The Art of Plastic Surgery–Less is More

The best plastic surgery is plastic surgery you can’t see. I often have patients who say, “when I walk down the street I can tell when someone has had filler, or a facelift.” I say that the only plastic surgery you can see is badly-done plastic surgery. Well done Botox, filler, peels, or even surgery should leave you guessing why your neighbor looks so well-rested, or why your college friend has looked the same for the last 15 years. A good rhinoplasty makes you notice your cousin’s beautiful eyes rather than her new nose. A good facelift has you hoping you’ll inherit your aunt’s great skin.
You and Your Plastic Surgeon Should Be a Team

You should feel heard, and you should choose a surgeon whose aesthetic and philosophy of beauty you share. I like to look at my relationship with my patients as a partnership. I am the plastic surgery expert, but you are the expert with regards to your face and your lifestyle. We not only need to work together to optimize results but we also have to trust one another and agree on what is beautiful. My philosophy of beauty is that “less is more.” My goal is to optimize your natural beauty, and to achieve an effortless-appearing, simple and timeless beauty that preserves the face as a fresh, clean palate.
Timeless Beauty

It transcends trends. It’s clean and it’s fresh. So if you want to experiment, do it with your hair, clothes, make-up – even nails. But please don’t experiment with your face! Just like any other aspect of fashion and beauty, trends in facial plastic surgery come and go. Unlike other aspects of fashion and beauty, you can’t shed a surgery like last season’s stilettos. Dramatic “reduction rhinoplasties” of the late 60s and early 70s have made many a pinched ski-slope nose on Madison Avenue. Extreme blepharoplasty (eyelid surgery) in the 70s has left many otherwise gorgeous ladies with hollow-looking eyes as they’ve aged. Plucking the eyebrows down to fine lines in the 80s has left models looking for eyebrow hair transplants now that the trend is for fuller brows (Yes! You can do that!).
Desperately Seeking Surgery

People seek out cosmetic surgery for many reasons, and that motivation is important. I have found that the happiest patients after Botox, filler, peels, or surgery are patients that chose to have a treatment, or surgery for themselves. This is the right motivation. I have no problem telling patients that I don’t think a treatment or surgery is right for them. Just because I’m a plastic surgeon, doesn’t mean that everyone should have surgery. Surgery has its place, and can produce fantastic results, but there are MANY other tools and tricks as well. You can always do more; but once you do too much, you can rarely do less.

Ralph Waldo Emerson said, “Love of beauty is taste, creation of beauty is art”. The perfect partnership between patient and surgeon respects the art of less is more.

Is your skin care all that?


You’re Not Using The Right Products For Your Skin Type
Quite a few of us don’t know our skin type. Others have been tricked into thinking we have a certain type of skin based on products we’ve been using that affect our face. For example, if you have combination skin and you’re using a product containing irritating ingredients such as alcohol, you may actually be exacerbating the oily areas. Because irritation stimulates nerve endings in skin, a subsequent hormonal surge leads to more oil and, potentially, breakouts.

On the other hand, if you have dry skin and load up on moisturizers but don’t use a good leave-on exfoliant, a buildup of dead, dry skin cells results. Moreover, that really rich moisturizer you’re using seems to stop working.

Basically, what you need is a routine that fits your skin type and manages your concerns. Each product in the routine should have a texture (cream, lotion, gel, liquid) that makes sense for your skin type. That means if skin is oily, avoid creams and lotions, and opt for gels or liquids. Combination skin calls for a mix of products applied to each area — or you can opt to layer lighter-weight products over the drier areas. Dry skin needs richer, thicker products; with normal skin there’s a little more leeway, and you can choose the product textures you like most. Above all, you really want to make sure that every product in your routine is free of irritating ingredients.

