Non-surgical Rhinoplasty: Nose Job without Surgery

Non-surgical rhinoplasty has reemerged over the past few years as a popular option for certain patients. In the past, only silicone was injected into the nose, but now Maryland and northern Virginia rhinoplasty patients can choose from a variety of cosmetic injectable fillers. As the FDA has not yet approved the use of fillers for cosmetic injection into the nose, they are currently being used off-label. Fillers are typically injected into the bridge of the nose to help smooth depressions and irregularities. They may also be used to build the bridge and provide augmentation for flat or wide noses. Injectable fillers which have been used for nonsurgical rhinoplasty include Radiesse and hyaluronic acids, such as Restylane or Juvederm.

However, I'd like to offer a few words of caution for those considering the use of fillers as non-surgical rhinoplasty. Nasal injections can have potentially serious problems. As a result, your cosmetic specialist should be appropriately trained and board-certified. Some potential complications include, but are not limited to lumps, irregularity, color changes, discoloration, swelling, infection, blood flow problems, skin loss, pain, or numbness.

Technically, any physician or nurse can treat a patient with cosmetic Restylane injections into the nose. However, laws vary by state within the US regarding who can treat with fillers. To help minimize potential complications, one should be treated by someone who has extensive training and experience with nasal procedures and rhinoplasty.

Additionally, non-surgical rhinoplasty with fillers is temporary given that fillers eventually dissolve. Fillers in the nose, however, do last much longer than in other areas of the face, such as cheek or lip enhancement. For example, hyaluronic acid fillers (Restylane and Juvderm) can last up to a year or longer in the nose while only 6 months in the lips.

Lastly, non-surgical rhinoplasty cannot achieve all the results that a formal rhinoplasty surgery can provide. Only surgical rhinoplasty can narrow wide nostrils with skin removal or narrow a bulbous tip with cartilage removal. In addition, only surgery can remove a nasal hump with bone and cartilage removal. Non-surgical rhinoplasty may possibly give the illusion of a reduced hump or narrowed bridge, but the non-surgical results are different from what surgery may provide.

Depending on the specific anatomy of your nose and your personal preferences, I suggest first speaking with a rhinoplasty surgeon who can use computer imaging to simulate rhinoplasty. You'll be able to visualize in real time what results are potentially available. Only after a comprehensive in-person evaluation can a facial plastic surgeon help determine the appropriate cosmetic surgery options for your nose.


© Copyright 2008 - 2011 Houtan Chaboki, MD. All Rights Reserved. Board Certified Facial Plastic Surgeon specializing in Cosmetic Surgery of the nose, face, neck, eyelids, and eyebrow in Washington DC, Maryland, and northern Virginia. Privacy Policy and Disclaimer.

Topical Ointment after Facial Surgery - Vitamin E

I had an interesting conversation with my dermatology colleague in the DC office. The dermatologist recommended Vitamin E ointment to help reduce scarring after surgical procedures, such as excisions, skin biopsy, and mole removal. The dermatologist claimed facial incisions looked better after using topical Vitamin E.

I've already talked a bit about ointments to help prevent facial scars in a previous blog post. So I asked her to review the medical literature again with me. Vitamin E ointment was not found to be any better than plain petrolatum for scar prevention. It did, however, contribute to skin allergy and contact dermatitis after prolonged use.

These educational debates among Maryland and Virginal skin care specialists occur commonly. For my northern Virginia face lift patients, we use an antibiotic ointment and avoid getting the incisions wet for the first two days after the cosmetic surgery. Once initial healing complete, then topical petrolatum jelly or silicone gel (patient's choice) is used on the incision daily for approximately 1-2 months.

What did we learn? Always speak with your Washington DC facial plastic surgeon or dermatologist and follow their advice. You can talk about recent scientific research or journal articles with your specialist. We learn from each other, both from patients and physicians.


© Copyright 2008 - 2011 Houtan Chaboki, MD. All Rights Reserved. Board Certified Facial Plastic Surgeon specializing in Cosmetic Surgery of the nose, face, neck, eyelids, and eyebrow in Washington DC, Maryland, and northern Virginia. Privacy Policy and Disclaimer.

Should Your Parents & Grandparents "Grow Old Gracefully?"

