Cosmetic Surgery defined as a subspecialty of surgery that uniquely restricts itself to the enhancement of appearance through surgical and medical techniques. It is specifically concerned with maintaining normal appearance, restoring it, or enhancing it beyond the average level toward some aesthetic ideal. In 2006, nearly 11 million cosmetic surgeries were performed in the United States alone. It is important to distinguish the terms "plastic surgery" and "cosmetic surgery": Plastic Surgery is a recognized surgical specialty and is defined as the subspecialty dedicated to the surgical repair of defects of form or function -- this includes cosmetic (or aesthetic) surgery, as well as reconstructive surgery. The term "cosmetic surgery" however, refers to surgery that is designed to improve cosmetics alone. Many other surgical specialists are also required to learn certain cosmetic procedures during their training programs. Contributing disciplines include dermatology, general surgery, plastic surgery, otolaryngology, maxillofacial surgery, and oculoplastic surgery. The most prevalent aesthetic/cosmetic procedures are listed below. Most of these types of surgery are more commonly known by their "common names." These are also listed when pertinent.

• Abdominoplasty (or "tummy tuck"): reshaping and firming of the abdomen
• Blepharoplasty (or "eyelid surgery"): Reshaping of the eyelids or the application of permanent eyeliner, including Asian blepharoplasty
• Mammoplasty


• Breast augmentation (or "breast enlargement" or "boob job"): Augmentation of the breasts. This can involve either fat grafting, saline or silicone gel prosthetics. Initially performed to women with micromastia
• Breast reduction: Removal of skin and glandular tissue. Indicated to reduce back and shoulder pain in women with gigantomastia and/or for psychological benefit in women with gigantomastia/macromastia and men with gynecomastia.
• Breast lift (Mastopexy): Lifting or reshaping of breasts to make them less saggy, often after weight loss (after a pregnancy, for example). It involves removal of breast skin as opposed to glandular tissue.


• Buttock Augmentation (or "butt augmentation" or "butt implants"): Enhancement of the buttocks. This procedure can be performed by using silicone implants or fat grafting and transfer from other areas of the body.
• Chemical peel: Minimizing the appearance of acne, pock, and other scars as well as wrinkles (depending on concentration and type of agent used, except for deep furrows), solar lentigines (age spots, freckles), and photodamage in general. Chemical peels commonly involve carbolic acid (Phenol), trichloroacetic acid (TCA), glycolic acid (AHA), or salicylic acid (BHA) as the active agent.
• Labiaplasty: Surgical reduction and reshaping of the labia
• Rhinoplasty (or "nose job"): Reshaping of the nose
• Otoplasty (or ear surgery): Reshaping of the ear
• Rhytidectomy (or "face lift"): Removal of wrinkles and signs of aging from the face
• Suction-Assisted Lipectomy (or liposuction): Removal of fat from the body
• Chin augmentation: Augmentation of the chin with an implant (e.g. silicone) or by sliding genioplasty of the jawbone.
• Cheek augmentation
• Collagen, fat, and other tissue filler injections (e.g. hyaluronic acid)
• Laser skin resurfacing
• Male Pectoral Implant : It is a procedure used to enhance chest size in men by inserting silicone implants under the chest muscle.

In recent years, a growing number of patients seeking cosmetic surgery have visited other countries to find doctors with lower costs.These medical tourists seek to get their procedures done for a cost savings in countries including Cuba, Thailand, Argentina, India, and some areas of eastern Europe. The risk of complications and the lack of after surgery support are often overlooked by those simply looking for the cheapest option.