You’re Only Applying Sunscreen When It’s Sunny
If you aren’t applying an SPF every single day — even if you only go outside to grab the mail — that’s a problem. All of those seemingly innocent, unprotected, incidental exposures add up, and the cumulative damage — even on a cloudy day — harms your skin’s immune response. When skin’s immune response is damaged, skin cannot be at its best, no matter what products you use.

Daily sunscreen use is the single most important thing you can do to get and maintain near-perfect (and certainly younger-looking) skin.

You’re Using A Face Scrub For Acne Or Blackheads
Still using scrubs to combat breakouts? Many people are gentler to their floors than they are to their face, yet acne cannot be scrubbed away. Ditto for clogged pores. At best, a scrub can remove the uppermost portion of a blackhead, but what you can’t see is the root, and, just like a weed on your lawn, if you don’t get the entire thing out, it’ll spring back before you know it.

Furthermore, it’s important to note that using harsh scrubs can cause inflammation that makes acne appear redder and more swollen. For breakouts and clogged pores, you can’t beat results from a well-formulated, leave-on BHA exfoliant (active ingredient: salicylic acid). Surprisingly, only a handful of cosmetic companies sell such products, but they’re worth
seeking out as they will do more for breakouts and large pores than any scrub you’ve tried.

You’re Using Lots Of Highly Fragranced Products
Fragrance is ecstasy for your nose but can be agony for your skin. While there’s nothing wrong with wanting your products to smell good, switching to those with a neutral or natural (but without added fragrance) scent may go a long way toward eliminating a lot of skin issues, from dry patches to sensitivity problems.

When shopping for skin care, be sure you’re checking the ingredients and avoiding products that list fragrance or “parfum” as well as products that contain fragrant oils like lavender, eucalyptus, all forms of citrus, and all types of mint.

You’re Not Removing All Of Your Makeup Each Night
I know: You had a long day. You’ve been going nonstop, and that glass (or two) of wine was well-deserved. But, no matter how exhausted you feel, you must be diligent about washing your face before you hit the sheets. Blotchy skin, breakouts, puffy eyes, and even red, irritated eyes often result from skipping that all-important bedtime ritual. It only takes a couple of minutes to wash your face thoroughly; at least once every few days, it’s also a good idea to soak a cotton swab in a good makeup remover (Almay, Clinique, and Paula’s Choice make gentle yet highly effective ones for less than $20) and gently go over the upper and lower lashline, plus eyelashes themselves.

Traces of eye makeup left on overnight will build up over time, leading to irritated eyes and a less than flawless complexion.

You Expect Skin Care To Work As Well As Cosmetic Corrective Procedures
That wrinkle cream promising to work like Botox or that serum promising to “mimic the results of a cosmetic corrective procedure”? Sadly, it’s mostly just fantasy, not reality. If these products worked even half as well as they claim to, the number of cosmetic corrective procedures would be going down, right? But, the stats tell a different story, as each year the number of minimally invasive procedures performed continues to increase.

Does this mean anti-aging products are a waste of time and money? Nope! What it suggests, though, is that getting and maintaining perfect skin requires the help of a brilliant skin-care routine and considering the procedures that address what excellent skin-care cannot. It’s my belief that sagging, reducing expression lines, and restoring lost facial volume may be better accomplished by a procedure and not a product. And, when you consider that some anti-wrinkle products cost upwards of $500, it’s something to think about.

Selfies are increasing Plastic Surgery!

From our recent interview in May on

Celebs aren’t the only ones who know about trends. Check out what doctors are dubbing the new thing to hit their offices: social media surgery?!

Plastic Surgeon Dr. Milgrim explained this new phenomena to us. So what is social media surgery exactly? The expert weighed in on what he and so many other specialists are noticing.

Like Us on Facebook

“The top three ways patients get information on facial surgery today is online, through patient referrals and social media,” the physician explained. “One third of facial plastic surgeons have seen an increase in patients due to how they are viewing themselves on these sites.” Dr. Milgrim would later tell us that 26% of patients now come to a doctor for advice due to seeing their selfies online, creating a significant rise in demand for more procedures.

