I wanted to start off by asking you Dr. Richards what Rhinoplasty is. Well Rhinoplasty is the changing of somebody’s nose. It’s as simple as that. And in what shape or form are we talking about when we say changing one’s nose? Well sometimes the nose is too small proportionally for the face, sometimes it’s too large. Sometimes there is just one area that may be aesthetically unattractive. There’s different approaches that can be used for Rhinoplasty. You can do a closed Rhinoplasty meaning all the incisions are inside the nose or you can do an open Rhinoplasty where most of the incisions are inside the nose but there’s one incision on the outside right about here, and you use that incision to lift the skin up off the nose to work on the structures directly. That’s called an open Rhinoplasty. Closed Rhinoplasty has been around for centuries. Open Rhinoplasty was really popularized perhaps about 10-15 years ago.
Can you please begin by telling us what the cheek lift is for those of us who may not know? Well quite simply the cheek lift is the most powerful method of rejuvenating the face with the shortest recovery, the shortest amount of surgery. And what exactly does a cheek lift do to one’s face? Cheek lift concentrates on the mid face area, the lower eyelids and the cheeks. As we age, it could be in our 30s or 40s, our cheeks tend to drift downwards. They drift downwards and into the mouth. It causes down turning of the mouth, an unhappy look, and lengthening of your lower lids. They get longer and longer. And how long has this been available? Well technically cheek lifts have been available as long as we’ve had cheeks but as far as the real plastic surgery procedure I would say we started focusing on it in the late 80s, early 90s. But it wasn’t until maybe the mid or late 90s that the procedure that I currently use was described and really has become popularized.
Who is a typical candidate for the cheek lift procedure? I’ll tell you, this is just amazing to me. The longer I do them the wider the audience I think that it’s applicable to. I’ve done people as young as in their early 30s, and I’ve applied it to people in their 70s. Ideally I like to do this procedure before the entire face needs to be rejuvenated. I certainly can do it and often do it as part of face lift and brow lift and eyelids and neck lift, etc., but it’s really a wonderful thing to do to somebody in their 30s or 40s or even early 50s before other areas of the face start to age.
The first patient that we’re looking at is a woman in her 20s who came to me and as you can see from the picture on the left she has a curvature to her nose, she has excessive width of her dorsum, the boning part of the nose, and she has some fullness of the nasal tip. On the right hand picture you can see that the nose is slightly narrowed. The nasal tip is natural but more defined. On the ¾ view you can see how before surgery the nasal tip not only didn’t have the cartilage definition but actually stuck out a bit. The top of the nose is flattened and wide. You can see the light reflections over the bones that were spread apart at the top, that’s just the way she was. And the after shot on the right, you can see the nasal dorsum is a smooth curve with an even light reflection coming right down the center of the nose where it should be. The nasal tip is slightly more rounded but more delicate at the same time. And the nasal tip is elevated ever so slightly. And finally on her side view you can see quite a change. Remember earlier I was discussing how you can have an indent up by the bridge of your nose that makes a hump look larger. I actually took down her nasal bones just a very tiny bit even though on the side view here it looks like she has a hump. What I did though is I filled in the indent with some cartilage, and you can see how it makes the nose look smaller even though I in fact added something to it.
The first patient that we’re showing is a woman in her early 50s. We have a front view where you can see the length of the lower eyelids on the left and the shortening of the lower eyelids after the cheek lift on the right. On the ¾ view you can see how the cheek is flattened, the right cheek is flattened. On the right hand side you can see after the cheek lift the natural curve that’s restored there. And finally on the side view you can appreciate the flatness of the cheek on the left-hand side. When you look at the right-hand picture you can see how the cheek is swept upwards and has a light reflection on it. It’s a reflection of beauty and youth. Second patient is approximately 40. Picture on the left shows a tired, somewhat perhaps unhappy looking person even though she is not unhappy at all. On the right side she looks more like she’s in her 30s, happy, the eyelids are shortened, they’re smoother. On the ¾ view you can see on the picture on the left how the cheek is flattened and on the right how there’s some prominence and some light reflection and again the eyelids have been shortened considerably. And finally on the side view you can see that some neck work was done as well however the enhancement of the cheek exposes more of the lip and again raises the light reflection and gives her some prominence of the cheek that is symbolic of youth and happiness. The third patient is in her 40s but has tremendous issues going on with the lower eyelids and the cheek area. You can see that on front view on the left, and on the right hand picture the cheeks are up, the eyelids are much shortened, she has a happy expression, really reflecting how she feels inside. On the ¾ shot again you can see the pouching by the mouth, the downturn of the lips in the corner. On the left side and on the right side the mouth when she’s at rest is at a neutral expression, it’s not unhappy, and you can see the prominence of the cheeks. Again with her on the side view you can see the prominence of the lateral side of the cheek, the outside part of the cheek, being brought up.
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