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Question of the Day

August 10

By

How much does the nose grow with age?

A: The nose does not “grow” with age but does appear bigger and longer because of the normal aging process.  Loss of tissue tone, changes in skin quality, and the effects of gravity give the impression that everyone born 75 years ago had a big nose.

What causes a dorsal nasal hump?

A: Most frequently a nasal hump is caused by genetic inheritance. Trauma or relaxation of the nose as we age can also lead to a change in nasal contour and the formation of a hump.

Why do I have a crooked nose or uneven swelling after a rhinoplasty?

A: If the nose is crooked before rhinoplasty surgery it is possible that the nose is not going to be perfectly straight after the operation because this is one of the most difficult problems to correct even in the hands of an experienced rhinoplasty specialist. The resolution of normal temporary post operative swelling, especially in a thick skin patient, may not progress symmetrically so patience is necessary.

Sleeping position after rhinoplasty.

A: Every surgeon has their own post operative instructions but most recommend the patient sleep on their back with the head elevated, as with two pillows, to minimize swelling and accelerate its resolution.

Taping the nose after splint removal.

A: Some surgeons do recommend taping the nose after the splint removal depending on what was done during the rhinoplasty procedure, such as the placement of extensive grafts, in a patent that had a little more bleeding than normal during the operation, or to help contraction of excess skin in a thick skinned patient.

June 28

By

Why do I have a swollen nasal tip three months after rhinoplasty?

Depending on what was done during your rhinoplasty surgery, it is very common to have temporary swelling just three months after the operation. We typically say it takes about a year to see the final results; even though you may see the final results much sooner than that, the tip always takes the longest to heal.

Is it ok for cartilage to “pop” in the nose after rhinoplasty surgery?

This is not normal, even after cartilage grafts are placed. When I have patients come to me complaining about moving cartilage after they’ve had surgery elsewhere, it is usually in the columella (the strip between the nostrils). This is why I don’t recommend the use of these “strut grafts”.

Will ibuprofen after rhinoplasty increase or decrease swelling?

 I instruct my patients not to take ibuprofen immediately before or after surgery because it can “thin” the blood, causing more bleeding and therefore more swelling, prolonging the patient’s recovery.

I have low eyebrows but also a very high hairline.

Many years ago I first described a technique to simultaneously raise the eyebrows and lower the hairline for patients like you. It is called Irregular Trichophytic Hairline Incision technique where the incision is made at the hairline, burying hair follicles in the skin which produce hair that grows through and in front of the new hairline. The incision is hidden and patient has total freedom of hair styling after the procedure.

What can I do to fix my hooded eyes?

If there is fullness and heaviness above your eyelid crease below your brows, a browlift is probably the best and longest lasting treatment. Botox can be injected but this needs to be done every 3 – 4 months to maintain good brow position.

April 26

By

How should I sleep after Rhinoplasty?

I tell my patients it is best to sleep on their back with the head elevated above the chest to minimize swelling. This can be achieved by simply using two pillows.

Why is my nose crooked after a rhinoplasty?

The nose may temporarily appear crooked after rhinoplasty surgery because of asymmetrical swelling secondary to more work, such as the placement of grafts, being done on only one side. Frequently, swelling does not resolve symmetrically as healing progresses. This apparent deviation typically will resolve with time. Discuss all of your concerns with your surgeon.

Swelling of my bridge has resolved after surgery but my tip still looks big.

Most noses will continue to improve for at least one year after rhinoplasty surgery. The swelling in the tip with thicker skin always takes longer to “mature” than the nasal bridge.

Is my nose fractured? It is swollen after getting accidentally hit with a ball.

Swelling does not mean your nose is broken. I always recommend that patients have their nose evaluated after trauma to make sure that there is no hematoma (collection of blood) in the septum which can destroy nasal tissue. As long as their is no unwanted change in appearance or breathing it is not necessary to have surgery even if the nose is broken.

What causes a dorsal hump?

A dorsal hump, an elevation of the nasal bridge, can be inherited or the result of trauma. Regardless the cause is frequently present in patients requesting rhinoplasty surgery.

Is it possible to have just a tip plasty? My nasal bridge does not bother me.

As I repeatedly said over many years, every rhinoplasty operation is individualized to meet the needs of each patient. The work can be limited to the nasal tip but it is important to achieve a balanced, natural result. An experienced surgeon will help you make an educated decision about possible changes so your nose is proportional to your surrounding facial features.

