Facial fillers like Juvederm, Voluma, and Restylane have quickly become one of the most commonly performed medical procedures. Fillers are used to contour parts of your face and are now being used on virtually every aspect of the face. You should know some basic things about fillers before you get this treatment.
1. Most fillers are temporary. Find out which product is being used.
Temporary Fillers: The most commonly performed filler today is made of a molecule called hyaluronic acid. However, it is not an “acid.” It is a molecule that is already normally found in your skin and is a part of the skin structure. Basically,pharmaceutical companies figured out how to artificially make the same molecule you already have in your skin and put it in a syringe to fill parts of the face. Fillers like Juvederm, Restylane, Perlane, Voluma, and Boletero are in this category. These fillers are temporary. The amount of time they last depends on which of the products was injected and where it was injected. Also, some people digest these products and break them down more quickly than others. The beauty of these fillers is they can also be dissolved with an enzyme if you are not happy. There are other temporary fillers like Radiesse which is composed of a molecule that cannot be dissolved. It usually lasts a little longer than the other temporary fillers, and that is why some people prefer it for certain parts of the face.
Permanent fillers: These are being used less and less. Silicone is still being injected and is considered relatively safe. However, if there are problems with it, the problems are hard to solve. Silicone cannot be easily removed or dissolved. Once injected, its permanent. Also, you can have a delayed allergic reaction down the line. Be very careful with these. They can be risky
2. Fillers can be done in a natural way
Do things in a stepwise, conservative fashion. Many people fear that they will look fake or strange after fillers. People who get fillers done appropriately have no signs of having work done. They look better without giving signs of having a procedure done. You probably walk by tens of people every day who have had fillers and you would not even be able to tell.
3. Do your research on who is injecting you.
Fillers can be performed by Doctors, Nurses, and Physician’s Assistants. Find out their certification. You should do your research before deciding on who does the injection. Nurses and Physician’s Assistants must inject under the umbrella supervision of a Doctor. Different injectors have different training, backgrounds, and techniques. We advise you to choose someone who is qualified and at least credentialed appropriately. If you are getting injections in a place that does not resemble a medical institution of some sort, do more research before undergoing an injection. There are many sad and tragic stories about people injecting material that is not approved by the FDA .
4. Injecting nasolabial folds (laugh lines) is falling out of favor
Most experienced injectors who have a high level of understanding of facial features are not injecting laugh lines very much anymore. The cause of laugh lines is descent (falling) of the cheek. So to counteract this, we now have learned that filling the cheeks and side of the cheeks (zygoma) is the best way to naturally improve the folds. Otherwise, injecting the folds creates unnatural fullness that doesn’t look right.
5. Wait 7 to 10 days before judging results of a filler
Once you get the filler, don’t be quick to judge. Injected areas will always look bigger after the treatment because of swelling and bruising. Let the swelling and bruising come down, and don’t move too quickly to adjust things. You will most likely be happy.
The ideal aesthetic for the nose has changed. There is a “New Nose” that is becoming the desired nose of Hollywood and around the world. In the past ten years, we have seen a dramatic shift to a nose that is more natural. Gone are the days when patients came in and wanted a scoop and a turned-up nose. In the 1980’s and 1990’s, young women consulted plastic surgeons pursuing noses that had a low bridge and a turned-up tip. During the 2000’s we began to sense a change. Patients who had undergone this previous style of surgery had grown unhappy. Many had kids who didn’t like their parent’s or aunts’ noses. They recognized that this style of nose did not fit the face. As a result, there began a shift towards a less telling, more natural nose. As rhinoplasty specialists, we are witnessing a rather drastic change in patient goals. Patients now want a stronger bridge. They would prefer a straight line on their bridge rather than this scoop. They don’t want their tip to be turned up and show their nostrils. As a rhinoplasty surgeon, my patient’s biggest concerns are that their nose will be too scooped out and have a tip that is too high.
This trend towards a natural, more classic-elegant nose is in direct response to noses that were over-reduced. This feeling exists all over the world, including in the Middle-East, where having a scooped out nose was a sign of wealth. It signaled that the person had enough money to have plastic surgery and therefore was elite. Now that plastic surgery is more affordable and considered common practice, people don’t want to have signs of surgery. They want to be perceived as being naturally beautiful. This is especially true for actor and models, which we see frequently in Beverly Hills. Having a nose that appears to have had surgery can negatively affect a model or actor who is trying to brand her image as being a natural beauty. Although the overall acceptance of plastic surgery has grown tremendously over the past decade, public personas do not want plastic surgery to be a topic that may take away from the success of their careers. This is also true for people who maintain a very private lifestyle. They don’t want people at work or school to know they had surgery. I have developed “Natural Structure Rhinoplasty” as a way to ensure this happens with patients who are undergoing nasal surgery in order to achieve this result. This technique ensures that all the techniques used during surgery maintain a structure that would naturally exist in nature. No strange grafts, no strange implants.
