Introduction
In New York City, individuals seeking nasal bridge prosthetic filling have a range of institutions to choose from. Nasal bridge surgery and prosthetic filling play a significant role in both enhancing aesthetics and improving nasal function. This article will evaluate five selected institutions, providing insights into their services, techniques, and the expertise of their medical professionals.
1. Cangello Plastic Surgery
Expertise in Rhinoplasty
Dr. David Cangello, a board - certified plastic surgeon in New York City, is widely recognized as a leader in rhinoplasty and a pioneer of preservation rhinoplasty. Nasal bridge surgery is a fundamental part of rhinoplasty, and Dr. Cangello is experienced in a range of techniques to successfully treat various nasal bridge issues. His skills are highly regarded in the field, and he has a proven track record of delivering excellent results.
Preservation Rhinoplasty
Dr. Cangello is among an elite few surgeons to offer preservation rhinoplasty in the United States. This modern approach to nose reshaping preserves as much of the original nasal structure as possible. By retaining the existing tissue, cartilage, and bone, it allows for a natural - looking result, improved nasal function, and a lower risk of complications. Preservation techniques are well - suited for nasal bridge concerns such as removal of humps, general bridge reshaping, and correction of minor asymmetries. Up to 80% of patients seeking nasal bridge surgery with Dr. Cangello are treated using this approach.
Advantages over Traditional Surgery
Compared to traditional nasal bridge surgical techniques, preservation rhinoplasty offers several key benefits. Firstly, the dorsum is completely preserved, eliminating the need for reconstruction and cartilage grafts. Instead of shaving down the dorsum, bone and cartilage removal occurs underneath the nose bridge, and the intact dorsum can be easily repositioned to lower the height of the nasal bridge. This reduces the possibility of dorsum irregularities and cuts down on revision rhinoplasty procedures. Secondly, the dissection takes place in a different plane. In a preservation procedure, the perichondrium and the periosteum are left intact, preserving the veins, arteries, and lymphatics, which almost eliminates bruising and swelling and minimizes the patient's social downtime. Finally, the tip plasty approach in a preservation procedure emphasizes a more natural look, avoiding problems with nose tip proportion that can be tell - tale signs of rhinoplasty.
Specific Procedures
Dr. Cangello performs various nasal bridge surgeries. When narrowing the appearance of the nose, he takes several factors into consideration. The width of the nasal base is crucial; if it is wide or flared, a nasal base reduction may be incorporated into the surgical plan. The natural shape and desired aesthetic of the nasal tip also need to be refined in proportion to the new nasal bridge. Additionally, the proportions of the nose in relation to ethnicity and facial features are considered, especially for non - Caucasian patients seeking ethnic rhinoplasty. The thickness and elasticity of the skin are also evaluated, as patients with certain heritages may have thicker nasal skin, which affects the surgical plan and patient expectations.
For correcting a dorsal bump, Dr. Cangello understands the complexity of the procedure. To ensure a proportionate, natural - looking, and functional result, he plans to integrate a series of maneuvers beyond hump removal, such as performing osteotomies to bring the width of the nose in proportion to the new bridge height, considering the integrity of the middle vault of the nose to determine if spreader grafts are necessary, and revising the position and shape of the nose tip to harmonize with the slope of the nose.
In cases of a saddle nose deformity, which can be caused by a traumatic injury, failed rhinoplasty, cocaine abuse, certain medical conditions, or be congenital, Dr. Cangello undertakes a careful assessment of the degree and cause. Surgical correction may involve restoration or augmentation of the nasal bridge. In mild cases, a graft of septal cartilage may be sufficient, while in more severe cases, more extensive grafting such as costal cartilage grafting or a synthetic biocompatible grafting material may be needed.
Finally, Dr. Cangello emphasizes the importance of both form and function in nasal bridge surgery. Many patients who undergo nasal bridge surgery experience a passive improvement in nasal function due to the correction of underlying nasal obstruction. If the nasal bridge is deviated due to septal deviation, septoplasty, which can improve nasal airflow, will be incorporated into the initial surgical plan.
2. Barry Weintraub Plastic Surgery
Surgeon's Credentials
Dr. Barry Weintraub is a top New York plastic surgeon who is board - certified and Ivy League educated at the Weill - Cornell Medical Center. He is a national spokesperson for the American Board of Plastic Surgery and has more than two decades of experience. Dr. Weintraub is known for his mature aesthetic judgment and a keen eye toward natural beauty.
