(Magazine L’OFFICIEL CHIRURGIE ESTHÉTIQUE)

A beautiful mouth has a nice contour, nicely shaped vermilion borders, the lips are plump but not excessively big, adapted to the shape of the face and the personality. Reshaping the lip line, correcting the Cupid’s bow, enhancingthe lips volume involves the proper know-how and a certain aesthetic sense. Here is how Dr. Hervé Raspaldo explains it (he is a plastic surgeon specializing in the face and neck surgery).

How do you properly reshape a mouth?
Dr. Hervé Raspaldo:

First of all, we establish a precise physiological and psychological diagnosis before any procedure concerning the lips enhancement and reshaping.

Just like before any other surgical procedure, I will carefully observe the patient’s face, take note of any possible issues. I will not only examine the mouth andthe lips, but also the teeth and their position, the bone structure of the face, the nasolabial folds. I will also ask questions to determine the patient’s social environment. Knowing a few things about my patient’s psycho-sociological environment is important, it helps me understand whether she wants an aesthetic improvement or a transformation, whether she aims for a subtle improvementor a rejuvenation.

Do you say no to certain procedures?
Yes, when a patient wants a full, plump mouth and sexy lips but such a correction is not fitting the patient’s face or style.

How do you conceive the corrections? As global procedures or small successive steps?
Each case is unique. In some cases I wouldonly rehydratethe mucous membrane, if the lips are thin and the patient is no longer very young. In other cases I would work on the mouth contour and enhance thevolume.

Do you have your own specific techniques?
I focus on perfecting my gestures, choosing the right injectables (Juvederm Volbella®, the new hyaluronic acid of the Allergan Laboratory), and the injecting process, during which the product is properly and evenly spread under the mucosa. This is essential for a correct procedure if you want to leave no place for bad surprises, and preservethe natural appearance of the lips as well as a nice, soft touch.

Is there something particular about this injectable gel?
This special lip product is based on the Vycross ™ technology (patented by Allergan), based on the combination of hyaluronic acids of low and high molecular weight,which produce a fluid and cohesive gel, with increased correction comfort. It allows to reshape the lipsandthe mouth in a more precise and less painful way (because it’s more fluid and it contains anesthetics). We only need one injecting point to hydrate and reshape contours at the same time. You can see the effect immediatelyand there is norisk of over-correction,because the product will not absorb water after the injection. There will be no edema during the procedure. It gives the practitioner more accuracy. The effect lasts up to twelve months.

Do you have to use local anesthesia?
No, the product is fluid and flexible, and it already contains anesthetics, so there is no need for another anesthetic technique nor creams before the procedure.

What do you work on first ? Lip line, volume, hydration? How to you make the injections in these cases?
I always start by reshaping the vermilion border, including the Cupid’s bow, then I proceed to the hydration of the lipsif necessary. Since the gel is soft and contains lidocaine (an anesthetic), it’s a painless procedure.

How do you avoid overcorrections?
This is a key feature of this new filler. You get no surprise, no edema during the procedure, so no overcorrection, no risk of unnatural, ”duck lips” appearance.

How do you correct a mouth that has suffered from over-injecting?
If the problem is the over-injection with fillers, we must wait for about oneyear beforethe product disappears. Only then can I inject again, and reshape the mouth. If we inject too soon, the two products combined can trigger inflammatory reactions in the form of granuloma.

If the problem is due to a permanent product, only surgery will solve it. In this case, I perform a procedure on the inside of the mouth, removing what needs to be removed and reshaping the lips. After a month of edema, the lips will pressent a nice shape again.

Do you treat drooping mouth corners?
Yes, I perform vertical and horizontal injections in order to lift the lip corners and reshape a nice smile, like Mona Lisa’s legendary smile.

How do you treat the fine lines on the upper lip (the so-called ”barcode”?)
I proceed by crossed intra dermal injection. The product isfluid, so there is no risk of irregularity or bulging effect.

How do you avoid pain?
The idea is to perform anterograde and retrograde injections in a smooth way, using very fine needles (32 gauges). These are the needles used for newborns. Another technique consists in  injecting an area where fillers have juste been injected. The anesthetic contained in the product is already active in this area.

Are there any postoperative measures?
In the following 24 hours, it is recommended to putice on the lips in order to prevent edema. Exercising should be banned, as it can increases the edema risk. If you have a tendency to develop herpes, you should take an antiviral.