This new trend aligns with what we’ve been hearing about when it comes to the new found social power selfies have on people and their looks.

When asked what he thinks what triggered this new wave of patients, Dr. Milgrim confirms everyone’s likely guess. “Facebook, MySpace, Instagram pictures are what triggered the phenomena,” he said without hesitation. “Patients look at their pictures posted online and based on the images they are unhappy with, typically I hear that their nose is too large, they have sagging necks, crows feet, etc.”

“Patients are deciding to alter their appearance because they want to look better in pictures, and are always unhappy with a hump on the nose, droopy eyes, or any number of specific facial features,” the expert explained. “Due to more online presence with endless images, the need to fix these things becomes more palpable.”

Dr. Milgrim also highlighted that dating sites, where pictures carry a lot of weight as well, are also the inspiration for patients who feel they need a new look. “Higher cheek bones, less tired eyes, and smoother skin all make the face more aesthetically pleasing and are among the requests I get most,” he said.

So what are some subtle changes one can make without drastically changing your face? Dr. Milgrim says start simple and go for touch-ups instead of total makeovers. “Simple procedures such as Botox and minimal amount of fillers like Juvederm work great to get rid of lines and smooth facial features. These types of minimal treatments help with subtle changes.”

And the doc’s advice for potential patients considering surgery? Dr. Milgrim says seek the opinion of a professional first. “My advice is to speak to your doctor and don’t look at your selfies! They are worse than the real thing,” he told us candidly.

“Change your appearance for you, not because of your friend’s Facebook comments. Remember, you can comment on them as quickly as they comment on you.” Great point!

Dr. Milgrim’s additional tips and tricks are to also remember to drink plenty of water, avoid sun exposure and wear moisturizer with SPF 50 or greater, even to go from the car to the supermarket. Keep the great looks you already have in tact and don’t let social media make you question them!

Myths About Nose Jobs— No Myths Anymore!

’ll have to hide for a month. Food will taste bland. Everyone will know.

Like any surgical procedure, rhinoplasty – a nose job – has its risks. But you won’t lose your sense of smell, your voice or end up looking like Michael Jackson.

Facial plastic surgeon Dr. Laurence Milgrim has heard just about all of the myths regarding rhinoplasty. And he has had plenty of practice debunking some of the most common ones.

My voice will change: Some celebrities who are in tune with their voices might be able to notice a tonal change because they are getting more air flowing through the nose. But generally there is no change in your voice. You will sound nasally after the surgery. That will go away.

I’ll be holed up in the house for a month: We don’t suggest exercising, singing or eating hot foods for that first week, but you can go out immediately after the procedure as long as you don’t mind the swelling and dressing on your nose. After rhinoplasty, some patients will develop black and blue bruises under their eyes. Some will look like they were badly sunburned. Everyone is different. Bruising usually goes away in a week. If there’s still some black and blue, most women will cover it with makeup and go about their normal lives.

I will get sinus infections more often: Not true. If you needed other work done, such as fixing a deviated septum, that wasn’t completed, then you might have more sinus infections. That’s why you should always tell the surgeon before the rhinoplasty if you have problems breathing. That being said, you will feel stuffy after surgery, but that will go away once the swelling has gone down.

My nostrils will be larger: A lot of people believe that rhinoplasty involves widening the nostrils. Unless you are actually having work done on your nostrils – we will generally see that more with African Americans and Asians who want thinner noses – the size of your nostrils will not change. Your nostrils may appear larger because of the change in the shape of the nose. But they are actually not.

I will lose my sense of smell: That is extremely uncommon. In fact, I have never seen someone lose her sense of smell. We are not working near the smell receptors, which are deep inside the nose. You might feel that you have lost your sense of smell, but that is because of the swelling and isn’t permanent.