March 22

By

Am I given steroids after my rhinoplasty surgery?

I do give my patients a small dose of steroids for several days after their rhinoplasty surgery. This does not impact the final result but will minimize post operative swelling and accelerate recovery.

Is it possible to reduce the visibility of my nostrils from the front and side?

If the patient has a short nose, this can be corrected by placing a septal extension cartilage graft to lengthen your nose. In a patient with a hanging columella (the strip between the nostrils) the nostril show can be eliminated by raising the columella which can be done under local anesthesia if the patient and surgeon prefer.

What is the cost of rhinoplasty?

This is a question that people email to us several times a day. Without seeing a patient or pictures it is impossible to even provide an estimate because there is so much variation from patient to patient.

Can I have a rhinoplasty after my crooked septum was straightened?

The fact that you had a previous septoplasty should not interfere with rhinoplasty surgery but this can be confirmed when you are evaluated for the cosmetic procedure. It is unfortunate that both the functional and aesthetic improvements were not done at the same time so the patient has one operation, one anesthetic and one recovery.

Do I need a rhinoplasty or can I improve my nose with fillers?

Fillers can be used in patients who need refinement such as changing unwanted contours and augmenting irregular depressions. In a large nose where a reduction and definition is the goal a rhinoplasty is usually necessary to achieve the desired result. While filler injection is much easier for the patient, the results are temporary. Discuss your alternatives with an experienced rhinoplasty surgeon.

February 15

By

Why does my nose look crooked after my rhinoplasty?

Sometimes swelling is asymmetrical a short time after rhinoplasty surgery. The nose is not actually crooked so this temporary abnormal contour will resolve as healing progresses.

Why do I still have swelling three months after my rhinoplasty?

Some swelling may be present in the nose for six to twelve months after surgery especially in the tip in patients with thicker skin and in individuals who had a revision rhinoplasty or extensive grafting to augment and define the nose.

When can I travel after rhinoplasty surgery?

I frequently do rhinoplasty surgery on patients from other states and countries. They can return home after I remove their cast on the sixth day after the procedure. Some patients who live a short distance from my office, such as other parts of California, will go home the day after surgery and return for the cast removal a week later.

Is it difficult to lift my hanging nasal columella after rhinoplasty surgery?

A hanging columella (the strip between the nostrils) can usually be elevated under local anesthesia with a relatively minor procedure after rhinoplasty. This is not a rare request from patients who come to me for a revision consultation after an operation.

In what position should I sleep after my rhinoplasty?

I recommend that my patients sleep on their backs using two pillows so their head is above the level of their chest. This will minimize post operative swelling and accelerate the recovery.

January 30

By

Is there a difference between hairline lowering and a forehead reduction procedure?

It is obvious that with a forehead reduction the size of the forehead is reduced, usually in the vertical height, so that proportions of the face are brought into better balance. As described by Leonardo da Vinci the distance between the chin and the nose, the nose and the eyebrows, and the brows to the hairline are each one third of the face. In a patient with a high hairline, this can be achieved with the use of transplants at the existing hairline or the forehead reduction procedure where an incision is made at the hairline and skin is removed below the hairline to decrease the height of the forehead. We prefer the later approach, using the Irregular Trichophytic Hairline Incision technique which we described many years ago because normal uniform hair density is maintained, the goal is usually accomplished with one procedure, and hair will grow through and in front of that incision so the patient has total freedom of hair styling. Occasionally an expander will be necessary in patients with a very tight scalp.

What is the risk of the hairline incision being visible after a forehead reduction procedure?

Rarely hair growth through the hairline incision is not adequate to totally hide this line. If this occurs, it can easily be hidden by placing a few micrografts in that incision.

Can I narrow my forehead?

The width of my forehead can be narrowed but this is usually best achieved with hair transplants because the normal density of the hair along the temporal hairline is much thinner. If this temporal hairline is advanced with an incision in the scalp expanders are usually necessary and it is much more difficult to camouflage the incision in this thin hair.

Will my hair be thinner after my hairline lowering procedure?

With hair transplants the hair will be thinner because normal uniform density cannot be achieved with this technique. Technically the hair will be thinner after a forehead reduction procedure because we have stretched the scalp but this is not cosmetically visible.

Can the forehead reduction procedure be done on men?