Types of Rhinoplasty
His rhinoplasty services cover both functional and cosmetic aspects. Functional rhinoplasty is used to correct breathing problems such as nasoseptal deviation, turbinate hypertrophy, and middle - vault collapse, which are often insurance - reimbursable. Cosmetic rhinoplasty addresses aesthetic problems like a hump or bump of the nose, a bulbous or ill - defined tip, a plunging tip, a too - wide or too - flat bridge, and problems with nostril size and projection. The surgery can be performed in a closed manner (no external incisions) for primary “virgin” rhinoplasty or in an open fashion (with small incisions at the nasal base) for more complex secondary or tertiary rhinoplasties, which are some of Dr. Weintraub's favorite procedures.
Patient - Centered Approach
Dr. Weintraub takes a patient - centered approach. During the consultation, he encourages patients to express their concerns and desires. He believes that a good plastic surgeon should listen to the patient's specific needs. He also provides a comfortable and inviting office environment, making patients feel at ease. For out - of - town or overseas patients, he advises a two - night post - operative stay and has relationships with hotels to offer special reduced rates and can provide a private nurse.
Surgical Techniques and Safety
He prefers his rhinoplasty patients to be in a comfortable state of twilight sleep during the procedure, with advancements in anesthesia ensuring a crisp and clear emergence without nausea, vomiting, or grogginess. He insists on the most sterile conditions in his New York City operating room, with board - certified anesthesiologists and state - of - the - art monitoring equipment. The surgery is always performed by Dr. Weintraub himself, with every intraoperative maneuver executed with precision and care, and all wounds sewn in multiple layers by his own hand.
3. Mount Sinai - New York
Comprehensive Rhinoplasty Services
Mount Sinai - New York offers a comprehensive range of rhinoplasty services. Rhinoplasty at this institution can be performed under local or general anesthesia, depending on the extent of the procedure and the patient's preference. The surgery is usually done through incisions made inside the nostrils, but in some cases, external incisions around the base of the nose may be used, especially for tip work or revision surgeries. If the nose needs to be narrowed, the incision may extend around the nostrils, and small incisions inside the nose may be made to break and reshape the bone.
Reasons for Rhinoplasty
The reasons for rhinoplasty at Mount Sinai are diverse. It can be used to reduce the size of the nose, change the shape of the tip or the nasal bridge, narrow the opening of the nostrils, change the angle between the nose and the upper lip, correct a birth defect or injury, and help relieve nasal breathing problems. Cosmetic nose surgery is considered elective and is usually preferred after the nasal bone has finished growing (around age 14 or 15 for girls and a bit later for boys).
Pre - and Post - operative Care
Before the procedure, patients are given instructions such as stopping blood - thinning medicines, getting medical clearance from their regular health care provider, stopping smoking at least 2 to 3 weeks before and after surgery, and arranging for someone to drive them home after surgery. After the procedure, patients usually go home on the same day. The nose and face will be swollen and painful, with headaches being common. The nasal packing (if present) is removed in 3 to 5 days, and the splint and cast may be left in place for 1 to 2 weeks. Full recovery takes about a year, but most swelling improves by 2 to 3 months.
Risk Assessment
Like any surgical procedure, rhinoplasty at Mount Sinai has risks. General risks for anesthesia and surgery include reactions to medicines, problems breathing, bleeding, infection, and bruising. Specific risks for rhinoplasty include loss of support of the nose, contour deformities of the nose, worsening of breathing through the nose, and the need for further surgery. Tiny red spots on the skin surface from burst blood vessels may also appear, and in rare cases, a revision procedure may be needed.
4. Use of Digital Technology in Nasal Prosthesis Design
While not a specific institution in the traditional sense, the application of digital technology in nasal prosthesis design is an important aspect of nasal bridge prosthetic filling. This approach offers new possibilities for more accurate and customized solutions.
3D Morphable Face Model Approach
An open - access digital database of nose models has been generated based on a 3 - dimensional (3D) morphable face model approach. This database can provide a rapid and straightforward way of trialing multiple options as a starting point for prosthesis design, especially in cases where preoperative information is limited or the nose is an unpaired facial feature. The Leeds face model, generated based on the facial scans of over 100 volunteers of varying ages, sexes, and ethnicities, is used to create a sample of randomly generated faces. The noses from these faces are then cropped and screened to form a database with thumbnail images and written descriptions of bridge profile, tip projection, nose length - to - width ratio, and key measurements.