Everyone will know I had a nose job: If it’s done correctly, people should not know. A long time ago, we did procedures where it was obvious that someone had their nose done. But these days, people don’t want their face changed to the point where their friends say, “Wow you had something done.” Everyone is looking for a natural look, and a lot of plastic surgeons are moving toward making people look better – the nose blending in with the face – rather than giving them a textbook perfect nose. People may say, “You look refreshed. Your face is brighter.” That’s what you want to hear. Of course, if you had a bump that we removed and your friend knew you had a bump, then it will be pretty obvious the bump is gone. But I tend to do a subtle rhinoplasty where my patients say, ”My friends didn’t know I had anything done.”

I’ll have to go back for touchups: If you’re happy with the results, you shouldn’t need a “touch up.” It’s not like a facelift where you might have to do it again in 15 years. There is revision rhinoplasty for people whose nose has shifted over time, but that is rare.

What Can Be Done for Under-Eye Hollows, Bags, Dark Circles

Screen Shot 2013-08-02 at 10.37.02 AMHave you noticed the area beneath your eyes has become sunken or hollow, and/or you now have dark circles beneath your eyes that weren’t there in the past? There are several options to treat the problem!

The Causes of Hollowness and Dark Circles Beneath the Eyes
While a tendency to dark circles beneath the eyes can be an inherited trait, most problems of hollowness beneath the eyes are related to aging. As we age, we lose bone density and soft tissue volume, which causes a hollow appearance. While your eyes appear to have “sunk,” they actually haven’t changed their position at all! It’s the “frame” around your eyes that has changed. The bony structure has diminished with age, as has tissue volume. As we lose tissue volume and our skin becomes thinner, the blood vessels cause a dark shadow to appear beneath the eyes.

Two Treatments for Under-Eye Hollows at our Teaneck, NJ Facial Plastic Surgery Practice
The easiest treatment for dark circles and under-eye hollowness is an injection of dermal filler, such as Radiesse®,  in the “tear trough” area of the eyes. Radiesse® is made up of tiny, calcium-based microspheres suspended in gel, which fills in the hollow area and, over time, will stimulate the production of collagen. This is important, because collagen production decreases as we age. The results of Radiesse® can last up to about a year, according to the manufacturer, Merz Aesthetics, although it can vary from one individual to another.

The best cosmetic surgery solution for eye bags, dark circles and hollowness beneath the eyes is blepharoplasty, also called an eyelift or eyelid lift.  I perform many of these for patients in the Teaneck and Englewood areas. Blepharoplasty can be performed on either the lower lid only or on both lower and upper lids. The lower blepharoplasty addresses loose skin and hollowness beneath the eyes, and an upper blepharoplasty eliminates excess skin in the upper lids that causes some patients to constantly appear “sleepy.” Most patients opt to have both upper and lower performed at the same time, as recovery is relatively short and scars are hidden quite well.

While it’s a fact that nothing will stop the aging process, an eyelift can certainly “reset”  your facial aging clock and eliminate multiple problems such as hollowness, dark circles, puffiness, and volume loss. Call me today for a complimentary consultation to see what can be done!

To your health & beauty,
Laurence Milgrim, MD
Double Board Certified Facial Plastic Surgeon near Englewood, NJ in Teaneck

Golden Skincare? Maybe Not!

Gold DropperYou may be aware that some skincare manufacturers include gold nanoparticles in their products, claiming that the addition of the precious metal will improve your skin. According to La Prairie, the inclusion of gold will “instantly ‘erase’ imperfections, producing smooth, radiant, line reduced skin.” Au contraire according to a recent study by researchers at Stony Brook University. Apparently, gold + skin is not a good mix.

The team of Stony Brook researchers are assigned the task of creating skin tissue for patients with burns or other wound problems. They performed a study on gold nanoparticles because they’ve become so common in over-the-counter skincare products. The goal was to discover if gold, highly touted as a curative, might, indeed, increase collagen and speed wound healing and, therefore, be a perfect addition to formulas intended to treat those with burns or wounds.

