Thursday, September 18, 2008

Regrettable Rhinoplasties

oes seem as if young Hollywood starlets all share a common gene pool? The ubiquity of the narrow bridge, defined tip, straight dorsum– something distinctly American and that you won't find on screen in foreign films– isn't due to the great melting pot, it's the surgeon's knife.

Like diamonds, rhinoplasties are forever. Once you've purchased it, you'll be wearing it for the rest of your life.

The nose doesn't grow back or stretch with time. The very best of the rhinoplastic surgeons (and there are fewer of them than you think) can improve on a bad result, but revision surgery will never restore your original nose to your face.

As they say in the business: "you want to hit a home run the first time you're up to bat."

So what makes for a poor result?

First, an anatomical primer. Surgeons identify the supporting structure under the nasal skin by its anatomical parts:
From the apex or nasal tip, the columella projects inferoposteriorly toward the center of the superior lip, adjacent on either side to the nares. Encompassing the border of the nares are the alae of the nose superiorly and laterally, and the floor of the nose inferiorly. At the posterior aspect of the base of the nose is the piriform aperture, bordered superiorly and laterally by the frontal processes of the maxilla and the nasal bones. The inferior portion of the cartilaginous nose, otherwise considered the base of the nose, includes the lobule, which consists of the lower lateral cartilages, the tip, the alae, and the columella. In the midline, the posterior aspect of the medial crura of the lower lateral cartilages articulates with the caudal membranous septum. Anteriorly, the medial crura are enclosed within the columella. The lateral crura of the lower lateral cartilages project superiorly to overlap the inferior aspect of the upper lateral cartilages in the midline. Laterally, these crura loosely attach to the piriform aperture....
And now to illustrate. Double-click on any of these images to get a close-up. Take a good look.

The nose falls apart over time, ie, the underlying architecture of the nose is so compromised that the look (and function) can't be maintained. Repeated surgeries become necessary. Michael Jackson (50) is the poster child for what is termed a 'crucified nose.'

Alternately, the surgical result may stay put but it's a look that doesn't appear in nature ala LaToya Jackson (51). Closely related to this phenonmenon is the 'operated look,' a nose that is plausible but clearly the result of surgery, distracting even to the untrained eye. Calista Flockhart (43) has just such a rhinoplasty. Her skin is thin and her resected greater alar cartilage on one side almost pokes through the tip, like a knuckle.

Scarring and overly aggressive resection of the cartilage causes a 'pinched tip' (thinning of lateral cura) and/or 'notched nostrils' (lateral crus). That girl, Marlo Thomas (70) has both.

Her first cosmetic surgery was way back in 1965. Joan Rivers (73) was actually much prettier than she ever thought she was and her initial surgeries made her only slightly less so. But her nose has been, for some time now, the classic example of too much, too often. The net result is a 'putty nose,' one which looks as if it was fashioned out of silly putty and stuck on her face.

Now you see it, now you don't. Onlay grafts to build up the dorsum are always tricky. Alloplastic grafts (eg, silicone, gortex) tend to become infected and extrude; allografts (eg, cadaver donor tissue) reabsorb over time. Only autogenous ones (eg, the patient's own septal/ear cartilage, rib, iliac bone) tend to last. Just ask Lil' Kimberly Jones (33).

Polly want a cracker? No. The pollybeak deformity is a disproportionate fullness in the supratip which evolves postsurgically. It can be cartilagenous or soft tissue in nature and is often the result of a misjudgment on the surgeon's part. Furthermost left is a 1983 preoperative photo of Meg Ryan (46); the next two date from '01 and '08.

Excessive 'columella show' can cause the operated nose to have the appearance of a long, drooping tip. And seeing inside someone's nostril can provide fodder for embarrassing rumors about what's up inside there. Here are three postoperative views of Paris Hilton (27).

Correction of the twisted nose poses one of the greatest challenges in septorhinoplasty. "My face is full of imperfections and it is what it is." Easy to say when you're Dr. McDreamy and have landed gigs as the face of both Versace and Avon campaigns this year. Patrick Dempsey's (41) rhinoplasty took place sometime around 1991-1994. Symmetry is defined by an imaginary line drawn equidistance between the medial canthus (inner corners of the eye) through the middle space of the two front teeth/cupid's bow.

Perhaps the most incongruous mistake is when a perfectly natural-looking result simply doesn't suit the wearer. Jennifer Grey's (48) new nose so disoriented her fans that her career faltered. Twenty years postoperatively, it still hasn't recovered.