Plastic surgery sub-specialities

Plastic surgery is a broad field, and may be subdivided further. Plastic surgery training and approval by the American Board of Plastic Surgery includes mastery of the following as well

• Craniofacial surgery is generally divided into pediatric and adult craniofacial surgery. Pediatric craniofacial surgery mostly revolves around the treatment of congenital anomalies of the craniofacial skeleton and soft tissues, such as cleft lip and palate, craniosynostosis, and pediatric fractures. Because these children have multiple issues, the best approach to providing care to them is an interdisciplinary approach which also includes otolaryngologists, speech therapists, occupational therapists and geneticists. Adult craniofacial surgery deals mostly with fractures and secondary surgeries (such as orbital reconstruction). Both subspecialities usually require advanced training in craniofacial surgery. The craniofacial surgery field is also practiced by maxillofacial surgeons (see craniofacial surgery).
• Hand surgery is concerned with acute injuries and chronic diseases of the hand and wrist, correction of congenital malformations of the upper extremities, and peripheral nerve problems (such as brachial plexus injuries or carpal tunnel syndrome). Hand surgery is an important part of training in plastic surgery, as well as microsurgery, which is necessary to replant an amputated extremity. Most Hand surgeons will opt to complete a fellowship in Hand Surgery. The Hand surgery field is also practiced by orthopedic surgeons and general surgeons (see Hand surgeon).
• Microsurgery is generally concerned with the reconstruction of missing tissues by transferring a piece of tissue to the reconstruction site and reconnecting blood vessels. Popular subspecialty areas are breast reconstruction, head and neck reconstruction, hand surgery/replantation, and brachial plexus surgery.
• Burn surgery
• Aesthetic or cosmetic surgery is concerned with the correction of form and aging. Plastic surgeons usually excel in this field because of their thorough knowledge of anatomy and extensive experience with reconstruction and congenital anomalies correction. Popular operations include amongst other breast augmentation, rhinoplasty, face lift, liposuction and mastopexy.
• Pediatric plastic surgery. Children often face medical issues unique from the experiences of an adult patient. Many birth defects or syndromes present at birth are best treated in childhood, and pediatric plastic surgeons specialize in treating these conditions in children. Conditions commonly treated by pediatric plastic surgeons include craniofacial anomalies, cleft lip and palate and congenital hand deformities.
• Facial Plastic and Reconstructive Surgery is concerned with comprehensive care of aesthetic and reconstructive problems in the head and neck region. Surgeons have extensive experience in the head and neck surgery after completing a five year otolaryngology residency, and subsequently one-year facial plastic and reconstructive surgery fellowship. Most surgerons are double boarded to include American Board of Otolaryngology and American Board of Facial Plastic And Reconstructive Surgery. Most commonly performed procedures include rhytidectomy, rhinoplasty, blepharoplasty, brow lifting, skin cancer reconstruction, as well as microsurgery.

When the eyebrows are too low or too straight, they may give an old, tired, sad, or angry look to the face. Brow lift surgery is a procedure used to remove the wrinkles from the forehead and to enhance the position and arch of the eyebrows. As we age, it common to accumulate excess forehead skin, which reveals itself in wrinkles, deep furrows between the eyes, and drooping brows, contributing to the inevitable sign of aging. If you've looked in the mirror recently and pulled back on some of that skin, you probably realized that you could still have a youthful look without that constant frowning. As a result, more and more men and women are undergoing brow lift surgery to restore their previous youthful appearance. Brow lift surgery reconstructs your forehead's muscles and tissues in a way that makes them tighter, reducing the former sagging position. That way, the frowning and drooping are removed and replaced with a smooth forehead, raised eyebrows, and less frown lines. The results are often dramatic and can take many years off your facial appearance.

The most common candidate for brow lifts is men and women from the ages of 40 to 60 years. It is however not limited to this age demographic, there are many cases of younger people who have developed frown lines from intense stress or muscle activity. Also some hereditary traits cause low brows and furrow lines above the nose.

Many advances in Brow lift surgery have allowed men who are bald or have a receding hairline to undergo this operation. This is achieved by using endoscopic brow lift surgery, which employs strategically placed incisions. This procedure prevents any obvious scarring, so that the operation would yield less dramatic side effects.

Brow lifts can also be an added procedure for those undergoing other forms of facial plastic surgery. It is quite common for individuals to have brow lift surgery to supplement their facelift, eyelid surgery, and facial implant procedures.

Patients after brow lift surgery look younger, feel more confident, and generally feel happier. The procedure can give you that happier and attentive look to complement your renewed confidence and vigor.