In the study, adult stem cells were infused with various quantities of gold. Concerns immediately arose. First, once the gold was infused into the cells, it was noted that the gold was essentially “trapped” inside. While this might not seem to be a problem, cells require motility (ability to move). Secondly, researchers discovered that the gold nanoparticles interfered with genetic regulation. According to Professor Mironava, one of the researchers, “Reductions caused by gold nanoparticles can result in systemic changes to the body. Since they have been considered inert and essentially harmless, it was assumed that pure gold nanoparticles would also be safe. Evidence to the contrary is beginning to emerge.”

Further, the gold particles were shown to inhibit adiponectin, a protein involved in regulating glucose levels and fatty acid breakdown, which helps to regulate metabolism.

Here at my facial plastic surgery practice near Englewood, NJ, we neither now, nor plan to, offer skincare products with gold in them. We believe that thoroughly tested skincare product lines are the best option for our NJ skincare patients.

To your health & beauty,

Laurence M. Milgrim, MD
Board Certified Facial Plastic Surgeon, Englewood area, Teaneck, NJ

Study Examines Combo Chin, Nose Plastic Surgery

Beautiful BrunetteAccording to a recent study of 90 rhinoplasty patients in Verona, Italy, the profile proportions of ones face are important to a balanced appearance. Many New Jersey men and women come to my NJ facial plastic surgery practice for a rhinoplasty (nose job) procedure, and I find that at least half of them need a chin augmentation to make sure the final result is successful. This study confirms my thoughts about this combination procedure.
According to lead researcher, Dr. Dario Bertossi, “We can for sure improve facial profile with stable results with rhinoplasty alone, but the association with genioplasty [chin implant] is fundamental and necessary to achieve the best aesthetic results.”
According to the researchers, the nose-chin-neck relationship is a strong predictor of an “aesthetically proportionate” face. It explains why those with a “weak” chin who have only a rhinoplasty often find that their facial balance is still out of proportion, and that their profile is only minimally improved.

“Genioplasty, if performed with bone remodeling, is a stable operation which guarantees long-term results,” Bertossi said.

It’s always been my contention that performing both a chin implant (called genioplasty) with a rhinoplasty, (when necessary) at the same procedure just makes sense. It makes sense financially because my patient has only one expense for the operating room and anesthesia. It also makes sense because, when the final results appear, my patient is happiest with his or her results.  It also avoids having two recoveries, something many patients find difficult to tolerate physically and emotionally. Not to mention the time off to recovery twice.

The 90 patients in the study, all of whom had both noses and chins addressed with cosmetic surgery, were followed for three years after their procedures. About half of the patients had chin reduction, not augmentation and, throughout the three year follow-up period, and had no changes in the new chin; it remained in its smaller shape. Over 50% of those whose chins were enlarged still had a stable profile during the three year follow-up period.

It’s not uncommon for rhinoplasty patients to have some complications because rhinoplasty is an incredibly difficult procedure. Many plastic surgeons agree that it’s the most difficult of cosmetic procedures because you have little room to work in and because the nose is one of the most visible parts of a person’s appearance, leaving very little room for error.  Here in New Jersey, I’m often asked by other physicians to fix rhinoplasties that didn’t turn out well and, of course, patients come to me on their own when they learn that I’m an expert in Revision Rhinoplasty.

I love performing Rhinoplasty here in my NJ facial plastic surgery practice. It’s challenging, artistically-oriented, and really rewarding. If you or someone you know has concerns about their nose, or about a previous rhinoplasty, let’s meet and discuss what changes might be done to improve things.
To your health and beauty,
Laurence Milgrim, MD
Board Certified by the American Board of Head and Neck Surgery-Otolaryngology and the American Board of Facial Plastic and Reconstructive Surgery
Teaneck, NJ

I See Eye Trouble

screen-shot-2013-03-20-at-6-13-38-pm.pngYes, it’s true, your eyes will start to look older in your mid to late 30’s. Sorry, but that’s Mother Nature at work. Puffiness, dark circles beneath the eyes, fine lines, and sunken sockets can all be treated, thankfully, and some don’t even involve surgery!

