Category Archives: Rhinoplasty

Nose Jobs of The Rich and Famous: Miss California

Posted on by
Reply
"Miss California shows her nose job in before and after pictures

Miss California Before and After Rhinoplasty

When the new Miss California, Natalie Ann Pack, was a kid bouncing on a trampoline, her brother mistimed a bounce and smacked Natalie in the nose with a knee. The result: Natalie’s broken nose.

Nonetheless, Natalie went on to model and was named Miss California, January 15th.  A broken nose leads to other medical problems as well, probably restricting her breathing. If a broken nose is not treated within about ten days, the broken bones heal as they are, often creating twisted nasal passages that restrict healthy breathing.

Other people in the same boat as Natalie are often those with:

The plastic surgeon who performed the procedure blogged: “Natalie was concerned about the asymmetry of her nose as well as an overall feeling of visual heaviness.”

Last year, Natalie got a functional and cosmetic rhinoplasty, creating a better nose and taking care of some internal blockages that prevented healthy breathing.

Results? Natalie’s health profile improved. She told an interviewer about the effects of her nose job: “I can breathe, I don’t get headaches, I can sleep, the modeling pictures are better.”

Natalie’s plastic surgeon, quoted in the Orange County Register, said “she went from a nine to a 10” on the beauty scale

So why does a nose job make a person more beautiful? Or handsome? Because the nose is so prominent, it dictates how the eye takes in and “sees” a face.

When a nose is larger or swollen and thick as was Natalie’s, the eye mostly sees – and often gets stuck on – the person’s nose.

But when a nose is proportional, balanced and fits the face and profile, our eyes move up to take in the eyes and then the whole face. The person just looks better to us.

Many rhinoplasty patients opt for adding a little bulk to their receding chins, making their appearance go from never to constantly noticed and appreciated. However, Natalie’s chin needed no augmentation.

The January/February issue of Archives of Facial Plastic Surgery, a professional magazine for plastic surgeons is reporting additional benefits to a nose job that brings a face into better harmony. It may also make you look younger. A study of 53 patients found a rhinoplasty may make patients look 1.5 years younger.

(Read more about the nose job study.)

Rhinoplasty: Top 5 Things that Go Wrong

Posted on by
Reply
"A doctor operates on the nose of a lovely woman"

Nose Surgery on a Model

While everybody wants a pleasant looking nose that fits the face and flatters the profile, there are some things that bring a patient to a rhinoplasty surgeon for the first time and a few other things that may bring a nose job patient back to the surgeon.

The Top 5 things that can go wrong are:

  • Breathing

After all, the job of the nose is to pass air to the lungs. Often, people who have never been to a rhinoplasty surgeon go because something inside the nose hinders the flow of air.

After nasal surgery is often no different. If the nose has been under or over operated – that is, too much or too little has been taken out — or if problems still exist inside the nose, a revision rhinoplasty may be required.

  • Marks that show on the outside of a nose job

Many nasal surgeons often see a healed nose after rhinoplasty, yet the patient comes in with grooves, depressions, dips and tiny moguls that show on the outside.( An excellent way to easily correct those marks is with Silikon1000 nasal injections.)

  • An overdone nose

Cosmetic plastic surgeons also see patients returning because a nose has been overdone and looks pinched. It happens when a first surgeon takes too much tissue from the nose. But revision rhinoplasty can make things right by using donor cartilage from patients’ ears or ribs to augment the nose.

  • An underdone nose

For every patient returning to a surgeon complaining about a pinched nose, another patient somewhere is returning because not enough surgery was done. If the primary surgeon did not remove sufficient excess nose tissue, the tip of the nose will most likely point down. That means the revision rhinoplasty surgeon must redo the tip.

  • A bent nose

Normally resulting from a sports injury, an accident or a fluke of nature, a nose that leans sideways is common. A good assumption: the patient with a bent nose will also have breathing problems. The usual bugbear in such cases is usually the septum – that wafer thin strip of cartilage that separates the two nostrils. A revision surgeon does that work, too.

The good news? Virtually every nose can be repaired!

Are you getting the concept that rhinoplasty is very, very exacting? With little-to-no margin for error one way or the other? Good!

Rhinoplasty & Snoring

Posted on by
Reply
"A wife is wide awake and angry over her husband's snoring"

Before Rhinoplasty?

