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A lot of ice post operatively and when indicated, a Medrol Dose Pack (steroid) can reduce swelling faster.

The tip of the nose is the lower one-third.  There are cases in which the upper two-thirds are acceptable and don’t require any change.  In these cases the surgeon can focus on the tip of the nose and re-contour it. Usually this involves narrowing, improving definition and rotation of the nose.

The fee for revision rhinoplasty, as in primary rhinoplasty, varies.  Regarding insurance, unless there is a functional component, insurance does not cover this.

I have a lot of experience with ethnic noses, particularly African Americans, and the goal is not to produce a tiny, cute nose, which would not go along with your ethnicity; the goal would be to appropriately narrow and contour it so it looks nicer and natural.

Natural breast augmentation is significantly more expensive than implants. There are only a few doctors in the world with any significant experience with cosmetic natural breast augmentation. In addition to the augmentation, patients will have liposuction of the donor areas which will be a noticeable change.

The ultra-sound has the ability to destroy the fat cells and until there are studies demonstrating that fat survives and thrives after ultrasound it is probably best not to use these machines for harvesting.

We know for a fact that human fat contains a large number of adipose derived stem cells and so any fat transfer will contain some stem cells. It is possible to enhance a fat graft by adding extra stem and regenerative cells. We have the ability to do this using the stemsource technology from cytori. During the same procedure extra fat is harvested and placed into the stem source where it is processed into adipose derived regenerative cells which are then added into the fat to be transferred. The entire process takes place within our operating room and adds about an hour to the procedure. While it is very easy to get caught up in the hype of stem cells and it is a very exciting technology, we are not sure what the benefits of enhancing the fat are and we are carefully studying this.

We have been doing fat transfer since 1999 as well as teaching and writing text books. Over the past few years fat transfer has taken off and every doctor seems to be doing it. Most doctors are so concerned with getting enough volume that they do not realize that the real danger is too much fat and we are seeing a lot of puffy balloon head results. It is important to go to a doctor who has a long track record of satisfied natural looking patients.

Typically patients will look a bit swollen but socially acceptable within a week of surgery. If we do a large full fat transfer this may take up to two weeks. For the past 2 years we have been using a technology called Puregraft to process the fat. It removes all of the inflammatory cells from the fat that is injected while leaving all of the stem cells and growth factors. The patients we treat with puregraft fat have dramatically less swelling and quicker recoveries as well as more predictable results.

One way we look at volume is that fat grafting is more effective for larger volume treatment while the injectable fillers are better for small precise corrections. Sculptra is injectable filler that has an effect similar to fat in treating larger volumes and seems to create a permanent result.

We inject a significant amount of restylane under the eyes but we are starting to see these patients develop a sort of puffy swelling about 2 – 3 years after the injection. This is treated by dissolving the restylane. Fat does not have this type of problem and does provide a permanent improvement.