Revision rhinoplasty is one of the most technically challenging surgeries performed in the field of facial plastic surgery.  Altered anatomy and scar tissue are only a couple of issues a revision rhinoplasty specialist will have to address.

One of the more frequent concerns patients who are inquiring about revision rhinoplasty is for correction of a tip irregularities or tip bossa - (Bossa - is the term used to describe irregularities of the nasal tip region, such as knuckling of the cartilage or asymmetries of the cartilage structures.)  What causes these irregularities are a combination of two factors, thin skin in the nasal tip region or strong underlying cartilage structures that have been cut unfavorably resulting in sharp edges or bumps that show through.

To correct tip asymmetry, the underlying tip cartilages must be reoriented and sometimes reconstructed so as to create smoother contours in the nasal tip region.  

A look in any of todays beauty magazine and it may seem that every model has full and prominent cheeks.  Well having more defined cheeks, has been considered aesthetically more appealing for years.  Fullness to the mid-facial region, gives the allure of youth.  As we age, specific anatomic changes occur in the middle of the face, resulting in a flatter appearance.

With the recent introduction of synthetic injectable fillers (Radiesse and Sculptra), plastic surgeons now have more options to treat patients wishing for a more prominent cheek bone.  Besides the immediate effect of the procedure, this technique for augmenting the cheeks can be performed in the doctor's office and requires minimal down time. 

Dr. Kwak can also use the injectable fillers to customize the amount of augmentation desired with greater precision.

To learn more about cheek augmentation, we welcome you to come in for a consultation with Dr. Kwak. 

The nasal bones are the most frequently fractured bones in the face.  Unfortunately many of us can speak first hand on this type of injury.

Besides causing external changes to the nose, trauma to the nose can alter anatomic structures inside the nose.  One area inside your nose particularly sensitive to nasal trauma, is the internal nasal valve.  This portion of the nose is the narrowest region in the nose, as such this region significantly influences nasal airflow.  Trauma to the cartilage structures comprising this region of the nose can lead to collapse of the internal nasal valve, which can lead to a chronic sensation of nasal congestion (stuffy nose).

Beside resetting the fractured nasal bones to a straighter position, Dr. Kwak may need to address the middle portion of your nose to correct a collapse internal nasal valve.

If you have had nasal trauma in the past and have persistant nasal obstruction, you may be a candidate for a procedure to correct your breathing problems.  To learn more about crooked noses or nasal breathing we welcome you to come in for consultation. 

Traditional female facial aesthetics classically describe the lower portion of the face as an oval appearance, with gradual tapering of the a jawline inward. 

In the past to achieve this cosmetic appearance, patient's underwent bone contouring surgery, requiring significant postoperative recovery time and other potential risks.

Today, an innovated non-surgical approach using BOTOX (Allergan Inc, Irvine CA) has been developed to achieve these changes.  BOTOX - or Botulinum Toxin Type A, blocks the nerve transmission to muscle, weakening the activity of a muscle.  (This has been FDA approved for cosmetic treatment of the furrows between your eyebrows.)

To contour the jawline, BOTOX is injected into the masseter muscle.  As the muscle is weakened in a particular region,  some bulk of this muscle is reduced, resulting in a more tapered jawline.  Dr. Kwak performs this injection incrementally (approximately 2 weeks between injections) in order to achieve the desired changes.   

Reduction rhinoplasty is the medical term used to describe nasal surgery intended to reduce the over all size of the nose. 

When I talk to patients about nasal aesthetics, specifically reduction rhinoplasty, I tell them that the nose should be addressed in two distinct subunits: the bridge and the tip regions.

Most patients interested in reduction rhinoplasty, want the "bump" on their nose to be taken down.  This typically refers to the nasal dorsum or bridge of the nose.  

Other patients wanting to reducing the size of the nose may have a tip position aesthetically too far from the face (sometimes referred to as a Pinocchio nose).

To address these changes and to maintain proper nasal proportion, reduction rhinoplasty frequently needs to address both regions of the nose.  Meaning changes to the bridge will effect the tip appearance and vice versa.

To help understand these aesthetics, during your initial consultation, I will use a digital program of your nose to help show the intended changes. 

Almost every perspective patient inquiring about asian eyelid surgery, or double eyelid surgery, has concerns regarding healing time. Appropriately so, since many of my patients have highly demanding professions in the New York City metropolitan area.

As such, I thought I'd post a general outline for the typical healing process of Asian eyelid surgery.