A chemical peel is a body treatment technique used to improve and smooth the texture of the facial skin using a chemical solution that causes the skin to blister and eventually peel off. The regenerated skin is usually smoother and less wrinkled than the old skin. Thus the term chemical peel is derived. Some types of chemical peels can be purchased and administered without a medical license, however people are advised to seek professional help from a plastic surgeon or dermatologist on a specific type of chemical peel before a procedure is performed

Types

There are several types of chemical peels.

Alpha hydroxy acid peels

Alpha hydroxy acids (AHAs) are naturally occurring organic carboxylic acids such as glycolic acid, a natural constituent of sugar cane juice and lactic acid, found in sour milk and tomato juice. This is the mildest of the peel formulas and produces light peels for treatment of fine wrinkles, areas of dryness, uneven pigmentation and acne. Alpha hydroxy acids can also be mixed with a facial wash or cream in lesser concentrations as part of a daily skin-care regimen to improve the skin's texture. AHA peels are used to:

• Reduce fine wrinkling
• Treat areas of dry
• Reduce uneven pigmentation
• Aid in the control of acne
• Smooth rough dry skin
• Improve the texture of sun-damaged skin

AHA peels may:

• cause stinging
• cause skin redness
• cause mild skin irritation
• cause dryness
• take multiple treatments for desired results

Beta hydroxy acid peels

It is becoming common for the use of beta hydroxy acid (BHA) peels to be used instead of the stronger Alpha Hyroxy (AHA) peels due to BHA's ability to get deeper into the pore than AHA. Studies show that BHA peels control oil, acne as well as remove dead skin cells to a certain extent better than AHA's, due to AHA's only working on the surface of the skin.

Jessner's peel

Jessner's peel is a combination of salicylic and lactic acids, and resorcinol. It is thought to break intracellular bridges between keratinocytes.

Retinoic acid peel

Trichloroacetic acid peels

Trichloroacetic acid (TCA) is used as an intermediate to deep peeling agent in concentrations ranging from 20-50%. Depth of penetration is increased as concentration increases, with 50% TCA penetrating into the reticular dermis. Concentrations higher than 35% are not recommended because of the high risk of scarring. Trichloroacetic acid peels:

• are preferred for darker-skinned patients over Phenol
• smooth out fine surface wrink
• remove superficial blemishes
• correct skin pigment problems

Trichloroacetic acid peels may:

• require pre-treatment with Retin-A or AHA creams
• require repeat treatment to maintain results
• require the use of sunblock for several months (this is a must)
• take several days to heal depending on the peel depth

Phenol peels

Phenol is the strongest of the chemical solutions and produces a deep skin peel. Recent studies suggest that phenol is most likely only the carrier for another active component in the solution, namely croton oil. In fact, phenol alone produces only a light peel which is ineffective for restructuring the deeper dermal structures (such as wrinkles). The term Phenol/Croton oil peel has been proposed as a more accurate descriptor, but the established terminology phenol peel continues to be of dominant usage, as the role of croton oil in the mix is not as widely understood. Effects of a phenol chemical peel are long lasting, and in some cases are still readily apparent up to 20 years following the procedure. Improvements in the patient’s skin can be quite dramatic. A single treatment usually achieves the desired result.

Phenol peels are used to:

• correct blotches caused by sun exposure or aging
• smooth out coarse deep wrinkles
• remove precancerous growths

Phenol peels may:

• pose a risk for patients with heart problems
• permanently remove facial freckles
• cause permanent skin lightening by reducing the ability to produce pigment
• take several months to heal
• require increased protection from the sun for life

Anesthesia

Light chemical peels like AHA and glycolic acid peels are usually done in dermatologists’or plastic surgeons' offices. There is minimal discomfort so usually no anesthetic is given because the patient feels only a slight stinging when the solution is applied. If a patient were to request something for pain, an oral pain pill like Tylenol with codeine would be appropriate.[1] Medium peels like TCA are also performed in the doctor’s office or in an ambulatory surgery center as an outpatient procedure and are a bit more painful. Frequently, the combination of a tranquilizer like Valium and a pain pill usually suffice. TCA peels often do not require anesthesia because the solution itself has a numbing effect on the skin. The patient usually feels a warm or burning sensation. Phenol is the classic deep chemical peel. The application is very painful and most practitioners will perform it under either general anesthesia, administered by an MD-anesthesiologist or nurse anesthetist. Less often, the procedure is done using very heavy sedation, usually intravenous or intramuscular. But that approach is less desirable for several reasons including possible adverse influences of the phenol upon the heart.

