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Question of the Day

February 15


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


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


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


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


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


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


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


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


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.

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.

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.

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.

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


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

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.

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

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.

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

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.

Where are the incision placed for a browlift?

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.

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

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.

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

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.