How’s a rhinoplasty for an African American different? Mr. R

Hi Mr. R, traditional rhinoplasty techniques used by most surgeon’s leave the nose looking pinched, turned up and in poor overall harmony with the patients face. This makes the nose looked “done.” The shape of the African American (AA) nose comes from 1) the shape of the bone and cartilage under the skin and 2) the skin and soft tissue that drapes over the bone/cartilage.  The rhinoplasty will change the shape of the bone/cartilage as it redrapes the skin over the new frame to get the desired result.  However, in the AA nose, this framework is usually not supportive due to the small/flat nasal bones and weak/floppy cartilage.   With the skin and soft tissue being relatively thick and rigid, it will not reflect the changes made to the bone and cartilage beneath, very well.  These peculiarities make it crucial that you find a surgeon that has a deep understanding of the aesthetics of the AA nose.  Special techniques designed for the AA patient must be applied skilfully to achieve excellent results. A customized plan based on the surgeons understanding of the unique structure of the AA nose and the individual patient’s desires both have to be taken into consideration.

My identical twin is unhappy with her nose and wants us both to have rhinoplasty. I think my/our nose is fine and really don’t want to change it because I’m afraid of the possible risks and complications. What could go wrong with this type of procedure? Jill

Hi Jill, thanks for your question. The decision to have plastic surgery is extremely personal. Besides making your twin sister happy, you will have to decide if the benefits will achieve your own goals and if the risks and potential complications of rhinoplasty are acceptable. These risks or complications include: bleeding (hematoma), infection, anaesthesia risks, poor wound healing/ scarring, numbness or pain, nasal septal perforation, difficulty breathing, skin discoloration and swelling, unsatisfactory nasal appearance. While initial swelling subsides within a few weeks, it may take up to a year for your new nasal contour to fully refine. During this time you may notice gradual changes in the appearance of your nose as it refines to a more permanent outcome. As your body ages, it is natural to have some gradual changes to your face including your nose. But most of your improvement should be relatively permanent. A healthy lifestyle and life-long sun protection will help extend the results of your new appearance. These risks and others will be fully discussed prior to your consent. It is important that you address all your questions directly with your plastic surgeon.

Can a breast lift help me? Shirley B.

Hi Shirley, thank you for your question. A breast lift is recommended for sagging and uneven breasts, decreased breast volume and drooping nipples and stretched areolas (the darker area surrounding the nipples), to recreate a youthful shape and lift to your breasts. If there is too little or too much breast volume, a breast augmentation or breast reduction might be recommended in addition to a lift. It is commonly done for those whose breast shape has sagged due to pregnancy, nursing, gravity, weight gain or loss, normal aging, and heredity. Such procedures will improve breast shape, projection, and symmetry, giving the breasts a more youthful appearance, giving the patient a measure of self-confidence. However, the effects of a breast lift might slowly diminish over time because of gravity and aging. A breast lift leaves scars that will be hidden in a bra or swimsuit but more importantly, subsequent pregnancy may\ compromise your surgical results.

Can a fat transfer from my abdomen be done to increase my breast size? Bubbles

Hi Bubbles, those with large tummies can harvest fat from this area to augment their breasts. This procedure has become more widely accepted for breast enhancement. The tummy is an excellent donor area for transferring fat, having the advantage of removing unwanted fat at the same time. Breast enlargement with fat grafting will not give you as much enlargement as you can have with breast implants, but it can be improved by a second repeat treatment. On the other hand, fat can give breast contour improvements that cannot be accomplished with implants alone. The grafted fat is generally placed around your actual breast tissue, rather than in the gland itself, so it is unlikely to affect later breast feeding, but this has not been extensively studied. You can expect an increase of 1/2 to 1 cup size per setting. The cost of each fat grafting to the breast can be very similar to the cost of a breast augmentation with saline implants.


My hands are starting to look brittle and have protruding veins. Is fat grafting for the hands good for me? Edward

Hi Edward, fat transfer, also known as fat grafting or fat injections is a natural, minimally invasive treatment for those seeking breast/buttock augmentation or replacing age-related lost volume and subtly smoothing out wrinkles. Fat is removed, using liposuction from various parts of the body where there is a substantial amount, such as the thighs, abdomen and/or buttocks. The fat is then centrifuged, or purified, to separate the healthy fat cells from the damaged ones, and injected into another area of the body that is lacking in volume. Fat transfer or grafting is recommended for hands that may look brittle with protruding veins, bones and tendons. While there are various factors that can cause this, ageing more than any other thing, causes this on hands that lose its volume and become loose and relaxed. One benefit of fat grafting when compared to fillers and implants, is that the results of fat grafting lasts 10 times longer – up to 10 years, and because the source of the ‘organic filler’ is already in your body, it is perfectly well tolerated in the long term. Fat grafting into your hands is effective for adding volume, “plumping up” wrinkled areas, covering underlying vessels and tendons and improving the quality of your skin over time.

