Riverside Facial Plastic Surgery and Sinus Center

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Celebrity Plastic Surgery by Frank J. Scaccia, M.D., F.A.C.S.
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laser surgeryWelcome to Riverside's home page. As medical director of the facility, Dr. Frank Scaccia is a uniquely qualified Dual Board Certified Facial Plastic Surgeon and Otolaryngologist who specializes in cosmetic surgery, plastic surgery, rhinoplasty, facelift and treatment of sinus/nasal disorders. After a unanimous vote by his peers, Dr. Scaccia was appointed for 2012 as the Chairman and Section Chief for the departments of Ear, Nose and Throat, and Head & Neck Surgery at Meridian Health's Riverview Medical Center in Red Bank, NJ. Riverview is one of the busiest and most respected hospitals in the region being a 5 time winner of The J.D. Power and Associates Award. His list of honors in plastic surgery includes the Jack Anderson Award which he won in 1995 after receiving the highest score in the United States on the certifying exam given by the American Board of Facial Plastic & Reconstructive Surgery. In addition, his surgical abilities have been featured in Time, Newsweek, Channel 7 "Eyewitness News," and most recently this past June on the "Anderson Cooper Show" where a TV personality was commenting to Mr. Cooper how much she likes her new nose that Dr. Scaccia operated on for her and that he is an "amazing doctor." He has also contributed to the medical literature with publications in textbook and journals. Dr. Scaccia was one of the first to publish in a textbook a technique to perform simultaneous rhinoplasty and sinus surgery. Follow this link for a copy of this interesting book chapter.
MM More recently, Dr. Scaccia has been named as one of New Jersey's leading cosmetic surgeons in a special article on "Top Beauty Docs" by NJ Savvy Living Magazine magazine in the February 2006 through 2009 editions. Furthermore, he was cited as one of only seven cosmetic surgeons in New Jersey that was specifically recognized for his rhinoplasty nose skills. The criteria for selection of this honor was based on Castle Connolly's physician lead research team who uses a vigorous screening process to survey physicians and administrators at leading hospitals for recommendations of highly skilled, exceptional doctors in the field of cosmetic plastic surgery. In addition Dr. Scaccia has also earned the prestigious recognition of being listed in the 2006 to 2010 editions of "The Guide to America's Top Physicians," the 2006 through 2013 editions of "Top Doctors: New York Metro Area," the 2011 listing in "US News &World Report" of Top Doctors and 2012 edition of Top Doctors: The-Star-Ledger's Inside Jersey, the Marquis' 2007 through 2012 editions of "Who'sWho in America" and most recently, has been selected for inclusion in both the 2010 and 2012 editions of "Who'sWho in Medicine and Healthcare," and the 2011 through 2012 edition of "Who'sWho in the World." Finally, Dr Scaccia has the added distinction of being included in the 2013 list of "Top Cosmetic Doctors" in the nation by Castle Connelly Medical Ltd.
MM His new office is located in the historic town of Red Bank allowing convenient access from all northern and central New Jersey sites and the New York City metropolitan area. The plastic surgery NJ and sinus center NJ includes it's own federally approved and accredited ambulatory outpatient surgical suite built to hospital safety standards and is one of the first in Monmouth County to utilize Brain Lab's Image Guided Navigational Sinus System allowing for state-of-the-art endoscopic sinus surgery.
MMRiverside has also been awarded accreditation by JCAHO (Joint Commission on Accreditation of Healthcare Organizations) the nation's leading evaluator among hospitals and other healthcare groups for quality care and patient safety. The center underwent a thorough onsite evaluation against nearly 150 standards which demonstrates our mission to provide the highest level of care possible. Your safety, comfort and privacy are our top priorities. Procedures can be performed under various levels of anesthesia (including general and twilight sleep) and will be administered by only board certified physician anesthesiologists. You will find that Dr. Scaccia's commitment to safety and excellence is exemplified throughout this web site. One benchmark is the fact that in his 20 years (residency training and private practice) as a physician (which includes thousands of surgical procedures) no medical malpractice judgments or even settlements have ever been brought against him.
MMSome of the facial plastic surgery procedures performed at the center include facelift, rhytidectomy, mini facelift, midface lift, s-lift, platelet gel facelift, weekend neck lift, eyelid rejuvenation, blepharoplasty, eyebrow lift, forehead lift, lip enhancement/rejuvenation, chin/cheek implants, liposuction, snoring and sleep apnea correction, female nasal sculpturing, rhinoplasty, male nasal sculpturing, rhinoplasty, Asian nasal surgery, Afro-American rhinoplasty, Ethnic rhinoplasty, revision/redo nasal surgery and sinus surgery.
MMBotox injections, laser surgery for tattoos, moles, pigment, spider veins, wrinkles, skin resurfacing, hair removal and scars are also available. Other plastic surgery procedures performed include ear surgery (otoplasty), split earlobe repair, AlloDerm implants, sclerotherapy and chemical peels. Gentlewaves LED Photomodulation is a new technology that we are now using to reverse photoaging and potentially speeds healing after surgery.