To hear more, tune in to hear Anne discuss it all with Kevyn Burger on FM107.1 at 10am Thursday.

Thursday, September 4, 2008

Political Faces

arren Harding swept to the 1920 Republican nomination largely because an Ohio promoter thought "He looked like a President." He won by an unprecedented landslide, 60% of the popular vote.

Are we still voting by appearances? Anything worth chattering about?

On the Democratic presidential ticket the first Black First Lady in-waiting, Michelle Obama (44) has guts and glamour, indisputable professional credentials, and is incredibly smart. There's an unflattering high school photo in her past and she chemically straightens her hair. And they put her in flats so her 5'11" frame doesn't tower over Jill Biden (57). But that's about it.

Dr. Biden, also a very handsome woman, appears to be aging without any knifestyling. Her skin is weathered from outdoor running and she dyes her hair. But that's about it. Yawn.

If they both weren't such fabulous examples of vibrant womanhood, it'd be almost boring.

Obama (47) himself is remarkable for being within the 35% of adult Americans who are at a healthy weight. His ears stick out and he has a gleaming smile. Cartoonists and dentists across the land are celebrating.

Now Joe Biden (64) is a different matter.

Back when the West was won, hair transplants looked like they were accomplished with a pop riveter - the so-called 'doll's hair' look. Until the late 1980s, the best method of hair transplantation involved 'plugs' that each contained 15 to 30 hairs.

Sen. Biden's early career foray into arms and hair control has become a little less obvious over time, thanks to revision with updated transplant techniques and greying hair. Nor was he alone: plugged-in along with him were the late senators William Proxmire and Strom Thurmond.

The right-leaning blogosphere is roundly condemning the Vice Presidential candidate's "poor judgment" for undergoing "expensive cosmetic surgery" and deems it indicative of a character flaw, akin to dishonesty (which already plagues Biden): "a blatant sign of vanity above substance."

Would they feel the same way if it came out that Obama's white sparklers were veneers? After all, the ivories are all capped in Hollywood. (And tinsel town has it's share of balding beaus battling back, too. Rob Schneider, Ben Affleck, Matthew McConaughey, Brendan Fraser, and Tom Hanks have all been rumored to have had hair transplants.)

But now for the Republican half of the ticket. Ladies first.

Cindy McCain (54) has had a little thing for stolen prescription opioids, but is more widely criticized for being "plastic." You'll never find a photo of her with crowsfeet or wrinkled brow. But is it deeper than too much bleach and Botox? Her ears show no obvious signs of a traditional cut-and-pull facelift, but her face is tight, the neck is remarkably taut, and her jaw is free of jowling....something you just don't find in nature. Her face work is as carefully done as Hillary Clinton's. This photo shows those pearls are real.

Pro-life, pro-gun, pro-drilling, abstinence-only creationist, the undeniably beautiful Sarah Palin (44) has received a lot of attention for producing her fifth child virtually undetected. Scott Sloan appears to have the only footage from February showing the Alaskan governor just 8 weeks before she delivered a 6 lbs, 2 oz baby.

Here is her daughter attending the RNC this week in St. Paul, at 5 months pregnant. The photo-op was deliberate, as both John McCain and Sarah Palin greeted the couple-to-be at the MSP airport.

Medically, the timing is curious. Bristol Palin (17) conceived as a 16-year-old junior. Was it in defiance of her parents' prior decision to yank her from her boyfriend's high school midyear and take her home for some eight months? Or was it to finish something she started? There is one menstrual cycle gap between the two pregnancies.

The real significance of this for the Elephant and the presidential contest is thoughtfully discussed here. I predict conservative Christian voters will love this fertile family fable, for the same reasons they voted to sit down and have a beer with recovering alcoholic GWB.

"First Dude" Todd Palin is a good 'ol boy with nothing knifestyle-worthy. At most, his elopement with the someday VP candidate coincided with the conception of his first born, Track (can't tell for sure since the Bristol and Track's birthdates have been scrubbed.)

Presidential nominee John McCain's (72) war injuries and torture have left him with limited range of motion in his arms. (According to fellow POW cellmate Colonel Bud Day, McCain had 3 fractures in his right arm, a fractured right knee, dislocated left arm, bayoneted left leg– before his captors starved him and hung him by his arms). That and a loose zipper seem to be his main contribution to today's subject.

To hear more, tune in to hear Anne explore it all with Kevyn Burger on FM107.1 at 10am Thursday.