Designing a Nasal Prosthesis
The process of designing a nasal prosthesis using this database involves several steps. First, all required data are collected, including a facial scan and preoperative photographs. Then, appropriate nose models are selected from the database by comparing the preoperative information with the thumbnail images and descriptions, considering neoclassical canons or geometric rules while accounting for ethnic variation and patient preference. The facial mesh and nose models are imported into a preferred CAD software program, oriented, and the most appropriate nose model is selected. It is then resized, fine - aligned to the facial mesh, and the margins are blended. Retentive components are added, and the design is adjusted according to the patient's needs. Finally, the CAD file is used to produce a 3D printed replica or negative mold.
Benefits and Limitations
The digital nose model database supports operators with an understanding of prosthetic principles and general CAD techniques. It allows for rapid trial of multiple options and is compatible with a variety of software programs. However, the sample used to create the Leeds face model may be insufficient to fully represent all nasal shape variations, and the database may have a low prevalence of some features. Further improvements could include semi - automating key CAD steps and using augmented reality programs to aid nose model selection and patient input.
5. Non - Surgical Rhinoplasty and Nasal Filling
Use of Hyaluronic Acid
Non - surgical rhinoplasty using hyaluronic acid is an emerging option for nasal bridge prosthetic filling. It is a safe, less invasive, and less costly alternative to surgery, requiring a shorter recovery time and having fewer associated risks of complication. Hyaluronic acid can be used for both primary cases (patients with no previous procedures) and secondary cases (corrections after surgical rhinoplasty). It is suitable for patients who want to correct small defects or seek improvements complementary to a previous surgical procedure.
Anatomy and Evaluation
The nose is a complex three - dimensional structure composed of skin, cartilage, muscle, and bone. When considering nasal filling with hyaluronic acid, a detailed evaluation of the nose is necessary. The position of the nose in relation to the face is analyzed, both in the vertical and horizontal planes. Anthropometric measurements are taken, including nasal length, projection, and various angles such as the nasofrontal angle, columella labial angle, and columellar - lobular angle. These measurements and angles are established and applied individually to each patient to correlate with the main indications of non - surgical nasal filling, such as elevation or rectification of the tip or the nasal dorsum, correction of asymmetries, or correction of post - traumatic deformities and congenital hypodevelopment.
Technique and Results
The technique for nasal filling with hyaluronic acid involves sterilizing the area, applying a topical anesthetic, and using a high - density hyaluronic acid. A puncture is made with a 22 - gauge needle in the central region of the nasal tip, and a 22g cannula is inserted to deposit the filler. After the procedure, a sterile dressing is placed over the entry point, and a micropore is placed along the dorsum and around the tip. In the immediate post - procedure period, light local pain and ecchymosis may occur, and edema and erythema may be observed up to 30 days post - procedure. In a study of 44 patients, the nasal length increased by an average of 0.1 cm - 0.5 cm to + 0.7 cm, and the nasal projection increased by an average of 0.08 cm. The nasofrontal angle decreased by an average of 0.37 degrees, and the columellar - labial angle increased by an average of 5.97 degrees.
Complications
Like any filler procedure, nasal filling with hyaluronic acid has potential complications. These can be divided into early and delayed complications. Early complications include edema, redness, bruising, allergic reaction, inflammatory and non - inflammatory nodules, embolism with blindness, and tissue necrosis. Delayed complications include granulomatous inflammation, foreign body reaction, nodules, granuloma, migration of the implanted filler, scarring, and asymmetry. However, in a patient cohort, only one complication (a pustule with discrete pain) was reported, which was treated by extruding a small amount of the product.
Conclusion
In New York City, the five selected institutions and approaches for nasal bridge prosthetic filling offer a diverse range of options. Cangello Plastic Surgery and Barry Weintraub Plastic Surgery provide surgical expertise with a focus on patient - centered care and advanced techniques. Mount Sinai - New York offers comprehensive rhinoplasty services with proper pre - and post - operative care. The use of digital technology in nasal prosthesis design opens up new possibilities for customized solutions, while non - surgical rhinoplasty with hyaluronic acid provides a less invasive alternative. Each option has its own advantages and considerations, and patients should carefully evaluate their needs, consult with experienced professionals, and make an informed decision. If you are considering nasal bridge prosthetic filling, we encourage you to reach out to these institutions or further research the options available to find the best fit for your specific situation.
