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Endoscopic Nose Surgery: A Plastic Surgeon’s Guide

Endoscopic nose surgery, also known as endoscopic rhinoplasty, is a procedure used to correct nasal deformities and improve nasal function. This surgical technique uses an endoscope, a thin tube with a camera and light, allowing the surgeon to perform adjustments with smaller incisions. Endoscopic nose surgery is often chosen because it may result in less scarring and shorter recovery times compared to traditional open rhinoplasty. This guide provides an overview of endoscopic nose surgery, including its indications, procedural details, recovery process, and potential risks.

What is Endoscopic Nose Surgery?

Endoscopic nose surgery, or endoscopic rhinoplasty, is a surgical procedure that uses an endoscope to perform modifications on the nasal structure. The endoscope is a thin, flexible tube equipped with a camera and light, allowing the surgeon to see inside the nasal passages and make accurate adjustments. This method involves making smaller incisions compared to traditional rhinoplasty, which can result in less visible scarring. The primary objectives of endoscopic nose surgery are to correct nasal deformities, improve nasal function, and address both cosmetic and medical issues related to the nose.

Indications for Endoscopic Nose Surgery

Cosmetic Reasons

Endoscopic nose surgery is often performed for cosmetic reasons. Individuals may choose this procedure to change the shape, size, or proportions of their nose to improve facial balance. Common cosmetic goals include reducing a nasal hump, refining the nasal tip, and narrowing the nasal bridge.

Functional Reasons

Functional reasons for endoscopic nose surgery include improving nasal breathing and correcting structural issues that obstruct airflow. Conditions such as a deviated septum, nasal valve collapse, or enlarged turbinates can be addressed through this procedure to enhance nasal function.

Medical Indications

Medical indications for endoscopic nose surgery involve correcting issues caused by trauma, congenital defects, or chronic medical conditions. For instance, patients with nasal fractures, cleft palate-related nasal deformities, or chronic sinusitis that affects nasal structure may benefit from this surgery. The procedure can help restore normal function and alleviate symptoms associated with these conditions.

The Endoscopic Nose Surgery Procedure

Pre-Surgical Consultation

Before undergoing endoscopic nose surgery, patients have a pre-surgical consultation with their surgeon. During this consultation, the surgeon reviews the patient’s medical history, discusses their goals and concerns, and examines the nasal structure. The surgeon also explains the procedure, potential risks, and expected outcomes, addressing any questions the patient may have.

Preparation for Surgery

Preparation for endoscopic nose surgery involves several steps. Patients may be advised to avoid certain medications, stop smoking, and arrange for post-operative care and transportation. Pre-operative instructions often include guidelines on eating and drinking before the surgery. Blood tests and other evaluations may be conducted to ensure that the patient is fit for surgery.

Surgical Procedure

The endoscopic nose surgery procedure follows a step-wise approach:

  1. Anaesthesia Administration: The procedure begins with the administration of anaesthesia. This can be either local anaesthesia with sedation or general anaesthesia, depending on the patient’s needs and the surgeon’s recommendation.
  2. Making Incisions: The surgeon makes small incisions inside the nostrils or at the base of the nose to minimise visible scarring.
  3. Inserting the Endoscope: An endoscope, a thin tube with a camera and light, is inserted through one of the incisions. The endoscope allows the surgeon to view the internal nasal structures on a monitor.
  4. Reshaping the Nasal Structures: Using specialised surgical instruments inserted through the incisions, the surgeon reshapes the nasal bones and cartilage to achieve the planned outcome. This may involve removing or repositioning tissue to correct deformities or improve function.
  5. Closing the Incisions: The incisions are closed with sutures. Because the incisions are small and often placed inside the nostrils, visible scarring is generally minimal.
  6. Applying Dressings and Splints: Dressings or splints may be applied to support the new nasal structure and protect the surgical area during the initial healing process. Patients will be instructed on how to care for these dressings at home.

Post-Surgical Care

After endoscopic nose surgery, patients are monitored in a recovery area for a few hours before being discharged. Swelling, bruising, and mild discomfort around the nose and facial area are common. Patients receive instructions on how to care for the surgical sites, including cleaning the incisions and applying any prescribed ointments or medications.