Another key to this is by creating a nose that fits the face in a custom fashion. This means we customize approach, technique and procedure specific to the nose for each individual’s face. The tools that we have available now have revolutionized the results surgeons are capable of achieving. Innovations such as 3-Dimensional photography which can communicate surgical goals and has the potential to predict post-surgical results. We can sit with the patient and explain how taking the bridge too far down makes the nose look unnatural. We can see what style of nose may look more natural. This ability to image has also changed the way that patients look at their noses and their faces.
Also, the New Nose is one that works. The nose has a function…to breathe. We need to preserve and improve this. Previous surgical techniques was full of risks to the nasal breathing passages. Our new techniques have proven that the way that we now do rhinoplasty usually improves breathing (Zoumalan and Constantinides, Objective improvements in Rhinoplasty)
In the future, I believe that a natural appearance will prevail. I don’t think we will ever go back to the days when patients wanted something that looked operated on. We have entered a new era, and the “New Nose” is really a natural nose that will be a classic beauty for generations.
Cosmetic surgery is foreign territory to most patients and can be intimidating to consider initially. After performing thousands of rhinoplasty procedures, I have found the key to combating this fear is education; knowledge is power. For this reason, I have found these questions to be important when considering the correct path in pursuit of surgery.
1. Determine what your goals are. Do you want your bump gone? Do you want a narrower nose? Do you want your tip lifted? You want to develop a sense of what your biggest complaints are. The surgeon will be best able to help you if you can clearly tell him or her what bothers you the most.
2. Find the right surgeon for you. You want to know the surgeon’s Board Certification and specialty. There are two main specialties that perform Rhinoplasty. One is Board Certification through the American Board of Otolaryngology and the American Board of Facial Plastic and Reconstructive Surgery. These surgeons have training in Ear Nose and Throat surgery as well as Facial Plastic and Reconstructive surgery. They have training on both the inside (breathing) and outside of the nose. The other category of surgeons who performs rhinoplasty has Board Certification through the American Board of Plastic Surgery. These surgeons have been trained to perform plastic and reconstructive procedures on all body parts. While there are excellent rhinoplasty surgeons in both groups, you should seek out a surgeon who performs rhinoplasty regularly and is involved in research and academic aspects of rhinoplasty. This shows dedication to the art of nasal surgery. Rhinoplasty is very complex, and it requires someone who is focused on it. After this, it comes down to choosing the surgeon whose goals fit with yours. Of course, you also want to be comfortable with your surgeon.
3. There are surgeons who perform imaging of the nose. Imaging the nose can give you an idea of what your nose could look like after surgery. It is not a guarantee of results, but it is a great communication tool. You and the surgeon can work together to discuss whether certain maneuvers will make your face look better. There is now 3-Dimensional imaging which can really give you a further idea of what things can look like from many dimensions. However, because the nose can heal in various ways, the imaging is not a true predictor of the final result
4. Rhinoplasty can affect breathing. The surgeon needs to ensure that internal breathing issues are addressed during rhinoplasty. Half the reason why people seek revision rhinoplasty can involve breathing difficulties after surgeries. The surgeon needs to be aware of these issues. Dr. Zoumalan published an article on the potential to improve breathing during rhinoplasty (Reference Article here Zoumalan, Constantinides. Objective Improvement in Breathing after Rhinoplasty)
5. It takes one year to see the final result of rhinoplasty. Nasal tissues take time to heal. Even though you may have your bump gone after the first week, you still have healing to do. You have to be patient to see the full thinning out of the nose. This can take a year or longer.
6. There are two approaches in rhinoplasty: Open versus Closed. Open technique uses a very small incision between the nostrils which heals very well. There has never been a keloid scar of this area, and patients heal very well here. Open approach can allow for more exposure for the surgeon to do complex tip and middle nasal work. The closed approach is all done from the inside and does not use the incision between the nostrils. Both approaches can have excellent results. The result depends more on the surgeon rather than whether it’s an open or closed approach.
7. Look at before and afters. Different rhinoplasty surgeons have different styles. Some prefer a lower dorsum or “scooped” look. Other surgeons prefer a stronger bridge with a more natural look. Some surgeons prefer tips that are more turned up. Surgeons tend to have different aesthetic goals, as there is no “perfect nose.”
