I'm Unhappy with my Nose - What are my Options?

If you don’t like the way your nose looks, you’ve probably spent a long time wondering if you should do something about it - and, if so, what?

It can be difficult for people to tell what actually needs to be done to their nose to improve its appearance. In this article, we’ll help you understand the most common reasons people are unhappy with their noses - and the best treatments to correct them, including non-surgical options.

If your nose is too big

An ideally proportioned nose is one that’s in harmony with the rest of the facial features. If a nose projects too far out, it will look off-kilter and be very noticeable. To assess if the nose is too big, vertical and horizontal measurements are taken. The horizontal measurement is then divided by the vertical measurement. The optimum range is 0.55 to 0.60. 

To reduce the projection of the nose, a reduction rhinoplasty is needed. The procedure involves removing some cartilage and filing down the bone to bring measurements into the optimum range. 

If your nose is too small

If your nose falls below the ideal 0.55 to 0.60 size range it can also look out of proportion (according to Caucasian facial proportions). The projection of the nose can be increased non-surgically by injecting dermal filler (with the result lasting 12-18 months) or surgically, with a dorsal augmentation. 

A dorsal augmentation uses either a silicone implant or -preferably - your own septal cartilage to build up your bridge. If you don’t have sufficient cartilage, a rib or bone graft can also be used.

If your nose is too long

To analyse if the nose is too long for a face, surgeons divide the face into three equal sections horizontally. If the nose extends lower than the middle third of the face then it is too long. This is usually caused by an overly large nasal tip and/or hanging columella (the bit between the nostrils).

The angle of the tip of the nose (the amount the nose is turned up) also plays an important role. Measured from the lip up, the ideal range of rotation is 90 to 100 degrees for men and 95 to 110 degrees for women. A female nose that is rotated less than 90 degrees to the face looks droopy, long and masculine.

If the over-projection of the nasal tip is modest, the appearance can be improved by placing a small amount of injectable muscle relaxant at the base of the nose in between the nostrils, or possibly into the nose tip itself. This relaxes the fibres of the depressor muscle that pulls the nose downward and lifts the nose for 4 to 6 months. 

Where a greater uplift is needed, or the nasal tip/columella needs to be reduced in size, excess tissue can be removed during surgery and sutures can be placed to alter the angle of the nose.

If your nose is too short

A short nose is one that is too turned up or what is called ‘over-rotated’. It can result in very visible nostrils giving the appearance of a ‘pig nose.’ A mildly over-rotated nose can be improved with dermal filler injections into the bridge. These can soften the appearance and create the illusion of a more proportionate nose.

But for more severe over-rotation, a specialised plastic surgery technique called derotation or counter-rotation is needed. A derotation rhinoplasty procedure requires a cartilage graft (sourced from the septum or rib) to lengthen the nose and correct the position and rotation of the nasal tip. 

If your nose is too wide

The ideal width of a nose differs according to ethnicity. For Caucasians, the optimal measurement is considered to be one-fifth of the total width of the face. A wide nose will usually be caused by a flat and broad nasal bridge but it can also be contributed to by a bulbous or thick nose tip and flared nostrils.

The width of the nose cannot be shrunk without surgery but dermal fillers can add volume and give an illusion of a smaller nose bridge by adding more height. To treat a wide nose surgically, a medial or lateral osteotomy is performed. A medial osteotomy is the reshaping of the midsection of your nose, while a lateral osteotomy involves chiselling the outer, longer sections of your nose bone.

In some cases, both techniques may be combined to produce an overall narrower appearance of the nasal bridge. Surgery to reduce the size of the nasal tip and width of the nostrils (alarplasty) might also be included. 

If your nose is too narrow

A narrow nose can be due to a narrow bridge or a narrow tip. A narrow bridge is often caused by a dorsal hump and can be easily corrected by filing down the bone to give a flatter appearance. However, sometimes it’s due to collapsed nasal bones or cartilages and, in these cases, spreader grafts are needed to widen the area.

