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Question of the Day

December 13

By

Can I make my nostrils smaller?

The width of the nostrils can be decreased by increasing tip projection, narrowing the nasal base by removing tissue in the nostril sill at the junction with the upper lip, or decreasing nostril flare by removing excess nostril rim at the nasal base.

What can I do to minimize bleeding during rhinoplasty surgery?

Every rhinoplasty surgeon has their own preoperative regimen to reduce bleeding in the nose which is very vascular. I have a full 8.5 x 11 sheet of paper, single spaced, identifying foods, supplements, and medicines that may thin the blood and increase the risk of bleeding during rhinoplasty. In fact, I also recommend avoiding these products before less invasive procedures such as Botox and fillers to avoid or at least reduce bruising.

Can I improve both function (nasal breathing) and appearance with a rhinoplasty?

If a patient has both functional and aesthetic problems with their nose, both issues are more effectively and efficiently corrected at the same time rather than staging the procedures.

What is an open roof deformity after rhinoplasty?

An open roof deformity occurs when the nasal bones are separated from each other and the underlying septum in the center of the bridge. This causes a wider bridge and frequently a small groove or depression. This can be corrected by repositioning the bones and sometimes adding cartilage to correct the depression.

How should I select a rhinoplasty surgeon?

For many individuals this is the most difficult part of rhinoplasty surgery. You obviously want a board certified surgeon but also an individual that specializes in this procedure, who spends most of their time doing this operation, and can show you multiple examples of excellent results in patients who had a nose like yours.

Can a fractured nose be straightened without a full rhinoplasty?

If the deviation is located within the nasal bones, not the cartilage, it is easier to straighten the nose without a full rhinoplasty. I recommend patients see a rhinoplasty specialist within two weeks after the trauma because it is easier to effectively correct the deviation with a limited procedure before the bones have healed.

My nose is turned up (too short) three weeks after rhinoplasty. Will the tip drop?

I tell patients it is impossible to evaluate their rhinoplasty results three weeks after their surgery. I recommend they talk to their surgeon because many factors such as extensive tip work or reconstruction with revision surgery will influence their appearance during the post operative period.

Can I augment my weak chin at the same time as my rhinoplasty?

A chin implant is frequently placed at the same time as a rhinoplasty procedure. Augmenting a weak chin will improve lower facial balance and enhance the rhinoplasty results.

Why is my tip still hard 18 months after rhinoplasty?

We typically tell a patient that it will take about one year to see final results, but in some cases such as revisions, operations where extensive tip grafting is necessary, or individuals with thick skin, complete healing may take 18 – 24 months.

Can I do a lip lift at the same time as my rhinoplasty?

For a long time, we have discussed risks of doing both a rhinoplasty and a lip lift during the same operation. Recent studies have indicated that there is little or no increased risk of doing this when necessary but I suggest patients discuss this with their own surgeon because there is no consensus.

November 28

By

Are my rhinoplasty expectations realistic?

 There are limitations in rhinoplasty surgery depending on physical characteristics such as the size of the nose and the thickness of the skin. It is very important that every patient understands exactly what changes will be made and the specific goals of their procedure so they have a clear vision of what can be achieved. Unfortunately I see patients in consultation for a revision after rhinoplasty was done elsewhere who have a very nice result but are dissatisfied because it is not what they anticipated.

How do I prepare for rhinoplasty surgery?

Every surgeon has their own recommendations about activities, nutrition and medications to take or avoid before rhinoplasty surgery or any other cosmetic procedure. Ask your physician so you reduce the risk of complications, minimize bruising, and have a speedy normal recovery.

When can I resume normal physical activities, such as exercise, after my rhinoplasty?

I usually tell my patients to avoid “strenuous” physical activity which is anything that increases the blood pressure, pulse or breathing rate for about two weeks and any activity where there is a risk of nasal trauma for about six weeks after the procedure.

How much does a rhinoplasty cost?

The cost of rhinoplasty surgery, which includes the surgeon’s fee, operating room charges and anesthesia fees, varies depending upon what needs to be done to each individual nose. Cost will also depend on your location and the experience of your surgeon; having said that, the average total fee will start at about $7000.

Should I bring pictures of noses that I like to my rhinoplasty consultation?

While a specific example can not be duplicated I feel that pictures of noses you like are helpful because it gives the surgeon visual insight into what you want to achieve.