When can you see the results?
The effect is immediate. I very rarely re-inject fillers during the first month after the procedure. In some cases, small injections may be needed again after 3 months. Depending on the volume injected, the results last up to twelve months.

Latest trends in nose treatments

Today, no one wants to get just a ”nose job” anymore. Nose treatments are about embellishing the nose, correcting its anomalies, but fully respecting its natural uniqueness. Modern rhinoplasty has become a refined artistic procedure with a much faster recovery.

(Interview with Dr. Hervé Raspaldo, by Paule Cornille)

Whether the nose is hunchbacked, crooked, too big,too wide, too short, too hollow or the patient had a surgery that went wrong, we can make any nose look better. Sometimes,it only takes a few millimeters here or there, to reveal the beauty of a faceandthe perfection of features. The embellishment work is performed on all angles, front, three quarters and profile. A good surgeon does not only focus on the nose, but considers the face as a whole, and aims the most natural and harmonious results possible.

The practitioner uses the 3D morphing during the first consultations, in order to have a practical exchange with the patient and make useful suggestions on the different nose treatments.This technology makes it possible to clearly visualize the rhinoplasty project in three dimensions. However, before any procedure, the surgeon must check that the nasal septum is not deviated, he does this using a small endoscope and a camera. He may also use a laser to improve the air passage inside the nasal cavity,because there is nothing more unpleasant than having a nice nose but not being able to breathe.

A minimally-invasive technique

Using micro-instruments and a video camera (endoscope), the surgeon will have perfect control over his actions, making the procedure much less traumatic. All the work is done inside the nose, so there is no visible scar. There are no stitches to be removed either, they are all resorbable. This procedure has become almost painless. Some discomfort may be caused by the small cottons or absorbable pads that force the patient to breathe through the mouth the first night. There will also be a small splint to support the reshaped nose, but it will be removed on the sixth day. Since this resin splint is much more comfortable and more discreet than the old plaster molds, the patient has a nearly normal life the next day. However,exercising should be avoided for a monthafter the procedure! Oedemasand bruising can occur near the eyes forten to fifteen days, but the result can be seen after eight days.

Cryotherapy can help overcoming these small inconveniences – very cold air is sprayed on the tissues, a procedure that is also used for treating athletes’ injuries. Lymphatic drainage can also be helpful. In the last twenty years, the unpleasant nasal packings have been replaced by resorbable pads and if the nasal septum is in perfect condition, there is no need for any internal dressing. All these medical progresses have made it possible to get a better result, in a shorter time. Let’s just remember that fifteen years ago, the patient had to wait for a month before resuming normal activity, whereas today you can wear makeup the following day.

The embellishment treatment is performed on all angles, front, three quarters and profile. The morphing, a 3D imaging system allows the patient to see the reshaped nose on a screen before the procedure.

AULINE V. :  ”I really saw the difference when I looked at my pictures”

“My face is rather long,with prominent cheekbones, and I always thought that my nose, although straight, was too long and too wide to fit in. So I decided to shorten ita little, and to reduce the size of the nostrils. The procedurewas not painful.After the procédure, I only felt a slight discomfort when breathing, in the first weeks. At first, my nose was swollen and it seemed wider than before, soI was a little disappointed. But then it started to become thinner and after a few months, it had its new, permanent shape.

It didn’t look like a nose job at all, and my new nose fitted perfectly in my face, as if ithad always been like this. But I really realized the change when I looked at my pictures: I was just much more photogenic. A little later, I had another procedure to make my nostrils a little rounder, because I thought their shape was a little too sharp. It was a simple and quick procedure – using a cartilage graft behind the ear – and this improved the results even more. “

Prerequisites

 Puberty is the minimum age prerequisite for rhinoplasty. When performed correctly, the procedure can provide enormous satisfaction, both aesthetic and psychological. For an adult patient, it can make the face look younger, similar to a facelift but in a much easier way. The patient should consult one or several surgeons before considering the procedure. Once the choice is made,two preliminary consultations must be scheduled with the practitioner. The latter will use digital photos and morphing to suggest treatments,discuss the nose reshaping possibilities and understand the patient’s expectations. After the treatment has been decided, the patient will receive a complete consent document explaining the benefits and risks, as well as the costs involved. Even thoughthe risk is kept to a minimum, a period of reflection is mandatory for patients before undergoing surgery. The procedureusually lasts less than one hour and hospitalization does not exceed twenty-four hours.