Meanwhile, a narrow or pinched tip can be corrected by using grafts to rebuild the proper cartilage support of the nose and nostrils. Where cartilages in the tip are overlapping, soft tissue spacer grafts can be placed to separate them.

There are non-surgical possibilities, though. For some patients, the use of dermal fillers can enhance volume in different parts of the nose. 

If your nose is bumpy or wonky 

A bumpy or wonky nose is caused by a dorsal hump and/or a deviated septum. These can occur naturally or through trauma - a broken nose can result in a dorsal hump if the cartilage and bone heal unevenly.

A dorsal hump can be treated non-surgically using filler above and below the bump to smooth out the transition and make the bump less noticeable. The drawback is that because you are adding volume to the nose it can make it appear bigger. Also, the injections have to be repeated every 12-18 months.

If the bump is small, it can be filed or shaved down, which avoids having to break the bones of the nose but for larger dorsal humps, osteotomy is necessary. This involves making small cuts to the nasal bones where they meet the cheek so they can be repositioned. 

Septoplasty is the usual way to repair a deviated septum. During septoplasty, your nasal septum is straightened and repositioned in the centre of your nose. This may require your surgeon to cut and remove parts of your septum before reinserting them in the proper position. 

Getting the right treatment for your nose

The truth is, getting a perfectly sized and shaped nose for your face may require a combination of revisions. The best way to find out is to have a consultation with a surgeon who can examine your nose and assess it in relation to your other facial features. 

Even if you have a clear idea of what you’d like to achieve, a surgeon will be able to advise what’s actually possible, taking into consideration your anatomy, skin type and overall health. At Ocean Clinic, we can advise on both surgical and non-surgical options for changing your nose. 

Contact us to make an appointment 

What is Composite Breast Augmentation?

Have you heard the term ‘composite breast augmentation’ and wondered what it is? It sounds pretty strange and technical, but actually, composite breast enlargement is designed to give a very natural-looking enhancement to the chest. 

As the fashion for overly-large and artificial-looking breasts moves towards a more subtle aesthetic, composite breast augmentation is becoming increasingly popular.

Ocean Clinic has been a leading force in developing the procedure and, thanks to the enhanced results it offers, it’s being adopted as a protocol of choice by plastic surgeons globally.

Read on to discover how the procedure differs from standard breast enlargement, how’s it’s performed and what the benefits are...

What is composite breast augmentation?

Composite breast augmentation is a procedure that combines traditional breast implants with transplanted body fat. It’s carried out to increase the size of the breasts and/or to enhance their shape.

As well as providing a more natural result, the procedure is popular because it also includes liposuction of common problem areas, like the tummy. Stubborn pockets of fat can be targeted, with the fat then grafted into the breasts. In this way, composite breast augmentation is a 2-in-1 procedure. 

How is composite breast augmentation performed? 

To carry out composite breast augmentation, it’s first necessary to locate donor fat elsewhere on the body. Because of this, the procedure is not suitable for very lean patients, however, most of us have sufficient fat stored in one place or another. 

Fat is most commonly harvested from the stomach, waist, thighs and flanks. It’s extracted with a liposuction cannula, which is small in diameter and requires only very tiny incisions. This means it leaves next to no scarring.

The fat extraction is carried out at the same time as the rest of the surgery, so patients are fully anesthetised. While the fat is being prepared for reintroduction to the body using a centrifuge, the surgeon will make the incisions for the implants. 

These are made in the creases beneath the breasts and are small in size (only about three centimetres). In most cases, the fullness in the base of the breasts will completely conceal the scars when you are sitting or standing.

The implant will then be placed. Composite breast augmentation allows for the use of smaller implants because volume can be added with fat. It also allows for asymmetry to be corrected, since different volumes of fat can be placed around the implants in each breast.

The implants will be placed subpectorally (under the muscle), which helps to produce the most natural-looking results. This is because it creates more cushion between the implant and the skin, so you’re less likely to feel the edges or see rippling. 