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Dr. Scaccia

70 East Front St., Third Flr., Red Bank, NJ 07701 • Tel: (732) 747-5300 / Fax: (732) 747-9922

Additional Offices:


525 Route 70, Suite 3A, Brick Township, Ocean County, NJ 08723 •
Tel: (732) 262-3695
305 Seguine Avenue Suite #1 Staten Island, NY 10309 • Tel: (718) 967-2411
219 Taylors Mills Road, Manalapan, NJ 07726 • Tel: (732) 308-6000

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Content and photos are the intellectual property of Frank J. Scaccia, M.D., F.A.C.S. and Riverside Nasal & Sinus Center and may not be used or duplicated for any reason. ©2015

 

Fat Nose Fix Aberdeen NJ 07747

 

For plastic surgical correction, the structural anatomy of the nose comprehends: A. the nasal soft tissues; B. the aesthetic subunits and segments; C. the blood supply arteries and veins; D. the nasal lymphatic system; E. the facial and nasal nerves; F. the nasal bones; andG. the nasal cartilages. Fat nose fix Aberdeen NJ 07747.

A. The nasal soft tissues
  • Nasal skin — Like the underlying bone-and-cartilage (osseo-cartilaginous) support framework of the nose, the external skin is divided into vertical thirds (anatomic sections); from the glabella (the space between the eyebrows), to the bridge, to the tip, for corrective plastic surgery, the nasal skin is anatomically considered, as the:
  1. Upper third section — the skin of the upper nose is thick, and relatively distensible (flexible and mobile), but then tapers, adhering tightly to the osseo-cartilaginous framework, and becomes the thinner skin of the dorsal section, the bridge of the nose.
  2. Middle third section — the skin overlying the bridge of the nose (mid-dorsal section) is the thinnest, least distensible, nasal skin, because it most adheres to the support framework.
  3. Lower third section — the skin of the lower nose is as thick as the skin of the upper nose, because it has more sebaceous glands, especially at the nasal tip.
  • Nasal lining — At the vestibule, the human nose is lined with a mucous membrane of squamous epithelium, which tissue then transitions to become columnar respiratory epithelium, a pseudo-stratified, ciliated (lash-like) tissue with abundant seromucinous glands, which maintains the nasal moisture and protects the respiratory tract from bacteriologic infection and foreign objects.
  • Nasal muscles — The movements of the human nose are controlled by groups of facial and neck muscles that are set deep to the skin; they are in four (4) functional groups that are interconnected by the nasal superficial aponeurosis — the superficial musculoaponeurotic system (SMAS) — which is a sheet of dense, fibrous, collagenous connective tissue that covers, invests, and forms the terminations of the muscles. Fat nose fix Aberdeen NJ 07747.
The movements of the nose are affected by
  1. the elevator muscle group — which includes the procerus muscle and the levator labii superioris alaeque nasi muscle.
  2. the depressor muscle group — which includes the alar nasalis muscle and the depressor septi nasi muscle.
  3. the compressor muscle group — which includes the transverse nasalis muscle.
  4. the dilator muscle group — which includes the dilator naris muscle that expands the nostrils; it is in two parts: (i) the dilator nasi anterior muscle, and (ii) the dilator nasi posterior muscle. Fat nose fix Aberdeen NJ 07747.
B. Aesthetics of the nose — nasal subunits and nasal segments

To plan, map, and execute the surgical correction of a nasal defect or deformity, the structure of the external nose is divided into nine (9) aesthetic nasal subunits, and six (6) aesthetic nasal segments, which provide the plastic surgeon with the measures for determining the size, extent, and topographic locale of the nasal defect or deformity. Fat nose fix Aberdeen NJ 07747.

The surgical nose as nine (9) aesthetic nasal subunits
  1. tip subunit
  2. columellar subunit
  3. right alar base subunit
  4. right alar wall subunit
  5. left alar wall subunit
  6. left alar base subunit
  7. dorsal subunit
  8. right dorsal wall subunit
  9. left dorsal wall subunit

In turn, the nine (9) aesthetic nasal subunits are configured as six (6) aesthetic nasal segments; each segment comprehends a nasal area greater than that comprehended by a nasal subunit. Fat nose fix Aberdeen NJ 07747.