Recovery Process

Immediate Post-Surgery

Patients may experience swelling, bruising, and mild discomfort around the nose and facial area. Keeping the head elevated helps to reduce swelling and avoid pressure on the nose.

Short-Term Recovery

During the first week of recovery, patients should avoid strenuous activities and heavy lifting to reduce the risk of complications. Cold compresses can be applied to reduce swelling and bruising. Follow-up appointments are usually scheduled to monitor the healing process and remove any splints or sutures. Most patients can return to work and light activities within 1 to 2 weeks, although some residual swelling and bruising may persist for several weeks.

Long-Term Results

Long-term results of endoscopic nose surgery become more apparent as swelling continues to decrease. It can take several months to a year for the final outcome to be fully visible. Patients are advised to follow their surgeon’s recommendations for maintaining results, which may include avoiding direct sun exposure and adhering to a skincare routine. Attending all follow-up appointments is also important to ensure proper healing and address any concerns.

Managing Post-Surgical Issues

Follow your surgeon’s post-operative care instructions to reduce the risk of complications. Any unusual symptoms, such as severe pain, signs of infection, or excessive swelling, should be reported to the surgeon promptly. Follow-up appointments are necessary for monitoring the healing process and addressing any concerns.

Conclusion

Endoscopic nose surgery, or endoscopic rhinoplasty, is a procedure used to correct nasal deformities and improve nasal function with smaller incisions compared to traditional methods. It is chosen for both cosmetic and medical reasons, ranging from reshaping the nose to improving breathing issues. The procedure involves careful pre-surgical planning, accurate surgical techniques, and thorough post-surgical care to ensure appropriate recovery and results. While the surgery offers benefits such as less visible scarring and shorter recovery times, it also carries risks and potential complications. Patients should have detailed discussions with their surgeons to fully understand the procedure, the recovery process, and the potential outcomes. Proper follow-up and adherence to post-operative care instructions are important for a successful recovery and achieving the desired results.

Endoscopic Brow Lift: A Plastic Surgeon’s Guide

An endoscopic brow lift is a surgical procedure to elevate the brow and reduce wrinkles. This technique uses an endoscope, a small camera device, allowing the surgeon to make smaller incisions compared to traditional brow lift methods. The procedure aims to result in less scarring and a shorter recovery time. This guide provides an overview of the endoscopic brow lift, including its indications, procedure details, recovery process, and potential risks.

What is an Endoscopic Brow Lift?

An endoscopic brow lift is a cosmetic surgical procedure intended to elevate the position of the brow and smooth forehead wrinkles. The procedure uses an endoscope, a thin tube with a camera and light, inserted through small incisions made in the scalp. This method allows the surgeon to view and adjust the underlying tissues and muscles. Compared to traditional brow lift techniques, the endoscopic approach is less invasive, using smaller incisions. The primary goal is to lift sagging brows and reduce the appearance of forehead lines and wrinkles. This procedure is chosen by individuals seeking to address signs of ageing or those with naturally low or sagging brows.

Indications for Endoscopic Brow Lift

Cosmetic Reasons

An endoscopic brow lift is usually performed for cosmetic reasons. Individuals may choose this procedure to achieve a more youthful appearance by elevating drooping brows and reducing forehead wrinkles. This can address aesthetic concerns related to the brow and forehead area.

Age-Related Changes

As people age, the skin and tissues around the brow and forehead can lose elasticity, leading to sagging and the development of wrinkles. An endoscopic brow lift can address these age-related changes by lifting the brow and smoothing out wrinkles.

Medical Indications

In some cases, an endoscopic brow lift may be indicated for medical reasons. For instance, individuals with brow ptosis, a condition where the brow droops significantly and impairs vision, may benefit from this procedure. By lifting the brow, the procedure can improve the field of vision and reduce discomfort caused by sagging brows.

 

The Endoscopic Brow Lift Procedure

Pre-Surgery Consultation

Before undergoing an endoscopic brow lift, patients have a pre-surgery consultation with their surgeon. During this consultation, the surgeon reviews the patient’s medical history, discusses their aesthetic goals, and examines the brow and forehead area. The surgeon also explains the procedure, potential risks, and expected outcomes, addressing any questions the patient may have.

