Plastic Surgeon Measures Important Angle before Rhinoplasty

When most rhinoplasty patients start inquiring about a nose job, they learn how many factors can affect the quality their procedure.

It’s not only the size and shape of your nose, but some seemingly unrelated matters like the type and quality of your skin.

For instance, oily skin is usually thicker and tends not drape down even if the cosmetic surgeon removes a nasal hump and makes the tip less wide. In effect, the surgeon is taking material away from nasal framework.

Skin is something like upholstery; it looks better in the end when it can shrink down equally all over the nose, providing a nice contour. For a cosmetic plastic surgeon performing rhinoplasty, thick skin can be challenging.

Moreover, the patient with oily skin can expect skin eruptions and other breakouts. (Read more about skin and rhinoplasty)

And who among us ever think about the actual strength of one’s cartilage? But to a nasal specialist, stronger cartilage is easier to work with. (Post continues, below)

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The patient below had only rhinoplasty with no change in the shape of his nostrils, creating a more youthful appearance and handsome face. (Robert Kotler, M.D. photo)

Left, before rhinoplasty and three months after surgery, right

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(Continued from above) Weaker cartilage is a different creature. The surgeon can’t remove very much because less robust cartilage may not support the rest of the nasal framework, leading to nasal collapse.

Don’t get the idea we discover the answers during nose surgery. Nasal surgeons figure these things out during the patient’s first consultation so we can answer all the questions and perhaps explain why a certain request cannot be met or only partially met.

Smart rhinoplasty surgeons look up inside the patient’s nose and discover if there are any breathing blockages.

Here’s a typical quandary: the patient wants a narrower nose. But the surgeon observes the breathing airways in the nose aren’t the best. Satisfy the patient 100 percent and the after-surgery breathing will be hampered. Of course, there is no real choice because — first and foremost — the nose is a functional organ whose purpose is to pass air to the lungs.

But surgeon and patient can have a discussion about internal surgery to open the airways as much as possible.  Perhaps this particular nose has a deviated septum or needs turbinate reduction.

Among other factors, your rhinoplasty surgeon also needs to know if you:

• Smoke
• Had a previous nose job
• Have an untreated broken nose
• Are old enough
• Have legitimate reasons for wanting a better looking nose.

Dr. Kotler: Ranked by MapQuest as #5 out of 500 medical & health professionals in Beverly Hills’ “Golden Triangle”

Several rhinoplasty patients recently wrote to us. A British man, L.C., wrote after we performed rhinoplasty on his son. The lad had an unattractive nose and had applied to the American Academy of Dramatic Arts while applying for small acting jobs on the side.

But he was rejected by the Academy and getting very few acting parts. In the performing arts, both men and women are judged on appearance as well as talent.

The British lad then came to us for nose surgery. After healing, his improved appearance helped and a proud father later penned:

“I just wanted to give you an update on the wonderful surgery you performed on my son O.C. His nose looks so natural you would never doubt that he wasn’t born with it.

Attached is a photo he sent to the American Academy of Dramatic Arts. He obtained a place.

Thank you so much for your incredible skill and kindness. You transformed my boy.

My very best wishes,

-L.C.”

Rhinoplasty improves a person’s perception of self via more self-confidence, so you could almost consider a nose job a type of brain surgery. (Post continues below.)

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On the left, a man’s nose is shown as it looked after two failed rhinoplasties done elsewhere plus sports injuries to the nose. On the right, his nose shows the results of permanent non-surgical rhinoplasty, using only a filler and a syringe.

Permanent, non-surgical rhinoplasty

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(Continued from above.) Another patient, understandably concerned about the price of cosmetic plastic surgery on her nose, came in thinking she needed revision rhinoplasty. A first rhinoplasty seven years ago left unsightly indentations on her nose. We saw immediately her nose could be vastly improved by permanent, non-surgical rhinoplasty, using Silikon 1000 in a syringe, all at a sharply reduced price over the cost of nose job surgery.

