Cosmetic Surgery Serving Washington, DC - Dr. Roger J. Oldham Board Certified Plastic Surgeon

The open rhinoplasty is a relatively new approach to performing nasal cosmetic surgery.  The surgeon makes an incision across the columella (the vertical skin column separating the two nostrils) and elevates the skin from the cartilage of the nasal tip.  The modification to the nasal skeleton (cartilage and bone) is then done under direct vision.  Some surgeons feel that this direct visualization of the underlying structures improves their results.  The open rhinoplasty approach, however, produces increased postoperative swelling and prolongs the receovery time.  Many surgeons are also concerned about creating a permanent scar from the incision across the columella.

Other surgeons prefer the traditional closed rhinoplasty and remain confident that they can see the internal structures very well as they operate through the nostril with specialized instruments and lighting techniques.  

Injection of various "fillers" to eliminate some of the undesirable lines and depressions of the aging process is among the most commonly used non-surgical techniques for cosmetic improvement of the face.  While there are dozens of fillers in use throughout the world, only a few have been approved by the FDA for use in the United States.  The most popular filler in this country is hyaluronic acid (Restyland and Juvederm).  Results usually last 6 to 12 months. The FDA recently approved a permanent injectable filler, Artefil.  The prospect of a permanent result from a filler has obvious appeal.  Because facial structures and tissues change as the face matures, however, many plastic surgeons are hesitant to inject a permanent material.  The placement of the filler that creates a perfect result today may give an unattractive bulge or line as the face ages.  This could result in an uncorrectable aesthetic problem.

The most commonly used incisions for breast augmentation are around the areolar (the pigmented skin around the nipple) and in the crease under the breast.  While most scars are rather conspicuous, there is a lot of variation in the appearance of incision scars from one person to the next.  With breast augmentation, there will always be an incision scar.  An incision line around the areolar is often less noticeable than one in the crease under the breast.  However, the areolar incision line is visible in the upright position as well as in the lying position whereas an incision in the breast crease is hidden in the standing or sitting position.  Other incision locations include the armpit and around the navel.  Many plastic surgeons, however, feel that these incisions are too far from the breast to get an optimal placement of the implants.

FACT:  Basal Cell Carcinomas do, in fact, grow very slowly.  Although it is rare, there are reports of Basal Cell Carcinomas which metastasize.  The greatest concern, however, is that these tumors can reach a very large size if left untreated and can readily invade and destroy underlying tissue including cartilage and bone.

Pain pumps are becoming used quite commonly in plastic surgery especially with abdominoplasty surgery.  Tiny cannulas (tubes) are placed along the muscle-tightening sutures.  This allows the area to be bathed with a long-acting local anesthetic, thereby significantly decreasing the pain.  The cannulas are then painlessly removed three days after the surgery.

Microdermabrasion is a very effective technique for improving skin textures and skin complexion as well as reducing fine lines and pore size.  The procedure exfoliates the skin in a 30 to 40 minute procedure and leaves the skin feeling smooth.  The very mild degree of pinkness can be expected but this is easily covered with make-up and subsides in just a few hours.

FACT:  Fat never moves around the body any more than any other body tissue can travel.  When we are born, we are given a number of fat cells in our body which, with only minor exceptions, never changes throughout our life.  As we gain weight, each of the fat cells in our body increase in volume, and they then shrink with weight loss.  With liposuction, fat cells are removed in the suctioned area, so that there are fewer fat cells there to enlarge and the process of liposuction also helps hold the remaining fat cells in place.  When someone gains weight, the fat in the adjacent areas appear to enlarge more than they do in the suctioned areas, giving the appearance that the fat has traveled.  While it isn't essential, it is preferable to be close to one's desired weight prior to liposuction.  Liposuction should never be considered a weight loss technique.

Depending on the types of skin problems being treated, there are individual differences in how patients react following Fraxel treatment.  Generally, however, there is usually a very mild degree of swelling for two days and a minimal amount of pinkness for a couple of weeks which is easily covered with make-up.  After having the procedure on a Friday, our patient can return to work on Monday.  You can go to Fraxel.com to get more information and see photos of results.

Nearly all women with large breasts who want a breast reduction also have sagging and desire to have the breasts lifted. We define sagging in this context as nipples which are below the inframammary crease. (The inframammary crease is the fold under the breasts where the breasts and lower chest meet.) A breast lift is nearly always routinely done with a breast reduction to get the desired result.

Melanoma, a potentially life-threatening skin cancer, can start as a melanoma or it can start as a normal mole and later turn into a melanoma.  Any mole which changes in any way should be evaluated for possible mole removal.