Case 37: Achieving a beautiful, natural change in an already beautiful woman is one of the great challenges we love in rhinoplasty. In front view you see a beautifully defined, natural change that simply looks great. Then on profile and 3/4 views, you see an elegant change where the tip is deprojected (made smaller) but retains a beautiful, natural aesthetic- this is finesse rhinoplasty.
"Many times, the cost of rhinoplasty or other surgery in New York City would be three times the price as in a smaller town, but it is not three times better necessarily," Dr. Park said. "At the same time, I would warn patients to beware of a physician in a small town that costs a fraction of what an average rhinoplasty would cost. In general, when a surgeon is throwing in discounts, I would be very wary."
Case 37: Achieving a beautiful, natural change in an already beautiful woman is one of the great challenges we love in rhinoplasty. In front view you see a beautifully defined, natural change that simply looks great. Then on profile and 3/4 views, you see an elegant change where the tip is deprojected (made smaller) but retains a beautiful, natural aesthetic- this is finesse rhinoplasty.
We here at Surgeons In Canada have seen a significant increase in patients from the United States coming to Canada to have their breast surgery. This is a wise choice for many Americans as boob jobs in Canada can be quite a bit cheaper due to the currency exchange rate. Currently women from the U.S. can easily save anywhere from $2000 – $5000 dollars on their breast augmentation by coming to Canada.
Because the nose plays such a prominent role in the facial structure, many patients choose to have additional treatments along with their nose jobs. These procedures can help to maintain the balance of the face and provide more dramatic results. In most cases, combining rhinoplasty with one or more additional treatments is quite safe. However, to ensure safety and good results, patients should choose surgeons who are experienced in all areas of facial plastic surgery.
Breast implants are not lifetime devices and breast implantation may not be a one-time surgery. The most common complications for breast augmentation and reconstruction with MemoryGel® Implants include any reoperation, capsular contracture, and implant removal with or without replacement. The most common complications with MemoryShape® Implants for breast augmentation include reoperation for any reason, implant removal with or without replacement, and ptosis. The most common complications with MemoryShape® Implants for breast reconstruction include reoperation for any reason, implant removal with or without replacement, and capsular contracture. A lower risk of complication is rupture. The health consequences of a ruptured silicone gel breast implant have not been fully established. MRI screenings are recommended three years after initial implant surgery and then every two years after to detect silent rupture. The most common complications with MENTOR® Saline-filled Implants include reoperation, implant removal, capsular contracture, breast pain, and implant deflation.

However, it’s not without real risks. A liquid nose job should be done only by a skilled plastic surgeon with extensive knowledge of facial anatomy, using only hyaluronic-acid-based fillers. Misplaced filler can cut off blood flow and cause skin necrosis (tissue death). If it’s caught quickly, the hyaluronic-acid filler can be dissolved by a doctor, using an injection of hyaluronidase. But because this risk is serious, fillers have not been approved by the U.S. Food and Drug Administration for use in the nose. 
If the repair or revision of the nose is extensive, then the operating time is longer and there will be more expense involved. The fee is also based on the geographical location. For example, the cost of any facial cosmetic surgery in Hollywood, Beverly Hills, will be more expensive than the same procedure here in Toronto. The other factor and the most important consideration is the experience of the facial plastic surgeon performing the operation. As a facial plastic surgeon gains experience and clientele, their fee is usually more than that of a novice.
Rhinoplasty, a surgical procedure commonly known as a “nose job,” has become much more common in recent years. There are several reasons for this. For one thing, increasing media use focuses wide attention on the successful surgeries of celebrities (and even ordinary individuals). For another, the culture as a whole has increasingly accepted various means of improving and enhancing one’s appearance. The third, and perhaps most important, reason for the popularity of rhinoplasty is the astonishing improvements that have been made in the operation itself.
It is important for patients considering rhinoplasty to understand that if their nose requires repair due to congenital malformation, illness or injury, at least part of the operation is likely to be covered by insurance. This includes situations like sports injuries, vehicular accidents, or birth defects that result in breathing problems. In most cases of cosmetic surgery, however, performed only to improve the patient’s appearance, the patient should expect to pay out-of-pocket.