She writes in part:

“… I was very self-conscious about this (nose) flaw. I went to another Beverly Hills plastic surgeon before Dr. Kotler for a consultation..but he said it (non-surgical rhinoplasty) would probably help but he was very cool about it . …I felt like he just wanted the most expensive procedure done…But I didn’t have the time or money. The minute I met Dr. Kotler, I felt at ease….I also noticed how he treated everyone in the office with such warmth regardless of background. He has such empathy, charisma, and confidence. He took his time with me; explained the different options I had, etc. I felt like I was in great hands. I only needed two injections, and my nose looks much better now. I may go back to fix my deviated septum in the future, and I will definitely chose Dr. Kotler to perform this surgery.

Sincerely,

J.”

(Read more cosmetic surgery patient stories about nasal surgery changing their lives.)

Dr. Kotler: Ranked by MapQuest as #5 out of 500 medical & health professionals in Beverly Hills’ “Golden Triangle”

Two recent cases of teen rhinoplasty give pretty good guidelines on when a young adult should — and should not – have a nose job.

Frequently, teens want a less-than-attractive nose rejuvenated through surgery because an overly large or misshapen nose makes them a target for:

• Teasing
• Bullying
• Ridicule

Bullying is such a serious issue that most psychiatrists and plastic surgeons recommend children with large ears have otoplasty, the ear pinning procedure, before starting the first grade.

Discussing teen nose jobs in a recent Medscape blog was a professor of psychiatry and a professor of plastic surgery.

(Read our last post about the deciding factors for granting, or turning down, a teen rhinoplasty.)

In one case, a 17-year-old girl with mild cerebral palsy and developmental delay complained the size and shape of her nose caused others to “be mean”. The parents put off any cosmetic surgery until the young lady was “old enough to decide for herself” but could go ahead if she wanted. (Article continues below.)

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Below, the young lady’s unsightly nasal bump and drooping tip are rejuvenated, using tissue from inside her nose, creating a more feminine appearance.

However, the plastic surgery professor, Sherrell J. Ashton, M.D., in the department of Plastic Surgery at N.Y. University School of Medicine thinks cosmetic plastic surgery should be put off for now due to the patient’s developmental delay.

The professor of psychiatry and pediatrics, Robert L. Findling, MD, MBA at Case Western Reserve, wondered about what would happen after cosmetic nose surgery. Would her intellectual status cause continued teasing and abuse? Both professors agreed the best decision was waiting until the youngster was old enough to ask for her own surgery.

In the second case, an 18-year-old woman had just graduated from high school and had been admitted to a performing arts program at a prestigious university. Her parents were wishy-washy about her nose job but decided to leave the go-ahead to the teen who asked her university advisers about the importance of improved appearances.

The instructor just pointed to a line in a song in A Chorus Line which tells of the impression a theater critic had about one wannabe star: “Dance: Ten; Looks, Three..”

Results? The 18-year-old had every good reason to go ahead with her surgery. Improving her looks would also vastly improve her self-confidence which stage performers need in spades.

Adds Dr. Findling: “Her concern about looks and being in the performing arts is a realistic one.”

(Read more about nose jobs.)

Dr. Kotler: Ranked by MapQuest as #5 out of 500 medical & health professionals in Beverly Hills’ “Golden Triangle”

Left, A.H. before rhinoplasty

Many patients pen thank you notes, but one in particular stands out.

When A.D. (privacy laws prevent us from revealing her name) now 29, came to see us, she said she could not recall a time when she liked her nose or willingly posed for pictures.

Her displeasure with her nose was constantly on her mind when dating or attending social functions.

She wrote: “I always wondered if people noticed how big my nose was, the size of the bump on the top or the way it comes down too far, covering my upper lip.”

If you read much about plastic surgery, you’ll find there are many who feel that we should accept ourselves as Nature made us, forgetting “vanity” and nose jobs.

But all that depends on whose shoes you are walking in.

A.H. was in the accept-yourself-as-you-are camp for a while, writing, “I thought I needed to simply accept my nose and finally learn to love it.”

Nonetheless, A.D.s nose had a clear impact on her self-esteem and confidence. Three years ago, she made an appointment with a plastic surgeon but cancelled. And then never rescheduled.

More recently, she realized the hours she fretted about her nose was a waste of time and energy. Like many who have an intensely disliked body feature, she wanted confidence when meeting new people and appearing in pictures.

A.D. then came to us after combing the Internet and doing other research with her mother, an R.N. The duo asked all the right questions and, when satisfied, booked cosmetic surgery. She wrote: “Dr. Kotler’s academic credentials and quality of work were obvious …as was his empathy and compassion.”

