, which is a firm but flexible connective tissue. It may involve adding, removing, or rearranging this tissue.
- Cartilage sparing. It uses sutures to improve the ear position and shape. Compared with cartilage scoring, it is less invasive hence patients can resume normal activities sooner.
Occasionally, ear pinning is combined with ear reduction, which may include “downsizing” the earlobes. The goal is to improve the balance and symmetry between the face and ears, explains Dr. Smiley.
Most otoplasty surgeries are performed as an outpatient procedure, although individuals who require a more complex approach (reconstructive plastic surgery) may be advised to have an overnight stay.
In adults the surgery is typically performed under local anesthesia with sedatives, but in children general anesthesia is highly ideal for a more comfortable and anxiety-free operation.
Revision liposuction surgery involves a host of unique challenges. While not every case involves a difficult situation, a correction that deals with the effects of over-correction such as surface irregularities, hanging skin, and gaunt appearance will involve a complex approach.
Leading Upland plastic surgery expert Dr. Tarick Smiley says that poor results from liposuction are very rare in the hands of a “competent” surgeon—i.e., a board-certified plastic surgeon who has performed hundreds if not thousands of the said procedure.
Should revision liposuction become necessary, Dr. Smiley says that a waiting period of four to six months is ideal to make sure that the swelling has dissipated and the skin has redraped to the new contour. But in some cases, a corrective surgery could be attempted as soon as after three months provided the area has softened to a significant degree.
Under-correction, or leaving behind excess residual fat in the treated area, is often one of the easiest “problems” to address because another surgery is enough to achieve good improvements. In fact, some doctors may “slightly” under-correct their patients who are then asked to wait about a few months to decide if a minor touch-up is warranted.
Sometimes, under-correction causes visible asymmetry; for instance, the left hip has more “fullness” compared with its right side. To avoid or address this problem, Dr. Smiley says that right after completing liposuction a prudent surgeon “will carefully assess the treated area through visual methods and sweep/pinch tests.”
Over-correction or inadvertently removing too much fat, meanwhile, is much harder to address because it requires fat transfer, which in essence is a “reversed liposuction.”
Fat transfer collects fat from one or two donor sites, which is then purified and reinjected into the deep indentation and other contour irregularities caused by inadvertent over-correction.
While most contour irregularities can be improved by fat transfer, repeat liposuction, or even both, in severe cases it would be better to leave the area alone than risk making it worse, warns Dr. Smiley.
Proper patient selection is crucial because it is closely tied to patient satisfaction. Aside from the person’s underlying anatomies, Dr. Smiley says that her cosmetic goals must also be taken into account.
One of the challenges on the surgeon’s part, Dr. Smiley says, is to identify patients who are less likely to be happy with the results even though these are successful based on objective assessment.