It doesn’t surprise anyone when friends or family members between the ages of 45 and 60 choose to undergo facial cosmetic surgery. After all, as we age, we’ll all experience sagging, bagging and wrinkling, which is particularly visible on our faces. Although I make every effort to help my Washington, DC patients age gracefully by utilizing Botox and dermal fillers, eventually they’ll need more correction than these non-surgical methods can provide. Ultimately, a facelift is the best choice for those with signs of facial aging. In my Virginia-area facial cosmetic practice, I’d estimate that 55 is the average age of patients seeking facial rejuvenation, with some patients opting for age-related corrections earlier than others due to lifestyle habits and inherited aging patterns.

However, did you know that those over the age of 65 are embracing aesthetic enhancements at a rapid rate? It’s true. The Baby Boomers, the largest cohort group in the US, are increasingly represented in our facial plastic surgery office here in Washington, DC. In fact, procedures that were once deemed for those of “middle-age” are now quite popular for grandmothers and grandfathers, too!

As an indication of this trend, there was a recent story in the London press about a 65-year-old woman, Joan Lloyd, who decided that as a fairly new widow, she needed cosmetic enhancements in order to “help me find love again,” in her words. When asked why she decided to have her breast augmented to an F-cup, she replied, “I decided to get maximum impact.”

Although this charming woman no doubt did create maximum impact, most of the Virginia and Maryland men and women I see for facial cosmetic surgery are more likely to desire a facelift that’s a bit less “maximum” in terms of revealing that they had anything done. A beautiful facelift should suggest rest and relaxation; nothing pulled, nothing jarring, just soft and full, like the face of youth. If there is a lesson to be learned by Mrs. Lloyd, certainly it’s that there is no shame in wanting to look as young as you feel, or even to look younger than you are. As long as a patient is in good health and has realistic expectations, I have no qualms about older patients undergoing cosmetic procedures.

Are Older Americans Getting More Plastic Surgery?

The American Society of Plastic Surgeons reported that in 2010 there was a 2% increase in the number of both male and female patients over 55 that underwent a cosmetic procedure. It could be, at least to an extent, that older celebrities are very open about the work they have had themselves to look younger. Even Betty White has recently admitted to undergoing cosmetic procedures. With so many older celebs praising plastic surgery, it is only natural for the older crowd to accept cosmetic procedures for themselves as well.

I’m interested in hearing what you think! Is cosmetic surgery a good idea for those 65, 70 and older or should they “grow old gracefully?” What would you think if your parents or grandparents chose to undergo a cosmetic procedure?

To your health and beauty,

Dr. Houtan Chaboki

© Copyright 2008 - 2011 Houtan Chaboki, MD. All Rights Reserved. Board Certified Facial Plastic Surgeon specializing in Cosmetic Surgery of the nose, face, neck, eyelids, and eyebrow in Washington DC, Maryland, and northern Virginia. Privacy Policy and Disclaimer

How to Determine if you are a Face Lift candidate

When you look in the mirror and lift your jawline and cheek skin, do you like what you see? Perhaps it's time to consider facial rejuvenation surgery.

Face lift or neck lift surgery is a purely elective cosmetic procedure to rejuvenate the face for men and women over 40. Both the face lift and neck lift are cosmetic procedures that one chooses to reduce the signs of aging and sun damage of the lower face. Cosmetic surgery is an option, among many other good aesthetic options. Keep in mind that your face continues to age with time, despite any treatment or surgery, but you will continue to look better after cosmetic surgery than if you've never had the initial face lift surgery.

Generally during the consultation, I discuss non-surgical face lift options first, especially for patients who have never tried any procedure and just starting to consider plastic surgery treatments. These patients may be looking for minor changes or minimally invasive treatments to freshen their appearance, or they may not have opportunity to take time off work to recover after a face lift. Non-surgical face lift options for DC area residents may include facial fillers, fat transfer, or Botox Cosmetic. These non-surgical treatments are sometimes referred to as "liquid facelift".

Washington DC face lift candidates may include those who have already tried Juvederm or Restylane but were not completely satisfied with the short term results. Alternatively, some Washington area patients prefer to have natural results without the injection of synthetic materials. Anatomically a face lift might be a better aesthetic option, as compared to laser skin resurfacing, Botox Cosmetic, or injectable fillers (hyaluronic acid, Restylane, etc), for one who has loose, sagging skin especially along the jawline (jowls) and neck (turkey gobbler).

Face lift candidates generally have the following qualities, but circumstances may vary for each person:

• over 40 years old
• good general health
• excess neck skin or fat
• jowls or loose skin tissue along jaw line
• time for recovery after surgery

As with other face lift surgeons, I will tailor the facelift appropriate for you. The plastic surgery is customized to the degree of facial aging you have, in conjunction with your personal goals. Some patients require a limited or mini lift, while older patients with excess sagging skin would benefit from a full face lift or traditional lift. Only after a comprehensive evaluation can a surgeon help determine appropriate options.