 

 

November 1st

By

At 22 years of age am I too young for a browlift?

Sagging low eyebrows, which make us look angry or tired with heaviness of the upper eyelids, can be caused by the normal aging process but in many individuals, especially young females, it is an inherited characteristic. Properly executed brow lifts last many years and are appropriate for a young person who wants a more rested appearance consistent with their age.

Is it difficult to straighten my crooked nose?

A: Rhinoplasty surgery is arguably the most challenging cosmetic operation that we do. The crooked nose is even more difficult because frequently it is secondary to trauma which has distorted the normal anatomy. Select an experienced specialist to fix the crooked asymmetrical nose.

My chin is too big?

A: When evaluating the size of the chin it is important to measure the anterior projection, width, and height. Typically we see a significant increase in projection which we reduce with a fine burr through an incision under the chin. However each procedure must be individualized because it is not unusual to see increase projection in a patient who has a narrow jawline which we simultaneously augment with an implant. When contouring a chin the ultimate goal is to achieve a result that is balance and proportional to the surrounding jaw and facial features.

I am over 70 can I have a face lift?

A: As long as the patient is in good health without significant medical issues such as serious cardio vascular problems they can pursue significant facial rejuvenation with a facelift. Your medical condition can be reviewed with your primary doctor, surgeon, and anesthesiologist.

Is “Ethic” rhinoplasty different?

A: Frequently ethic rhinoplasty is different because the patient wants to remove unfavorable nasal characteristics but maintain their cultural aesthetics. I know I’m generalizing, but some physical characteristics such as the size of the nose, skin thickness and cartilage strength are similar within various ethnic groups.

 

 

October 11

By

Q. I have a large nose; can I get a non-surgical rhinoplasty?

A rhinoplasty procedure is necessary to reduce a large nose so it is proportional to the surrounding facial features. A so called “non-surgical rhinoplasty” typically involves the use of fillers. This is appropriate for improving irregularities and refining contours but injecting fillers will not actually reduce the size of the nose.

Q. Are implants the best way to improve facial projection and contours?

There are many options to improve facial contours and definition including fillers, fat injections and implants. There are advantages and disadvantages of each technique depending on the needs of the individual patient. Filler injections are the easiest for a patient, fat injections typically last a lot longer, and implants provide a permanent result. The most common requests include cheek augmentation, chin augmentation and improving jaw line definition. Patients frequently request chin reduction procedures but that is a topic for another time. Consult with a surgeon that is experienced with all of these techniques so you can make an educated decision about what is best for you.

Q. Can I change part of my nose without doing a full rhinoplasty?

Every rhinoplasty procedure should be individualized based on the undesirable anatomy, nasal function and goals of the patient and surgeon. Sometimes a limited rhinoplasty is appropriate but it is important that a balanced, natural nose be created. A good experienced surgeon who specializes in rhinoplasty surgery will carefully describe the exact changes that will be made so the patient clearly understands the goals of their procedure.

Q. What can I accomplish with facelift surgery?

A facelift operation is a rejuvenation procedure which is done to lift sagging muscles, remove excess skin and restore normal youthful fat distribution which has changed as part of the aging process. There are many, many different facelift procedures and individual variations depending on your surgeon. The best advice I give patients is to ask what physical signs of aging will be reversed or reduced, what are reasonable expectations for the duration of improvement, and see results of other patients who looked like them before surgery.

Q. I have thick nasal skin. Will rhinoplasty improve the appearance of my nose?

In a patient with thick skin, it is sometimes difficult to get ideal definition in the lower part of the nose. However the tip can be narrowed and reduced using specific rhinoplasty techniques so that significant improvement can be achieved. Although the ideal refined result is not possible, I encourage these patients to consider rhinoplasty after establishing realistic expectations so they can achieve more balanced facial features. I’d also recommend that they establish an appropriate skin care regimen which will not only improve facial skin quality but also the rhinoplasty result.

October 2

By

Q: Is it better to do an upper eyelid blepharoplasty or a browlift?

A: While eyelids are frequently the first to show the signs of aging, brow position is always evaluated when considering surgery to correct the tired appearance caused by excess skin and fat of the upper lids. Removal of the excess skin and fat from the upper eyelid can be accomplished through an incision in the upper eyelid crease. However, if the brows are low or there is significant hooding and heaviness below the brows a browlift is the best approach to give the patient a more alert, rested appearance. Sometimes the browlift will eliminate all of the excess upper lid skin but an upper blepharoplasty can also be performed.