She also liked our computer-enhanced “after” image prediction. (Read more about cosmetic surgery “after” imaging.)

Her procedure: Classic rhinoplasty with hump removal, narrowing of the entire nose and raising the nasal tip.

One-month after surgery, A.H. reported that her nose was tender, but she did not require medication. She was delighted no marks were seen on her face while friends said the rejuvenated nose matches her face and is so natural-looking, it makes her face look smaller and her profile softer.

She writes: “I can’t adequately describe how much better I feel knowing my nose no longer haunts me….it’s such a relief to look in the mirror and be happy.”

Regrets? Yes, one.

Interested in a rhinoplasty or other internal nasal surgery to promote healthy breathing?  If you get a nose job, it may be worthwhile considering the other surgeries you could get during the same surgical session.

Why?  If you want more than one cosmetic plastic surgery, consider the benefits of a single surgical session which include:

• One session under anesthesiology
• A single anesthesia charge
• One recovery and healing period
• Missing less time at work

The most obvious procedure that many choose with rhinoplasty is chin augmentation or mentoplasty, for patients with receding chins.

Mentoplasty does wonders for the profile and sharply improves your whole facial appearance. Patients with receding chins who go ahead with only rhinoplasty often regret it, according to Medical News Today.

We know this because two plastic surgeons from the department of Otolargyngology at Charing Cross Hospital in London, England, rounded up other plastic surgeons and lay people to study before and after rhinoplasty pictures of 100 past nose job patients.

Using four different evaluation methods, the doctors and lay people found that between 17 and 62 percent of male nose rejuvenation patients and 39 to 81 percent of women rhinoplasty patients should have also considered chin augmentation.

Concluded the authors: “Every nation values a balanced face so all cosmetic plastic surgeons should inform potential rhinoplasty patients of the impact mentoplasty can have on balancing facial profile profiles.”

(Read more about the rhinoplasty study.)

Chin augmentation, however, is not the only procedure that facial cosmetic surgeons often provide during one surgical session.

While the upper limit for any one surgery is about five hours, the health of the patient decides the actual time.

For instance, some nose job patients opt to also have otoplasty (ear pinning) while under anesthesia. Some choose to have surgeries of the body like breast augmentation or tummy tuck. In the best scenarios, a facial specialist performs the rhinoplasty while another plastic surgeon who does only surgeries of the body steps in.

An expert facial cosmetic surgeon performing nasal surgery could also perform at the same time:

• Eyelid lifts
• Face lift
• Cheek implants

The best part of all? Most plastic surgery offices offer discounts for “add-on” surgeries after you’ve already decided on one!

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Below, rhinoplasty plus chin augmentation equals a perfect profile (Robert Kotler, M.D. photo)

Most plastic surgery articles list the common side effects of a rhinoplasty, including:

• Swelling
• Bleeding
• Bruising
• Possible adverse reactions to anesthesia

But some are surprised to find their sense of smell has gone askew.

Writing in an issue of BMC Ear, Nose and Throat Disorders, a professional journal for physicians, Iranian plastic surgeon Hashem Shemshadi, M.D. and three associates rounded up a study group of 40 to 65 male and female patients, all of whom had rhinoplasty via the open method which peels back the nasal skin to show the nasal framework.

(Read more about open and closed rhinoplasty.)

Before surgery, each patient took and passed a smell test which involved sniffing common odors. Then, one week after the rhinoplasty, the surgeons repeated the test with the exact same smells.

Result? 87.5 percent could not identify any odors at all while the remainder reported losing at least a little ability to sniff ordinary things. The good news: the smell loss was not permanent.

About six weeks after surgery, 85 percent of the study group said they were experiencing only a slight to moderate loss in their olfactory abilities.

The third and final test at six months revealed that all the patients’ sniffers were just as sharp as when first tested.  (Read more about the rhinoplasty smell study.)

The Iranian cosmetic plastic surgeons noted that while the study group needed half a year to completely regain their smell, other nose job patients said it took a little longer.

But the larger question for any patient is: why would a rhinoplasty cause a loss of smell, if only for a short while?