Preparation for Surgery

Preparation involves several steps. Patients may be advised to avoid certain medications, stop smoking, and arrange for post-operative care and transportation. Pre-operative instructions often include guidelines on eating and drinking before the surgery. Blood tests and other pre-surgical evaluations may be conducted to ensure the patient is fit for surgery.

Surgical Procedure

The endoscopic brow lift procedure follows a step-wise approach. Here is an overview of the steps involved:

 

  1. Anaesthesia Administration: The procedure begins with the administration of anaesthesia. This can be either local anaesthesia with sedation or general anaesthesia, depending on the patient’s needs and the surgeon’s recommendation.
  2. Making Incisions: The surgeon makes several small incisions, typically 3 to 5, within the hairline to reduce visible scarring. These incisions are usually less than an inch in length.
  3. Inserting the Endoscope: An endoscope, which is a thin tube with a camera and light at the end, is inserted through one of the incisions. The endoscope allows the surgeon to view the underlying tissues and structures on a monitor.
  4. Lifting and Repositioning the Brow Tissue: Using surgical instruments inserted through the other incisions, the surgeon lifts and repositions the brow tissue. The underlying muscles and skin are adjusted to achieve the desired elevation and contour of the brow.
  5. Securing the Brow in Place: The repositioned brow is secured in its new position using sutures or fixation devices. This maintains the brow’s new shape and position during the healing process.
  6. Closing the Incisions: The incisions are closed with sutures or staples. The small size of the incisions typically results in minimal scarring, which is hidden within the hairline.
  7. Applying Dressings: Dressings or bandages may be applied to protect the incisions and reduce swelling. Patients are given instructions on how to care for these dressings at home.

Post-Surgical Care

After the endoscopic brow lift procedure, patients are monitored in a recovery area for a few hours before discharge. Swelling, bruising, and mild discomfort around the forehead and brow area are common. Patients receive instructions on caring for the surgical sites, including cleaning the incisions and applying any prescribed ointments or medications.

Recovery Process

Immediate Post-Surgery

After the endoscopic brow lift procedure, it is common to experience swelling, bruising, and mild discomfort around the forehead and brow area. Patients are typically given instructions on how to care for the surgical sites, including how to clean the incisions and apply any prescribed ointments or medications.

Short-Term Recovery

During the first week of recovery, patients may need to keep their head elevated and apply cold compresses to reduce swelling. Strenuous activities and heavy lifting should be avoided to prevent complications. Follow-up appointments are usually scheduled to monitor the healing process and remove any stitches or staples. Most patients can return to work and normal activities within 10 to 14 days, although some residual swelling and bruising may persist for a few weeks.

Long-Term Results

Long-term results of an endoscopic brow lift become more apparent as swelling and bruising subside. It can take several months for the final outcome to be visible. Patients are advised to follow their surgeon’s recommendations for maintaining results, which may include protecting the skin from excessive sun exposure and following a regular skincare routine.

Managing Post-Surgical Issues

It is important for patients to follow their surgeon’s post-operative care instructions to reduce the risk of complications. Any unusual symptoms, such as severe pain, signs of infection, or excessive swelling, should be reported to the surgeon promptly. Follow-up appointments are crucial for monitoring the healing process and addressing any concerns that may arise.

Conclusion

An endoscopic brow lift is a procedure that alters the position of the brow and reduces forehead wrinkles. In Singapore, this procedure involves a series of steps, including pre-surgical consultations, preparation, and post-surgical care. While the procedure can provide aesthetic improvements, it is important to be aware of the potential risks and complications. Patients should have thorough discussions with their surgeons to understand the procedure, recovery process, and expected outcomes.

 

Dermal Fillers: What You Need To Know

Introduction

Dermal fillers are injectable treatments used to restore volume, smooth lines, and enhance facial contours. They can provide quick results with minimal recovery time. Understanding the different types of dermal fillers, their uses, and potential risks is important before considering treatment. This knowledge helps individuals make informed decisions and achieve their desired outcomes.

What are Dermal Fillers?

