Author name: cocoona cocoona

Anatomy and Aesthetics of the Tip of the Nose Tip of the nose is a very important aesthetic subunit of the nose. The component of the tip of nose includes; Skin- The skin of the tip is thick and immobile and in many people it is very sebaceous. The thickness of the skin masks the underlying architecture of the cartilages. In some people the skin is thin and cartilages are prominent, so the internal architecture is visible through the skin. SMAS layer- this is a layer of fibrofatty tissue under the skin and thickness varies in different people. Lower lateral cartilages (LLC)- These are specialized nasal cartilages that is arranged in butterfly shape.  The medial part of the LLC forms the columella of the nose and the lateral part supports the ala of the nose. The dome is the midsection of the LLC and gives shape to the tip of the nose. Nasal Mucosa is the layer inside the nostril which lines the cartilage. Nasal tip is one of the aesthetic subunits of the nose. The aesthetics of the tip is also defined by surrounding subunits of nose such as the ala and supratip area. The contour of the supratip area and the characteristics of ala add to the beauty of the tip of the nose. An aesthetically balanced tip has a subtle dome projection which elevates above the supratip area. The lobule of the nose forms inferior part of the tip, and angle formed by columella and lobule is the key to an aesthetic nose tip. Nose Tip-plasty Tip-plasty is an artistic procedure to reshape the tip of the nose by harmoniously balancing with the rest of the nose. Essential components of tip plasty Tip reduction by defining the cartilaginous dome Columellar and medial crural strengthening Supra tip reduction of soft tissue and septal cartilage Soft tissue and SMAS resection at key places to enhance tip- alar complex Tip grafts and columellar strut grafts Correction of tip angle and rotation Correction of lobule and columellar proportion Tip plasty is best accomplished by open tip approach and can be performed under local anaesthesia. Plane of dissection is either subSMAS or SupraSMAS depending upon the thickness of the skin. In very thin skin patient the dissection is close to the cartilage keeping the overlying perichondrium and SMAS intact to prevent postoperative unevenness. In thick skin the dissection can be above the SMAS for adequate soft tissue resection. Once the tip complex is adequately exposed, the anatomy is assessed. A) Primary modification begins in the lower lateral cartilage (LLC). Assess the LLC for its contribution to the tip. The cranial part of lateral crus of LLC  can be convex causing tip bulges Lateral crus can be wide increasing the size of the tip Dome position and interdomal distance contributes to broadening of tip ( boxy tip) and inadequate tip projection Medial crural distance and strength causes bifurcation of tip and columella and dynamic tip drooping. The Lower lateral cartilage (LLC) is reduced in size by resecting the cranial part leaving at-least 4-5 mm of lateral crus for alar support. Creating a dome by lateral crus stealing and interdomal sutures help defining the tip of the nose. Medial crus strengthening by using a columellar strut graft is very useful for supporting the tip. Additional tip graft is used for tip projection. B) Upper lateral cartilage and caudal septum may also contribute to the tip of the nose. Prominent and thick ULC makes the supra tip area wide Cranial border of ULC and septum can cause supra tip fullness Since ULC and septum plays a significant role in maintaining the integrity of internal nasal sphincter, a careful modification is performed in this area. Cranial edge of ULC can be trimmed down along with resection of caudal and cranial part of septum in the supra tip area. C) SMAS and soft tissue also contributes to the thickness of tip and alar region. Careful resection of soft tissue in the tip, supra tip and alar area will help improve the contour of the tip. Excessive resection and breach of dermis can result in severe deformities of the tip. Soft tissue removal will improve the contour of the supra tip area and alar groove that improves the aesthetics of the nose. D) Secondary modification of the tip is performed to give a final shape as compared to the rest of the nose and lip- columellar complex. Skin redraping is most important to drape the newly constructed tip complex. Few sutures can be placed in the supra tip area catching the subcutaneous part of the skin. This will prevent excessive edema and scar formation in supra tip region. Splinting with steritapes and thermoplastic splints for 5-6 days will also prevent excessive swelling.   Dr Sanjay Parashar Rhinoplasty   Filed under: Rhinoplasty Dubai

Tip of the nose is a very important aesthetic subunit of the nose. The component of the tip of nose includes; Skin- The skin of the tip is thick and immobile and in many people it is very sebaceous. The thickness of the skin masks the underlying architecture of the cartilages. In some people the skin is thin and cartilages are prominent, so the internal architecture is visible through the skin. SMAS layer- this is a layer of fibrofatty tissue under the skin and thickness varies in different people. Lower lateral cartilages (LLC)- These are specialized nasal cartilages that is arranged in butterfly shape. The medial part of the LLC forms the columella of the nose and the lateral part supports the ala of the nose. The dome is the midsection of the LLC and gives shape to the tip of the nose. Nasal Mucosa is the layer inside the nostril which lines the cartilage. Nasal tip is one of the aesthetic subunits of the nose. The aesthetics of the tip is also defined by surrounding subunits of nose such as the ala and supratip area. The contour of the supratip area and the characteristics of ala add to the beauty of the tip of the nose. An aesthetically balanced tip has a subtle dome projection which elevates above the supratip area. The lobule of the nose forms inferior part of the tip, and angle formed by columella and lobule is the key to an aesthetic nose tip.

