Fractures of the nasal bones are the most common fractures in the face. In the body, nasal fractures rank third after fractures of the collar bone (clavicle) and wrist. In general, fractures of the nose occur after injury sustained from a lateral (from the side) blow to the nose. Some occur from a straight frontal force, and rarely, fractures occur from a force from below or above. Fractures of the nose may involve bone along the bridge or back of the septum (wall in between the two sides of the nose), the cartilage of the bridge and septum, and rarely the cartilage of the tip or sidewalls of the nose. Most fractures of the nose are sustained in young individuals, and many are sustained during participation in sports.
When a nasal fracture occurs there is generally a loud noise, bleeding, bruising, and a significant amount of swelling that occurs both on the outside and inside of the nose. Although fractures should be evaluated as soon as possible after the injury is sustained, the treatment may not always be possible in the immediate phases due to swelling. Evaluation of the injury includes direct examination of the bones by feeling the integrity and shape of the bones, and internal examination to evaluate the septum for deviation. X-rays and CT (CAT) scans may be helpful in some cases, but are generally not considered specific enough for minor or simple fractures.
Septal fractures can occasionally lead to an emergent complication called a septal hematoma, or a blood clot that forms in the tissues of the wall in between the two sides of the nose. If a septal hematoma is not recognized or treated in a timely fashion, the blood flow to the mucus membrane and cartilage of the septum may be compromised. This compromise in blood flow may lead to a perforation, or hole in the septum. Septal perforation is a fairly common complication of nasal trauma that may lead to severe crusting, noisy breathing, and occasionally to nasal deformities of the external appearance that are difficlut to correct. Thus, septal hematomas should be detected early and drained promptly to avoid these complications.
Treatment of simple nasal fractures may easily be conducted in an office setting or in an operating room when sedation or general anesthesia is required. In general, numbing medicines are injected and fractured bones and cartilages are moved into their proper positions to allow appropriate healing of these skeletal structures. A splint may be applied to the bridge, and occasionally to the septum. Packing may be necessary in the event of a septal hematoma or heavy bleeding. The bones generally are "set" and begin to stabilize by about 7-10 days in adults and 4-5 days in children.
During the first few hours after injury, the swelling that appears externally may prevent your doctor from being able to preciscely replace the bones in their pre-injury position for propper healing. Thus, if you see a doctor after 2-3 hours of the injury, he/she may defer the initial treatment of the fracture for 2-4 days in expectation of some decrease in swelling that would enable you to have the best possible overall result.
Delayed repair of nasal fractures that have remained untreated, or healed inappropriately currently accounts for approximately twenty percent of my practice. Many of these patients have sustained injury in their childhood that have later led to problems with breathing and external deformites. In these cases, surgical correction is required to repair changes in the structure of the nose inculding cartilage and bone. The repair of bony structural defects usually requires re-fracture of the bones and stabilization of the bones using a splint. The cartilagenous components including the septum, sidewalls, and bridge may require alterations in the connections of these cartilages to eachother, and to the bony components with internal stabilization using internal stitches. The goals of these operations include improvement of nasal airflow, and restoration of propper form of the nose. These often go hand-in-hand, and may partially be covered by insurance when appropriate.
Recovery is considered speedy and usually with only a few days of pain. Most patients are able to return to school or work within one week. Breathing slowly improves within one month as internal swelling improves. External appearance generally improves slowly over the course of one year. The greatest decrease in swelling is seen within the first 6 weeks, then slowly thereafter for the next 10 1/2 months.
Wednesday, October 29, 2008
Sunday, November 4, 2007
Better than BOTOX - or not?
It seems that you cant go anywhere without seeing a sign that reads "Better Than BOTOX" promoting some type of topical (applied to the surface) skin cream. The first product to be marketed with this ingenious tag line is Strivectin. Strivectin is a skin cream made with plant derived extracts that may or may not help your skin look more youthful. The product was originally designed for treatment of stretch marks related to pregnancy or rapid weight gain.
Recently, I saw a booth at a local mall in near Beverly Hills with a sign reading the same text - "Better than BOTOX!" promoting another skin cream. I immediately had the same thoughts cross my mind as the first time I saw these words.
"They can't say that!" I thought.
Here is why. In order to compare the type of products being called "better than BOTOX" to BOTOX itself you must first understand BOTOX.
BOTOX is a trade name registered to Allergan Inc. based in Irvine, CA. The BOTOX product comes in cosmetic and therapeutic formulations. BOTOX is a toxin that has long been known to cause paralysis if ingested in foods (canned foods or honey) contaminated by a bacterium called Clostridium Botulinum. In the very low doses used medically, BOTOX is an INJECTABLE (not topical) substance that is directly injected into the target muscles. It can also be used in nerve endings that cause sectretion from certain glands such as salivary or sweat glands.
