admin | Rhinoplasty Surgeon Beverly Hills Blog

Is My Nose Really Broken?

Posted on February 16, 2012 by admin

"A close of a woman's nose is pictured with traces of blood"

Broken?

From school boys who have been in their first fist fights to middle-aged, weekend jocks playing Rugby, the question is often the same:

“Doctor, is my nose really broken? Will I need a nose job?”

The question about a fractured nose is pretty common because the nose:

Protrudes from the face
Contains fragile, eggshell thin bones
Comprises almost 40 percent of all facial injuries

The basic dead-bang giveaway that a nose is really broken is changed shape. In a true broken nose, you’ll also feel a change in breathing and may see some black and blue marks on your face with some swelling of the nose. You will likely have a nosebleed, too, which comes from the nasal mucosa, a type of moist tissue found inside the nose.

The most common reasons for broken noses, Rugby notwithstanding, include:

Other sports injuries like “touch” football
Falls
Car accidents
Fighting, scuffles, assaults, brawling, melees & donnybrooks

The most serious situation is if you can’t breathe. Then, you’ve got real trouble because the nose’s chief function is passing warmed, filtered air to the lungs. Mouth breathing brings its own set of problems, so being unable to breathe through the nose constitutes a situation close to a nose emergency.

It usually takes about a week for swelling to resolve so that a nasal surgeon can tell – through his sense of touch – what has happened to the nose bones.

A good exam would include a serious look up inside the nose, too.

For instance, an injured nose could have a septal hematoma, a bruise or bleeding from the septum, that thin wall of cartilage that separates your two nostrils. An untreated septal hematoma can lead to destruction of the septum and a condition known as saddle nose deformity.

Plus, there are many different parts of the nose that can be fractured. That’s why it’s best to have it examined by an experienced nasal surgeon who really knows the anatomy of the nose.

It’s a very, very complicated part of your body!

(Read more about deviated septums.)

This gentleman broke his nose in a basketball game and eventually his nose caved in. Rhinoplasty restore the appearance of his nose as well as his healthy breathing.

Nose Job, Chin Implant: Go Together like Love & Marriage

Posted on February 13, 2012 by admin

Many rhinoplasty patients know exactly what it is about their nose they do not like.

But the one thing that prevents a complete mental picture forming in the patient’s mind about what their nose might look like after a cosmetic rhinoplasty is…….they can’t see inside the surgeon’s mind.

The surgeon can describe the appearance of an improved nose after rhinoplasty for days on end but it’s like trying to describe a painting; words alone fail.

But there is a way around it: computer imaging. It’s an ap that takes the guessing out of plastic surgery but it’s not found on iPhones.

Here’s how it works: a picture of your existing nose is fed into a special computer.

The nasal surgeon then explains to the computer artist what changes the nose will undergo during surgery.

When the likely, expected after rhinoplasty look is generated on the computer screen, it’s as plain as day to anybody with eyes how much better you will look.

Some patients are surprised when the cosmetic plastic surgeon also mentions that the profile is out of balance and suggests adding an implant to make the chin look less receding.

The icing on the cake often happens when the actual after pictures are taken of the newly healed nose – usually three months after surgery – and fed into the imaging computer to be displayed with before and predicted pictures.

In many cases, improvements to the nose are better than what the computer predicted!

People often ask why cosmetic surgery to the nose alone can make a person look so very much better.

When a nose is seen as too big, twisted, humped, hooked, wide, flat or otherwise unattractive, the human eye stops on the nose.

After plastic surgery, when the nose fits the face and also flatters the profile, the eye skips over the nose and moves up to the other major central point of the face, the eyes. You literally “see” that person’s face differently.

So if you visit a cosmetic plastic surgeon to inquire about a nose job, make sure you:

Have a concrete idea what your face may look like after surgery
Always ask if your profile appears to be in balance

"A young woman shows the difference a chin augmentation has made"

Rhinoplaty + Chin Implant = Perfect Profile

Nasal Surgery Costs over Skype, E-mail

Posted on February 10, 2012 by admin

"A lovely young woman talks on her phone while working on her computer"

Cosmetic Surgery Consultation

Many cosmetic plastic surgeons offer consultations via:

Skype
Phone
The Internet.