The transplanted fat is used to further disguise the outline of the implants. By carefully injecting it into the medial borders, it makes the transition from chest to implant smoother. Fat grafting also gives the surgeon the opportunity to give the patient a nicer cleavage. Providing cushioning between the implants creates a soft undulation, which cannot be achieved with implants alone.

How does recovery from composite breast augmentation differ from regular breast augmentation?

With composite breast augmentation, two separate procedures are performed, so recovery is slightly more extensive. There will typically be some swelling and some bruising where fat has been removed and you will need to wear a compression garment/belt around the donor site for 2-3 weeks. 

The chest will also be more swollen than when implants alone are used. This is because an overabundance of fat is grafted during the procedure to account for the cells that don’t become vascularised (gain a blood supply) and therefore die off. Usually, this is between 40-60%.

It means your breasts will initially appear bigger than they’re going to be once healing is complete. The fat that remains 6 months post-surgery should be with you for the rest of your life. Meanwhile, the donor areas will be more resistant to weight gain due to the removal of fat cells.

Am I a good candidate for composite breast augmentation?

You’re a good candidate for composite breast augmentation if you have small breasts that are in a good position on your chest. Ideally, you’ll have an area/s on your body with an amount of excess fat to serve as donor site/s. If you are on the slimmer side, it’s still possible to remove smaller amounts of fat to be grafted but the benefits will be more modest. 

If you have sagging breasts, you will not be suitable for this procedure as an uplift will be required (take our breast test to check). However, if you have simply lost volume in the upper part of your breasts and the nipple is still in a perky position, composite breast augmentation can yield a great result by replacing lost volume. It’s also a good technique for correcting differences in breast size or shape. 

Would you like to learn more about composite breast augmentation? Contact us for an in-person or online consultation. 

Why we love... Lateral Brow Lift and Upper Blepharoplasty

 Plastic surgeon Dr Felix Paprottka loves restoring drooping brows to their youthful position. He explains how he does it using a combination of procedures; lateral brow lift and upper blepharoplasty. 

What is your favourite procedure to perform? 

I personally like the lateral brow lift in combination with an upper blepharoplasty (upper eyelid correction). Patients with a long forehead, at some point in their life, will face the problem that their brows look droopy. These patients will always look a bit tired because of their heavy brows — meaning the lateral sides of their brows are hanging down and there is an excess of skin in the upper eyelid area. Sometimes this look can be even more visible after a cosmetic injectable treatment in the forehead area, which makes the muscles relax even more. 

Many surgeons treat this appearance with just an upper blepharoplasty, removing only the skin in the upper eyelid area. By doing this, the distance between the brow and the upper eyelid becomes shorter and shorter with every surgical procedure and it starts to look unnatural. Also, the problem with the hanging brow has not been solved by this attempt. By carrying out a lateral brow lift with an upper blepharoplasty, the excess skin is removed and the outside tail of the eyebrows is lifted. This not only helps to correct hooded eyelids and smooth crow’s feet but also creates the appearance of sexy, foxy eyes.

Why do you like performing lateral brow lift and upper blepharoplasty? 

I am a big fan of it because the natural position of the brows can be restored by this procedure. In order to restore the brows, the plastic surgeon first lifts the lateral brow area and, thereafter, removes the left-over skin in the upper eyelid area. When combining these two procedures, it’s very important to start with the lateral brow lift, since then the surgeon can actually see how much skin needs to be resected in the upper eyelid area. 

I also like this intervention as it can be easily performed under sedation. This means the patient receives some intravenous medication in order to feel sleepy and relaxed but is breathing on her/his own. They mostly cannot remember anything about the procedure when they wake up. If a patient wishes to have this procedure performed with local anaesthesia only, this can be offered as well.

How many times have you done lateral brow lift and upper blepharoplasty? 

This is a procedure we perform at least once every two weeks in Ocean Clinic.

How are lateral brow lift and upper blepharoplasty surgery carried out? 