Otoplasty

Otoplasty, is a cosmetic surgery to change the appearance of a person's external ears. Otoplasty can take many forms, such as bringing the ears closer to the head (often called ear pinning), reducing the size of very big ears, or reshaping various bends in the cartilage. Other reconstructive procedures deal with the deformed, or abscent-microtic ears. Otoplasty surgery can involve a combination of moving, reshaping, adding, or removing structural ear elements. This procedure is usually performed by either an oral and maxillofacial surgeon, plastic surgeon, or ENT surgeon. The pinna, or external ear, is made of a thin structural cartilage cover over with thin skin. Each of the various folds and structures of the pinna is named. Ear deformity results from distorted, damaged, or missing ear elements. Many otoplasties are performed not because of actual deformity, but because the individual is displeased with the shape of their ears.

How otoplasty ear surgery is performed

Anesthetic options depend on the problem to be treated and ability of the patient to cooperate and can include local anesthesia alone, local anesthesia with sedation, and under general anesthesia (which is generally the case for children). Most otoplasty surgery is performed as a outpatient surgery, some requires a hospital stay. The procedure can take from two to five hours depending on the problem. Incising one side of a flat cartilage piece leaves unopposed elastic forces on the other side and permits the shape to evolve over time. Thus, incising one side of the lop-ear cartilage along the new anti-helical fold may be one element of the surgery. This can be done through a small incision, or without an incision: an "Incisionless Otoplasty," where a needle is placed through the skin to model the cartilage and also to place the retention sutures.

For many ear operations, one or more incisions give access to the structures to be sculpted. The main, and often only incision, is behind the ear. Other possible incisions depend on what needs to be done. Through the incision behind the ear, the concha bowl can be moved closer to the head, a small tunnel created along the front of a poorly folded antihelix to weaken this cartilage, sutures placed to reshape the anti-helix fold, and to balance the ear lobe with the rest of the ear.

Ear reduction otoplasty may involve reducing one or more components of the ear. Incisions are typically hidden near folds in the front when a part of this surgery. Addressing Microtia (small ear deformity) or Anotia (missing ear deformity) involve augmentation or adding elements to replace deformed or missing structures. Cartilage from the ear or rib are the most common for these more extensive reconstructions. Other ear shapes may be changed through moving, adding, and weakening ear structures. Internal sutures often are permanent. The wound(s) are then closed with either dissolvable sutures or ones that are removed by a doctor after the wounds have healed. A bulky ear dressing protects the ear after surgery.

EYELID CORRECTION

Blepharoplasty

Blepharoplasty of an upper eyelid Blepharoplasty can be both a functional and cosmetic surgical procedure intended to reshape the upper eyelid or lower eyelid by the removal or repositioning of excess tissue as well as by reinforcement of surrounding muscles and tendons. When an advanced amount of upper eyelid skin is present, the skin may hang over the eyelashes and cause a loss of peripheral vision. The outer and upper parts of the visual field are most commonly affected and the condition may cause difficulty with activities such as driving or reading. In this circumstance, upper eyelid blepharoplasty is performed to improve peripheral vision. Patients with a less severe amount of excess skin may have a similar procedure performed for cosmetic reasons. Lower eyelid blepharoplasty is almost always done for cosmetic reasons, to improve puffy lower eyelid "bags" and reduce the wrinkling of skin. Blepharoplasty is performed through external incisions made along the natural skin lines of the eyelids, such as the creases of the upper lids and below the lashes of the lower lids, or from the inside surface of the lower eyelid. Initial swelling and bruising take one to two weeks to resolve but at least several months are needed until the final result becomes stable. Depending upon the scope of the procedure, the operation takes one to three hours to complete. The anatomy of the eyelids, patients' skin quality, patients' ages, and the adjacent bony and soft tissue all affect the cosmetic and functional outcomes after blepharoplasty. Factors which are known to cause complications after surgery include failure to recognize factors such as