In most cases, the patient sends or emails a picture of the bodily part in question and the conversation flows from there.

(Read more about live, remote contact for nasal surgery consultations.)

Obviously, patients also want to know the cost of cosmetic plastic surgery.

For rhinoplasty, a cosmetic plastic surgeon, working remotely, can get a pretty good idea of:

What can be done
What needs to be done
If the patient is making a realistic request

So the surgeon can provide a fairly accurate quote during the remote conference.

But in the case of, say, functional nasal surgery for healthy breathing in a case of deviated septum or turbinate reduction, the nasal surgeon needs to see inside your nose.

Some patients opt to save time, money and inconvenience by having not only a cosmetic rhinoplasty but an additional procedure like septoplasty to repair a deviated septum in one surgical session.

But the fees for internal nasal surgeries are just too hard to pin down without a personal exam.

It’s too difficult for any cosmetic plastic surgeon to give a patient a fee quotation on internal nasal surgery, based on the photos and information gleaned remotely.

Eventually, the patient must see the doctor in a personal consultation before receiving, solid, take-it-to-the-bank advice and, of course, a carved-in-stone fee schedule.

Several factors come into play about the cost of a nose job, like:

How difficult is the rhinoplasty?
Is a chin augmentation required?

But for functional surgery, the surgeon needs to examine the inside of the nose to determine its structure and airway function. The doctor also needs to manipulate the nasal cartilage with his fingers to get an idea of the tissue’s strength. Likewise, the thickness of your skin is a factor.

So, you may be misinformed by receiving quotation about internal nasal surgery like turbinate reduction via long distance without first being seen by the prospective surgeon.

Also keep in mind, the complete costs of plastic surgery involve not only the surgeon’s fee, but:

Charges for the surgery center, hospital, or doctor’s office
Additional fees for a doctor/anesthesiologist
Pre-surgery exams and blood tests

So be sure and ask your surgeon for the total costs of your plastic surgery.

Nose Job Surgeon: Top 10 Questions to Ask

Posted on February 9, 2012 by admin

"A senior woman talks with a doctor while sitting"

Interviewing a Surgeon

Before having rhinoplasty surgery, you’ll have a consultation with your cosmetic plastic surgeon. That is your chance to ask him or her anything, from where the cosmetic surgeon was trained to the last time he or she flubbed a procedure.

The top 10 best questions include:

In what board are you certified?

There are many bogus boards but you should listen for the only two that train cosmetic plastic surgeons: American Board of Plastic Surgery or the American Board of Otolargyngology (head and neck surgery.) Extra points: ask where the surgeon’s fellowship was.

How many nose jobs do you do in a typical week?

Look for two to three weekly over the last 10 years.

What is your policy on revision rhinoplasty?

Even in the best of hands, things can go astray. Ask who covers what expenses and fees in case you need a re-do or more work after surgery.

What is your percentage of satisfied patients?

Read patient reviews on the surgeon’s website and the Internet; there should be many.

Where are your before and after rhinoplasty pictures?

Look for patients who had changes like what you want. You should see many dozens, if not hundreds.

Do you have computer imaging?

Surgeon and patient really get on the same page when computer imaging shows what you will most probably look like after healing.

How long does it take to perform a cosmetic rhinoplasty like I want?

How did you handle your last infection?

The national average for infections in plastic surgery is one percent. If the surgeon says he never had one, he’s not being straight with you. A board-certified nasal surgeon has seen every possible, off-the-wall wrinkle that can crop up and knows what to do.

What kind of anesthesia do you use and how long does it take to recover?
Do you think what I’m asking for is realistic?

Some patients like a particular nose, say, Brat Pitt’s, and tell the surgeon that’s what they want. But Brad’s nose on your face may look goofy; part of the art of rhinoplasty is to perform the changes you want while creating a nose that fits your face and flatters your profile.

(Read 15 more basic questions to ask a rhinoplasty surgeon before you go ahead with surgery.)

After Rhinoplasty: What to Do

Posted on February 8, 2012 by admin

"A surgeon operates with his surgical nurse standing beside him"

In Surgery

One of the most common questions asked by nose job patients is: “After rhinoplasty, what should I do, doctor?”

Overall, don’t put any pressure on the newly rejuvenated nose. Some patients have even found that industrial protection type eye glasses are too heavy to sit on the bridge of the nose.