For the incisional double eyelid technique, the typical postoperative healing time is as follows:

The first day after surgery - we have you come back to the office to have your eyes evaluate.  You can expect swelling and some bruising during this time.

On day 3-5, you will make a second post-operative visit to our office. On this visit, some of the skin sutures will be removed.

On day 7, you will make a third post-operative visit to have all of your skin sutures removed.

Typically, the first 48 hours after surgery is when most of the swelling of the surgery is seen. During this time to minimize this swelling, use of cold compresses over the eyes will help.

Usually by the 7th-10th day after surgery, the eye swelling has reduced to the point when most patients feel comfortable to return to work.

For patients with high profile events to attend, (such as weddings or photo sessions) we recommend considering surgery at least one month prior to the event.

Augmentation rhinoplasty is a term used to described nasal surgery in which the shape of the nose is increased. Although many of the patients undergoing augmentation rhinoplasty are non-Caucasian this type of surgery is performed on patients of all ethnicities.

Whether the nose requires a larger bridge or a more pronounced tip region, grafts or implants are frequently necessary for the required changes. A graft is a term used to describe a material harvested from your own body, and transfered to another location. The most frequently used grafts are cartilage grafts from inside your nose (septal grafts). Septal cartilage grafts are typically the first-line option used nasal surgery.

Sometimes the amount of material needed is greater than the amount of grafting material available, in which implants may be an option. Implants are synthetic materials designed to use in the nose. There are several implants available for augmentation rhinoplasty. Common implants used include: polytetrafluoroethylene (Gore-Tex), Silicone, and porous polyethylene (MedPor). Although no ideal implant exists, these implants can be safely used in nasal surgery.

To learn more about augmentation rhinoplasty we welcome to a consultation with Dr. Kwak.

One of the most common changes Asians are seeking is the shape of the nose.  The majority of Asian rhinoplasty is to increase the height of the bridge and tip of the nose (also called augmentation rhinoplasty). 

One area many Asians patients get confused is assessing the length of the nose.  Many patient ask to have their nostrils reposition to a higher location.  However, many of these patients have what I believe to be a short nose.   A short nose appearance is frequently associated with a retracted columella  (The columella is the structure between the nostrils).  This finding is best appreciated on your profile view.  In some cases where the columella is too retracted, the nostrils can have an appearance of "hooding" over the columella. 

To address these finding, lengthening the nose (in addition to building the bridge and tip) may create more aesthetic harmony to the nose.

The epicanthal fold is present during early infancy in all ethnic groups. However in most ethnic groups as the face grows this fold becomes less apparent. In adulthood, the epicanthal fold is a unique feature to the Asian eye.

The epicanthal fold is located on the middle portion of the Asian eyelid and is essentially redundant skin overlying the lacrimal lake (aka the pink portion of the central eyelid).

The shape of the epicanthal fold can vary considerably, with a prominent fold creating a smaller appearance to the eye.

An epicanthoplasty is a surgical procedure performed to change the shape of the epicanthal fold. This procedure is usually performed in conjunction with Asian double eyelid surgery.

Several various surgical techniques have been developed over the years, using various skin flap advancement techniques.

Like all techniques in plastic surgery, the best results are usually from careful preoperative evaluation and proper selection of an effective surgical technique.

Asian double eyelid surgery is one of the most common cosmetic procedures performed on patients of east Asian decent.  This procedure is done to create an upper eyelid crease.  Approximately 50% of east asians, are born without a supratarsal fold (aka double eyelid crease).  

This procedure can be performed using several techniques.  But the major differences in techniques is whether the surgeons approaches this surgery using an incision or a suture technique (non-incision) to create a double eyelid fold.

Below, I have broken down some of the major differences between the two surgical approaches.  

Incisional technique          

Pros: more predictable long-term outcomes, more control to create precise placement of the desired fold, able to address other anatomic factors to the eyelid (such as addressing upper eyelid fat deposits, excess muscle, and redundant upper eyelid skin).

Cons: increased healing time, increased potential for a conspicuous scar,  and irreversible

Non-incision-suture technique

Pros: relative ease of performing the procedure, quick recovery time, reversible

Cons: Unable to address other structures in the eye (redundant skin, fat, or muscle), increased potential for loss of crease over time, increased potential for asymmetry.

In addition to performing both techniques, I also perform a limited incision technique.  The approach I use depends on several factors, including your desired changes, your eyelid anatomy, and your lifestyle.

I welcome you to come in and learn more about the different techniques I perform for asian eyelid surgery, as well as other facial cosmetic procedures.

ESK