Dr. Oakley Smith

Written by Niki Stad

Oakley Smith MD FRCSC, a renowned facial plastic and reconstructive surgeon, is Surgeon-in-Chief in the Department of Otolaryngology — Head and Neck Surgery at Toronto East General Hospital. Dr. Smith is also an Assistant Professor at the University of Toronto. Dr. Smith is at the forefront of the latest in rhinoplasty innovations and has designed instruments as well as new techniques and procedures. Dr. Smith performs 9% of all rhinoplasties, or “nose jobs” and 20% of the complex nasal reconstruction in Ontario. That is believed to be more than any other single surgeon in Canada.

Here are some great tips and information about reconstructive and cosmetic surgery of the nose and what the difference is between the two surgeries. Dr. Smith also provides answers to some common problems and questions that people have before and after surgery.

1) What do you love about your work?
I like making people happy and that’s what cosmetic surgery does when done well. When you do a good job, people get a real boost in their self esteem and they feel more confident. The other aspects I really enjoy are designing instruments as well as new techniques and procedures to help get the best rhinoplasty outcome I possibly can. As an assistant professor at University of Toronto I get to pass on my experiences and teach what I’ve learnt to the next generation of surgeons which is very rewarding.

2) Can you tell us about your work on a typical day?
I start early and finish late! (Laughing) my typical day starts off by conducting follow ups with post surgical patients and then seeing new ones coming in for a variety of reasons. The majority of consultations and exams are for either reconstructive nose for breathing problems, or cosmetic patients, who want to improve the outward appearance of their nose. So its either we end up booking those patients for surgery or there is small group of people who can have injection rhinoplasty, which can be done then and there, in the office, without surgery.

3) What is the NO SURGERY OR FILLER NOSE JOB you just mentioned that can be done right there in the office?
The non-surgical nose job is when you inject fillers like Restylane or Juvederm to fix and shape the nose without surgery. This procedure typically takes about 25 minutes and the patient leaves without bandages or any tell-tale signs of surgery. This is a great procedure for correcting bumps on the bridge, and mildly crooked or slightly asymmetric noses. In some cases you can even solve a large nose just by camouflaging a bump or making a crooked nose straight, the nose will appear smaller. It is sometimes used to perfect or apply finishing touches following surgical rhinoplasty as well. Injecting dermal fillers into the nose requires a high level of skill as well as a thorough understanding of nasal structures and soft tissues. This procedure only applies to 5 to 15% of people; the majority of people still need surgery.

4) In regards to cosmetic surgery of the nose, how much can you change the shape?
Well in regard to how much change you can provide, is very dependent on the nose shape as well as the skin, which most patients don’t realize. If its thin skin, you can make a bigger change and you can see the change but when you’ve got thick skin, then it acts like a rug and covers the change. Even when it’s a big structural change underneath it doesn’t show through as much, so skin is a big issue and a huge factor in how much of a change is possible. So, in fact, that’s where the experience and expertise of the surgeon comes in. I can’t emphasize enough the importance of doing your homework, research and asking the physician the right questions including, how many of this type of surgery have they done and what experience they have. Ask to see before and after photos. They should be able to tell you how much can be done and what you can expect as a result at the end.

5) Can you always satisfy the patient’s requests?
The most important first step is to get an understanding of what bothers the patient about their appearance and what they want to change or correct. You must then make it very clear if these changes are possible and what results they can expect. If their expectations are not realistic its better not do the surgery because they are not going to be happy no matter how the surgery turns out. In my practice I see a lot of patients who have had previous surgeries they want me to correct. In many cases this is different than not having realistic expectations but rather having previous work that needs correcting.

6) I understand you also specialize in ‘ETHNIC RHINOPLSTY’ which is growing in demand and popularity in your practice?
Yes, I see noses of all ethnic origins. These range from Persian (Iranian), Hispanic, and African-American to Israeli, Arab, and Asian. Rhinoplasty is in and of itself a unique operation. Every nose should be tailored for only that person. No two people should have the same nasal shaping performed. Living in a multi-cultural society like Toronto Canada makes it necessary and very important to be able to provide and treat each patient according to their ethnic and cultural wishes and needs. This makes the operation of a nose job even more challenging, but always interesting. It’s all about the balance between the physical traits of the individual and their ethnic background. There was a time when it was one nose job fits all. No matter your race or facial shape each surgery requires pre-operative evaluations and a precise and custom-tailored rhinoplasty.

7) What are the reasons for SNORING? And do you have any treatments available in your clinic?
Most of the time snoring is due to the back of the throat where the tongue ends, when you go to sleep all the muscles relax and they actually drop and you start to snore which is the usual cause. In maybe 5 to 15% of the snorers, the nose is also part of the problem, because if you don’t breathe through your nose you end up breathing through your mouth and that causes the tongue to drop back even more. For this small group of patients it may require a nasal surgery to help correct their snore problem.

