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The Nose
The Ears
The Facial Skeleton: Chin, Jaw, Eyebrows, Cheekbones

The Nose     Photos

The search for a better looking nose is one of the most popular reasons for seeking plastic surgery in the United States. Rhinoplasty is the most common cosmetic procedure for men and the fifth most popular overall. Modern rhinoplasty (rhino meaning "nose") goes back about a hundred years and first became popular in the United States in the 1930's. Early rhinoplasties often removed too much cartilage, resulting in the characteristic scooped-out or "ski-jump" nose. Some noses were made too short and some had a pinched look.

A standard method of performing "nose jobs" soon developed. Until the sixties and early seventies, rhinoplasty continued to be done "by the book." Every plastic surgeon followed the same steps, regardless of what the nose originally looked like. If a patient had a nose that was too long with a hump, but had a beautiful tip, the surgeon still followed the recipe and operated on the whole nose.

That approach has now been abandoned in favor of new techniques that allow custom design, more precise control, and better ways to avoid problems. The resulting nose fits the face so well that it is no longer obvious surgery has been performed. The current trend is to correct less, rather than more, and to operate only on the part of the nose that needs improvement. Given the scenario of a long nose with a bump on the bridge, but a good-looking tip, today's surgeon would shorten the nose, rasp down the bump, and leave the tip untouched. The reconstructed nose would look more natural rather than like transplant.

However, what one person considers unattractive, another may think perfectly fine. Like anything else, noses are a matter of personal perception. If your nose bothers you, you can usually get the change you desire through modern techniques of rhinoplasty.

The Possibilities
The wide range of possible improvements is amazing. Rhinoplasty can:
  • Reduce the overall size of the nose
  • Remove a hump on the bridge
  • Reshape a tip that appears too bulbous, too short, or too long
  • Narrow the span of the nostrils or the base of the nose
  • Increase the angle between the nose and upper lip
    "tuck in" a low, hanging columella (the short column of skin and cartilage that runs from the tip of the nose to the upper lip), or make it longer or narrower.

The Consultation
In the consultation, the surgeon must visualize both the immediate and long-range look of your nose in relationship to your face. A well trained surgeon creates a nose that best matches the rest of your facial features. His task in the consultation is to evaluate the anatomy of your nose and envision its potential relationship to your whole face and body.

This is why the surgeons warn against bringing in a photograph of someone else and requesting a similar nose. What can be achieved depends on your anatomy. The surgeon will assess the shape of your nasal bones and cartilage, the shape of your face, your age, and the quality of your skin. In the fifteen to thirty minutes of the consultation, he will discuss the many variables that might influence the procedure and whether the imperfection can be improved.

Even if you think you are a poor surgical candidate, don't disqualify yourself without consulting a plastic surgeon. Only a professional evaluation can determine your potential for rhinoplasty. In this day and age, there are very few people who cannot be helped.
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The Ears     Photos
Your ears are as distinctive as fingerprints and as complex as labyrinths. Your ears may be unusually large or unusually small. They may have well-defined, circular lobes or almost no lobes at all. They may be slightly pointed on top or completely round. They may stick out prominently or lie close to your head. Your ears may even be radically different from each other.

Ears differ from race to race. Polynesians generally have large ears, whereas Africans often have ears that are quite small. The size and shape of the earlobes also varies from race to race. Despite their dazzling variety, most of us don't notice our ears much. Occasionally, however, the size or shape of the ears is so extreme that it causes embarrassment. In these cases, plastic surgery can help.

Protruding Ears
The most common cosmetic procedure performed on the ears is otoplasty, which "pins" the ears closer to the head. About 5 percent of the human race has protruding ears, although not every culture considers this a flaw.

One of the persistent myths surrounding protruding ears is that you can cause them yourself by sleeping on folded ears or that you can prevent them by sleeping with a scarf or nightcap tied around your head. This is not true. The shape and size of the ear is determined long before birth; after birth, almost nothing can be done to alter its shape except plastic surgery.

Otoplasty can be quite simple or quite complex, depending on the reason for the ears' protrusion. The optimum result is a natural shape with natural curves, without being set too far back. It is impossible to achieve an exact match between both ears, but as long as surgery is not overdone and as long as natural curves are achieved, no one will notice that the ears are slightly different from one another.

Best Candidates
Otoplasty usually can be performed on a patient any time after the age of four, when ear growth is almost complete. (Surgery does not stop further growth of the ears.) When disfigurement is severe, it is recommended that a child be operated on early to avoid possible emotional stress from teasing when he or she enters school.