• preexisting dry eyes - which may become exacerbated by disrupting the natural tear film
• laxity (looseness) of the lower lid margin (edge) - which predisposes to lower lid malposition
• prominence of the eye in relation to the malar (cheek) complex - which predisposes to lower lid malposition

The manner in which blepharoplasty surgery can alter a person's appearance is best appreciated by comparing before and after photos of surgical patients. An upper blepharoplasy in someone who is east Asian is termed Asian blepharoplasty or double eyelid surgery. It is the most popular form of cosmetic surgery among those of east and southeast Asian background.Due to anatomic differences between the Asian and occidental eyelid, about half of this population are born without a supratarsal eyelid crease and are called single-lidded. Surgery can be used to artificially create a crease above the eye. Transconjunctival blepharoplasty involves removing lower eyelid fat through an incision on the back of the eyelid, eliminating the need for an external incision. Because there is no external incision, excess skin can not be removed during the surgery, but skin resurfacing with a chemical peel or carbon dioxide laser may be performed simultaneously. This allows for a faster recovery process.

Non-Surgical blepheroplasty


This is a technique using injectable fillers like Restylane or Juvederm to replace volume in the tear trough area between the lower eyelid and the cheek. As we age, some of the fat in the upper central cheek area moves lower and shrinks. This gives a tired appearance to the face as a dark shadow falls into the concavity left behind by the fat loss. This is what we call dark circles under the eyes. Some people have more of a genetic predisposition to this happening than others, but it happens to most people at one point or another with age. Injecting Restylane or Juvederm into this area is very effective in correcting the tired appearance and eliminating most of these dark circles. The technique does not work for people who have much fat bulging inside the lower eyelid or if the indentations are severe. In the former case, blepharoplasty and fat repositioning is the indicated procedure, whereas in the second, fat transfer (fat injection) will fill in the lost volume. As newer, longer lasting and more effective injectable fillers have come on the market, non surgical alternatives to common cosmetic procedures have become possible. The Non Surgical Blepharoplasty takes 10 minutes to perform, is essentially painless (with some topical numbing cream) and results in little to no bruising. Most people can go back to work immediately. The effects last for 18 months or more. The unusually long duration of effect is probably due to collagen stimulation in the tear trough area, since Juvederm and Restylane usually last only 6 or 7 months when injected elsewhere.

This procedure should be performed with care and only by specialists with training in cosmetic procedures and in the anatomy of the eye area. The medi-spa at the mall is not a good place to have this procedure performed. After the first injection session, the doctor should want to see you again in two weeks or so to make sure no touch-ups are necessary. It is very common to have some swelling or bumpiness after Non Surgical Blepharoplasty. This can sometimes be massaged away by the doctor. If not, there is an enzyme available (hyaluronidase) that dissolves hyaluronic acid (Restylane and Juvederm). Injecting tiny amounts of that into the bulge should reduce it, without dissolving all of the material and losing the effect. Any doctor performing this procedure must be comfortable using hyaluronidase. This should be established during the consultation. If the doctor does not use it, you should move on.Swelling happens all the time and you should not risk having puffy eyes for two years just because your doctor is inexperienced.

Surgeries for Aging Face

As we grow older, different parts of our body and face start to sag. But, gravity alone is not the only factor for sagging, the other culprit being loss of the 'elasticity' and the 'tone' of the skin.

