Richard C. Mattison, MD (retired)

Numbness of the tip of your nose is universally seen in rhinoplasty. It clears in two months.  No residual numbness is expected.  For the bump on your nose, this is not uncommon even if the bone beneath has been reduced.   The skin is expected to settle down within the next 4-5 weeks. 

Most plastic surgeons use a series of digital nose images which define your existing nose anatomy, The surgeon then modifies the images with computer software to reflect your selection of the nose which you find attractive.  This is the image to which you can hold your surgeon accountable.   The difference between the computer image and your post surgical images should be very close the same anatomy.

Chemical Peels are old, yet useful technology. Dr's Gordon and Baker (Miami) improved the "Phenol" peel used in south Miami to a safe and effective skin improvement in 1962. It is useful; however requires IV ringer's lactate to clear the toxicity of phenol/oil/water solution in recovery of phenol from the body. Redness continues for weeks. The benefits are reduction in skin pigment and longer term (3-6 mo) wrinkle reduction.

Alternatively, trichloroacetic acid (TCA) is a safer chemical peel which does not require IV hydration, but must be started with lower concentrations of TCA in the range of 15-20%, repeated at 6 weeks intervals until an effective clinical result is achieved. On monthly or bi-monthly peels, wrinkle reduction is observed. Concentration of phenol or TCA is increased over monthly sessions, maxing at 70% TCA. More aggressive chemical peeling concentrations will cause scaring in a number of clients.

Chemical peels are effective! The efficiency of laser skin rejuventation are so much better and less likely to create hypopigmentation or scaring complications that they have disappeared from an active skin rejuvenation practice.

Current practice: skin rejuvenation

1. Microdermabrasion: (sand blasting) superificial layer of dead skin cells is useful as a prelude to chemical peel, Independent pulsed light, photodynamic therapy (levulan + Blue light), erbium laser; fractional laser, or the current gold standard, Candela fractional CO2 laser skin resurfacing.

2. Levulan applications, 20% aminolevulonic acid application -- 145-60 minutes incubation, followed by 16-30 minutes of ultraviolet light (1710 nm-blue) light will remove superficial brown pigmentation in one to three treatments with minimal pain and no down time.

3. Independent pulse light (340-950 nm) light therapy will remove brown and red dyschromia in three to five monthly sessions. Minimal discomfort and no down-time is useful as a mantenance therpy.

4. Fraxel (vertical CO2 skin penetrations) is the former winner in skin rejuvenation; however has been superceded by the Candala Quadralase due to the technology described below. Fraxel causes penetration of vertical CO2 ablations but cannot crease tangential CO2 ablation.

5. CO2 laser skin ablation is the gold standard in wrinkle/pigmentation reduction; however has longer down-term effects. The 1995 CO2 pattern ablation removed epidermis and superficial dermis, heating the papillary dermis which was dramatically effective in immediate skin tightening. The re-growth of dermis arises from the roots of hair follicles (4-800 microns). This epidermal rejuvenation required 6-12 weeks of redness to recover a wonderful winkle reduction and two-three shade pigment reduction. It is safe only on the face (contra-indicated on neck or other non-hair bearing skin). The traditional CO2 skin ablation only offers tangential epidermal ablation.

6. The current "gold" standard is the Candela Quadralase which can be set for vertical penetrations in 5-40% of skin serface; vertical penatrations from 100-1500 micron penetrations (power time [on skin 2-40milliseconds] -- energy wattage from 0-30 watts). Superficial skin rejuvenation can create a down-time of three days using topical anesthesia only. Deeper winkles (lips, eyelids) can be removed by the Quadralase using a traditional tangential CO2 ablation (1995 technique) which causes immediate skin wrinkle ablation with down-times of 1-3 weeks.

Home laser hair removal has a long tradition using:

1. Waxing effective for six to eight weeks; however leaves red spots where the hair is removed

2. Chemical depilatory: Calcium thioglycolate is an over-the-counter product which dissolves elements in hair allowing it to be scraped from your skin. Hair regrows in the usual time, face two weeks, legs a month.

3. Home Light emiting diodes: These product may someday be effective. Current owners must know that the technology will change and soon; buyer beware.

Traditional laser are safe and effective. For the forseeable future remain the gold standard for permanent hair reduction.