Most surgeons will not operate until the child becomes aware of the abnormality and asks to have his ears "fixed". If the child personally desires the change, he is usually cooperative during the process and happy with the outcome. For some children, this awareness comes as early as three and a half or four years old. For others, it may not occur until eight or twelve years of age. If a child does not want his ears changed, most plastic surgeons will follow the wishes of the child, regardless of what the parents think.

Should you encourage your child to have his ears fixed? If you child is feeling stressed because he is being teased about his ears, you probably should consider it. However, if your child doesn't seem to notice his protruding ears, or doesn't complain about teasing, plastic surgeons suggest that parents merely stay alert for problems. For example, although there is no scientific rationale, physicians have observed that children with protruding ears tend to be become combative, possibly because they are teased and ridiculed at school, which makes them defensive and angry.

After age four, otoplasty can be done on patients of any age. It's not unusual for an adult who didn't or couldn't have the operation as a child to come in years later for otoplasty.

The Consultation
Almost every well-trained plastic surgeon does otoplasty, but it's not as common a procedure as nose reshaping. Even a very busy and successful plastic surgeon may only do a few otoplasties a year. Simply look for a physician who performs enough otoplasties on a regular basis to make you feel comfortable.

Every otoplasty is individually designed. After examining the patient, the surgeon will choose the most effective technique to correct the specific problem.
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The Facial Skeleton: Chin, Jaw, Eyebrows, and Cheekbones

A new way of looking at the face as a whole is to evaluate the skeleton underneath. If you look in the mirror at your own face, you see how your facial bones harmonize with each other to form what science and artistry call a pleasing countenance. The bones of your face--the ridges above your eyebrows, the ledges formed by your cheekbones, and your lower jaw, which starts below your ears and extends forward to your chin--capture light and are called "highlight" zones. Between these bony ridges are "lowlight" zones, that is, your forehead, your eyes, the soft tissue of your cheeks, and the hollow of your neck.

The highlight zones that define the shape and balance of your entire face vary widely. You may have a pronounced ridge above your eyes, yet have flat cheekbones or a receding chin, or vice versa. The prominence of these ridges varies considerably from person to person. When one or more ridges are drastically oversized or undersized, they seem to throw the face out of balance.

To adjust this imbalance is why facial skeletal surgery has been developed to adjust this imbalance. There are now plastic surgery procedures to correct problems in each of the highlight zones. The most common procedures are augmentation of the chin and cheekbones. Less commonly performed but still possible are procedures to build up or reduce the eyebrow ridges and jaw.

Lower-Jaw Implants
The back of the lower jaw, whose wide, square shape is the hallmark of the model's look, is called the posterior mandible. New plastic surgery techniques now allow artificial implants to be placed along the jawline to create the clean, distinct definition that photographers love.

Implants placed along the posterior mandible can (1) help increase the definition between the jaw and neck, (2) increase the width of the jaw to make it more angular, or (3) improve the balance of the face if the jaw is asymmetrical. Posterior mandible implants are usually inserted only in young people with one of these specific goals in mind. It is still not a common procedure, and it carries the same risks of infection and rejection as other implants procedures.

The Eyebrow Ridge
Protruding eyes can be set back by building up bones around the eyes. Plastic surgeons use several different methods to build up this ridge. Overall, this is not a frequently sought procedure, but can be done for the individual who has a strong desire for the particular improvement.

The Chin
The chin must be evaluated when looking at it both straight on and in profile. Straight on, the chin may appear square or pointed. In profile, it may jut or recede. Sometimes the chin itself isn't so bad, but drooping, aging skin gives the effect of a "witch's chin." An implant can help take up the slack without visible scarring.

A plastic surgeon who has experience with the technique may recommend bone surgery. Most surgeons, however, use a chin implant--in a procedure called augmentation mentoplasty--rather than bone surgery because it is a less extensive operation and requires minimal recovery for the patient. Bone surgery is usually chosen only when an implant won't do the job.

Cheek Implants
Many people say, "I wish I had prominent cheekbones." Occasionally, however, someone is dissatisfied with the planes of her face, but can't define the problem. Something just looks out of balance. It's possible that this person has a well-defined eyebrow ridge and a prominent jaw, but a flat midface. The plastic surgeon will evaluate the harmony of her face and may suggest cheek implants. A dialogue is needed between patient and surgeon, because everyone's perception is different. Some people like prominent cheekbones and others don't.
If you have any questions or need further assistance, please CONTACT US.
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