Dermal fillers are substances injected into the skin to fill in wrinkles, add volume, and enhance facial features. They are commonly used to treat areas such as the cheeks, lips, nasolabial folds (smile lines), and under the eyes. The primary purpose of dermal fillers is to rejuvenate the skin and improve its appearance.

Common Areas Treated with Dermal Fillers

Dermal fillers can be used on various parts of the face and body to address different cosmetic concerns. 

  • Cheeks: To restore volume and lift, giving the face a more youthful contour.
  • Lips: To add fullness, shape, and improve symmetry.
  • Nasolabial folds: To smooth out deep creases extending from the nose to the corners of the mouth.
  • Under the eyes: To reduce the appearance of hollows and dark circles.
  • Jawline and chin: To enhance definition, balance facial proportions, and create a more structured appearance.
  • Marionette lines: To fill in lines that run from the corners of the mouth down to the chin.
  • Temples: To add volume to hollowed temples, improving overall facial balance.
  • Hands: To improve the appearance of ageing hands by adding volume and reducing the visibility of veins and tendons.

Types of Dermal Fillers

Hyaluronic Acid Fillers

Hyaluronic acid fillers are the most commonly used type of dermal filler. They are known for their ability to retain moisture and provide a natural result. Common brands include Juvederm and Restylane. These fillers are often used for soft tissue augmentation, including lips and cheeks.

Calcium Hydroxylapatite Fillers

Calcium hydroxylapatite fillers, such as Radiesse, provide structure and stimulate collagen production. They are often used for deeper lines and to enhance volume in areas like the cheeks and jawline. This type of filler is thicker and lasts longer compared to hyaluronic acid fillers.

Poly-L-lactic Acid Fillers

Poly-L-lactic acid fillers, like Sculptra, work by stimulating collagen production over time. They are typically used for overall facial volume restoration and require a series of treatments for gradual results. These fillers are biodegradable.

Polymethylmethacrylate (PMMA) Fillers

PMMA fillers, such as Bellafill, contain tiny beads that provide long-lasting support under the skin. They are used for deeper wrinkles and acne scars. PMMA is a semi-permanent filler, offering longer-lasting results compared to other types.

Autologous Fat Injections (Fat Grafting)

Fat grafting involves using the patient’s own fat, harvested from another part of the body, to add volume and enhance facial features. This method uses natural tissue but requires a more invasive procedure. The results can be long-lasting, but the process involves both liposuction and injection.

How Dermal Fillers Work?

Dermal fillers work by injecting a gel-like substance beneath the skin to add volume, smooth wrinkles, and enhance facial contours. The effects of dermal fillers can vary in duration, depending on the type of filler used. Hyaluronic acid fillers typically last 6 to 18 months, while other fillers like PMMA and autologous fat injections can provide longer-lasting results. The fillers act as a supportive structure to fill in areas where volume is lost due to ageing or other factors.

The Procedure

What to Expect During the Consultation?

During the consultation, the surgeon will assess the patient’s facial structure, discuss their goals, and recommend the most suitable type of dermal filler. They will also explain the procedure, potential risks, and expected outcomes. A personalised treatment plan will be created based on the patient’s needs and desired results.

The Treatment Process Step-by-Step

  1. Preparation: The treatment area is cleaned, and a topical anaesthetic may be applied to minimise discomfort.
  2. Injection: The filler is injected into the targeted areas using a fine needle or cannula.
  3. Massage: The surgeon may massage the treated areas to ensure even distribution of the filler.
  4. Evaluation: The results are assessed, and any additional filler may be injected if needed.

Aftercare and Recovery

Post-procedure care includes avoiding strenuous activities, excessive sun exposure, and touching the treated areas for a few days. Mild swelling, redness, and bruising are common but usually resolve within a week. Following the surgeon’s aftercare instructions is important for good results. Applying ice packs can help reduce swelling and discomfort.

Risks and Side Effects

Common Side Effects

Common side effects are usually mild and temporary. They can occur immediately after the procedure and generally resolve within a few days to a week.

  • Swelling: Mild to moderate swelling at the injection site is common and typically subsides within a few days.
  • Redness: Temporary redness may occur immediately after the procedure but usually fades quickly.
  • Bruising: Bruising at the injection site is a common side effect and can last up to a week.
  • Pain at the injection site: Some discomfort or tenderness at the injection site is normal and should diminish within a few days.