© Copyright 2008 - 2011 Houtan Chaboki, MD. All Rights Reserved. Board Certified Facial Plastic Surgeon specializing in Cosmetic Surgery of the nose, face, neck, eyelids, and eyebrow in Washington DC, Maryland, and northern Virginia. Privacy Policy and Disclaimer.

Botox Injection and Eyebrow Waxing, Plucking, Threading, and Tweezing

Botox Cosmetic is a great option to help reduce wrinkles and smooth the skin in the forehead and around the eyes. Many DC area women, and some men, frequently have their eyebrows regularly groomed, either at a salon or done by themselves. My Washington DC Botox patients often ask if they can have an eyebrow waxing after Botox injection.

Most DC plastic surgeons and dermatologists suggest avoiding any eyebrow or skin treatment around the eyes and eyebrow for least the first day after Botox Cosmetic injections. This restriction includes similar treatments such as skin care, microdermabrasion, and facial massages. Some DC cosmetic specialists will encourage 1 week for this restriction. After 2 weeks, it should be OK to get eyebrows waxed or tweezed following your Botox Cosmetic treatment. Always check with your Botox injector regarding any concerns you may have.

© Copyright 2008 - 2011 Houtan Chaboki, MD. All Rights Reserved. Board Certified Facial Plastic Surgeon specializing in Cosmetic Surgery of the nose, face, neck, eyelids, and eyebrow in Washington DC, Maryland, and northern Virginia. Privacy Policy and Disclaimer.

Face Lift Anesthesia Options for Maryland & Virginia

A lower face lift or neck lift can greatly rejuvenate the face and help restore the appearance of youth and beauty. Maryland or Virginia face lift patients are typically active individuals who have sagging skin and jowls and excess neck fat. Face lift patients often ask about the incisions used during the face lift and anesthesia during the cosmetic surgery.

A face lift is not one operation, but rather many potential cosmetic procedures, dependent on the surgeon and patient to improve neck line, jowls, and signs of facial aging. Although there are many different face lift procedure terms, there are really only a few different types. These basic face lift surgery types are the SMAS, deep, or composite. Face lift may be combined with other cosmetic surgery for Maryland or Virginia patients such as a eyelid surgery, fat transfer, or others.

The amount of tissue adjusted or tightened depends on the specific approach & the requirements of a particular patient. The minimal access or minimal incision lift that leaves a short scar is more appropriate for younger patients (less than 60) or patients with little/moderate skin aging. All of these types of face lifts are variations of SMAS lifts. Older Maryland or Virginia patients or patients with severe & excess skin sagging will require a more traditional facelift procedure. By far, a majority of plastic surgeons who perform face lift surgery do a SMAS lift variation. This face lift type generally has the quickest recovery with great results.

Typically most face lift surgery is performed with either IV sedation (twilight anesthesia) or general anesthesia, along with local anesthesia. Either are good, safe options, with their own advantages and disadvantages. IV sedation or general anesthesia may be provided by a board-certified anesthesiologist and/or nurse anesthetist dependent on the surgical facility. It's better to have someone else other than your face lift surgeon monitoring you and your vitals during anesthesia. Let your plastic surgeon concentrate on the cosmetic surgery.

Some cosmetic surgeons perform face lift surgery under local anesthesia only, termed "awake surgery". Read my press release on awake surgery. I advise my Maryland and Virginia face lift patients against performing any extensive plastic surgery via local anesthesia only. While minor procedures can be performed in the office with local anesthesia, patients are more comfortable with IV sedation or general anesthesia for more extensive procedures.

The decision on the type of anesthesia depends on the extent of face lift surgery, combined cosmetic surgery procedures along with the face lift, patient factors/preference, and surgeon factors/preference. After an evaluation by a plastic surgeon, one chooses the appropriate anesthesia type for their plastic surgery.

Facial Plastic Surgery with a Single Injection

Which single medication has been used for a variety of aesthetic treatments for Washingtonians? Botox Cosmetic.

Botox Cosmetic may be applied in specific ways to achieve certain results for facial rejuvenation. Wrinkle reduction around the eyes and forehead is the most common application, but lifting the eyebrows or slimming the jawline are alternative treatments that have been used by DC area plastic surgeons and dermatologists.