Snoring is often the stuff of which cartoons are made.

How many times have you seen an artist’s clever vision of snoring, including:

  • Window shades flapping in and out
  • A bedroom filled with giant Z-Z-Z-Z-Z-Z’S
  • A care-worn wife dashing screaming from the room, her hands clamped over her ears

But there’s nothing funny about snoring — it’s actually some very loud bad health in progress.

We note that because, in our practice, about half the patients coming in for cosmetic plastic surgery have breathing problems

Causes of snoring can be many, but you must be wondering what has snoring to do with the nose job procedure?

Simple answer: many snoring cases are abated or cured in connection with rhinoplasty.

Deeper answer: Before rhinoplasty,  the savvy nasal surgeon will examine the nose’s insides for blockages if the patient (or patient’s wife!) reports habitual snoring. The exam is a thorough look-see by a surgeon trained and experienced in head and neck surgery.

The surgeon best qualified to perform that inside the nose exam is also usually board-certified in otolargyngology.

(Read our post about plastic surgery’s board certifications.)

That surgeon thoroughly checks the inside of the nose because some conditions could exist which require a separate surgery before the patient can proceed on to the cosmetic rhinoplasty.

Internal nose passages include:

  • The septum – that thin wall of cartilage separating the nostrils. A septum could be bent, twisted or blocked
  • The turbinates, larger structures farther up in the nose, could require reduction because they sometimes swell
  • Untreated broken noses that healed on their own

Turbinates humidify, filter and warm air before it reaches the lungs. If you snore, you become a mouth breather and get second choice air. Lungs are healthier with nose breathing.

Another answer to snoring may also be found in the sinuses, throat or neck when polyps or allergies are discovered.

In some cases, the patient’s uvula, that dangling structure in the very back of the throat, hangs too far down into the throat and flaps back and forth, causing the sleep robbing Z-z-z-z-zs.

An enlarged adenoid can be the bugbear, especially in children.

But, of those many adult patients who come in with snoring problems, most are totally cured or significantly reduced.

Bottom line: healthy breathing is quiet breathing!

Deviated Nose: What Your Life is Like

Posted on by
Reply
"A humiliated boy hides his face in his hands"

Down in the Dumps: A Blocked Nose?

Scientists are always studying off-the-wall things. We remember one study by a handful of scientists and physic professors trying to find why toast always falls to the floor, buttered side down. (We are NOT making this up!)

Ever since, scientists have worked on various other factors affecting the downward flight of buttered toast toward your kitchen floor. Query the phrase, “Why toast falls to the floor buttered side up” and you’ll find at least 18 journal articles on Google Scholar.

We also observe that nose job patients coming into our offices asking about rhinoplasty also often complain about a nose that blocks breathing. And they also tend to not feel so well. You can pretty much take it for granted.

But has it been officially studied by cosmetic plastic surgeons or anybody else? Not until now.

Eight Brazilian Ph.Ds noticed the same thing – that bends, twists and swollen structures inside the nose can affect your life in more ways that just poor breathing.

So they studied the effects of:

  • A deviated septum
  • Other internal nasal blockages

Sixty patients were rounded up with 32 assigned to the deviation group. Another 28 who had no nasal blocks were put in a comparison group.

Then, all sixty filled out several questionnaires on general health. Findings included that the deviation group had 11 depressed people while the non-deviation group had only two.

Moreover, the deviation group had a “worse quality of life score” while the non-deviation group enjoyed a 90 percent rate of physical functioning like running, sports, doing housework and other activities. But the subjects with breathing obstructions only had a 77 percent rate of ability doing physical tasks.

Overall, a deviated septum was linked to feeling tired and worn out and having less energy. The blocked nasal group also had more emotional problems and did not get along with others as well as those in the no-deviation group.

For women, that meant having a blocked nose can cause more:

  • Introversion
  • Immaturity
  • Obsession with self-image

It gets worse for guys with blocked noses; they tend to be stubborn, skeptical, pessimistic and perfectionistic.

Commonly reported among both men and women with nasal deviations:  they “feel so down in the dumps that nothing could cheer them up.”

Unfortunately, “nasal deviation” covers a lot of ground. Anybody with a deviated septum or blocked turbinates could fit into the group.