For the lateral brow lift, a 2 cm horizontal cut is applied in the hairline around the temples. This is an area where women do not lose any hair while ageing so the scar is well hidden. Via this access, the lateral brow is moved upwards by applying an interlocking suture. The same result is reproduced on the contralateral side and the wounds are closed with staples (staples are used since they can be removed almost painlessly in the hair region after 10 days following surgery.)

Next, a fine skin resection is performed, removing the left-over skin in the upper eyelid region. The scar is placed in the tarsal fold, so it’s almost invisible. In general, scars in the face heal very well. With these two combined interventions, the tired look from which many patients suffer can be resolved and corrected. I am always amazed by the great results we can achieve!

What’s the most technical part of lateral brow lift and upper blepharoplasty surgery? 

The most technical part of the lateral brow lift is placing the interlocking suture. It functions as a pulley block; with one suture, the deep fascia is grabbed and with the other part, the overlaying skin is pulled upwards. As a result, the lateral part of the brow can be lifted nicely, resulting in a “V” shaped brow area. 

The challenging part of an upper blepharoplasty is to resect the skin in such a manner that the scar is placed directly in the existing tarsal fold and therefore is not visible. But since we do these surgeries very frequently these surgical steps are not difficult for us.

Have there been any changes in the technique or technology used in this procedure? 

In the beginning, some plastic surgeons performed a full forehead-lift. This results in a long horizontal scar, which is placed in the hairline transition zone. This technique can be used if the medial part of the brow is also drooping and needs to be lifted. But for most patient cases with just a lateral drooping brow, the lateral brow lift is the best treatment option. An endoscopic technique can be applied when it makes sense, resulting in even smaller scars.

How might lateral brow lift and upper blepharoplasty surgery change in the future? 

This technique has already been improved over a long period of time and really works very well. So we do not expect major changes in the future.

Do you have any memories that stand out in relation to this procedure or the patients you’ve carried it out on? 

Yes, all of my patients are always very happy and excited directly after the surgery, since the new V-shaped position of the brows is immediately visible. 

Tired of looking tired? Make an appointment to find out more about lateral brow lift and upper blepharoplasty surgery. Both in-clinic and online video consultations are available.

Why We Love... Coolsculpting

Ocean Clinic's Cosmetician Ángela Conde tells us why she gets great satisfaction zapping fat bulges away with Coolsculpting.

What is your favourite procedure to perform? 

Coolsculpting. It’s a non-surgical treatment that reduces stubborn fat bulges using fat freezing technology. Fat cells don’t like the cold and at a certain temperature, they will freeze and die. Once that happens, your body will naturally eliminate the dead cells in 1-3 months, resulting in up to 20%-25% reduction of fat in a treated area.

Why do you like it? 

The results are amazing for those patients who do not want to undergo surgery. It can be used under the chin and jawline, on the thighs, abdomen and flanks. It’s also effective for bra fat, back fat, underneath the buttocks and upper arms. Patients can start to see a difference after as little as one treatment.

How many times have you done it? 

More than 100 times.

How is it carried out? 

First, we create the design of the area to be treated, which depends on the volumes of fat we want to reduce and the type of localised fat found in the area. Then, the patient lies on the bed in a comfortable position and the appropriate transducer is applied. The patient will feel a cold, tingling sensation but won’t be in pain. The treatment usually lasts between 35 and 75 minutes, during which time, the patient can be reading or using their phone or laptop.

What is the most technical part? 

You need to measure the localised fat area very well to be able to create the best design. The challenge is finding the ideal manipulations, according to the patient's body, to sculpt the fat and achieve the patient's expectations.

Have there been any changes in the technique or technology used in this procedure?

In addition to Coolsculpting, there’s now a new device to tone muscles called CoolTone. It uses Magnetic Muscle Stimulation (MMS) technology to penetrate below the fat layer, strengthening, toning, and firming the muscles beneath. It can be used on the abdomen, buttocks, and thighs.

How might this procedure change in the future? 

