Fanny Brice’s Nose Job

In the year 1923 Fanny Brice was the talk of the town. She was the star and main attraction of Florenz Ziegfeld’s Follies, the most attended vaudeville act of tis time with the most famous attraction. Ziegfeld’s Follies was where Fanny Brice became a celebrity. Not bad for a Jewish girl who evidently suffered from image problems due to her very ethnic and large proboscis. As a comedienne on stage her nose was a perfect prop for her comic routine. At what point in her seemingly glorious life did she decide to “bob” her Jewish nose is unknown.

Barbra Streisand, a half century later, faced the same critical audiences that had persuaded the young Fanny Brice to change her Jewish appearance, but could not persuade Streisand to do the same. It was after Streisand’s brilliant performance in Funny Girl, a play about the life of Fanny Brice, that the questions about her looks began.

Fanny Brice was a prolific self-marketer and realized the national publicity her nose job would have. How she found her plastic surgeon, Dr. Henry Junius Schireson, a man of forty-two with a dubious past, questionable educational background as a doctor, and a reputation that he would operate on anything for money, remains a mystery.

For the event the media were notified and Fanny Brice had her nose bobbed in her hotel room by a quack surgeon. Her nose job was the medical event of the day and generated press attention until the birth of the Dionne quintuplets in Canada in 1934. Henry Schireson was an overnight sensation and probably the first celebrity plastic surgeon. It wasn’t too many years later that Schireson lost his medical license under a barrage of lawsuits and retired a disgraced man.

As far as Brice, she continued to be the gold standard for female comediennes, continued her ethnic Yiddish humor on stage until 1934 when she changed to radio and had an illustrious career on air where no one could see her new and improved nose.

The Ins and Outs of Rhinoplasty by Dr. Paul Howard

By its very nature, Rhinoplasty is one of the most personal of Plastic Surgical procedures.  Many people define the way they look and reflect their ethnicity on their noses and any changes anticipated must be fully discussed pre-operatively.  To do this the patient must have a firm and unwavering commitment to facial change as well as an honest and realistic expectation about the nose they wish to have.  This may start with a look through today’s fashion magazines to see what the “beautiful people” look like.  While it is rarely possible to recreate another’s nose, it does provide a starting point and does give the Plastic Surgeon a general idea of what the patient wants.  The process can then begin to alter the patient’s expectations to something nearer to reality.  Every patient should expect to have a more attractive nose that also breathes well, but not every patient can have the perfect little turned-up nose seen in so many of our current movie actresses.  Once the Plastic Surgeon gets a general idea of what the patient desires, then he/she can begin discussion of the details of the operation and what may or may not be possible.  During this part of the consultation, drawing expected results on the pre-operative photos or utilizing computer imaging is essential.  The only caveat regarding computer imaging is that it is always better if the operating surgeon does the imaging so that the imaged results are as close to realistic as possible.

Explaining the details of the procedure is important as the possibility of complications is hidden in these details.  For instance, describing a dorsal hump reduction should lead to the possibility of a small elevation at the bone-cartilage junction and in large reductions leads to a discussion of osteotomies and supra-tip problems.  We usually perform a septoplasty as straightening the outside of the nose can incur septal deviations that cause breathing difficulties if no septoplasty is performed.  Additionally, the sub-mucous resection of the septal cartilage can be replaced (banked) for possible future use or used to help define a nasal tip or to open an internal valve or straighten the cartilaginous dorsal septum.

The thickness or thinness of the skin needs to be addressed as each can affect the visualized result; thick skin will camouflage tip contouring while thin skin may show the tip architecture created in the finest detail.  Therefore, in a thin skinned patient more discussion of tip detail is crucial.  Explaining planes, cartilage breaks, and light reflexes may then become important.

The most important pre-operative information that must be understood clearly by the patient is that it takes at least 6 months and usually up to a year before the final result is realized and that any necessary revisions should wait at least 6 months in most circumstances.  It is important to not over-sale the cosmetic rhinoplasty.

From the Plastic Surgeon’s point-of-view, reconstructive and even cosmetic rhinoplasty is challenging and has a “steep learning curve” which means it takes a lot of cases to become facile with the instruments and the operation.  I personally was trained by one the best rhinoplasty surgeons ever (see: Rhinoplasty Tetralogy by D. Ralph Millard, Jr., MD).  My early practice encompassed a lot of broken noses due to automobile or physical trauma.  Then I gained a reputation for cleft lip and palate as well as the most difficult rhinoplasties on infants and children.  After 20 years of experience I now only concentrate on teenage and adult cleft lip rhinoplasties, complex rhinoplasty due to trauma and most cosmetic rhinoplasty.   After an extensive 26 year experience, I still find rhinoplasty to be the most taxing and the most rewarding operation that I perform.

Read more about Rhinoplasty by top plastic surgeon Dr. Paul Howard..

To Schedule a Consultation call 205-877-PAUL

Chin Augmentation

In Hollywood, where most of the talent trades on their facial attractiveness, it has been common for both men and women to enhance their profiles with chin enhancement.  Especially in men a strong jawline and profile are a must for matinee idol handsomeness.   In an industry where attractiveness is the primary currency, chin surgery has always been common; more common than anybody suspected.  So it is not a surprise that the American Society of Plastic Surgeons statistics show that chin augmentation with chin implants has risen 71% making it the fastest growing plastic surgical procedure.  Slightly more men than women are undergoing the procedure which is not a surprise due to the large cachet placed on a strong chin and jawline in men.