Look at some nasal deviation before and after pictures.

Rhinoplasty — Done, Re-done….and Re-done Again

Posted on by
Reply
"A lovely woman holds her nose after a nasal surgery"

"Another Nose Job?"

Recently, on a very busy day, we performed four nasal surgeries. But two of those four patients each had three previous nose jobs.

Our sense, along with the judgment of many other experienced nasal surgeons, is that too many revision surgeries are being done. Put this situation into any other surgical specialty like chest or heart surgery or neurosurgery and it would be totally unacceptable, leading to cries for reform.

Nonetheless, year in, year out, the professional plastic surgery organizations estimate that about 20 percent of rhinoplasty cases leave the patient unsatisfied with the nose’s look and in the market for a revision rhinoplasty.

What is it about cosmetic nasal surgery and such poor results?  Granted, rhinoplasty is the most difficult plastic surgery procedure. But it does not help to teach all 136 cosmetic plastic surgery operations. It only dilutes learning.

Would it not make more sense to have extra training in, say, five to eight procedures?

Typically, here’s what goes wrong with a first nose job: due to inexperience, a younger surgeon takes out too much tissue, bone or cartilage, leaving grooves, depressions and other unsightly marks on the outside of the nose. Many other noses look too pinched, too narrow and just too scooped out.

A second or third nose surgery becomes more difficult due to scar tissue in the nose and the patient’s knowledge of what must be endured for a presentable nose. It’s not only expensive, but time away from work and family and other inconvenience  like some post-operative discomfort.

But there is another way: filler injections. Provided nothing inside the nose needs corrective surgery, the correction of deviations on the outside of the nose can be done:

  • Permanently
  • Predictably
  • Without invasive surgery

Known as a “Nonsurgical Rhinoplasty”,“Injection Rhinoplasty” or “Rescue Rhinoplasty,” the procedure is done in the surgeon’s office and places micro-drops of Silikon 1000, (a medical grade silicone), just under the skin where the body walls off the tiny droplets.

Just look at Wikipedia’s before and after injection rhinoplasty pictures.

Silikon 1000 is FDA-approved for use inside the eyeball (could anywhere else be such a sensitive and critical area?), so using droplets under the skin is an off-label use. But with over 60 years of such use in the US, safety and reliability is no longer questioned.

What’s more, there are no bruising, swelling or odd colors on your face that shout SURGERY! NOSE JOB HERE!

Typically, it takes a series, usually three to five injections, six weeks apart but you will have neatly bypassed surgery. Plus, you’ll have a nice looking nose that flatters your face.

(Read more about injection rhinoplasty)

Nose Jobs: More for Ethnic Groups

Posted on by
Reply
"A closeup shows a pretty African-American girl"

After Rhinoplasty

According to Modern Medicine, more racial groups are asking for rhinoplasties. So Rod Rohrich, M.D. a Texas rhinoplasty specialist and president of the Rhinoplasty Society, is asking colleagues to learn the unique requirements for patients of various ethnic backgrounds.

Thus, nasal surgeons are taking a closer look at ethnic differences in the structure of the nose like the thickness of skin and width of the bony base.

Back in 2002, about 19 percent of cosmetic surgery patients were minorities. But in 2010, the number had jumped to 30 percent.

American Society of Aesthetic Plastic Surgery (ASAPS) head counts revealed that minority plastic surgery patients were:

  • Hispanics, 12 percent
  • African-American, eight percent
  • Asian descent, six percent
  • Other races, five         “

Not long ago, many assumed that seeing a cosmetic surgeon for rhinoplasty would result in changing one’s ethnic features to an Anglo-Saxon nose.

No longer!

Black patients often want reduced nostrils but none want a too-narrow Anglo nose – it just does not fit the face.

The poster child for what black patients absolutely do not want is Michael Jackson’s delicate, overdone nose.

The complicating issue in black noses is thicker skin. Those nose tips are also difficult to slim because risk exists of losing the blood supply.

Even internal tissues get into the act: Asians and Hispanics tend to have softer cartilages.

Middle Eastern background patients often have a longer and somewhat droopy profile with the tip dropping even farther when the person smiles.

Reading between the lines, you can probably sense that – depending on ethnicity – some changes to the nose can be made while others can’t.

