A Comprehensive Three-Dimensional Rejuvenation Center

Monthly Archives: October 2018

The non-surgical rhinoplasty; what are the possibilities?

Noses occupy a prominent position on the human face. Many normal anatomic and ethnic variations exist and, depending upon proportionality (e.g. width, length, projection, etc.), the rest of the face can accentuate nasal variations. In some individuals, these variations can and do detract from the overall aesthetics of the face. The key to any surgical or non-surgical intervention by a plastic surgeon is a carefully performed detailed facial analysis. Once analyzed, a surgical or non-surgical approach involving the nose and interplay of the middle and lower third of the human face both in terms of bony structure and soft tissues such as fat pads, muscle of the lips and mouth and chin can greatly enhance the appearance of the nose.

A common nasal variation that many Middle Eastern and Asian descendants have, which they commonly want corrected, is a prominent nasal dorsal hump which slides down an inclined plain to a projecting nasal tip referred as the “poly beak” deformity. Often this is paired with a prominent caudal (lower) septum that plunges downward giving the appearance of a large view of the side nostril. The nasal tip can be further pushed downward during smiling animation if the person has a paired muscle that spans the lower portion of the nose and inserts into the circular muscle of the lips/mouth. Any time the person animates a smile it further pulls the lip upward and the tip of the nose downward. If the lower facial third is diminutive with respect to the middle facial third, such as people with an underbite, the nose in these cases rises to a more prominent position with the overall face. Without question a definitive surgical open septo-rhinoplasty for nasal deformities would provide the best results and, if the individual has the above-mentioned dental-skeletal relationship, adding a chin procedure such as a genioplasty or, if indicated, a chin implant would add harmony with the lower facial third to provide a superior result.

Alternatively, if surgery is not an option, non-surgical approaches can be employed to reduce the appearance of the anatomic variations that might displease the individual. Once again taking a very global detailed facial analysis is imperative to achieving the best results. Primiarily, if a patient presents with the animation deformity of the nasal tip when smiling leading to further lack of nasal tip projection, planned neurotoxin injections such as BOTOX or Dysport can be placed into the depressor muscle under the lip to prevent this action from occurring. If the patient has a retruded chin as we have specified previously, we can enhance the projection with a filler agent such as Radiesse which has the greatest “G prime” number meaning it resists deformity better than any other filler agent. Radiesse can be injected just above the bone on the chin’s tissue to enhance the furthest projection point of the chin creating a more balanced lower facial third making the nose appear less prominent. With respect to the nose itself we can add a hyaluronic acid filler agent such as Juvederm Voluma to the dorsum of the nose to soften the appearance of the nasal hump in conjunction with additional volume added to the nasal tip minimizing the “hook nose” shape. If the plunging caudal (lower) septum gives a greater view of the inside of the nose from a lateral view then adding a filler agent in the nasal mucosa above the lower lateral cartilage may act like a alar strut graft and push the inferior alar rim downward to reduce visualization of the inside of the nose.

If patients have had previous trauma to the dorsum of the nose or have an anatomic variant such as a ski slope deformity, added volume deep to the dorsum and below the skin can build this area up obscuring the underlying deformity. One important point to make is that non-surgical approaches cannot provide a subtraction affect which is needed in a bulbous nasal tip but can provide added volume in other areas such as the chin to balance out the enlargement of a nose.

Bottom line: never chose a provider to perform non-surgical approaches to the nose if they are not already an experienced rhinoplastic surgeon because filler agents are not in-expensive and it takes years of experience to be able to properly analyze and treat noses for optimal results, therefore – invest wisely.

State of the art lipo-abdominoplasty

Many women, after childbearing or significant weight loss, find themselves less than satisfied with their abdominal contour. They may have joined a gym, hired a personal trainer, engaged in cross-fit or boot camp and despite all the blood, sweat and tears still have sagging skin and loose abdominal tissue resulting in bulging of the tummy area. Often the flank areas “muffin top” and the mons pubis and perineum (or genital area) can also cause issues that detract from a sleek look with current athletic leisure wear. Fortunately, board certified plastic surgeons who remain engaged and committed to the continuous evolution of our craft have good options to improve the contour of the abdomen and surrounding areas.

Abdominoplasties have been around for many decades but refinements in techniques have led to better aesthetic outcomes:

  1. Liposuction of the epigastrium (upper central region of abdomen): reduces the skin thickness and can lead to a less bulky appearance when combined with tissue resection of excess loose skin.
  2. Resection of the upper abdominal skin flap sub-fascial fat plan: which can reduce the metabolic load of the flap by eliminating the poorly vascularized fat plain while diminishing the overall thickness of the skin.
  3. Discontinuous undermining of the abdominal skin flap off the costal (rib) margin: to allow further inferior repositioning of the skin flap to lower the final incisional scar to hide better in undergarments and or bathing suits.
  4. Progressive tension suture plication technique of the upper abdominal skin flap: to aide in the obliteration of dead space to reduce and or eliminates the amount of time that drains are necessary and to further sculpt the underlying abdominal shape.
  5. Fascial plication of the inferior edge of the upper skin flap to the lower abdominal wall to prevent scar migration superiorly.
  6. Resuspension, lipocontouring, and reshaping of the mons pubis to provide a sleeker appearance in leggings and yoga pants.
  7. A vertical narrow appearing belly button.
  8. Contouring the flanks with liposuction simultaneously with the abdominoplasty for more circumferential rejuvenation.


Just as fashion changes occur so must the plastic surgeon respond to effectively provide aesthetic outcomes that provide body contours that complement the new overlying clothing. The above-mentioned refinements can produce superior results compared to traditional abdominoplasties. If you would like to initiate a consult to see if you are a candidate for abdominoplasty please contact The Lucas Center, Plastic Surgery in Knoxville TN at thelucascenter.com, or 865-218-6210.