The mechanism of action of BOTOX is directed against the passage of signal from nerves to muscles. When BOTOX enters the neuromuscular junction, it blocks the transmission of the signal from nerves to muscles for approximately 3-4 months. In order to acheive the same blockage causing temporary paralysis, BOTOX must be re-injected once its effects are noticed to fade away.
In most cosmetic patients, active wrinkles in the area of the forehead, and around the eyes are improved by partially paralyzing the muscles causing the wrinkles with BOTOX. In younger patients who use BOTOX regularly, the deep furrows in the brow, forehead, and crow's feet areas may be prevented by decreasing the muscle activity under these wrinkle-prone areas.
Now lets compare the creams. Neither of these "Better than BOTOX" creams are injectable, therefore, none are directly applied into the muscles causing wrinkles in the face. Neither of the creams have any effect on the muscles at all. Neither of the creams have been proven by peer reviewed research to help prevent wrinkles in the areas that BOTOX can be used. Furthermore, creams and topical applications to the skin have very unreliable absorption profiles. We know that many medications / chemicals can be absorbed through the skin, but most of the skin creams have not been studied, and cannot be expected to have any effect on anything beneath the surface of the skin.
In summary, "Better than BOTOX" is a comparison of apples and oranges, and should not be taken to mean that any of the topical skin creams that you can buy at the mall will ever replace or supercede BOTOX. As always, you should consult your favorite Facial Plastic Surgeon, or Dermatologist prior to using any of these skin products.
Recently, I saw a booth at a local mall in near Beverly Hills with a sign reading the same text - "Better than BOTOX!" promoting another skin cream. I immediately had the same thoughts cross my mind as the first time I saw these words.
"They can't say that!" I thought.
Here is why. In order to compare the type of products being called "better than BOTOX" to BOTOX itself you must first understand BOTOX.
BOTOX is a trade name registered to Allergan Inc. based in Irvine, CA. The BOTOX product comes in cosmetic and therapeutic formulations. BOTOX is a toxin that has long been known to cause paralysis if ingested in foods (canned foods or honey) contaminated by a bacterium called Clostridium Botulinum. In the very low doses used medically, BOTOX is an INJECTABLE (not topical) substance that is directly injected into the target muscles. It can also be used in nerve endings that cause sectretion from certain glands such as salivary or sweat glands.
The mechanism of action of BOTOX is directed against the passage of signal from nerves to muscles. When BOTOX enters the neuromuscular junction, it blocks the transmission of the signal from nerves to muscles for approximately 3-4 months. In order to acheive the same blockage causing temporary paralysis, BOTOX must be re-injected once its effects are noticed to fade away.
In most cosmetic patients, active wrinkles in the area of the forehead, and around the eyes are improved by partially paralyzing the muscles causing the wrinkles with BOTOX. In younger patients who use BOTOX regularly, the deep furrows in the brow, forehead, and crow's feet areas may be prevented by decreasing the muscle activity under these wrinkle-prone areas.
Now lets compare the creams. Neither of these "Better than BOTOX" creams are injectable, therefore, none are directly applied into the muscles causing wrinkles in the face. Neither of the creams have any effect on the muscles at all. Neither of the creams have been proven by peer reviewed research to help prevent wrinkles in the areas that BOTOX can be used. Furthermore, creams and topical applications to the skin have very unreliable absorption profiles. We know that many medications / chemicals can be absorbed through the skin, but most of the skin creams have not been studied, and cannot be expected to have any effect on anything beneath the surface of the skin.
In summary, "Better than BOTOX" is a comparison of apples and oranges, and should not be taken to mean that any of the topical skin creams that you can buy at the mall will ever replace or supercede BOTOX. As always, you should consult your favorite Facial Plastic Surgeon, or Dermatologist prior to using any of these skin products.
Surgeon Shopping - Finding the Best Surgeon For Your Plastic Surgery
Finding a skilled surgeon is the most important task anyone seeking plastic surgery faces.
My patients always ask me questions regarding years in practice, track record (law suits), board certification,training, and "how many times have you preformed this surgery". My primary goal during a consultation is to help patients find the right surgeon for them - as an individual. The truth is, no surgery is like the last one, and no patient is like the last one. Here are some signs of a "skilled surgeon" regardless of training, years in practice, or board certification. Read about the American Academy of Facial Plastic Surgery here.
1. Skilled surgeons should have an interest in what the patients specific goals are.
2. Should have an honest approach to the surgical task at hand and reaching the patient's goals... does the surgeon think it would beeasy or challenging to reach the patient's goals - does he/she tell you?
3. should have an honest approach to previous results - I always show patients before and after pictures myself - not in a book shown by anassistant or consultant. During the picture review - a skilled and confident surgeon will have "perfect" results as well as "imperfect"results - honesty about the uncertainties of healing, surgery and overall results is a sign that the surgeon will stand by his results, and usually improve upon imperfections - if there are any. Beware of the surgeon who does not discuss persona lexperience with complications, near-misses, touch-ups, or revisions. Everyone has complications and near-misses, and their honesty regarding these proves that they will have experience managing them, and improving your results.