The non-surgical brow lift to raise the eyebrows is achieved by injecting the muscles just below the eyebrow (orbicularis muscle) which pulls down the brow. Results are temporary and subtle with the Botox browlift. This non-surgical brow lift method may not be noticeable if you have severely droopy eyebrows. Cosmetic surgery with an endoscopic brow lift would be more appropriate for severe eyebrow ptosis (droopy).

Speak with a Washington DC Botox specialist to perform a comprehensive evaluation and help determine appropriate options for you.

Plastic Surgery to Augment Sunken Cheeks

Sunken, flattened cheeks are signs of inadequate facial volume. While this may occur from natural aging in patients I see from northern Virginia, sunken cheeks are also commonly congenital or genetic. These facial features may run in families. Cheek volume loss may also be seen earlier with some medical conditions, severe weight changes, trauma, or medications too.

Several cosmetic options are available to improve volume loss in the cheeks or midface and to sculpt the face. Treatment obviously is to add volume, typically. Injectable fillers with hyaluronic acid (Restylane or Juvederm) may be appropriate in the tear-trough or nasolabial folds, otherwise known as smile lines. Alternatively, longer acting facial fillers such as Radiesse or Sculptra provide longer-term improvement of the cheeks. All these injections are office procedures with temporary results.

Other cheek enhancement options include fat injections, which have been used for decades for facial rejuvenation. Fat injections have the potential for long-term natural cheek enhancement, in addition to a poorly understood possible "stem-cell" effect. Cosmetic surgery with a silicone implant or midface lift may be more appropriate in selected patients. Silicone cheek implants are a good option for permanent cheek enhancement in northern Virginia patients. Cheek implants placed via small intraoral incisions enhance the cheek bones, add volume underneath the cheek bones or midface, or both.

Lastly, the cheeks can be enhanced by removing excess volume, which may appear counterintuitive. However, some patients are born with too much fat and may benefit from buccal fat reduction. Alternatively, large jaw muscles may distract from the cheeks. These patients can enhance the upper face by jaw line reduction with Botox.

There isn't one best treatment for facial plastic surgery procedures. Cosmetic cheek augmentation has several options. Only after a comprehensive evaluation by a specialist can he/she help determine appropriate options for your northern Virginia cheek enhancement.

Face Lift Recovery and Healing

A very common question for Maryland plastic or cosmetic surgeons is how quickly can one return to normal activities after a face lift. Of course, recovery after face lift surgery varies on the specific type of face lift you had, and your body's natural healing ability.

First, there will be recovery from the anesthesia along with the surgery. Most Maryland patients recover from the anestheisa effects within the first day or two. You should'nt drive or make any major decisions during this early period after anesthesia. You'll feel tired and gradually regain strength once the effects of anesthesia are gone.

The surgical recovery typically is longer. Mini face lifts (short scar or minimal access) or neck lifts have a faster recovery than traditional face lifts or full face lifts, since mini lifts require less surgery and tissue manipulation. Combination facial plastic surgery procedures in Maryland such as eyelid surgery or fat transfer along with the face lift will have a longer healing period. Generally, most swelling and bruising after facial cosmetic surgery resolve within a couple weeks. You may have residual slight bruising or swelling for longer, however, may still be able to go into public without drawing attention. Plan for at least 2 weeks of recovery, especially when combined with other cosmetic surgery. During this early healing period you should avoid any activity that increases your blood pressure or heart rate, such as exercise, bicycling, sex, or yoga, while light-activity like walking is permitted.

To maximize your cosmetic results, follow the face lift care instructions of your facial plastic surgeon. Lastly, speak with your face lift surgeon regarding any concerns you may have.

Cost-Effective Skin Care without Expensive Laser Treatment

Lasers are everywhere and play an important role for Washington DC area skin rejuvenation patients. However, cosmetic laser treatments aren’t the only or the best answer for every aesthetic patient.

I’ve already spoken a bit about basic skin care and sunblock. Now let’s focus on another great option for DC, Maryland & northern Virginia skin rejuvenation: tretinoin.

Tretinoin has been available for over 20 years in the United States. A couple of brand names include Retin-A ® and Renova ®. Tretinoin is a form of vitamin A that is used as a cream or gel on the skin and has targeted various conditions:
• Acne
• Wrinkles or photo aging
• Sun damage
• Age spots or sun spots
• Stretch marks
• Skin preparation for chemical peel

Many dermatologists and plastic surgeons agree that tretinoin is the best collagen building anti-wrinkle cream available.