Dark Circles Under the Eyes
While it’s true that dark circles beneath the eyes can be caused by poor eating habits and a lack of sleep, they’re also a result of collagen and elastin loss, which is a normal part of aging. Rubbing your eyes, allergies, and genetics also play a role, too.

First, you can avoid rubbing your eyes by using an anti-histamine like Claritin or Benadryl if allergies cause itchy eyes. There are also decongestant eyedrops, such as Albalon, Clear Eyes, and Vasocon, to name a few. These can keep you from pawing at your eyes, which creates the pigment buildup and chronic inflammation that results in those dark circles.

If dark circles are a result of hyperpigmentation, which is often caused by too much sun exposure and/or a genetic tendency, a skin bleaching product like hydroquinone can reduce this excess pigmentation.

If you need a higher-octane treatment, don’t forget fillers like Restylane® and Juvéderm®, which I often use in my NJ cosmetic surgery practice for under eye plumping, which can make the blood vessels in that eye area less apparent, as can a chemical peel.

Under Eye Bags and Puffiness
As your skin’s connective tissue weakens, the fat pads under your eyes begin to slip out of place and bulge on top of the orbital rim (the bone you can feel beneath your eyes). Fluid can build up, creating a bag-like effect, which is exacerbated by allergies, sinus congestion, too little sleep and too much salt intake. Besides drinking more water and getting more sleep, the my New Jersey Restylane® and Juvéderm® patients find these two dermal fillers to be tops at minimizing eye bags.

The Saga of the Sunken Sockets
As we age, we often get a hollowed-out appearance under the eyes. Again, this is due to fat loss and shifting of that fat, as well as bone changes. There aren’t any creams that can treat this, so fillers are your best friend again. I inject filler in the concave area and my New Jersey facial plastic surgery patients find that this solves the problem nicely.

Over time, fillers won’t be enough and an eyelift will be needed. An eyelift will eliminate the bags beneath the eyes as well as puffiness beneath the brow. You’d be amazed how much younger you can look with a simple eyelift procedure performed here in my New Jersey plastic surgery office.

So you see, there’s hope for aging eyes! Call me at 201-837-2174 or complete this convenient online form for a complimentary consultation to see what can be done!

To your health & beauty,
Laurence M. Milgrim, MD
Board Certified in Facial Plastic & Reconstructive Surgery and Head and Neck Surgery-Otolaryngology
Teaneck, NJ

Neck Lift without a Facelift?

Screen Shot 2013-04-01 at 6.04.49 AMYes, it’s true. Although a neck lift is traditionally performed with a face lift here at my NJ plastic surgery practice, it’s becoming common to consider a neck lift before a full face lift. It’s appropriate for men and women with neck and jaw aging who don’t have enough facial aging to justify a facelift.

If you’re over 40, you aren’t alone if you feel bad about your neck. For years, women have hidden neck wrinkling and sagging with scarves, high collars, turtlenecks and choker necklaces. But you no longer need to do that because aging in the jaw and neck, caused by sagging muscles and bulging fat, can be treated.

Neck Aging
Around our early 40’s, the skin on the neck becomes thinner and more crepey (that’s crepey, not creepy, although some of us think it’s pretty creepy when we look in the mirror and see it!). Next to the eyelid skin, neck skin is the thinnest on the body. That’s why it shows signs of aging earlier than fattier and thicker parts of the facial anatomy. While thin skin doesn’t help matters, the platysma muscle starts to protrude, which is what creates those ropey cords that appear on the front of the neck. Not sure you have this problem? Look in the mirror and say “eeee” and you’ll know if you do!

