Eyelid Surgery (Blepharoplasty)

Q: I have been disappointed with fillers to correct nostrils- I would like less nostril show from the front; thought of using sillikon 1000 but that is permanent. Am scared of vascular probls/necrosis since I have had 2 rhinops. So, thought perlane as it goes away. Will it hide nostril show?
My answer: I have been disappointed with injectible fillers for nostril show in general. The problem is that most fillers are too soft to really force down the nostril edge. Every one of my patients that have tried fillers have, in the end, had surgery for correction of the nostril asymmetry or nostril show. That operation is complex and requires the experience of a skilled rhinoplasty surgeon, so pick carefully. Hopefully that helps.

There are a lot of articles being written and news stories being broadcast regarding plastic surgery and facial plastic surgery options for patients in today’s economy. It is difficult to figure out what is right for you and even more what is the most economical way to go.
We at Dr. Constantinides’ office are here to help you make an informed decision by supplying you with all of the new and updated informational brochures from cosmetic injectable companies whose products include Sculptra, Botox, Restylane, Evolence, Perlane, Artefill, and Juvederm Ultra Plus.
Our office uses Jane Iredale medical grade makeup with SPF to help you not only protect your skin from sun damage but to enhance your skin’s natural look.
If your skin has the winter blues one of our two aestheticians will design a personal program for at home use to maintain your skin’s healthy balance.
More importantly Dr. Constantinides will answer all of your questions, address your concerns, and enable you to make the right choice not only for your face but your pocket as well.

So far, an exciting month with many fantastic rhinoplasties, revision rhinoplasties, functional surgery, cosmetic surgery…all great successes.  I am preparing for my participation in a cosmetic surgery course in Newport Beach, CA, next month.  I have been asked to discuss complications in rhinoplasty, the physician-patient relationship, and my experience with off-label uses of Sculptra.  I have also been invited to speak at the Dept. of Otolaryngology at UC Irvine while I am in California…another honor.  I am really looking forward to the trip, not only because it gives me a chance to return to Southern California, but because I enjoy talking about my passions…surgery and how it affects my patients.

I just received an email:

Dr. Constantinides: You gave a lengthy interview for The Body.com discussing Sculptra, however, you did not mention the possibility of “lumps” forming. Unfortunately, I have had these lumps under my eyes for over a year. Will they go away?

My answer:  

Thanks for your question.  Nodules, or lumps, are the most common complication of Sculptra.  They occur either when too much Sculptra is placed into one location, or when muscle motion pushes the Sculptra together in a location.  The lumps are actually your body’s formation of collagen around the Sculptra particles, and not the Sculptra itself. Fortunately, they can be improved with steroid injections.  The lumps will last for as long as the Sculptra particles are there, if they are not treated with steroid injections.  This is typically for 2 to 3 years after the injections.

Lumps can be prevented by not injecting the Sculptra into very mobile areas, any by massaging the area for the first 3 weeks after injecting.  I advise my patients to vigorously massage the injected areas for 10 minutes a day for the first 3 weeks.  I have had some small lumps develop in a few of my patients, but have not had a lump develop that is visible.  I attribute my success to experienced injection technique and careful instructions about post-injection massage.

I just tried Artefill on two of my established patients.  It really looks great…very easy to inject, excellent flow characteristics, and very easy for the patient to tolerate.