Nose Reshaping
Q:
I am ashamed to ask this but I need to know if any prior drug use from a long time ago (through the nose) would have any effect on having a rhinoplasty done.
A:
Some of the substances that are "snorted" can damage the septum of the nose (the structure that separates the left and right sides of our nose, internally) and in such situations this needs to be addressed during the rhinoplasty procedure. If no such damage exists, then rhinoplasty should be no different than in a patient who has no history of such drug ingestion. In general, patients who have suffered damage to the septum will have both intermittent bleeding and breathing problems related to the septal damage. This will be an easy diagnosis to make as such damage is easily visible to the surgeon when he or she examines you during your office visit.
Q:
I am scheduled for a rhinoplasty procedure with an accredited doctor next month. He does not specialize in surgery of the face, but instead, the face, body and breast. Should I be concerned that his focus is too broad or that he has not done enough rhinoplasty procedures compared to surgeons who specialize in surgery of the face alone?
A:
Patients need to feel comfortable with their plastic surgeon and confident in their expertise with the procedure that is planned. All board certified plastic surgeons need to demonstrate competence in all areas of plastic surgery in order to be certified by the specialty. This confirms a level of expertise that consumers can feel reassured about. Plastic surgeons are the only physicians who are trained with an eye for the aesthetic from day one of residency whether it is for reconstructing patients back to normal or improving patients’ appearance through cosmetic procedures.
It is important to check your plastic surgeons credentials as well as ask for their experience with the proposed procedure. It is helpful to ask for before and after photographs of their patient results. Another great resource is talking to patients who have had this procedure performed by this surgeon for their overall experience and satisfaction.
The American Society for Aesthetic Plastic Surgery is an organization reserved for board certified plastic surgeons that demonstrate an interest in aesthetic surgery and have a significant portion of their practice dedicated to it, as well as an interest in continuing education in this area. The web site is an excellent resource for consumers and I think you will find it helpful in making your decision.
Q:
I had rhinoplasty in June of 2006. I only wanted the hump smoothed on the bridge of my nose; however, the doctor removed a lot of cartilage and made several changes to it. Can rib cartilage be grafted to my nose and can it be lengthened to look similar to my original nose?
A:
It is a bit difficult to reply without pictures, but here goes. When a rhinoplasty is performed, often the cartilage that supports the nose is reshaped and changed to provide the desired result. Unfortunately, the results may not be as satisfying as desired. If the overall support is decreased, the nose can shorten and even collapse. In that case, the structural support needs to be rebuilt. The first choice in reconstructive material is cartilage from the septum. Unfortunately, often this has already been used or is not efficient for the reconstruction needs. In that case, a rib cartilage can be taken to provide structural support and aesthetic integrity to the reconstruction of the nose.
Q:
I just recently underwent an open nasal reconstructive surgery to fix my deviated septum, and I also received some facial cosmetic work as well. I am an avid runner, and although I understand I cannot go back to fully intense workouts as of yet, I am wondering how long I should wait until I begin to jog again? Currently, it has been a week since the surgery.
A:
Regarding the patient who is one week post-op after an open rhinoseptoplasty, my first response would be for her to follow the instructions of her plastic surgeon. However, my routine is to totally restrict sports and physical activities for 2 weeks. After the incisions are well healed and there is no bruising or edema, then the patient may begin light exercises (usually between 2 to 3 weeks). After 3 weeks I do allow most patients to begin slow speed jogging (6 mph) on a treadmill. There should be no nasal pressure from glasses for 3 weeks.
Q:
I have had two rhinoplasties over the last six years. The first left me with extensive scar tissue in the tip of my nose. The second removed this, but it came back after a while. I have been having cortisone injections which make my nose look tighter and smaller. However, after about 6 weeks, it returns back to normal. The skin left at the end on my nose is rather bulbous and thick – the cortisone shrinks this only temporarily. I have heard about thermage and was wondering if this would be feasible to use on the tip of my nose. Would it make a favorable difference or is it possible that it would increase the scar tissue built up inside the tip? What in your opinion would be the solution to my problem of a bulbous tip?
A:
It is somewhat difficult to give exact advice without looking at the nose. Regarding the characteristics of soft tissue, cartilage support, etc……..if the last surgery was done less than 12 months ago, it is quite possible that time will shrink soft tissue over the tip further. If the problem you have is supra tip deformity, surgical correction is possible with removing a small portion of the septum above the nasal tip. If there is too much skin over the tip, and not enough cartilage support, that problem may have to be addressed. Limited cortisone injections are fine, however, too many or excessive cortisone injections may cause additional problems over the nose.
I do not think thermage would be that helpful to you.
Q:
My cheeks have always embarrassed me because they are quite big. As a result, my face is puffy with no clear definition. People always think that I have gained weight even though I am only a size 6. I would like to know if it is possible to use a liposuction procedure to reduce the size of my cheeks or if other surgery is needed. Also, can it be done at the same time as a nose reshaping?
A:
There are certainly a number of procedures that could reduce your cheeks or at least de-emphasize your cheeks. Lipoplasty (liposuction) might be one, but remember that lipoplasty is a surgical procedure. You need to be evaluated either in person (preferably) or at least by photograph to receive a definite and appropriate answer. Most likely a nasal reshaping procedure could be done at the same time. If you have realistic expectations, you can most likely be helped, but you should seek a personal consultation with a board-certified, ASAPS-member plastic surgeon.
Q:
How long does it normally take to see the final results of rhinoplasty? I had surgery in September 2000, and my nose is beginning to taper, but the tip is still full or swollen looking.
A:
It takes about one full year for all of the swelling to disappear following nose reshaping. Swelling in the nasal tip takes the longest to go away. Your surgery is over a year now, so this is probably your final result. You may need some minor modification to further reduce the tip, which is not at all uncommon. Return to your surgeon and discuss what you would like enhanced.
Q:
I want plastic surgery to straighten my nose and make it a lot smaller. I have a very big nose. I also have a nasal deformity that is very noticeable, showing my left nostril closed and my right nostril open. It needs to be totally reconstructed. I have problems breathing through the closed nostril on the left side. If I hold my right nostril closed, I can't breath through my left nostril at all!
A:
Thank you for your question. It seems that you have a functional problem and a cosmetic imbalance with the nose. Obviously, it is hard for me to analyze your condition without any photographs or a personal consultation. It appears that you need your septum reconstructed to straighten the nose and alter the other nasal cartilages to recontour the nose. With such extensive surgery, my personal preference would be an open septorhinoplasty. Some insurance companies might cover the septal part of the procedure (normally the surgeon has to request preauthorization before he/she can proceed with surgery). This technique allows one to expose the underlying cartilages without deforming them and trim, suture, or graft certain areas to give a long lasting result.
Q:
How long after a nose job (rhinoplasty) can one return to physical activities -- specifically basketball? Would four months be long enough?
A:
The answer to your question depends to some degree on the specific changes that were made to the nose and how complicated the particular surgery was. It is likely that the structures involved would be pretty solidly in place after four months. This does not mean that all healing would be complete, since the total healing process can take a year or more. At four months, a
significant trauma, such as might occur in basketball, could affect the final results of surgery.
One suggestion I might make would be to play with a nasal mask/protector. I am sure that your coach or trainer can help you out with this. You have probably seen one on an NBA player from time to time. It would be a good compromise just to be on the safe side. Of course, you should consult with your operating surgeon before undertaking any such activity following surgery.
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Note: ASAPS cannot give advice about specific medical problems nor should answers provided by responding surgeons be substituted for a personal medical/surgical consultation. Sorry we can't answer all questions. We try to select questions that have the widest general interest.