A few rhinoplasties require additions to low bridges. Typically, Asian patients request ta raised bridge. That can be done with transplantation of the patient’s own tissues like:

  • Bone
  • Cartilage
  • Or, a man-made implant like solid silicone.

Asians also want to raise the tip which is often round and somewhat plunging. Many also narrow the nostrils which can be too wide where the nostrils meet the wall of the face.

The common denominator: conservative change is the watchword being, “Less is more.”

In the end, each nose is unique and must naturally fit the patient’s face.

How do you know your rhinoplasty will fit your own face?

Easy!

Find a surgeon who has great before and after rhinoplasty pictures among various ethnicities!

Rhinoplasty: Top 5 Myths

Posted on by
Reply
"A close up of a lovely woman's nose and lips are shown"

After Rhinoplasty

While the Internet has been a wonderful democratic process, giving everybody the right to publish their opinions, some ‘Net information is bogus and not worth the pixels in which it appears.

Plastic surgery procedures are no different.  For some reason, untruths about nose job surgery continue to circulate.

Because we have over four decades experience with matters regarding the human nose, let us set at least some of the record straight.

  • Myth 1: Nose jobs hurt!

Perhaps pain was involved many years ago before the advent of modern anesthetics which not only keep pain at bay, but also allow for an easy, no-hangover, no-hurl awakening. Most particularly, Propofol, (the same drug Michael Jackson abused) goes very smoothly on recovery.

(Still got doubts? Fair enough. O.K., try this: Watch a plastic surgery video show a cosmetic surgery patient awaken, totally refreshed, in 27 scant minutes after being put under with Propofol.)

  • Myth 2: All plastic surgeons offer rhinoplasty

Rhinoplasty is the most intricate, challenging, involved and complicated of all plastic surgeries. Nose jobs require years of diligent study and practice to learn. (Hint: if you want a nose job to look good, find a rhinoplasty surgeon who has hundreds of before and after rhinoplasty pictures.

  • Myth 3: Rhinoplasty equals a dream nose

Depends. What can be done in rhinoplasty depends on your bone structure and skin, past nose surgeries, your breathing and other factors. Sometimes, a patient requesting a nose job must be turned away because yet another surgery would not be safe. (Read one account on WebMD of a rhinoplasty patient who was turned down.)

  • Myth 4: Everybody will notice I had cosmetic surgery!

Not if the surgery is done well! Nose jobs are so attractive because, after healing, your nose fits with your face. When a nose has a blemish, bump, hook, twist or some other tweak, others’ eyes stop on the nose. But if your nose is otherwise nicely shaped, it changes the way others perceive your face. Instead of stopping on the unattractive nose, the eye goes instead to the person’s eyes, making the whole face look, well, better as well as somehow different.

  • Myth 5: Ye-e-e-c-c-tch! Plastic in my nose! What if it melts?

No worries! The “plastic” in plastic surgery comes from the Greek “plastikos” meaning “mold or form”. Your rhinoplasty surgeon works inside your nose with many different structures consisting of your own bone, cartilage, flesh and muscle.

None of that melts. Seriously.

Sleep Apnea on the Rise

Posted on by
1

Recently, the Health & Wellness section of the Los Angeles Times had two excellent articles that dealt with the problem of sleep apnea and snoring

According to the Los Angeles Times, “2% of women, or at least 4% of men, suffer from obstructive sleep apnea.”  If you are not familiar with sleep apnea, it is a condition “in which the airway collapses and blocks breathing for 30 seconds, or even up to a minute or two.  The brain senses that it isn’t receiving enough oxygen and sends a signal to the patient to wake.”

People with sleep apnea (apnea is translated as “without breath”), find themselves in an unsatisfactory and untenable situation because their sleep quality is poor.  Poor sleep quality can generate  a myriad of problems including sleepiness at work and leisure, and even possible elevations of blood pressure, and other imperfections in your normal bodily function.

Maybe there is a connection between the rise in obesity in the United States and sleep apnea.  The paper says, “the incident rises with age: experts estimate that it affects about 40% of people age 65 and older.”  What we are seeing in the United States is that older people tend to be heavier.  That is not good news on many fronts. 