Implants for chin augmentation have been around for 30 years or more so the science behind the procedure is fairly well worked out.  Commonly, an incision is placed in the mouth below the front teeth on the bottom (a skin incision below the chin is also feasible).  A pocket is then created over the boney part of the chin or mentum.  This pocket is carefully placed below the tooth roots and away from the nerves that supply sensation to the lower lip.  Small improvements of 4-5 mm are easily achieved with a variety of silastic (silicone) implants with various shapes and sizes.  Most experienced surgeons would agree that a chin augmentation of 10mm or more is more difficult to obtain with an implant.  These large augmentations are associated with a small chin (microgenia) as well as a poorly defined, obtuse, neck contour.  Simply placing an implant gives minimal improvement to the neck.  Large implants are more likely to cause boney erosion of the chin due to their size and the tension required to advance the tight soft tissues.  For this reason, large chin advancements of a centimeter or more are frequently achieved with a different operation known as a genioplasty.  A genioplasty is performed again through an oral incision, but rather than placing a silastic implant, the chin bone is cut in a horizontal direction below the tooth roots so that the small chin may be advanced and fixed in position with titanium plates and screws.  If the small amount of titanium hardware becomes a problem it may be removed after healing of the bone at about 6 months post-operatively.  The intrinsic beauty of the genioplasty is that the neck muscles are left attached to the boney chin and as the chin is moved forward to effect the augmentation, the neck muscles are also tightened improving the once obtuse neck line.  In the rare instance of a chin implant infection, removing the implant and performing a genioplasty can salvage the result as the small amount of titanium used for fixation almost never causes an infection.

The most common complications of chin implant surgery are the rare infection, rare boney erosion involving tooth roots, and more commonly prolonged lip numbness (rarely permanent) with the most frequent complication being inadequate chin projection as well as over-projection of the chin giving a profile in women that it too strong and sometimes masculine.  Occasionally, a chin implant that is not properly healed can shift causing the chin to be asymmetric.  Even years after fully healing, a trauma to the chin implant can cause a secondary hematoma and inflammation necessitating implant removal.  On a very rare occasion a lower jaw (mandibular) tooth abscess can secondarily infect a chin implant, but not a genioplasty.

Over the years, many creative surgeons have tried to create chin implants with mesh material such as mersilene or prolene mesh.  The primary problem with porous materials is that they can get chronically infected causing prolonged oral drainage.  Also, these porous implants become incorporated into the chin soft tissues and thus are impossible to revise (bigger or smaller) and can be very difficult to remove.  The good news is that these so called “chin cripples” can be salvaged by a well performed genioplasty.

Chin augmentation is one of those procedures that lends itself to facial imaging.  Using the already well known proportions, the exact profile can be agreed upon pre-operatively so that no misunderstandings develop post-operatively.

All in all, chin augmentation is one of the easiest and most satisfying operations performed by Plastic Surgeons.  Naturally, when studying the profile, the nasal profile comes under scrutiny and in many cases rhinoplasty and chin augmentation are done simultaneously to overhaul the entire profile all at once.  Again, facial imaging can predict the profile that is desired.  One warning is in order:  Many times dental malformations (malocclusions) can mask themselves as a weak profile.  A good dental evaluation to rule out malocclusions and dental caries, especially in the lower jar, is indicated pre-operatively.  Beware the dentist/orthodontist with today’s fancy facial imaging software.  Not everyone with minor malocclusions needs $5,000 of orthodontics on a fully formed jaw.  These orthodontists many times feel the need to recommend both nasal and chin surgery acting like they and their referrals are a necessity.  This is the tail wagging the dog.  It should be very easy to identify fully trained Plastic Surgeons to perform both chin augmentation as well as the rhinoplasty in a single operation.

Call today for your consultation 205-871-3361

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Rhinoplasty – Minimal Surgery with Major Results

There is a certain subset of patients who, by genetics or trauma, will require a true septo-rhinoplasty to correct breathing problems and to straighten an injured nasal pyramid.  There is a much larger group of patients who have relatively minor cosmetic nasal problems, usually confined to the tip or the bridge of the nose.  It is a well-known that the tip of the nose tends to lose its support as we age causing the nose to tilt over the upper lip and gives the impression of a longer nose.  Minor nasal tip cartilage problems can create the impression of a “boxy” tip or even a “pointy” nose.  Minor bridge problems can be addressed with small operations.

The use of filler in the nose has only recently become popular.  There are a few situations where fillers may improve the nose without surgery.  Small discrepancies of the nasal bones usually due to trauma and certain small tip and bridge asymmetries may be improved with the judicious use of fillers.  To this point in time the “perfect filler” is still your own fat.  Harvested and processed fat is long-lasting and usually does not require secondary procedures.

The nasal refining procedures do not require general anesthesia and are not covered by insurance.  These procedures are for refining the nose and as such do not change to overall ethnicity of your nose.  Think of your same nose yet more refined, elegant, and at a greatly reduced price.  For some people a major nasal reconstruction may be necessary due to trauma, for those who want a completely new nose, or those with significant nasal breathing problems.

 

Dr. Paul Howard

View rhinoplasty before and after photos on Dr. Paul Howard web site.