Q: How can I tell if a browlift or upper eyelid blepharoplasty is the best approach?

A: Obviously, the ideal way to determine what procedure is best to correct the tired appearance is to consult with an experienced surgeon. However, a patient can also stand in front of a mirror and lift their brows; if they like that look a browlift is probably the best approach for them.

Q: How can I reduce the deep grooves in my lower eyelids?

A: There are several choices depending on the appearance of the lower lids. If there are bags adjacent to the depressions a blepharoplasty can be done, the bags removed and some of that fat repositioned to fill the depressions at the eyelid margin. In other patients where the grooves are the only problem they can be filled and the lower eyelid contour improved with a filler such as Restylane or the patient’s own fat. If fat is injected the patient should carefully select a surgeon who is experienced in this technique because problems such as surface irregularities are difficult to correct.

Q: Where are the incision placed for a browlift?

A: There are multiple choices for incision placement in browlift surgery with advantages and disadvantages of each. I avoid incisions at the brow or in the forehead where there is a risk of visible, unfavorable scaring. Incisions are hidden within the hair using the coronal incision across the top of the scalp or multiple small incisions with the endoscopic approach but these techniques will both elevate the hairline. If a patient wants to maintain or lower their hairline position I recommend the Irregular Trichophytic Hairline Incision technique that we described many years ago. With this approach hair will grow through and in front of the hairline incision so it is not visible.

Q: When can I resume my exercise routine after facial cosmetic surgery?

A: While recovery is different with every patient and after every procedure I usually instruct my patients to avoid strenuous activities for 10 – 14 days after surgery. By “strenuous” I mean any activity that increases the blood pressure, pulse, or breathing rate. I also advise them to avoid any activity where there is a risk of facial contact or trauma for about 6 weeks.

Q: What is the minimal age a young person can have rhinoplasty surgery?

A: We advise patients to physically mature before considering rhinoplasty surgery. For ladies, that is usually 14 – 16 years old and for boys, it is 17 – 18 years old. I have occasionally done this surgery on younger individuals who had severe nasal functional problems or significant abnormal psychological and social issues because of their nasal appearance.

September 28

By

Q: What is an open rhinoplasty?

A: The location of the nasal incision determines whether the rhinoplasty is open or closed. With the closed technique, which has been used for over 125 years in the United States, all incisions are made within the nose. In open rhinoplasty an additional incision is made in the columella (the strip between the nostrils). In some noses there is a distinct advantage to this approach because it provides better exposure of the underlying structures and therefore more predictable results. I use the open technique in noses that require cartilage and soft tissue grafting, in most revision noses originally done by other surgeons, in patients who need extensive nasal tip work, in patients with inherited or congenital nasal deformities such as cleft lips, and in patients with crooked noses.

Q: What type of anesthesia is used in rhinoplasty surgery?

A: Local anesthetics are always used to numb the nasal tissues and minimize bleeding during the surgery. In full rhinoplasty cases a topical anesthetic is also placed on the internal lining of the nose. In most procedures some form of general anesthesia, whether it be intravenous medication (sedation) or inhaled gases are provided by an anesthesiologist (MD) or a certified registered nurse (CRNA).

Q: Solid silicone or cartilage grafts in nasal surgery?

A: Solid silicone grafts are frequently used to augment the nose but I avoid their use because of the increased risk of movement, extrusion, and infection, sometimes years after placement. Cadaver cartilage can be used but in my hands I don’t feel survival of these grafts is optimal. I prefer using the patients own cartilage, preferably harvested from the nasal septum or the ears. I personally feel that it is rarely necessary to harvest rib cartilage, which is more difficult for the patient and the surgeon but this is available if necessary.

Q: Is a rhinoplasty revision more difficult than the original procedure?

A: Rhinoplasty surgery is one of the most challenging operations that we do and a revision is usually more difficult than the original procedure because frequently the normal anatomy and function has been compromised if the results are not satisfactory. For this reason, a patient should always consult with an experienced surgeon who specializes in revision rhinoplasty.

Q: How long after my original rhinoplasty should I wait for a revision?

A: Generally I advise a patient to wait about one year because some parts of the nose, such as the tip, will continue to improve as healing progresses. Although some of these changes are minor it is best to wait because the patient’s ultimate goal is to achieve the best possible result.