Rare but Serious Complications

Although rare, some serious complications can arise from dermal filler treatments. These require prompt medical attention.

  • Infection: Infections can occur at the injection site or within the skin. Symptoms include increased redness, swelling, and pain.
  • Allergic reactions: Some patients may have allergic reactions to the filler material, which can cause itching, redness, and swelling.
  • Granulomas: Small lumps can form under the skin, which may require treatment to dissolve or remove.
  • Vascular occlusion: If the filler is inadvertently injected into a blood vessel, it can block blood flow and cause tissue damage, potentially leading to skin necrosis.

How to Minimise Risks?

To minimise risks, it is important to choose a qualified and experienced surgeon, follow pre- and post-procedure instructions, and report any unusual symptoms to the surgeon promptly. Ensuring that the procedure is done in a sterile environment also reduces the risk of complications.

Conclusion

Dermal fillers offer a versatile solution for enhancing facial features and addressing signs of ageing. Understanding the different types of fillers, their applications, and potential risks can help individuals make informed decisions about their treatment. Consulting with a qualified surgeon is important to achieve safe and satisfactory results.

 

Types of Rhinoplasty: A Comprehensive Guide

Introduction

Rhinoplasty, or nose surgery, is a procedure to alter the nose’s structure. It addresses both aesthetic preferences and functional issues, such as breathing difficulties. Different types of rhinoplasty are tailored to specific needs, making it important to understand each one. This knowledge helps in choosing the appropriate procedure based on individual goals, anatomical considerations, and medical history.

What is A Rhinoplasty?

Rhinoplasty is a surgical procedure that modifies the shape, size, or functionality of the nose. It serves both cosmetic and medical purposes. Cosmetically, rhinoplasty can change the nose’s appearance by altering its profile, width, or tip shape. Medically, it can correct structural issues that impair breathing, such as a deviated septum or nasal deformities resulting from trauma or congenital conditions.

Types of Rhinoplasty

Open Rhinoplasty

Open rhinoplasty involves making a small incision on the columella, the soft tissue separating the nostrils, along with additional internal incisions. This approach allows the surgeon greater visibility and access to the nasal structures, making it suitable for complex reshaping tasks, such as significant structural alterations, correction of asymmetry, and extensive tip work. The resulting scar is usually small and becomes less noticeable over time.

Closed Rhinoplasty

Closed rhinoplasty, also known as endonasal rhinoplasty, involves incisions made entirely within the nostrils, leaving no external scars. This technique is generally used for less extensive nasal reshaping.

The surgeon works through these internal incisions to make the necessary adjustments to the bone and cartilage. Closed rhinoplasty typically involves a shorter operative time, less swelling, and a shorter recovery period compared to open rhinoplasty.

Revision Rhinoplasty

Revision rhinoplasty is performed to address issues that arise from previous rhinoplasty procedures. These issues may include unresolved cosmetic concerns, breathing difficulties, or complications such as scarring or asymmetry.

Revision rhinoplasty can be more complex than primary rhinoplasty due to the presence of scar tissue and altered nasal anatomy. It requires a surgeon to manage these challenges and improve the results.

Filler Rhinoplasty (Non-Surgical Rhinoplasty)

Filler rhinoplasty uses injectable dermal fillers, such as hyaluronic acid, to temporarily alter the shape of the nose. This non-surgical approach can address minor cosmetic concerns like smoothing out small bumps, enhancing the nasal tip, or correcting asymmetry.

Filler rhinoplasty offers immediate results with minimal downtime, although the effects typically last six months to a year. This option is typically more suitable for individuals seeking subtle changes without undergoing surgery.

Conclusion

Rhinoplasty encompasses various techniques to address both aesthetic and functional nasal concerns. Understanding the differences between these techniques and consulting with a surgeon are key steps in making an informed decision. This approach ensures that patients choose the most suitable procedure for their needs, leading to satisfactory outcomes.

Considering reshaping your nose? Contact us today to schedule a consultation with Dr. Marco and discover the personalized treatment plan that’s right for you.

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