8) Some people complain that after their nose job they have difficulty breathing. Is there any treatment for this problem or any recommendations?
It depends on the cause, just about everybody, after nose surgery in the recovery period or the first few weeks, aren’t breathing well through their nose. The usual cause is either there is packing putting in the nose or the nose inside has swelling so it’s congested. That’s typical and expected but that should resolve as soon as the packing is removed which is usually about a week or within maybe a month when swelling has gone (maybe half the swelling is gone within a month) and that’s expected and normal. There is another, very small, group, only about 5% of patients who have surgery and they can’t breathe after, is a result of the surgery. The surgery usually has been too aggressive, too much of the structure of the nose has been removed and that causes the nose to clasp and the internal channels to narrow and people have trouble breathing. Now most of them we can fix and some of them we can’t. In my practice I do a lot of reconstructive cosmetic nose surgery on patients who were not happy with the work done by previous surgeons. In some cases this can be a third surgery for these patients. That is why it’s so important for patients to do their research and find a surgeon with the experience and proper skills to provide a good outcome the first time around.

9) Do you have treatments for allergy sufferers? And do you have a preference on an allergy relief product?
I don’t generally treat allergy sufferers. When a patient does, however, come in because they are having trouble breathing and I’ve determined that it’s not a nose problem but allergies my first line of treatment is nasal sprays. In some cases I will also refer the patient to an allergy specialist for further testing. The prescription nasal sprays we recommend do not cause holes in the nose, and they don’t rot the nose out. The ones you can buy over the counter are the ones that can rot your nose out if used continually. I also perform surgery to fix holes in the nose caused by excess use of nose sprays and cocaine use.

10) I saw on your website that you perform EAR PINNING WITHOUT SURGERY (Incisionless Otoplasty)! Can you explain a little more about it and if this is suitable for all ages?
Incisionless Otoplasty is a big advancement. The traditional ear pinning required an operation where you make an incision behind the ear in the crease. For this procedure the patient had to be put to sleep under a General Anesthetic, followed by several weeks of uncomfortable recovery. The patient had to wear bulky bandages for a month and then a ski band, at night, for several months. Now we don’t do surgery, we do it while the patient is awake with freezing to the area being treated like when you go to the dentist. We simply put stitches underneath the back of their ear (inside their skin). The incisions are hidden and they bend the ear back which gives the same result as the traditional surgery and requires half the time. With the incisionless Otoplasty the patient walks out after the procedure and by the next day they are back living their life, returning to work or school. This is a huge improvement over the traditional ear pinning surgery and a favorite for men who can’t hide those jumbo ears or scars behind hair. Men also don’t want the down-time or tell-tail signs of surgery. The young women also love the procedure as they can finally pull their hair back into different styles and wear cool earrings. This procedure is best suited for teens and adults as young children are still better to be put to sleep for even this procedure. There is also a very small group that will still require the traditional surgery but the Incisionless Otoplasty has proven to work well for most patients. The procedure is covered by OHIP up to the age of eighteen years old.

11) What are the non-surgical facial refresher treatments you offer in your practice?
We offer a variety of non-surgical rejuvenation treatments including dermal fillers and Botox Cosmetic

Botox Cosmetic: is used for erasing those frown (11) lines between and around the eyes. Botox is also used as a preventative treatment from getting those lines by freezing those muscles that cause them in the first place.

RESTYLANE AND JUVEDERM: are hyaluronic acid injectable fillers used to:
Smooth fine lines, wrinkles and deep folds between the nose and lip, plump lips and cheeks, and contour the jaw line for a more youthful refreshed look.
These fillers are also used for shaping the nose “Filler Nose Job”

Sculptra:
Is one of the newer and longest-lasting dermal fillers on the market. The results appear gradually over a few weeks. It also requires several treatments over several months. Because it causes the body to stimulate its own collagen, the results can last two or more years. It adds volume to the cheeks, to the folds around the chin, and to hollow areas around the eyes. This product requires a very skilled physician for good results. Sculptra is rumored to be the filler Madonna had for facial volume restoration giving her a more youthful refreshed appearance

Selphyl system for treating fine lines and improving skin quality.
Its also been nick named the ‘vampire face lift’ as it requires drawing a small amount of the patient’s own blood and putting it through a spinner which separates out the red and white cells to concentrate the platelets and fibrin. This mixture is called creating a platelet-rich fibrin matrix (PRFM). This clear liquid is then injected into the treatment area, where it releases growth factors over the following several weeks, stimulating the skin to regenerate its underlying layers to thicken, creating volume. Selphyl fools the body into believing the treated area has been injured, the body responds by wound healing which renews, rejuvenates and refreshes the skin. Selphyl is used to erase the fine lines above the upper lip, around the eyes and the crescent folds on both sides of the mouth. The benefits of Selphyl is it’s 100% natural, so there’s no allergic reaction, the procedure takes only 20 minutes and the results lasts for 18 months
Dr. Smith’s objective is always to provide a natural not done result with all his filler treatments.

For more information or a consultation:
www.droakleysmithrhinoplasty.com
Dr. Oakley Smith
416-465-5795