The surgical nose as six (6) aesthetic nasal segments
  1. the dorsal nasal segment
  2. the lateral nasal-wall segments
  3. the hemi-lobule segment
  4. the soft-tissue triangle segments
  5. the alar segments
  6. the columellar segment

Using the co-ordinates of the subunits and segments to determine the topographic location of the defect on the nose, the plastic surgeon plans, maps, and executes a rhinoplasty procedure. The unitary division of the nasal topography permits minimal, but precise, cutting, and maximal corrective-tissue coverage, to produce a functional nose of proportionate size, contour, and appearance for the patient. Hence, if more than 50 per cent of an aesthetic subunit is lost (damaged, defective, destroyed) the surgeon replaces the entire aesthetic segment, usually with a regional tissue graft, harvested from either the face or the head, or with a tissue graft harvested from elsewhere on the patient’s body. Fat nose fix Aberdeen NJ 07747.

C. Nasal blood supply — arteries and veins

Like the face, the human nose is well vascularized with arteries and veins, and thus supplied with abundant blood. The principal arterial blood-vessel supply to the nose is two-fold: (i) branches from the internal carotid artery, the branch of the anterior ethmoid artery, the branch of the posterior ethmoid artery, which derive from the ophthalmic artery(ii) branches from the external carotid artery, the sphenopalatine artery, the greater palatine artery, the superior labial artery, and the angular artery.

The external nose is supplied with blood by the facial artery, which becomes the angular artery that courses over the superomedial aspect of the nose. The sellar region (sella turcica, “Turkish chair”) and the dorsal region of the nose are supplied with blood by branches of the internal maxillary artery (infraorbital) and the ophthalmic arteries that derive from the internal common carotid artery system.

Internally, the lateral nasal wall is supplied with blood by the sphenopalatine artery (from behind and below) and by the anterior ethmoid artery and the posterior ethmoid artery (from above and behind). The nasal septum also is supplied with blood by the sphenopalatine artery, and by the anterior and posterior ethmoid arteries, with the additional circulatory contributions of the superior labial artery and of the greater palatine artery. These three (3) vascular supplies to the internal nose converge in the Kiesselbach plexus (the Little area), which is a region in the anteroinferior-third of the nasal septum, (in front and below). Furthermore, the nasal vein vascularisation of the nose generally follows the arterial pattern of nasal vascularisation. The nasal veins are biologically significant, because they have no vessel-valves, and because of their direct, circulatory communication to the sinus caverns, which makes possible the potential intracranial spreading of a bacterial infection of the nose. Hence, because of such an abundant nasal blood supply, tobacco smoking does therapeutically compromise post-operative healing. Fat nose fix Aberdeen NJ 07747.

D. Lymphatic system of the nose

The pertinent nasal lymphatic system arises from the superficial mucosa, and drains posteriorly to the retropharyngeal nodes (in back), and anteriorly (in front), either to the upper deep cervical nodes (in the neck), or to the submandibular glands (in the lower jaw), or into both the nodes and the glands of the neck and the jaw. Fat nose fix Aberdeen NJ 07747.

E. Nerves of the nose

The sensations registered by the human nose derive from the first two (2) branches of cranial nerve V, the trigeminal nerve(nervus trigeminis). The nerve listings indicate the respective innervation (sensory distribution) of the trigeminal nerve branches within the nose, the face, and the upper jaw (maxilla). Fat nose fix Aberdeen NJ 07747.