Patients may stay in the clinic for one night, but a lot of them are able to safely leave the hospital in the evening, if the surgery was performed early in the morning.

Before surgery, the skin is deeply cleansed and the surgeon will have been informedif the patient has a tendency to acne or pimples. ”There are subtle ways to correct a bump on the nose, or a nose that is too long; rhinoplasty can also solve more challenging problems, like injuries caused by an accident, major congenital malformation or bad results from a previous nose surgery. In these extreme caseswe are dealing with reconstructive rhinoplasty, but despite the technical difficulties, we must always have an aesthetic approachas well”, says Dr. Raspaldo. As for the touch-ups, they are only required in 5% of the cases and must always be scheduled prior to the surgery. They are simple corrections, most often performedunder local anesthesia.

I want a natural-looking nose

Article from ”L’officiel chirurgie esthétique”

Respect the harmony, the unique personality of a face and the natural anatomy, commit to embellishingthe nose withless invasive products and techniques, this isDr. Raspaldo’snew concept of rhinoplasty. By Paule Cornille.

1.WHO IS THIS FOR?
For women who prefer anatural-looking nose, as well assimple and soft techniques that take physiology into consideration.

 2. BEFORE THE PROCEDURE
Just as any other rhinoplasty, this procedure requires two consultations, as well as a complete blood test. Then, you will have to wait for at least 15 days, a mandatory waiting period because you might want to think your decision over. After a complete analysis of the nose and the tissues, the surgeon takes photos with front views, profile and three-quarter views. He will then use the morphing technique to simulate the different reshaping possibilities, that you will be able toseeon a screen.

3. THE SURGERYPROTOCOL
The procedure is performed under general anesthesia only if the nasal septumis concerned, otherwise a neuroleptenalgesia will be enough. “It is almost always an outpatient procedure,” says Dr. Herve Raspaldo. To reshape the nose, mask hollow areas or deformities, heuses cartilage harvested from the patient herself (himself) rather than synthetic products (silicone, goretex, coral) – he will not inject synthetic products either. Instead of using the classic occlusive splints made out of plaster, he prefers thermoformable models, whichare well ventilated, more solid and easier to reshape. And to keep them in place, he chose a biocompatible surgical varnish rather than using plasters,which are often allergenic. Also, when it comes to fixing the cartilage or the mucous membrane in the nose, heuses a biological glue, preventing any inflammatory reaction.

4. POST–OPERATIVECARE
The recovery time is shorter than with conventional rhinoplasty. In 80% of cases, edema and bruising disappear after eight days. Their resorption can be accelerated by cryotherapy sessions – a gas at 70° C is sprayed all over the face for a few days. The splints are removed after six days. The old nasal packings that cause so much discomfort are now replaced by painless,resorbable pads. They prevent bleeding, but allow patients to breathe almost normally and can be removed after 12 to 24 hours. Thanks to the less invasive instruments and technique, this rhinoplasty is almost painless.

5. AFTER THE PROCEDURE
The patient will be advised to sleep on the side or on the back for a while and torefrain from sports or any physical activity for at least a week.

6. SCARS
They will be invisible,because all sutures – made with absorbable threads – are located inside the nose.

 7. RESULTS
The final result is usually visible after one week, but it continues to refine for several months.

8. RISKS
They are kept to a minimum: the cartilage, muscles and mucous membranes will be protected and respected.In addition, thanks to the prior morphing, there is no risk of having a dramatical change in your face or not having the expected result. However, small imperfections can appear, but they can be corrected after 3months to one year.

DOCTOR HERVÉ RASPALDO’S OPINION
“I have been practicing aesthetic rhinoplasty since 1986 and my long experience allowed me to develop this”new way of conceiving the nose”. The “Rhino-bio” is inspired by the general organic trend, starting with bio-ethics. This approach involves guiding the patient towards the nose shape that will best suit him or her, refusing a surgery that is considered unsuited, providing the best analyzeand understanding by usinga morphing software that shows the expected results. It also involvestaking biodiversity into account – reshaping different noses adapted to the patient’s personality but also his or her racial origins.

This is also about biotechnology and biocompatibility: we only use natural materials that are not likely to be traumatic or harmful in ashort or long term. Rather than introducing foreign components, westrive to keep as much original cartilage as possible,by refining orreshaping it as needed. In a word, it’s an innovative process, totally adapted to the latest evolutions in our society.”