Our patients can wear contacts one to two days after cosmetic surgery; for those who must wear eye glasses, we show them how to suspend their spectacles from the forehead so there is no pressure on the nasal bridge; that continues for five weeks.

Most cosmetic plastic surgeons have lists of recommendations on how to care for one’s self after nasal surgery so be sure and follow those instructions.

It’s obviously also a good idea to stay away from any sport, hobby, pastime or person which could involve a blow to the nose.

Many are curious when they can resume regular workouts and exercise. For the first seven to 10 days after nose job surgery, let your body concentrate on healing and catch up on your reading although slow walking and stretching can start the day after surgery.

But exercise that really gets the blood going is not a good idea because increased blood pressure can lead to a bleeding nose and a possible increase in swelling and bruising. Another caution about nose bleeds: don’t blow your nose for the first 10 days after rhinoplasty surgery.

If you have stopped smoking for some weeks before rhinoplasty surgery, let the smokes lay unlit for a while longer – the nicotine in tobacco injures veins and reduces the blood flow which is needed to promote healing.

If you are fond of herbs, beware the “Four Gs”: garlic, gingko, ginseng and ginger. Those substances can affect blood clotting and a good cosmetic surgery result.

Catch up on your Z’s because adequate sleep ensures quicker recoveries. Also, mild pain medications, if needed, are usually available to help you sleep. Most patients find the nose is dry after surgery. But you can keep it better humidified by using saline nasal sprays.

Following doctors’ instructions usually means you are good to go in seven to 10 days….. although it may require a month for your breathing to reach its optimal level.

The rhinoplasty patient below had the bump on her nose removed while the scoop above the tip of the nose was corrected. (Robert Kotler, MD photo)

Before and After Rhinoplasty

Non-Surgical Cosmetic Surgery to Rule in 2012

Posted on February 7, 2012 by admin

"A man and a woman sit at a table staring into a glass ball"

2012 Cosmetic Surgery Trends

A major plastic surgery organization for surgeons worldwide, the International Association for Physicians in Aesthetic Medicine (IAPAM) queried its global membership, medical professors and other experts in aesthetic medicine to predict some of the major trends you are likely to see among plastic surgeons during 2012.

Nonsurgical and minimally invasive cosmetic surgery procedures will top the charts.

Some experts say the economies of the major nations still dictate that many patients must forgo more expensive surgical face lifts for less expensive facial fillers.

But that’s always the nature of a recession: people learn to cut, squeeze, trim and make do with less until the good times start to roll again.

Also look for:

Combination packages.

More cosmetic surgeons will offer medical skin care, facial injectables and laser conditioning in a single treatment package.

More cosmetic injectables: Botox will have more competitors that create the same wrinkle removing effects. Already, a rub-on Botox cream is completing clinical trials. Plus, new fillers like Belotero and LaViv may come into wide use. (Read more about LaViv, a facial injectable made from the patients’ own cells.)

More uses for neurotoxins.

Botox, Dysport and Xeomin are in a class of medications known as “neurotoxins.” As time goes on, more uses are found for neurotoxins which are now used to treat migraine headaches, stop excessive sweating and halt other medical woes. Already, according to the IAPAM, one professor is using Botox and Dysport together to reshape the face, instead of just removing its wrinkles.

One nonsurgical procedure that is rising on more patients’ radar screens: permanent, non-surgical rhinoplasty.

Used in cases where only the outside of the nose needs correction, a needle replaces the scalpel to fill in humps, depressions and other unsightly nasal marks. And, for the many budget-concerned patients who have learned to do more with less, a non-surgical, permanent nose job costs a fraction of surgical rhinoplasty in both money and time.

Many patients with botched nose jobs are candidates for the procedure.

(Read more about permanent non-surgical rhinoplasty.)

Nose Job Fix: Top 5 Reasons Why Beverly Hills is THE Place

Posted on February 6, 2012 by admin

Plastic surgery experts know that the nose job is the toughest cosmetic plastic surgery procedure to teach and to learn.

It’s because the human nose is a 3-D structure which has supports, supporting walls and is extremely interconnected. It’s also a procedure where less is more; most flubbed nose jobs are due to newer surgeons removing too much cartilage, tissue and, sometimes, bone.