I’ve been invited to a botox party. Should I go? I’m 3 months pregnant. Steph

Hi Steph, I’m assuming you’re talking about a social gathering at which Botox injections are given.   It might seem like a comfortable way to get Botox treatments, sometimes at reduced rates but the party might not have measures in place to ensure safe and effective treatments. Botox should be used only under a doctor’s care. While Botox injections are relatively safe when given by an experienced doctor, side effects and complications can occur — including pain and bruising at the injection site and temporary muscle weakness.  Alcohol is often served at such gatherings and it bears mentioning that drinking before getting Botox injections can increase your tendency to bruise afterward.  Most experts recommend having cosmetic procedures, including Botox injections, in a doctor’s office. I suggest that you ask for a referral from your primary care doctor or look for a doctor who has experience with Botox treatments.  Botox is made from human plasma (part of the blood) which may contain viruses and other infectious agents. Donated plasma is tested and treated to reduce the risk of it containing infectious agents, but there is still a small possibility it could transmit disease. As such, it is not known whether Botox will harm an unborn baby. Also, Botox can pass into breast milk and may harm a nursing baby.

What is a chemical peel? Am I good candidate for one? I’m originally from East India. Sonali


Hi Sonali, There are three basic types of chemical peels that provide varying penetration, from mild (penetrates outer skin layer for gentle exfoliation; aka alpha-hydrolic acid); medium (gets to the outer and middle layers of skin to remove damaged skin cells; aka glycolic acid); and deep peel (aka tricholoracetic acid) deeply penetrates middle layer of skin to remove damaged skin cells).  Each has its PROs/CONs:  Mild Peel: used to refresh the face, neck, chest or hands; Medium Peel:  used to improve age spots, fine lines and wrinkles, freckles and moderate skin discoloration; and Deep Peel:  used to remove moderate lines, age spots, freckles and shallow scars; provide a dramatic improvement in skin appearance; can be used only once.  Chemical peels are usually indicated for those with fair-skin and light-hair and it should be remembered that skin sags/bulges/wrinkles do not respond well to chemical peels.  These are better addressed by other kinds of procedures such as laser resurfacing, facelifts, brow lifts, eyelid lifts or soft tissue fillers.  Please consult a dermatologic surgeon to see which peel and/or procedure will address your concerns.

What causes cellulite? What treatment can I have done to take care of it? Cottage Cheese

Hi Cottage Cheese, Cellulite is nothing more than normal fat beneath the skin.  The fat appears bumpy because it pushes against connective tissue, causing the skin above it to pucker.  It is caused by poor diet, slow metabolism, and lack of physical activity, hormonal changes, and dehydration. There are many products and treatments that promise to get rid of cellulite on thighs and buttocks. But there is little evidence that shows that many of them work well or for long. Cellulite creams that contain aminophylline are said to dissolve fat and smoothen the skin. There is no scientific evidence that these creams are effective against cellulite, and for some people, they can be harmful. Their apparent effect on cellulite may be due to narrowing blood vessels and forcing water from the skin, which could be dangerous for people with circulatory problems. Then there’s liposuction, a surgical procedure to remove fat deposits from the body. Liposuction, though, removes deep fat, not cellulite, which is just beneath the skin. You should have a board certified doctor or see the area in question to decide whether liposuction is better for you.

How can I tell my nose is broken?

Hi thanks for your question.  If you’re experiencing pain in or around your nose,  have swelling or bleeding, a stuffed nose that could point to blocked nasal passages, bruising around the nose and eyes or if you hear a rubbing/grating sound when moving the nose, it is possible that you do have a broken nose.  You didn’t mention how you hurt yourself, nor your age.  Some groups are predisposed for a broken nose – these are children and older adults – which both have bone health concerns and experience falls more than other age groups.  Once diagnosis and/or an x-ray confirms that you have a broken nose, corrective surgery (a closed reduction, rhinoplasty, and septorhinoplasty) will be done 3-10 days after the injury, once swelling subsides.  If it’s a minor fracture without misalignment, medical treatment may not be needed. Regardless, surgery can only happen within 2 weeks of the injury, and pain/discomfort from the surgery will decrease within 3 days of the surgery.

I’m having nose surgery but am afraid of needles. I’m worried about how anaesthesia will be administered. I’m also afraid of the blood panel they usually take before surgery — Is this test necessary? Karen R.

Hi Karen, thanks for your question.  Fear of needles is more common than you’d think.  You can try twilight anaesthesia which is like an intravenous valium; once you awaken from being under it, you won’t experience nausea, a headache or a hangover.  This is the same anaesthesia given IV (Intravenous) during a colonoscopy called propofol. Some patients prefer this type of anaesthesia because it reduces bruising compared to general anaesthesia. It is extremely safe, and patients often feel great after surgery just like they had a great night’s sleep.  Sorry but the blood tests are necessary to do to test for diabetes, urinary infections, bleeding disorders, etc. before the surgery.  While blood can be extracted from other parts of the body, the blood it will yield will be “old” i.e., at least 20-35 minutes old which means it may not have an accurate reading of your blood glucose.