 The use of the forehead reduction procedure in men is very limited because of the high incidence of male pattern baldness in men. If there is hairline recession later in life secondary to alopecia the patient will need hair replacement surgery using the hair transplants or the Fleming Mayer Flap to hide the incision from the hairline lowering which would become exposed. For most young men it is better to do hair replacement surgery at a young age which will permanently establish a more desirable hairline location.

January 19

By

What are the signs and symptoms of a broken nose?

Bleeding, swelling, nasal deviation and difficulty breathing can occur with a broken nose. Even if all of these signs and symptoms are present, the nose may not be fractured. For example, temporary asymmetrical swelling may cause the appearance of nasal deviation but this will resolve. X-rays are frequently unreliable. However, I recommend that patients be evaluated after nasal trauma to make sure that there is not a hematoma which could destroy part of the septum, causing long term problems.

I like my nose except the large bulbous tip. Can I change just the tip?

All rhinoplasty procedures are individualized. The surgery can be limited to just the tip as long as this change will give you a natural, balanced result.

Can I lengthen my nose?

 A nose may be too short secondary to a poorly done rhinoplasty procedure or an unwanted inherited nasal characteristic. There are several techniques used to correct the problem, including a septal extension graft or decreasing tip rotation.

Does insurance cover rhinoplasty surgery?

Benefits will depend on your health insurance policy. Most plans will cover the correction of damage after nasal trauma. They also typically will contribute to the correction of any functional problems such as breathing obstruction up to the limits of your policy but not cosmetic changes to the nose. Our staff will help patients communicate with their insurance company to determine if preauthorization is necessary and clarify their coverage.

Will I look completely different after a rhinoplasty?

A bad rhinoplasty result will call attention to your nose and the fact that you have had previous surgery. If the operation gives you a natural nose that is proportional to your surrounding facial features, it will not completely change your appearance so those around you that did not share your experience will not know that you have had a rhinoplasty.

January 17

By

Will my hairline be raised with a browlift?

 With a coronal or temporal incision, which is made within the hair, or an endoscopic browlift the hairline will be elevated. This is not a problem for a patient who has a low hairline but if you have a great hairline that you want to maintain or a high hairline that you’d like to lower, I recommend the Irregular Trichophytic Hairline Incision technique that we described many years ago.

Will a temporal browlift raise my lateral brows?

It is not unusual for a patient to request elevation of the outer (lateral) brow which causes hooding or heaviness of the upper lids. However, I very rarely recommend the temporal lift because more can be achieved by lifting the brows straight up with an incision at or behind the frontal hairline.

Will marijuana affect my general anesthesia?

Marijuana, like cigarettes, can interfere with lung function and therefore affect the administration of anesthesia. It can also cause increased coughing when the anesthesia is terminated. Therefore, I instruct my patients to avoid using marijuana for two weeks before their surgery.

Can I have a hairline browlift after hair transplants in the frontal scalp?

I have successfully done the Irregular Trichophytic Hairline Incision technique to lift the brows or lower the hairline in patients who previously had hair transplants. I recommend waiting six to nine months after the transplant work so the grafts are strong and fully established.

Can I lift just the middle portion of my eyebrows?

One basic principal of all cosmetic surgery is to use and modify accepted medical procedures to meet the needs of each individual patient. The short answer to your question is yes, the medial portion of your eyebrows can be lifted. Several options for a limited eyebrow lift are available and would be chosen depending on your specific physical characteristics such as location of your brows, the size of your forehead and the position of your hairline.

 

January 12

By

Is it necessary to have a rhinoplasty to fix a broken nose?

No. If a nose is fractured but there is no change in appearance or function surgery is not necessary. However, I recommend that a patient be evaluated by a rhinoplasty surgeon after trauma to examine the nose and rule out hematoma formation which can damage normal structures such as the septum.

What is the septum?

The septum is the structure composed of bone and cartilage in the center of the nose between the nostrils. A deviated septum can obstruct normal breathing and cause a crooked appearance of the nose.

Why is the lower part of my nose uneven two weeks after rhinoplasty?

Usually the asymmetry present a short time after rhinoplasty surgery is secondary to the temporary swelling which frequently does not absorb evenly and symmetrically throughout the nose.

What causes a nasal hump?

Most often a hump of bone and/or cartilage is an inherited nasal characteristic. Another frequent cause of a hump in the bony bridge is a broken nose following trauma.

Can I finance cosmetic surgery?

Most surgeons will not finance cosmetic surgery but there are independent companies that loan money with reasonable interest rates.

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.