With an estimate of some 20 to 25 percent of first rhinoplasties being botched, many patients worldwide ask for revision or secondary rhinoplasty.

And if a first rhinoplasty is hard, a revision rhinoplasty requires extreme specialization; it’s also because:

More scar tissue exists in a failed rhinoplasty
The nose looks different and no longer looks like nose pictures in medical texts
There may be no more nasal cartilage to work with

So why is Beverly Hills a Mecca for excellent rhinoplasty revision and other plastic surgery?

Beverly Hills is close to major university medical schools and top-rated hospitals

Medical schools often contribute the latest techniques because many Beverly Hills plastic surgeons are also university instructors.

Los Angeles International Airport is less than half an hour away

Many European and Asian patients arrive in Beverly Hills in just one flight.

Numerous types of cosmetic plastic surgery providers are clustered together (offering face lifts, neck sculpting, chemical face peels and other procedures) so seeing other doctors is easy; often, the other doctor is in the same building.

Beverly Hills is geared to visitors

That city offers an admirable selection of “hideaway” aftercare facilities that are staffed for the cosmetic surgery patient resting up before seeing the surgeon the next morning.

(Look at a list of plastic surgery after care hotel-like facilities.)

Moreover, after a day or two, many patients can go out and see the sites in the only North American region – Southern California — that offers a true, year-round Mediterranean climate.

Alternatives to surgery

If you only need cosmetic correction on the outside of the nose, you can opt for nonsurgical rhinoplasty. Many Beverly Hills cosmetic surgeons offer facial fillers like Juvederm and Restylane for nasal corrections but those injections must be repeated periodically to maintain the look.

Read more about permanent, nonsurgical rhinoplasty.

"A young soccer player shows his corrected nose in before and after pictures"

Nose Correction via Permanent, Non-Surgical Rhinoplasty

Bad Plastic Surgery: Finding A Better Fix

Posted on February 3, 2012 by admin

"A smiling young couple do a computer search"

Searching for Surgeons

The stories of bad plastic surgery seem to always have a common beginning; either somebody does not like the appearance of his or her nose or needs internal nasal surgery to:

Fix a once broken nose
Repair a deviated septum
Reduce turbinates

But then, things go wrong. Patients often quickly choose the closest plastic surgeon, the doctor who charges the least or the cosmetic surgeons they heard about through Aunt Sally’s boyfriend’s cousin.

However, a recent patient, 34-year-old J.G., at least made a stab at researching a qualified, trained, certified and experienced nasal surgeon near his Texas home to correct his deviated septum.

Although the Texas surgeon that J.G. found and used is:

A book author
Won awards for his work
Was well respected in his medical community

the procedure did not turn out well at all and made J.G’s breathing even worse. A deviated septum that twists and turns inside the nose creates additional blockages to healthy breathing.

J.G. then widened his search for nasal surgeons worldwide to correct the damage before landing in our Beverly Hills office. (Read more functional and cosmetic surgery patient stories.)

Finding corrective, or revision nasal surgery, requires much more research than finding a good surgeon for a first nose job.

Why? Revision nasal surgery is so much harder for many cosmetic plastic surgeons who routinely turn out first rhinoplasties day after day, they shy away from corrective surgery.

His corrective surgery went well with the breathing problem normalized.

Then, J.G. found that marks on the outside of his nose could be corrected without yet another trip to the operating room. He opted for permanent nonsurgical rhinoplasty which involves a series of quick injections in the office, separated by ten to 12 weeks.

(Read more about “Rescue” rhinoplasty, another moniker for permanent, nonsurgical rhinoplasty.)

So, for a while, J.G. traveled from his Texas home to Beverly Hills every three months to complete a corrective, non-surgical rhinoplasty that yielded a handsome nose which flattered his profile.

He then capped off his visits by having neck sculpture and was a very happy camper indeed.

Nose Surgery Can Mean Better CPAP Breathing

Posted on February 2, 2012 by admin

Nasal Exam

Regular readers of our blog posts already know a CPAP is a face mask and machine for people who snore, often due to problems inside the nose that block healthy breathing.