4. a skilled surgeon will examine you with their eyes, hands, and "ears" - the consulting surgeon should not tell you what they would do or how they can improve your look until a formal examination is done.
5. "Less is more" - skilled surgeons should be able to advise their patients regarding the realities of their goals and wheather or not your goals will leave you with a "natural" or "unnatural" look.
In addition - when choosing a surgeon:
1. your sense of beauty and appreatiation for what is beautiful should match with your doctor - my rhinoplasty patients are advised - if you dont like the look of my patient's nose jobs - find another doctor! If you see pictures of other doctors you dont like - do not commit to them.
2. you should feel comfortable with your surgeon and feel confidentt hat they will help you get through the tough times including healing and swelling periods, as well as adjustment to your new look.
My patients always ask me questions regarding years in practice, track record (law suits), board certification,training, and "how many times have you preformed this surgery". My primary goal during a consultation is to help patients find the right surgeon for them - as an individual. The truth is, no surgery is like the last one, and no patient is like the last one. Here are some signs of a "skilled surgeon" regardless of training, years in practice, or board certification. Read about the American Academy of Facial Plastic Surgery here.
1. Skilled surgeons should have an interest in what the patients specific goals are.
2. Should have an honest approach to the surgical task at hand and reaching the patient's goals... does the surgeon think it would beeasy or challenging to reach the patient's goals - does he/she tell you?
3. should have an honest approach to previous results - I always show patients before and after pictures myself - not in a book shown by anassistant or consultant. During the picture review - a skilled and confident surgeon will have "perfect" results as well as "imperfect"results - honesty about the uncertainties of healing, surgery and overall results is a sign that the surgeon will stand by his results, and usually improve upon imperfections - if there are any. Beware of the surgeon who does not discuss persona lexperience with complications, near-misses, touch-ups, or revisions. Everyone has complications and near-misses, and their honesty regarding these proves that they will have experience managing them, and improving your results.
4. a skilled surgeon will examine you with their eyes, hands, and "ears" - the consulting surgeon should not tell you what they would do or how they can improve your look until a formal examination is done.
5. "Less is more" - skilled surgeons should be able to advise their patients regarding the realities of their goals and wheather or not your goals will leave you with a "natural" or "unnatural" look.
In addition - when choosing a surgeon:
1. your sense of beauty and appreatiation for what is beautiful should match with your doctor - my rhinoplasty patients are advised - if you dont like the look of my patient's nose jobs - find another doctor! If you see pictures of other doctors you dont like - do not commit to them.
2. you should feel comfortable with your surgeon and feel confidentt hat they will help you get through the tough times including healing and swelling periods, as well as adjustment to your new look.
Friday, March 9, 2007
Thirties Eyelift
Did you know that the unsightly bags beneath your eyes can start as early as your twenties and thirties?
Dr. Behrooz Torkian MD has several patients in their early thirties who have complained about the unfavorable cosmetic appearance of their lower eyelid region.
Dr. Torkian beleives that most of these young people have decreased fat volume at the lower orbital rim (the bottom part of the eye socket). This leaves the relativley full lower eyelid fat appear to be bulging. In older patients the fat is frequently bulging in that area, and eyelid surgery may be necessary. For most young patients, however, surgery is neither desirable or necessary.
Dr. Torkian preforms the "Thirties Eyelift" in Beverly Hills and Brentwood with excellent results. Dr. Torkian uses the same "injectable fillers" (Restylane and Juvederm) used for lip augmentation and treatment of smile lines. These are safe and effective materials that are compatible with your own skin and tissues, and allow doctors to fill areas with volume loss giving you the "tired" and prematurely aging appearance.
You should also check out is before and after pictures of facial and nasal surgery.
Dr. Behrooz Torkian MD has several patients in their early thirties who have complained about the unfavorable cosmetic appearance of their lower eyelid region.
Dr. Torkian beleives that most of these young people have decreased fat volume at the lower orbital rim (the bottom part of the eye socket). This leaves the relativley full lower eyelid fat appear to be bulging. In older patients the fat is frequently bulging in that area, and eyelid surgery may be necessary. For most young patients, however, surgery is neither desirable or necessary.
Dr. Torkian preforms the "Thirties Eyelift" in Beverly Hills and Brentwood with excellent results. Dr. Torkian uses the same "injectable fillers" (Restylane and Juvederm) used for lip augmentation and treatment of smile lines. These are safe and effective materials that are compatible with your own skin and tissues, and allow doctors to fill areas with volume loss giving you the "tired" and prematurely aging appearance.
You should also check out is before and after pictures of facial and nasal surgery.
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