The most exciting part of the rhinoplasty is the use of our state-of-the-art operating facility! Our hand-picked staff want to give you the best experience possible, and they do everything to ensure that your needs are met before and after surgery. You will enjoy the comfort of our state-of-the-art private surgery centre in Yorkville, downtown Toronto, where you are treated like an individual rather than a number. Our fee includes anaesthetics, our qualified operating team, a recovery nurse and most importantly, the expertise of our Facial Plastic specialist, Dr. Cory Torgerson. After care is also included in the rhinoplasty fee. The doctor releases his private cell phone number so he can be contacted at any time if concerns arise. And finally, follow-up appointments to observe the healing process are also included.
Breast implants are not lifetime devices and breast implantation may not be a one-time surgery. The most common complications for breast augmentation and reconstruction with MemoryGel® Implants include any reoperation, capsular contracture, and implant removal with or without replacement. The most common complications with MemoryShape® Implants for breast augmentation include reoperation for any reason, implant removal with or without replacement, and ptosis. The most common complications with MemoryShape® Implants for breast reconstruction include reoperation for any reason, implant removal with or without replacement, and capsular contracture. A lower risk of complication is rupture. The health consequences of a ruptured silicone gel breast implant have not been fully established. MRI screenings are recommended three years after initial implant surgery and then every two years after to detect silent rupture. The most common complications with MENTOR® Saline-filled Implants include reoperation, implant removal, capsular contracture, breast pain, and implant deflation.
If you’re having what’s called an open rhinoplasty, the surgeon will make an incision (about 6 millimeters long) in the skin between the nostrils. “Open rhinoplasty is a very common technique, where the skin is lifted upward like the hood on a car,” says Dr. Ronald Schuster, a Baltimore plastic surgeon, in a RealSelf Q&A about open vs. closed rhinoplasties. If you’re having a closed rhinoplasty, all incisions are placed on the inside of the nose, so there are no external scars.
Rhinoplasty, a surgical procedure commonly known as a “nose job,” has become much more common in recent years. There are several reasons for this. For one thing, increasing media use focuses wide attention on the successful surgeries of celebrities (and even ordinary individuals). For another, the culture as a whole has increasingly accepted various means of improving and enhancing one’s appearance. The third, and perhaps most important, reason for the popularity of rhinoplasty is the astonishing improvements that have been made in the operation itself.
How much you’ll swell really depends on you and on your surgeon’s technique—not so much the type of rhinoplasty you had. Dr. William Portuese, a facial plastic surgeon in Seattle, says that “The amount of swelling after a rhinoplasty procedure depends upon the type of rhinoplasty performed [open versus closed], the thickness of the skin, the amount of alteration required to the nasal tip, and the patient’s variability with the healing process itself.” He notes that “Some patients require taping and steroid shots in the tip of the nose to reduce swelling in that area for the first several months after the procedure.” According to Dr. Miller, “A very clean open rhinoplasty can result in minimal swelling, while with a closed procedure that isn’t performed in the ideal tissue and cartilage, you can have a lot more swelling. If the dissection travels through soft tissue or muscle on top of the cartilage, more bleeding and swelling will develop.” He notes that most people can also expect some bleeding from days two to five, but it should lessen with each passing day.

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This 37 year old female patient was troubled by the furrows that were appearing between her brows. These furrows are one of the unavoidable signs of aging, but we were able to roll back the clock a little with a quick application of Botox. We have more Botox ‘forehead lines’ before-and-after photos available at our clinic if you’re interested. You can also schedule your consultation for a Botox treatment, here.

When Botox is placed near the sweat glands it signals the sweat to stop.  It can take a few days or more to work but the results are dramatic. On average, there is over 80% decrease of sweat production in that area that lasts on average 7 months. Remarkably, up to a third of patients can go 1 year before they return for more. Therefore, you are treated once or maximally twice per year and don’t have to worry about constantly treating the area.