Get a visible 6 Pack and a perfect toned body with 3D & 4D VASER Liposuction. What’s new in liposculpting? Another dimension added to Vaser liposculpting; 3D and 4D vaser high definition is a modern concept to define male and female body aesthetics. Not everybody can have a “6″ pac on their tummy. Even some of the athletes and body builders are unable to loose that few centimeters of fat between the skin and muscles. Why is that so? Are they not working hard enough? They are doing hours of gym and following the right diet. But the stubborn layer of fat, often genetic fat or residual empty bags of fat tissue fails to move. “6″ pacs tummy is possible by Vaser 3D liposculpting. The key is to remove the fat layer or the adipose tissue layer allowing the muscle to show its features. It is a procedure performed under local anaesthesia and sedation. It takes hour and a half to emulsify the fat by VASER and then to sculpt the tummy, to ensure the skin adheres to the underlying rectus sheath ( a tough layer of fascia encapsulating the muscles of abdomen) at strategic places. Dr Sanjay Parashar, Consultant Plastic Surgeon @ Cocoona Day Surgical says “The result achieved can be immediately visible in 24 hours, but body goes through a healing period with swelling in the treated areas. A firm compression garment with specialized foam allows excellent skin draping. We have given this satisfied feeling to many of our patients and confident about the natural looking results”. What’s 4 D liposculpting? If you wish to sculpt your chest, biceps, triceps , forearms, buttocks, and leg muscles and enhance the contours of your muscle; that’s now possible with the modern concept of fat grafting along with liposculpting. This procedure requires deeper anaesthesia. Vaser is used to liquefy the fat from tummy, chest, around the biceps, triceps or lower limbs. Dr Sanjay Parashar, comments “The key is to understand the anatomy of the muscle contour and artistically sculpt the fat out. This is followed by adding layers of fat under and over the muscles allowing enhancing and redefining of the chest pecs, arms and tummy”. Dr Sanjay adds “It’s advisable to see a plastic surgeon who understands the hidden fat pockets and body contouring art. We can help you see a perfect toned body in the mirror which you were struggling in the past. The cutting edge technology and high safety standards governs the results and helps us deliver the best possible outcome”. For more details: Reach Dr Sanjay Parashar for an in-person Consultation, one of the respected Plastic Surgeon in Dubai and the Member of Dubai Medical Tourism Club (Initiative by DHA).

Report of a clinical trial- by Chang Sik Pak et al Subjects with lower eyelid aging were treated using Ultherapy 1.5 and 3.0mm probes. The 1.5mm probe helps tighten subdermal tissue and 3.0mm tightens the orbicularis muscle and orbital septum. The subjects satisfaction with clinical photographs,  degree of pain and CT scan were evaluated. Conclusions were that tightening of eye lid laxity and skin could be achieved using Intense focused Ultrasound (Ultherapy). Patients showed a minimal pain level and CT scan demonstrated  significant improvement in fat bulge and skin tightening before and after 12 weeks of treatment Filed under: lower eyelid. blepahroplasty, ultherapy

Like our face even knees have aesthetic characteristics. A beautiful and youthful knee has mounds and sulcus. Bones and ligaments forms the mounds and they are surrounded by sulcus, I like to name them; Medial patellar sulcus, lateral patellar sulcus and Infra patellar sulcus. There are aesthetic lines on each side of the knee and they can be termed as medial and lateral aesthetic lines. Excess weight gain causes fat to deposit in this sulcus and obscures the aesthetics of knee. Every individual

Medical rhinoplasty is a very interesting advancement. Being a Craniofacial surgeon and an expert in surgical rhinoplasty, I realized Medical rhinoplasty is a great armamentarium in our practice.  Education is very important to make people understand that it does not replace surgery and is not “Magic”. It has a limited role and has its own pros and cons. Medical rhinoplasty is performed using Botulinum toxin injections and filler injections. Fillers are most useful to correct minor deformities of the nose such as depressions and dents. Fillers can also be used to camouflage a hump, droopy tip and deviated nose. it can also be used to correct minor deformities after a rhinoplasty surgery. In my opinion hyaluronic acid based fillers such as Juvederm, Teosyal etc  and hydroxyapetite fillers such as Radiesse are relatively safe in small quantities. Advantages are that it can be done under local anaesthesia without incisions and minimal downtime. Disadvantages are that it can cause allergic reaction, acne breakout, granulomas , displacement and has unpredictable longevity. Botulinum toxins products such as Antiaging has very limiyted and temporary role, it can be used to temporarily relax the muscles of the nose and so, can be used to reduce flaring of nostrils and elevate the tip of the nose.

Vaser is not an ultimate technology for liposuction. The result of liposuction depends upon many factors; most importantly technical skills of the Plastic surgeon, anatomical knowledge and Aesthetic perception of body beauty. Vaser High definition Liposuction in Dubai is very popular. Vaser surely has advantages of gentle emulsification of the fat without affecting the important structures such as nerves and the heat generated by vaser energy helps in collagen contraction. The combination of these two helps remove fat gently with less bruising, pain and discomfort and better skin draping. The key in high definition liposuction is the removal of fat from multiple compartments ie superficial and deep, and also from the edges of the muscles and costal borders. This will result into a sculpted tummy with muscle enhancement. The main disadvantages of Vaser are following- 1. Risk of skin burns- This is minimized by expertise and training. vaser has two modes Continuous and Vaser mode. Vaser mode is interrupted/ pulse mode so the energy is not continuously building up. The energy level if kept at 60-70 % the risk of burn is significantly reduced. 2. Large Inciison for port insertion and need to suture the wound- This can result in a longer scar and also it prevents drainage of fluid in first 24 hours increasing the risk of seroma. The safer way is to use less energy so there is no need for port and incision can remain smaller or use only few ports for vaser and small incisions for liposuction and drainage of fluid 3. Big machine- It is difficult to carry this machine to different hospitals. Ultra Z is a good alternative that gives good result and also is small to carry to other operating facilities.