Brand names, alphabetical order:

• Altinac®
• Atralin®
• Avit®
• Refissa®
• Renova®
• Retin-A®
• Tretin X®

Brand names of combination products, alphabetical order:

• Solage® (contains tretinoin and mequinol)
• Tri-Luma® (contains tretinoin, fluocinolone, and hydroquinone)
• Veltin® (contains clindamycin and tretinoin)
• Ziana® (contains clindamycin and tretinoin)

How does tretinoin work on your skin?
Tretinoin increases the rate at which the top layer of your skin (epidermis) sheds and replaces itself with new skin. Young skin sheds and replenishes cells much more frequently than older or sun damaged skin. Tretinoin speeds up the natural skin cycle so that the top layer is fresh and new. In addition, tretinoin thickens collagen and the dermis, or deeper skin layer, so that wrinkles are smoother. Sunlight breaks down tretinoin, so many specialist recommend using the cream nightly

While many patients are very happy with using tretinoin therapy, some are disappointed due to the redness, irritation, and scaling that often accompany the initial treatment. Below are suggested steps to help get through the irritation phase & tolerate tretinoin therapy. Speak with your northern Virginia, Maryland, or DC dermatologist, plastic surgeon, or skin care specialist to help determine the appropriate treatment plan for you.

Do’s
• Apply at night only, right before going to bed, when first starting tretinoin
• Use a mild, non-irritating cleanser to wash your skin and remove any makeup
• Apply tretinoin after washing your skin at night, and wait 15 minutes before applying any other skin care products. Tretinoin may cause more irritation if applied to moist or wet skin.
• Apply a “pearl” sized portion, or size of pinky fingernail. “Less is more” when using tretinoin. Applying a thick layer or dab/spot treatments isn’t appropriate.
• Continue your daily sunblock every morning. Protect your skin from both UVA and UVB

Don’ts
• Apply it during the day (unless advised by your physician)
• Use other skin care products such as glycolic acid or benzoyl peroxide (unless advised by your physician)
• Tan
• Allow excessive sun exposure

If you’re still having difficulty with initial irritation, but still want to use tretinoin for its beneficial cosmetic effect, then you may try the following (after consultation with your doctor):
• Start tretinoin slowly, either at a lower concentration or apply only every 2nd or 3rd night. You may advance to every night or a higher concentration as your skin adjusts to therapy. A little dryness or irritation is normal at first, but if the treated skin becomes really sensitive, take a break. Let the skin recover and then slowly begin treatment again.
• Try an oral antihistamine tablet to help reduce itchiness
• Switch your cleanser to something mild and non-irritating. Many facial cleansers are too irritating for tretinoin sensitive skin.
• Reduce sun exposure since your skin becomes more sun sensitive.

Important things to know about tretinoin treatment
• Epidermis may thin from therapy due to exfoliating effect, therefore no hair removal should be performed over treated areas, including plucking or waxing.
• Tell your doctor or skin care specialist performing a procedure such as a chemical peel, microdermabrasion, or laser treatments that you are on tretinoin. You may need to stop tretinoin for a period of time before and after your treatment.
• Anyone who is or may become pregnant should not use tretinoin.

Tretinoin comes in various concentrations or strengths, for example.

• 0.025%
• 0.05%
• 0.01%

Higher concentrations typically provides greater aesthetic results, but may have more initial skin irritation. Younger patients with mild acne may start with low concentration of 0.025%, while older patients with severe sun damage and wrinkles may start at a higher concentration. Based on your skin condition and personal preference, your plastic surgeon or dermatologist will help choose an appropriate concentration to start therapy. As your skin improves, your skin specialist may modify the concentration and/or frequency as needed.


Why bother with tretinoin treatment?
As a facial plastic surgeon , I'm current on all the latest in cosmetic surgery and skin care treatments. However, in my opinion, no treatment rivals tretinoin for such tested and lasting cosmetic benefits. Several scientific studies and professional experience give me many reasons to recommend tretinoin for appropriate Washington DC area patients:
• Reduces, reverses, and prevents wrinkles. Younger patients usually receive more of a benefit, but patients may start at any time and still experience visible improvement.
• Prevents and lightens age spots and sun spots.
• Thickens collagen & dermis.
• Improves acne.
• Helps decrease the risk skin cancer.
• Improves skin’s general appearance.

Tretinoin has been used for over 20 years, but doesn’t have the same marketing presence compared to other laser and skin care treatments. However, I see the benefits of this product in patients at my Washington DC facial plastic surgery office every day. How about you? Tell me about your experience with tretinoin.

Houtan Chaboki, MD