Although these side effects will eventually go away on their own, patients can take precautions to minimize their severity and speed recovery. Pain medication can reduce discomfort, and antibiotics can help control the symptoms of sinusitis. Some surgeons may prescribe drugs immediately after treatment. Patients should take these medications as directed. They should always finish each prescription, unless otherwise instructed by their doctors.
When doctors operate at these outpatient centers, they should have hospital privileges with at least one local medical center. A doctor must pass rigorous screenings to earn these privileges, so patients can rest assured that their surgeon maintains proper ethical and safety standards. Surgical complications during rhinoplasty are extremely rare. However, hospital privileges ensure that a patient will have access to emergency care in the unlikely event that something does go wrong.
Secondary rhinoplasty differs from the primary procedure in that it may require cartilage or bone grafting. If too much tissue or bone was removed in the first surgery, the doctor will need to replace this in order to achieve the desired look. Often, cartilage is taken from the ear or other areas of the nose. In rare cases, it is harvested from a rib, in what is known as a costal cartilage graft.

Rhinoplasty is a highly personal procedure that can affect a person's mental well-being, as well as his or her appearance. Therefore, it is vital that patients choose a surgeon with whom they feel comfortable. They should select a doctor who truly listens to their concerns, answers their questions, and creates a treatment plan that will address their specific goals. Patients should never choose someone who makes unrealistic promises or pressures them to undergo more surgery than they actually want.
Once your bone and cartilage have been resculpted, your surgeon pulls the skin back down and stitches it along the open-rhinoplasty incision across the columella (the tissue that links the nasal tip to the nasal base). “When done properly, that incision is extremely hard to see, once it’s healed,” says Dr. Miller. With a closed procedure, the incisions are made inside your nostrils, so there’s no visible scarring, and the sutures are usually dissolvable. 
After surgery, patients should be prepared for the cost of any pain medication they will take during recovery. These costs are not typically included in the overall cost of surgery. At my practice, we provide homeopathic medications as part of our total surgical package. Your surgeon can explain to you any prescription or homeopathic medications you may be prescribed and discuss their cost.
Case 3: A curvature and droopy tip brings undue focus to this young man’s nose. Although there is still some swelling in these early post-operative photos, we can already see a nose that is now straight, has a smooth profile and no longer droops. A sense of length is preserved to match his oval face. More than that, because of these positive changes, he also looks younger.
The consultation is your chance to get acquainted with the doctor and find out if you two see eye to eye. It is also your opportunity to explain why you want to have rhinoplasty and what your particular goals are. You will sit down with the doctor and tell him or her about your nose and what you would like to change. If you've had any previous nasal surgery or have broken your nose in the past, the doctor will want to know about that, too. If you have pictures of noses you like, bring them along so the doctor can get an even clearer idea of what you're hoping for. The doctor will examine your nose and explain what changes can be achieved and how the procedure will be performed.
After relaying to Nurse Libbie that I didn’t want it to look ‘too frozen’, she agrees to give me 10 units across my forehead, and 15 in the centre of my frown- the average dose is between 10-25 units. I lay down across the bed in her treatment room and as she preps the solution, I’m asked to frown and raise my brows. As I do so she inserts the needle, and a tiny dose of botox by Allergen is inserted across six points of my forehead and in between my eyebrows.
Surgical facilities: If a doctor does not have his or her own operating facilities, the procedure will take place at a hospital or ambulatory surgical center. These locations charge separate fees, which will vary depending on location, reputation, and equipment. Again, many patients are willing to pay slightly higher costs to enjoy greater safety and comfort.
After the doctor determines that a patient is physically qualified for surgery, he or she asks about the aesthetic or health-related objectives. When seeking rhinoplasty for cosmetic reasons, patients may want to bring in pictures of what they want their noses to look like. An exact replication may not be possible. However, these images will help the doctor create a treatment plan in keeping with the patient's cosmetic goals.
It is sometimes possible to have additional plastic surgery done at the same time while you are already asleep. It is not uncommon for Dr. Rival to perform lip enhancement, blepharoplasty (eyelift), otoplasty (ear setback) or even a facelift if the rhinoplasty is a limited procedure. Combined body plastic surgery procedures can sometimes also be arranged simultaneously. Overall each case must be assessed individually in this regard. For information on other facial plastic surgery procedures performed by Dr. Rival please see our main site www.rivalcosmeticsurgery.com .