8. There is no “perfect nose.” During one of his speeches before he retired, Dr. Jack Gunther stated that he never saw a perfect nose. Rhinoplasty can help improve noses dramatically and make you much happier. However, it is important to note that minor imperfections are common, but usually match the new nose in a harmonious way.
What is Cosmetic and Functional Rhinoplasty?
A rhinoplasty, known more commonly as a “nose job,” is anything but a simple job. In fact, rhinoplasties are considered among the most difficult of all cosmetic surgeries, given the delicate nature of the nose and its prominence among facial features. Receiving a nose job in Beverly Hills is an excellent decision as it is the premier destination for nose surgery. Dr. Zoumalan is not only a highly regarded and board-certified surgeon, he is an acclaimed artist.
A successful nose job in Beverly Hills requires a combination of hands-on surgical experience, artistry, and an understanding of a patient’s aesthetic and functional needs, but can completely transform a misshapen or damaged nose. For some, the boost in self-confidence is invaluable. For others, being able to breathe easy for the first time in years is invaluable.
While the decision to undergo a rhinoplasty will always be a highly personal one, prospective patients should familiarize themselves with the two major types of procedures: cosmetic and functional, as well as the associated risks.
Many individuals, either through nature or nurture, may decide that their nose is not aesthetically optimal and decide to undergo a cosmetic rhinoplasty, which aims to alter the physical appearance of the nose without affecting functionality.
Cosmetic rhinoplasties involve reshaping of the nasal cartilage and/or bone in order to enhance the nose and beautify the face as a whole. Different people will require different types of cosmetic rhinoplasties, and often a “dream nose” can be unrealistic, given a specific set of facial features. In other words, not everyone’s “perfect nose” will look the same.
Specifically, a cosmetic rhinoplasty can alter:
- nose size
- nose profile
- nasal tip shape
- nose width at bridge
- nostril size and shape
- nasal asymmetry
A functional rhinoplasty seeks to improve the shape of the nose in order to reduce airway obstructions.
Often, an individual suffering from an airway obstruction may not realize it for what it is – common signs can include nasal congestion, mouth breathing, dry mouth, or a reduced sense of smell. Nosebleed, sinus problems, sleep apnea, and insomnia are all possible symptoms of a physically obstructed airway that could be repaired through functional rhinoplasty. If you believe you may be suffering from airway obstruction, you should consult your doctor and ask if a functional rhinoplasty is right for you.
A purely functional rhinoplasty seeks to repair restricted airflow while altering the shape of the nose as little as possible. This may include:
- nasal septoplasty
- turbinate reduction
- nasal polyp removal
- nasal valve collapse
Combined Cosmetic and Functional Rhinoplasty
Often, individuals in need of functional rhinoplasty will often desire aesthetic reshaping, so many functional rhinoplasties are also cosmetic.
A combined nose surgery is a very challenging procedure. The best way to achieve desired results is to be open with your surgeon about how you want your nose to look, while understanding the limitations of rhinoplasty (based on your natural bone structure), as well as its associated risks.
The Risks of Rhinoplasty
All surgeries carry risk. Depending on your natural immunity, rhinoplasties can lead to infection, chronic swelling, and sinus problems. But the greatest risk involved with any nose surgery is psychological.
Many individuals with already-attractive noses may have skewed perceptions of their relative attractiveness, and become disappointed by rhinoplasties that produce less-than-incredible results. Others may desire noses that might not actually compliment their personal facial features. Still others may expect functional rhinoplasties to also be cosmetically ideal.
Dr. Zoumalan will walk you through receiving a nose job in Beverly Hills, and what your expectations are. Prior to going forward with anything, he will ensure that you will be receiving exactly what you hope for. If he believes he cannot make you happy he will be completely honest about the expectations.
Current Trends in Rhinoplasty
What has decades of new rhinoplasty techniques taught us? A tremendous amount. We have learned about how to create a nose that fits the face. We have learned how to create a nose that functions well. We have learned how to get people to heal faster and get back to work earlier. We have learned how to minimize the chance that we will have to do a “touch up” later on.
The New Nose is not a dramatic shift from the past. It is a nose that is focused on looking natural, and not having any pointy areas. It is focused on not turning the tip up too much. It is focused on not “scooping out” the nose too much. All of the above can make the nose look fake and unnatural. Smooth contours and appropriate size of the tip are keys to the procedure.