Surgical Face Lift

This is done to remove the excess of loose, sagging skin from the cheeks and neck. The incisions are made around, above and behind the ears. Skin is lifted from the cheeks and neck. The fascia over the muscles is tightened. Excess of the skin is removed and sutured in such a way that the stitch line is hidden within the hairline. The surgery involves either a local or a general anesthetic, and takes up to three hours. During the surgery, a cut is made from within the hairline at the temple to the top of the ear, round the front of the ear to the earlobe, and into the hairline round the back of the ear. Sometimes, a small cut is made under the chin to remove a double chin. The skin is gently separated from the underlying muscles of the face and any excess fat is removed. The skin is then lifted up and pulled back, with the excess trimmed off. The cut is then stitched closed. The face is dressed with bandages going all the way around the head, and a small plastic tube may be left in the wound for 24 hours for fluid drainage.

Non Surgical face lift

Wrinkle lines are infiltrated with dermal fillers to smoothen up the line & give a younger look.

Hair transplantation involves relocating (transplanting) bald resistant hair follicles from the back and sides of the head (the donor areas) to a person’s bald or thinning areas. The transplanted hair follicles will typically grow hair for a lifetime because they are genetically resistant to going bald. In recent years hair transplantation techniques have evolved from using large plugs and mini grafts to exclusively using large numbers of small grafts that contain from between 1 to 4 hairs.

Since hair naturally grows in follicles that contain groupings of 1 to 4 hairs, today’s most advanced techniques transplant these naturally occurring 1 – 4 hair "follicular units" in their natural groupings. Thus modern hair transplantation can achieve a natural appearance by mimicking nature hair for hair. This recent hair transplant procedure is called "Follicular Unit Transplantation." Given the improved naturalness of hair transplantation surgery hair loss sufferers are increasingly selecting this hair loss treatment

The procedure

At an initial consultation, the surgeon analyzes the patient's scalp, discusses his preferences and expectations, and advises him/her on the best approach (e.g.,single vs. multiple sessions) and what results might reasonably be expected. For several days prior to surgery the patient refrains from using any medicines, or alcohol, which might result in intraoperative bleeding and resultant poor "take" of the grafts. Pre-operative antibiotics are commonly prescribed to prevent wound or graft infections.

Post-operative care

Advances in wound care allow for semi-permeable dressings, which allow seepage of blood and tissue fluid, to be applied and changed at least daily. The vulnerable recipient area must be shielded from the sun, and shampooing is started two days after the surgery. Some surgeons will have you shampoo the day after surgery. Shampooing is important to prevent scabs from occurring around the hair shaft. Scabs adhere to the hair shaft and increase the risk of losing newly transplanted hair follicles during the first 7 to 10 days post-op.

During the first ten days, virtually all of the transplanted hairs, inevitably traumatized by their relocation, will fall out ("shock loss"). After two to three months new hair will begin to grow from the moved follicles. The patient's hair will grow normally, and continue to thicken through the next six to nine months. Any subsequent hair loss is likely to be only from untreated areas. Some patients elect to use medications to retard such loss, while others plan a subsequent transplant procedure to deal with this eventuality.

REMOVAL OF MOLE Most moles are harmless and don't need to be removed, but you do need to be aware that some forms of skin cancer can begin by looking like a mole. If you have a mole that has changed in any way-including size, colour, shape-or begins to bleed, see your doctor right away.

Moles (also called melanocytic or pigmented naevi) are areas of pigmented skin. Raised or flat, moles can be present from birth or can appear later in life. Most moles are harmless, but you may wish to have a mole removed for cosmetic reasons.

Sometimes a mole has to be removed because there is a risk it has become malignant (cancerous) or because it has become a nuisance (for example catching on clothes or a razor).

Various methods are used to remove moles. Raised moles can be treated with shave excision, where the mole is cut down to the level of the surrounding skin, either using a scalpel or electro-surgery. Flat moles or moles that are suspected to be malignant (cancerous) are cut out entirely and then the wound is closed up with stitches.