The articles also points out that it’s not just about age.  The overweight issue is very significant.  Overweight patients have double the risk of sleep apnea according to Dr. Lawrence Epstein, of a sleep center chain in Massachusetts.  Incidentally, if you have ever seen kids with large tonsils and adenoids struggling to get breath when they are sleeping at night, which is not that uncommon, you have a clue as to what sleep apnea is like. 

The article pointed out that there are mechanical remedies available including the infamous CPAP (“Continuous Positive Airway Pressure”) device, which is a spaceman-like mask which affixes tightly and to the face, akin to a scuba mask.  An external electrical power source drives the air into the lungs under pressure at night.  It is not too pretty; but, it does provide relief for people. 

Other technical aids are dental mouth pieces, and even some of these external nasal breathing strips. 

I was a bit disappointed that the article did not discuss management of one of the key causes of sleep apnea – that is a blocked nose. Nasal obstruction.

More on that to follow because there is a huge pool of patients in the United States, and worldwide, whose problems can be helped with a veteran, venerable, and reliable one-hour surgical procedure – nasal septoplasty and turbinate resection, with or without rhinoplasty. 

~Robert Kotler, MD, FACS

 

 

Considering Rhinoplasty?

Posted on by
Reply

CONSIDERING RHINOPLASTY?  BE SURE TO CHECK OUT YOUR CHIN ALSO.

Many people have rhinoplasty because they are not satisfied with their profile.  There might be a hump or the nose may project too far from the face.  The nose may be too long ; even  “so long” that it nearly touches your lip when you smile.  Most people do not see their profile and, rarely, can make the same objective judgment about their nose that they can about the width, which is visible from the front.  Often, photographs are what drive people to see us for consultation concerning their nose because, “Whoa, I saw what I look like from a side view, and I sure don’t like what I see.”

A complete consultation will include evaluation of the appearance of your nose in all views.  The wise cosmetic surgeon, or plastic surgeon, or facial plastic surgeon will also take into account the dimensions and position of the chin.  It is very important because often the nose appears unduly large because the rest of the face is not large enough.  In other words, there is a disproportion between the nose and the face based on how the other facial structures are formed and what their dimensions are.

The chin often needs to be augmented.  In other words, the profile is improved if the nose is made smaller, and the chin is made larger on the profile.  I am not talking about looking like Jay Leno.   But, I am suggesting, and in some people, just a very small increase in the forward projection of their chin will compliment the improvement in the nose and make the profile as good as possible.  At consultation, it is very important that all aspects of your appearance be considered.  Do not go in with a narrow-minded view of “I need a rhinoplasty.”  The point of consultation is for you to learn and understand what the anatomic issues are.  If the surgeon suggests that you consider a chin implant, do not take it as an insult, but, rather, that the surgeon is thinking about your entire face, and that is exactly what his mission should be.

 

Rhinoplasty Packing Anxiety

Posted on by
Reply

After nasal surgery, cosmetic or reconstructive to improve nasal breathing, there is generally some sort of “packing” placed inside the nose.  The same process for people having a nasal and sinus surgery.  Whether it be a cotton pad or Telfa, or cloth-like material, the purpose is to maintain the reconstructed parts in the proper anatomic position, reduce the chance of bleeding, and to deliver important medications into the tissues, such as antibiotics and even medications to speed healing.  So, packing has always been a traditional part of rhinoplasty, nasal septoplasty, and turbinate resection, but not necessarily welcomed by patients. 

Patients, understandably, dislike the complete blockage, the feeling as though “there is a clothes pin put on my nose.”  They do not like it because it produces a dry mouth and, worse, a sense of anxiety that they cannot catch their breath.  One patient likened his experience to being “waterboarded.”  Another said it was one of the worst experiences of his life because he was very anxious, he could not sleep, and was “generally miserable.”

Interestingly, the specialties of facial plastic surgery, head and neck surgery, ear, nose and throat and general plastic surgery have not paid enough attention to  patient satisfaction with the post-operative experience. While the results of the rhinoplasty and other procedures generally been good, patients rarely give high grades to the experience.

With that in mind, recently, I have developed a new medical device that allows patients to breathe completely freely and normally during the entire postoperative period, including right after surgery.  This Kotler Nasal Airway is placed by the surgeon at the operation, and then the packing is placed.  So, the airway is guaranteed, and the comfort and security of being able to breathe is assured. 

More to follow on this later.