Three Neck Problems
Most of the NJ cosmetic surgery patients that come to me with concerns about neck aging have one, two or all three of these neck concerns: wrinkles, sagging skin due to weaker muscles, and/or a fatty neck. Banding, wrinkling and sagging in the neck, as well as fullness, make you look old. The good news is that we can treat it!

How I Treat an Aging Neck
At my NJ facial plastic surgery practice, a neck lift will restore a better jaw angle by tightening the underlying muscle structure and redraping the skin. Liposuction in the neck can remove the excess fat. Although the neck is often treated in a facelift procedure, those without significant facial aging may find that their neck aging can be addressed several years before a facelift is necessary. The key is to know your facial anatomy, and who better to know that than a board certified facial plastic surgeon?  I understand facial aging. When I see you in private consultation at my NJ plastic surgery office, I’ll know whether or not you need a full facelift (which includes the neck) or just a neck lift. Or just liposuction.

Recovery from a neck lift is fairly rapid, and the procedure itself is quick as well. If you have concerns about neck aging, do schedule a consultation by completing this discreet online form or calling my office at 201.837.2174.

To your health & beauty,
Dr. Laurence M. Milgrim
Double Board Certified in Head and Neck Surgery-Otolaryngology and Facial Plastic and Reconstructive Surgery
Teaneck, NJ

Open vs Closed Rhinoplasty New Jersey

Some men and women who consult with me about a rhinoplasty (nose job) in my New Jersey plastic surgery office in Teaneck are interested in knowing whether I’ll do an open or closed rhinoplasty procedure. Some never ask because they don’t know the difference. Both techniques have been around for many years, and some surgeons perform only one or the other, though most cosmetic surgeons do both. Some nose surgeons only know one technique and that’s the one they perform. Because, in my opinion, no nose is identical to another, I base my decision upon the unique needs of each particular patient. There is no “one size fits all” nose and, therefore, no “one size fits all” rhinoplasty procedure.

The Difference Between Open and Closed Rhinoplasty

  • In a closed rhinoplasty, the entire surgery is performed inside the nose; all the incisions are inside and invisible to the eye from outside.
  • In an open rhinoplasty, there are incisions inside the nose and a small incision between the nostrils that, when healed, is invisible without extremely close inspection.

When I Perform Closed Rhinoplasty
If my patient has a dorsal hump, either procedure can be done, although here in NJ at my cosmetic surgery practice, I prefer the closed method. It lessens my patient’s time in the operating room and there is less postoperative swelling compared with the open rhinoplasty technique. Most rhinoplasty procedures can be beautifully performed in the closed technique.

When I Perform Open Rhinoplasty
If my patient needs significant changes, has tip and/or mid-vault (middle portion of the nose) problems or is a revision rhinoplasty patient, I will likely do an open technique because it allows me greater visibility. Obviously, in the open technique, there’s more room to maneuver. The resulting scar between the nostrils is extremely small and, with excellent suture technique, will be barely visible afterwards. For some patients, this is the best choice.

Using Computer Imaging Before Rhinoplasty
Computer imaging has its place but it often leads to false expectations. Patients love to think that the computer image is exactly the nose they will have after surgery but everybody heals uniquely, and nasal surgery isn’t 100% predictable. The best method to choose a rhinoplasty surgeon is to examine closely each plastic surgeon’s before and after photos and not rely on computer imaging.

How To Know Which Rhinoplasty Approach is “best” for You
While you may have a preference for open versus closed rhinoplasty, your facial plastic surgeon will know which is the best approach for you, based on your goals and nasal anatomy.  This isn’t a decision that you should make, any more than you’d make the decision about suture materials. A skilled and experienced rhinoplasty surgeon knows the best approach when he or she examines your nose during consultation.

If your nose is problematic, call my office at 201-837-2174 to schedule your private consultation.

To your health and beauty,
Laurence Milgrim, MD,
New Jersey Plastic Surgeon
Board Certified in Facial Plastic Surgery & Head and Neck Surgery-Otolaryngology