Patients may require reconstructive rhinoplasty if they have lost all or part of their noses to an accident, skin cancer, or another serious illness. During the treatment, a surgeon rebuilds the nose using skin grafts, flap techniques, and other advanced methods. Due to the complex nature of this procedure, patients may require multiple surgeries over a period of several months. Additionally, reconstructive rhinoplasty is a specialized procedure, and patients should look for surgeons who have extensive experience in this area.
Secondary rhinoplasty differs from the primary procedure in that it may require cartilage or bone grafting. If too much tissue or bone was removed in the first surgery, the doctor will need to replace this in order to achieve the desired look. Often, cartilage is taken from the ear or other areas of the nose. In rare cases, it is harvested from a rib, in what is known as a costal cartilage graft.
Both anesthesiologists and registered nurse anesthetists can administer anesthesia. An anesthesiologist is a specially trained physician who will administer anesthesia and monitor your vital signs during surgery. A registered nurse anesthetist has specialized training to do the same.  However, while a registered nurse's services can cost about $300 per hour, an anesthesiologist's services can cost closer to $500 per hour.
After the patient is sedated, the surgeon creates tiny incisions inside the nostrils or on the columella. Then he or she carefully lifts the skin to access the underlying bone and cartilage. The surgeon can then remove or graft tissues, as needed. Typically, a doctor uses conservative methods to minimize the impact to the surrounding tissues while still achieving the desired results. When the reshaping process is complete, the doctor lays the skin back down over the new contours of the nose and closes the incisions.

To apply for insurance coverage for a functional rhinoplasty, your surgeon can perform one of several tests. A CT scan shows irregularities within the nose that are not visible to the naked eye. An acoustic rhinometry is a test that maps the inside of a patient's nose. A rhinomanometry tests the level of airflow within the nostrils. In some cases, insurance companies require that patients show that they have attempted to treat nasal obstruction with other treatments. These may include antihistamines, allergy desensitizing injections, and steroid spray.
The results are usually permanent, aside from normal changes that come with the aging process. If you’re really not happy with your results or have breathing difficulties once your nose has healed, you may be a candidate for a revision rhinoplasty. In many cases, scar tissue is the main culprit. “The force of a scar is very strong,” says Dr. Miller. “It can pull a nose one way or another—push it in, pull it out, turn it.” When this happens, a surgeon has to go back in and tweak the work. 
Case 47: This patient’s primary surgery left her with valve collapse, nostril notching, persistent tip rounding and hanging columella. Secondary surgery involved correction of these issues with repositioning and reconstruction of the tip cartilages to improve tip contour. Although she is still a little swollen in the after photos, she is already happy with her new nose.
Some people opt for a temporary nonsurgical nose job—also called a liquid rhinoplasty—with hyaluronic=acid-based injectable fillers, like Voluma or Restylane Lyft. This minimally invasive procedure can camouflage bumps, create more symmetry, or lift and build up the tip of your nose. This approach has its limitations though. “If you have a large nose, it’s not going to get any smaller with fillers,” says Dr. Miller, though changes in proportions can sometimes make it appear smaller. It also can’t fix a crooked nose.
Once your bone and cartilage have been resculpted, your surgeon pulls the skin back down and stitches it along the open-rhinoplasty incision across the columella (the tissue that links the nasal tip to the nasal base). “When done properly, that incision is extremely hard to see, once it’s healed,” says Dr. Miller. With a closed procedure, the incisions are made inside your nostrils, so there’s no visible scarring, and the sutures are usually dissolvable. 
Rhinoplasty can be performed in one of three places: private surgical suites, ambulatory surgical centers, or hospitals. You should speak with your surgeon and make certain that their chosen venue has been accredited by an organization such as the American Association for Accreditation of Ambulatory Surgical Facilities (AAAA), the Accreditation Association for Ambulatory Health Care (AAAHC), or the Joint Commission for Accreditation of Healthcare Organizations (JCAHO).
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