Also, as the effects of improved sleep and exercise are more and more evident as time passes, rhinoplasty surgeons have become more and more sensitive to making sure the nose can function well. I performed a study that looked at rhinoplasty patients (over a 7 year span) that was published in the JAMA Facial Plastic Surgery Journal last November which shows that using certain techniques, we can improve breathing in rhinoplasty patients consistently.
Rhinoplasty is an art and a science. I have published over 40 research studies and book chapters on Facial Plastic Surgery, and about half of those have helped advance the field of rhinoplasty. There is a tremendous amount of literature on rhinoplasty, and more and more is learned by the year. This has helped shaped my approach to create the best result for the patient.
If you have breathing problems, rhinoplasty may be partially covered by insurance. If it is purely for cosmetic reasons, it is unlikely that insurance will cover any of the surgery. However, if you want both functional (breathing or sinus surgery) and cosmetic rhinoplasty, there may be some cost-savings for you. The reason for this is that the insurance company may help pay for part of each of these 3 costs:
- Surgeon’s fee
- Operating Room Fee
- Anesthesiologists Fee
Dr. Zoumalan’s Los Angeles office usually gives one total price which estimates what you expect to have to pay out of pocket. If you want the breakdown of the estimate of each part of the Beverly Hills rhinoplasty cost, feel free to ask.
If you need surgery for better breathing at the same time, insurance may help pay for this. Examples of these surgeries are:
- Septoplasty, turbinate reduction (turbinoplasty), internal nasal valve repair, repair of nasal stenosis, nasal polyps, sinus disease
- The insurance company can help pay these and therefore bring the total price of the rhinoplasty down, sometimes significantly.
What Makes up the Total Cost of Rhinoplasty Surgery?
Price of Rhinoplasty = Surgeon’s fee + Operating Room Fee + Anesthesiologists Fee
is a profession fee charged by the rhinoplasty surgeon. This price depends on how complex the surgery is expected to be. No two rhinoplasties are the same, so this number can vary depending on how many maneuvers the surgeon expects to do. There is some estimation involved in this, because sometimes the surgeon makes decisions during the operation that may make the rhinoplasty longer. Some rhinoplasties seem simple on the outside, but once the surgery gets going, it may require more time than estimated. The rhinoplasty surgeon must use experience to determine this cost. Insurance can help pay for part of this, if there is a breathing problem. Breathing problems are known as functional problems, because they pose a problem for the function of the nose, which is breathing.
Operating Room Fee
is based purely on time. This is also known as the Facility Fee. Each facility has its own hourly rate. Hospitals tend to have a significantly higher rate. For this reason, almost all rhinoplasty surgeons operate at Surgery Centers. These are state-of-the-art, highly certified facilities which provide the ultimate patient care, all while maintaining lower costs than a hospital. Surgery Centers also have been found to have a lower infection rate and a more personal experience. For patients that care about their privacy, these centers provide the ultimate in private and personal experience. Insurance can also help with the cost of this, if you have a breathing or sinus problem.
is based on time. Your insurance can help pay for this as well, if you have breathing or sinus problems.
Relative Costs of Different Types of Rhinoplasty
The cost of a Beverly Hills rhinoplasty is based on how much surgery needs to be performed. More complicated rhinoplasties need more time in the operating room. Because the cost of rhinoplasty includes the cost of the operating room facility fee and anesthesiologist’s fee, a longer surgery will increase the price of all of the above.
Primary (first-time) rhinoplasty
is almost always less expensive than revision rhinoplasty.
is less expensive than the full rhinoplasty. Tip rhinoplasty only focuses on contouring the lower third of the nose. It is shorter and simpler, which lowers the cost of all three parts of surgery.
(also known as secondary rhinoplasty) is usually more complicated and more challenging. The nose has been altered and there is scar tissue that makes the surgery slower. Furthermore, revision rhinoplasty usually requires the use of grafts which make the surgery longer and more complicated.
Medications and Supplies:
Cost is minimal. Much of this will be provided for you.
If you have someone who can help you the first evening (family member or friend), this is preferable. Some patients choose to stay at a recovery center for a night. We can arrange for this. This is an extra cost, and is usually unnecessary for rhinoplasty, as there is not much that the patient needs.
CALL US TO GET A RANGE OF PRICE OF RHINOPLASTY
. WE CAN USUALLY GIVE A BALLPARK NUMBER IF WE SPEAK WITH YOU.
Rhinoplasty is one of the most complicated surgeries in plastic surgery due to the delicate nature of the nose and the way the nose heals. It is important to find a surgeon that focuses on the nose and face.