This is a very advanced technology. Combining Coolsculpting and CoolToning can produce spectacular results, all without the need to undergo surgery. In the future, maybe the technology will advance further to be effective on larger volumes of fat - not that it’s a substitute for a healthy diet and exercise.  

Do you have any memories that stand out in relation to this procedure or the patients you’ve carried it out on? 

Everyone is very happy after the treatment since no downtime is required and they can carry out their daily life without any problem. And they’re delighted when they start to see results. Usually, patients have had these stubborn pockets of fat for many years so it’s always very rewarding to see them disappear.

Want to freeze your fat away? Call Ocean Clinic to find out more about Coolsculpting or make an appointment.

A New Innovation in Stretch Mark Treatment

Ocean Clinic is proud to present a brand new treatment for stretch marks, developed in-house by Dr Gabriela Casabona.  

The treatment is a combination of procedures that Dr Casabona has been trialling, and it has been getting great results for our patients. It combines Venus Viva with Dermapen 4, two non-invasive, pain-free treatments. 

Understanding stretch marks

Stretch marks develop when the body grows rapidly and the skin is stretched - this often happens during puberty and pregnancy (other causes include weight gain and bodybuilding).

Rapid stretching causes the connective tissues and fibres of the dermis (the middle layer of the skin) to become thin and overstretched. In some places, they may break, allowing deeper layers of skin to show through. This is why stretch marks can appear red or purple in colour. 

As we age, skin becomes less able to stretch and snap back into shape due to decreased collagen levels. Collagen is a protein that functions to hold or bind skin cells together and which serves to keep skin supple. When less collagen is available in the skin, it becomes more likely to develop stretch marks or wrinkles.

How does our new stretch mark treatment work?

Our new stretch mark treatment works by combining two procedures that boost the production of collagen. They do this by causing micro-injuries beneath the surface of the skin and triggering the body’s natural healing response. 

Venus Viva is a skin resurfacing treatment that uses nanofractional radiofrequency to heat the cells deep in the dermis. This stimulates collagen production and encourages the skin to repair itself. As the skin regains elasticity and tightens, stretch marks become smoothed out. 

Delivering up to 700 pulses of energy, the device is very powerful but still gentle enough to be used on even the most delicate areas of the face and body. It is often used to treat facial wrinkles but has also been shown to have a significant benefit on stretch marks (referred to medically as striae).

A published clinical study showed that four weeks after treatment with Venus Viva, total surface area, length, and width of stretch marks significantly decreased and patient satisfaction for overall improvement was 96.97%. 

The effect of Venus Viva is enhanced with Dermapen, the only microneedling device with a dedicated setting for stretch mark scars. The pen uses 12 tiny needles to create microscopic punctures to the inner and outer layers of skin. This results in a regeneration of the collagen and other elastic fibres.

The “channels” created by the derma pen also allow for the delivery of nutrient-rich serums deep into the skin. Topical creams can provide real benefit when they’re able to penetrate beneath the skin’s surface. We use a vitamin C serum, which is well known for boosting collagen production.

Who is a good candidate for this treatment?

Our new stretch mark treatment can be used on all skin types. It’s beneficial for all types of stretch marks but the best results are seen on more recent stretch marks. Stretch marks that are still red or purple and haven’t faded away to a silvery colour respond very well.

It means that the treatment is ideal for people who have seen recent changes to their bodies, such as women who have suffered stretch marks to their tummies following pregnancy. Stretch marks affect around 8 out of 10 pregnant women and can give the tummy a stripy, scarred appearance. 

The results you’ll see from the treatment will depend on the size and depth of your stretch marks. Stretch marks that are wider than 0.5 cms will not respond as well as smaller ones. 

Treatment of larger stretch marks

If your stretch marks are very extensive, an alternative treatment protocol can be used, which combines Ultherapy, Radiesse and Dermapen 4. Ultherapy is an ultrasound treatment used to stimulate collagen and elastin. It does this by heating the layers beneath the skin and creating thermal microtrauma - this leads to a reformation of elastic fibres

To fill the gap created by the stretch marks and give the skin a smoother surface, Radiesse, an injectable filler, is used. The filler is diluted (mixed with saline and lidocaine to thin it out) and injected superficially. As well as adding volume and helping to disguise the colour of stretch marks, it acts as a bio-stimulating agent, triggering the production of collagen and elastin. 