NOSE CORRECTION ( RHINOPLASTY)

Rhinoplasty

(Greek: Rhinos, "Nose" + Plassein, "to shape") is a surgical procedure which is usually performed by either an Otolaryngologist, Maxillofacial Surgeon, or Plastic Surgeon in order to improve the function (reconstructive surgery) and/or the appearance (cosmetic surgery) of a person's nose. Rhinoplasty is also commonly called a "nose reshaping" or "nose job". Rhinoplasty can be performed to meet aesthetic goals or for reconstructive purposes to correct trauma, birth defects or breathing problems. It can be combined with other surgical procedures such as chin augmentation to enhance the aesthetic results.

How rhinoplasty is performed

Patient, three days post-op. Procedures included dorsal bone reduction, re-setting and refinement of nasal tip cartilage. The typical orbital discoloration is also present due to trauma and disruption of blood vessels around the eyes. Also present is a splint. It can be performed under a general anesthetic or with local anesthetic. Incisions are made inside the nostrils (closed rhinoplasty). Sometimes, a tiny, inconspicuous incision is also made across the columella, the bit of skin that separates the nostrils (open rhinoplasty). The surgeon first separates soft tissues of the nose from the underlying structures, then reshapes the cartilage and bone. This is not a particularly painful procedure. Most people remain at home for a week. If there are external sutures, they are removed 4 to 5 days after surgery. The external cast is removed at one week. If there are internal stents, they are usually removed at one to two weeks. The periorbital bruising lasts two weeks. The swelling subsided over several months, the majority in the first one or two. Due to wound healing, there are minor and subtle shifting and settling of the nose over the first year.

In some cases, the surgeon may shape a small piece of the patient's own cartilage or bone to strengthen or change the structure of the nose. Usually the cartilage is harvested from the septum although if there isn't enough which can often occur in revision rhinoplasty, cartilage can be taken from the concha of the ear or rarely the ribs. In the rare case, again usually revision rhinoplasty, where bone is required, it is harvested from the cranium or ribs. Sometimes a synthetic implant may be used to reconstruct the nose. This is most common when agmenting the bridge of Asian noses. To improve nasal breathing function, a septoplasty may also be performed. If there is turbinate hypertrophy, an inferior turbinectomy can be done. There are several complications that can arise in rhinoplasty, although it is usually considered to be safe and successful. Post operative bleeding is uncommon and often resolves without needing treatment. Infection is rare and can occasionally progress to an abscess that requires surgical drainage under general anesthetic. Adhesions, which are scars that form to bridge across the nasal cavity from the septum to the turbinates, are also rare but cause nasal obstruction to breathing and usually need to be cut away. A hole can be inadvertently made at the time of surgery in the septum, called a septal perforation. This can cause chronic nose bleeding, crusting, difficult breathing and whistling with breathing.

If too much of the underlying structure of the nose (cartilage and/or bone) is removed, this can cause the overlying nasal skin to have little shape resulting in a 'polly beak' deformity. Likewise if the septum is not supported, the bridge of the nose can sink resulting in a "saddle nose" deformity. The tip of the nose can be over rotated causing the nostrils to be too visible and creating a 'miss piggy' look. If the cartilages of the tip of the nose are over resected, this can cause a pinched look to the tip. If an incision is made across the collumella (open approach rhinoplasty) there can be variable degree of numbness to the nose that may take months to resolve.

In the entertainment industry

"Having one's nose shaped to fit the talkies is the most popular thing in Hollywood now. Hollywood plastic surgeons agree that more than 2000 facial beautification operations have been performed among film players within the past few years." Siblings Michael, Janet and La Toya Jackson's are among the most prominent rhinoplasties in show business with a dramatic reduction of nose size and change of shape. Like many starlets, a young Marilyn Monroe had work carried out on her nose before her first film roles at the advice of her mentor Johnny Hyde. Jennifer Grey is another famous movie star whose looks transformed completely after a nose job. It should be noted that there is some controversy as to whether Monroe ever had a rhinoplasty. Her friend and biograher James Haspiel has stated "Monroe never had a nose job" , although according to him she did have some modifications made to her chin. If this is true then the differences in size that have been observed in various pictures may be explained by the length of the lens used by the photographer.