The indicated nerve serves the named anatomic facial and nasal regions
Ophthalmic division innervation
  • Lacrimal nerve — conveys sensation to the skin areas of the lateral orbital (eye socket) region, except for the lacrimal gland.
  • Frontal nerve — conveys sensation to the skin areas of the forehead and the scalp.
  • Supraorbital nerve — conveys sensation to the skin areas of the eyelids, the forehead, and the scalp.
  • Supratrochlear nerve — conveys sensation to the medial region of the eyelid skin area, and the medial region of the forehead skin.
  • Nasociliary nerve — conveys sensation to the skin area of the nose, and the mucous membrane of the anterior (front) nasal cavity.
  • Anterior ethmoid nerve — conveys sensation in the anterior (front) half of the nasal cavity: (a) the internal areas of the ethmoid sinus and the frontal sinus; and (b) the external areas, from the nasal tip to the rhinion: the anterior tip of the terminal end of the nasal-bone suture.
  • Posterior ethmoid nerve — serves the superior (upper) half of the nasal cavity, the sphenoids, and the ethmoids.
  • Intratrochlear nerve — conveys sensation to the medial region of the eyelids, the palpebral conjunctiva, the nasion (nasolabial junction), and the bony dorsum. Fat nose fix Aberdeen NJ 07747.
The maxillary division innervation
  • Maxillary nerve — conveys sensation to the upper jaw and the face.
  • Infraorbital nerve — conveys sensation to the area from below the eye socket to the external nares (nostrils).
  • Zygomatic nerve — through the zygomatic bone and the zygomatic arch, conveys sensation to the cheekbone areas.
  • Superior posterior dental nerve — sensation in the teeth and the gums.
  • Superior anterior dental nerve — mediates the sneeze reflex.
  • Sphenopalatine nerve — divides into the lateral branch and the septal branch, and conveys sensation from the rear and the central regions of the nasal cavity.

The supply of parasympathetic nerves to the face and the upper jaw (maxilla) derives from the greater superficial petrosal (GSP) branch of cranial nerve VII, the facial nerve. The GSP nerve joins the deep petrosal nerve (of the sympathetic nervous system), derived from the carotid plexus, to form the vidian nerve (in the vidian canal) that traverses the pterygopalatine ganglion (an autonomic ganglion of the maxillary nerve), wherein only the parasympathetic nerves form synapses, which serve the lacrimal gland and the glands of the nose and of the palate, via the (upper jaw) maxillary division of cranial nerve V, thetrigeminal nerve. Fat nose fix Aberdeen NJ 07747.

F. Bony anatomy of the nose

In the upper portion of the nose, the paired nasal bones attach to the frontal bone. Above and to the side (superolaterally), the paired nasal bones connect to the lacrimal bones, and below and to the side (inferolaterally), they attach to the ascending processes of the maxilla (upper jaw). Above and to the back (posterosuperiorly), the bony nasal septum is composed of the perpendicular plate of the ethmoid bone. The vomer bone lies below and to the back (posteroinferiorly), and partially forms the choanal opening into the nasopharynx, (the upper portion of the pharynx that is continuous with the nasal passages). The floor of the nose comprises the premaxilla bone and the palatine bone, the roof of the mouth. Fat nose fix Aberdeen NJ 07747.

The nasal septum is composed of the quadrangular cartilage, the vomer bone (the perpendicular plate of the ethmoid bone), aspects of the premaxilla, and the palatine bones. Each lateral nasal wall contains three pairs of turbinates (nasal conchae), which are small, thin, shell-form bones: (i) the superior concha, (ii) the middle concha, and (iii) the inferior concha, which are the bony framework of the turbinates. Lateral to the turbinates is the medial wall of the maxillary sinus. Inferior to the nasal conchae (turbinates) is the meatus space, with names that correspond to the turbinates, e.g. superior turbinate, superior meatus, et alii. The internal roof of the nose is composed by the horizontal, perforated cribriform plate (of the ethmoid bone) through which pass sensory filaments of theolfactory nerve (Cranial nerve I); finally, below and behind (posteroinferior) the cribriform plate, sloping down at an angle, is the bony face of the sphenoid sinus.

G. The cartilaginous pyramid of the nose

The cartilaginous septum (septum nasi) extends from the nasal bones in the midline (above) to the bony septum in the midline (posteriorly), then down along the bony floor. The septum is quadrangular; the upper half is flanked by two (2) triangular-to-trapezoidal cartilages: the upper lateral-cartilages, which are fused to the dorsal septum in the midline, and laterally attached, with loose ligaments, to the bony margin of the pyriform (pear-shaped) aperture, while the inferior ends of the upper lateral-cartilages are free (unattached). The internal area (angle), formed by the septum and upper lateral-cartilage, constitutes the internal valve of the nose; the sesamoid cartilages are adjacent to the upper lateral-cartilages in the fibroareolar connective tissue.

Beneath the upper lateral-cartilages lay the lower lateral-cartilages; the paired lower lateral-cartilages swing outwards, from medial attachments, to the caudal septum in the midline (the medial crura) to an intermediate crus (shank) area. Finally, the lower lateral-cartilages flare outwards, above and to the side (superolaterally), as the lateral crura; these cartilages are mobile, unlike the upper lateral cartilages. Furthermore, some persons present anatomical evidence of nasal scrolling — i.e. an outward curving of the lower borders of the upper lateral-cartilages, and an inward curving of the cephalic borders of the alar cartilages.