Dermapen 4 enhances the effectiveness of the other two treatments. After each session, the skin continues to regenerate leading to long term improvements in tone, texture and elasticity.

How many sessions are required?

The treatment requires three sessions of each procedure (six sessions in total). The procedures have to be alternated, so one week you’ll have Venus Viva and the next week you’ll have Dermapen 4. You’ll visit the clinic once a week until the treatment course is complete.

Each session will take around 20 to 30 minutes, depending on the size of the area being treated. There is no downtime needed so you can get straight back to your normal activities afterwards. 

Following each session, you’re likely to have some redness and roughness for 2-4 days, which you may want to keep in mind when you’re planning outfits. It’s also important to avoid any sun exposure to the treated area.

For more information about our new stretch mark treatment or to book your course, contact Ocean Clinic Marbella on (+34) 951 77 55 18.

Why We Love... Orthodontics & Porcelain Veneers

Ocean Clinic’s Cosmetic Dentist Dr Nina King tells us why she loves transforming patients’ smiles with orthodontics and porcelain veneers. 

What is your favourite procedure to perform?

Doing orthodontics combined with porcelain veneers.

Why do you like it?

Orthodontics involves moving the teeth into the correct position and then the ceramic veneers change the colour, shape and size so we can completely transform someone's smile. Often my adult patients have been ashamed and embarrassed by their smile for a very long time and the boost in self-confidence is amazing.

How many times have you done it?

We have done many, many cases using these treatment techniques combined.

How is it carried out?

I work with a specialist orthodontist who tends to use “invisible braces”; clear retainers like Invisalign or a system called Incognito, which goes behind the teeth. This is because many of my adult patients are conscious of wearing a traditional metal brace.

Communication is absolutely essential between the orthodontist and myself as I plan and design the final result, normally using digital smile design techniques. We use this as a road map to direct where we want the teeth to be.

In this way, I can then prepare the teeth as minimally as possible and take the impressions for the new ceramic veneers to be fitted making sure that they are customised to meet each individual patient's needs.

What’s the most technical part?

Preparation for the veneers is a delicate procedure because there must be a balance between preserving as much healthy tooth structure as possible versus removal of enough so that the veneers sit well.

We can then create beautiful looking ceramic work, which will blend in naturally. I try to remove no more than 0.5mm of the top layer enamel.

Have there been any changes in the technique or technology used in this procedure?

With the onset of digital design and scanners, if we are using the invisible brace system Invisalign, we can now anticipate the final smile and get it preapproved by the patient. We enter this information into the system and simulate the movements and design the correct retainers for each phase.

Thus after the orthodontic work, the teeth are already positioned exactly as we need them to be. For example if I am using ceramic veneers to close spaces between teeth, the orthodontist can ensure the spaces are evenly spread out so we can have symmetrical final veneers.

How might this procedure change in the future?

I am doing more and more ceramic veneers in-house. That means that instead of taking traditional moulds and sending them to the laboratory technician, we can do milling in the surgery and have them ready in a matter of hours instead of days.

This is, however, still not appropriate for all cases due to limitations of the equipment. For example, how thin some of the ceramics can be prepared. I am sure that there will be even more evolution in the technology making it possible to do every case in-house.

Do you have any memories that stand out in relation to this procedure or the patients you’ve carried it out on? 

Patients sometimes think it's too late for them… they are aware their teeth are very overlapped or crooked and they may have wanted the treatment in the past but for financial or time constraints simply not gone ahead.

When they realise what can be achieved and the effects that we can create, it truly is a wonderful feeling to be able to help someone's self-confidence grow.

Interested in redesigning your smile with orthodontics and porcelain veneers? Book an online or in-clinic consultation.