Ethnic rhinoplasty

Many individuals of African or East Asian descent, and others with non-European looking noses, choose to have an aesthetic rhinoplasty. Although techniques and methods employed during rhinoplasty surgeries are the same regardless of race, there are some trends that apply to patients of certain ethnic backgrounds. East Asian patients often want their noses to appear narrower. This can be done through the use of infractures, where the nasal bones are broken and moved in or reset to thin out the nasal area and add projection in the process. Outfractures, where the nasal bones are broken and moved outwards, are used to widen a too-narrow dorsum. East Asian patients typically seek augmentation (adding material) of the bridge of their nose which will make the nose appear narrower as well. In Asia, patients typically use a variety of alloplastic implants including Gore-Tex, Med-Por, or silicone. Due to the risks of alloplastic materials, natural materials to the bridge of the nose, such as rib cartilage (costal cartilage) or ear cartilage (auricular cartilage) are being used more commonly. Patients of African descent commonly seek narrowing of wide nostrils. This procedure may include removing sections of the base of the nostrils or sections of the nose where it meets the face. The tip of the nose can be restructured by removing tiny sections of cartilage to give the nose more shape, or even adding cartilage to provide additional structure to the nasal tip.

Revision rhinoplasty

Revision rhinoplasty is a nose operation carried out to correct or revise an unsatisfactory outcome from a previous rhinoplasty. It is also known as secondary rhinoplasty. Occasionally there can be a third or even more surgeries. An unsatisfactory outcome occurs from 5 to 20% of rhinoplasties. There are two main reasons for performing secondary rhinoplasty. The first is purely cosmetic. A patient may be unsatisfied with all or part of a previous "nose reshaping”. A nasal fracture may not have been reduced enough, or too much. A prominent or bulbous nasal tip may have not been addressed appropriately, or over-aggressively. The nose may looked pinched, it may look like a parrot’s beak, or like a boxer’s nose. There are many ways in which previous nose surgery may have left a nose aesthetically unappealing to a patient. The second reason is functional. The original nasal surgery may have been carried out to help with difficulties in breathing, and the outcome may have been unsatisfactory. Alternatively, the original surgery may have been performed for cosmetic reasons, but may have disrupted a normal physiologic mechanism involving the inspiration or expiration of air, making it difficult to breathe. Secondary rhinoplasty, and especially tertiary rhinoplasty, are extremely complicated procedures. This is self-evident because it is clear that even when the patient was operated upon for the first time, even when the tissues were “virginal,” and untouched the desired result could not be obtained.

Non-surgical rhinoplasty

Non-surgical rhinoplasty refers to a procedure in which fillers are used to alter and shape a person's nose without invasive surgery. This procedure has been performed by doctors since 2003. By filling in depressed areas, lifting the angle of the tip or smoothing the appearance of bumps on the bridge of the nose, it can create a symmetrical nose that goes in harmony with the rest of a person's face, creating a better balance, and give the appearance of a smaller nose. Although the procedure is usually performed for aesthetic purposes, it can also be used to correct some birth defects. Because the procedure is not invasive, the bruising and swelling are minimal. Duration of results depends on the type of filler used. Radiesse (calcium hydroxyapatite) lasts for 8 to 12 months and this is the filler that is ideal. Hyaluronic acid fillers usually last for 5-6 months. Artefill, a permanent filler was recently approved by the FDA.

Burns are devastating injuries that have the potential to kill, maim, and cause great pain.

First and superficial second degree burns are partial thickness burns which may heal without skin grafting as there is still healthy skin at the bottom of the burn to heal the skin from the bottom up. Full thickness or 3rd degree burns and deep 2nd degree burns most often require surgery in the form of skin graft to restore skin coverage.

Patients who burn large parts of their body will often need more than one trip to the operating room for the plastic surgeon to remove the nonviable skin and replace it with skin grafts.

When people are burned across joints, the burns may heal by tightening the skin and restricting joint movement. This is called joint contracture. Joint contracture occurs quite frequently in poorer countries Plastic surgeons are often called upon to provide reconstruction after burn injuries even when skin grafting is available and performed. Combinations of skin flaps and grafts are used to provide additional skin when it is required. where skin grafting is not available.