But, as a curious cosmetic plastic surgeon, we also scan forums and bulletin boards for news about CPAP (which stands for “continuous positive air pressure,” a fancy way of saying “forcing air into your lungs through your nose”.)

So we note some users have found that nasal surgery makes their CPAP work even better.

The basic start of all this is raw snoring….ear-splitting, freight train decibel, nocturnal snoring that makes the bedroom curtains flap in the breeze and can be heard downstairs, if not the next house. Pity the sleep-robbed mates of snorers.

Snoring can have many causes but some of the most common are:

A deviated septum
Swollen turbinates, structures higher up in the nose

A septum is the thin wall of cartilage that separates your two nostrils. When bent, twisted or otherwise deformed, they can block the breathing channels in the nose.

Turbinates warm and humidify the air you breathe. But they often react to allergies and other conditions by swelling, again blocking healthy, quiet breathing.

Curious about the numbers of healthy and blocked breathers, The University of Washington’s Sleep Disorders Center studied 306 CPAP users for two years. They wanted to find why some did not wear the CPAP mask regularly. (Read more about nose surgery and CPAP use.)

After exams, 108 patients showed abnormal nasal exams and were also the same group who did not use the mask correctly, if at all. The study authors concluded patients with abnormal nasal exams had decreased CPAP use and tolerance.

Concluded the authors: why not treat nasal conditions before prescribing a CPAP?

Yet another study at the Stanford Sleep Disorders and Research Center in Palo Alto, California, found that turbinate treatments, when appropriate, appear to benefit nasal obstruction and ease the breathing of CPAP users.

But before you say “yes” to a CPAP, ask yourself if any medical professional has actually looked up into your nose to see and diagnose the state of your nose and if its internal architecture allows for easy, quiet breathing.

Perhaps that would be the best first step possible!

Permanent non-surgical rhinoplasty?

Posted on January 25, 2012 by admin

"A lovely woman closes her eyes as a needle approaches her nose"

Injection Rhinoplasty

Quite a few rhinoplasty surgeons offer non-surgical (or injection) rhinoplasty. But does it last?

Facial fillers like Sculptra, Radiesse, Juvederm and Restylane are often used. But they dissolve back into the body within six months to a year. That means more trips back for additional injections and more time lost from work.

But, permanent injectable fillers last as long as you do. To date, there are only two for the face:

Artefill
Silikon 1000

While Artefill is intended for the deep creases, lines and age-revealing folds in the face, Silikon 1000 is used for permanent nose jobs done by injection. And that’s only if you need correction on the outside of the nose.

With Silikon, you can get a preview of coming attractions.

If you have divots, marks, scars, pocks, a nasal hump, a low bridge or other marks on the surface skin of the nose, only a few U.S. rhinoplasty specialists offer Silikon 1000 corrections. The very best surgeons can show you what your nose will look afterwards by using sterilized saline – plain old salt water – to reveal what the Silikon 1000 injections will do for your nose.

Saline improvements last perhaps an hour, long enough to snap a few pictures. Compare the saline test shots with pictures showing the nose in its natural, unrepaired state and then decide if you want to make it permanent.

Silikon 1000, a medical grade silicone, is used in internal eye surgery. A standard, approved and legal part of any medical practice – including those of cosmetic plastic surgeons – is using a substance or technique “off-label”.

Meaning? While the substance has not been tested by the FDA for that particular use, it is the best treatment available to the doctor who has seen it work in many patients.

Some history: Silikon 1000 for injection rhinoplasty has been used successfully in nasal skin improvements for the last 50 years. According to scientific literature, the secret is placing tiny micro droplets just under the skin to plump out and disguise hollow places.

(Read more about permanent, non-surgical rhinoplasty in Plastic and Reconstructive Surgery, a professional magazine for plastic surgeons.)

For instance, a nose with a large hump can be made to look straight again using no more than 1/8^th of a teaspoon of Silikon 1000 injected at many different locations on the nose.

The body walls off the tiny micro-droplets, creating a plumping action that fills in humps, scars, lines and other marks on the nose.

"A very pretty young woman shows her nose before and after injection rhinoplasty"

Before and After Non-surgical Rhinoplasty

The woman’s nose, left, caved in from a failed surgical rhinoplasty done elsewhere. Right, the results of permanent non-surgical injection rhinoplasty. No further surgery needed.