The very convoluted, complex nose can sense odors because as you breathe, the air rolls around in eddies within the nose as it passes on to your lungs. Contained within the nose are nerve-rich regions that react to the molecules of various odors. Swelling is a reaction to surgery – and perhaps more so with open rhinoplasty – so scent molecules in that air can’t pass over the correct nerves. When the swelling subsides, so does the loss of smell.

The affect is stronger when a septoplasty on a deviated septum is done in the same surgical session.

Worth noting: the most skilled rhinoplasty surgeons use the closed method in which the surgeon works entirely through the nostrils.

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The patient below had rhinoplasty to improve the appearance of his nose plus septoplasty and  turbinate reduction to improve breathing. (Robert Kotler M.D. photo)

Before and after rhinoplasty

After Rhinoplasty

If you follow the ponies, you’ve probably heard the expressing, “winning by a nose.”

In Egypt this week, it was losing by a nose when an Egyptian lawmaker had a rhinoplasty in secret, tried to hide the cosmetic surgery by saying the bandage on his face was the result of a beating and robbery attack – but was caught in the fib.

While nose jobs among the famous have led to lots of embarrassing incidents like celebrities who deny something as plain as, well, the nose of their faces, this incident has the singular honor of being the first scandal in Egypt’s fledgling democracy.

Result? Member of Parliament, Anwar el-Balkimy, was forced to give up his seat. Fired, basically. It got to be crushingly embarrassing because the new speaker of the 40-day old Egyptian parliament went to Mr. Balkimy’s hospital room to wish him well after the attack.

But newspaper reporters – also exercising new freedoms – went to the plastic surgery clinic where the procedure was done and asked staffers who then openly spilled the beans about the nose job.

The lie about the rhinoplasty was such a major event because Mr. Balkimy belongs to Al Nour, an extremely conservative faction of Islam.

High on the no-no list for its members are:

• Music
• Most forms of entertainment
• Cosmetic plastic surgery

But don’t get the idea that plastic surgery is scarcely done in that part of the world. It’s just the opposite.

Elsewhere in Egypt and the entire Middle East, cosmetic plastic surgery flourishes with some extremely talented and highly respected, world-class plastic surgeons plying their trade for millions who – like people everywhere – just want to look better and have more self-confidence.

For instance, the American Academy of Cosmetic Surgery built a multi-million dollar hospital dedicated to cosmetic plastic surgery in the Gulf nation of Dubai. Moreover, one of the highest rates of rhinoplasty anywhere in the world takes place in Iran. It’s because many women choose to wear veils, which only show the nose and the eyes. So it’s noses looking better first.

"Don't look at my nose!"

If you’re a teen boy, at least 17, or a 15 or 16-year-old girl, you may be old enough for a cosmetic nose job.  One thing’s for sure, you’ve got lots of company: in 2010, the best year we have for statistics, about 35,000 American teens had rhinoplasty.

But how do you ask mom and dad?

You’ll make a better case for rhinoplasty if you have been teased at school or if you have a cruel nick-name like “Big Nose.” Then, your self-confidence is flattened. So you dread giving that speech in a class. You also probably don’t want to raise your hand – even when you’re the only one who knows the answer—because you don’t want attention. Some teens go to great lengths to hide their noses, letting their hair grow down over the face or pulling down a baseball hat.

So what to say to parents? Try: “I feel singled out because of my nose – it’s actually holding me back. Because my nose is ugly, I feel ugly and I don’t volunteer for things, I don’t join things and I don’t speak out because I don’t want to people to notice me. I have about zero self-esteem.”

Rhinoplasty changes the entire appearance of a face; when looking at a person with a bad nose, the eye stays on the nose. But when a nose fits and flatters a face, the observing eye then takes in the person’s eyes. (Just look at the teen before and after rhinoplasty picture, below.The only change was to her nose.)

Explain that the ear pinning operation – otoplasty – is often given to kids with big, stand-out ears before they start first grade. It’s because the teasing starts immediately and can sour a youngster on education for life.

Then, go on your computer and Google the studies that find attractive people:

• Do better in school
• Get more attention from teachers
• Make more money at work
• Are treated better by peers
• Are more likely to have leadership roles

Offer to pay as much as you can now and repay any money mom and dad spend.

When you go see the cosmetic plastic surgeon, he or she wants to see:

• The teen has initiated the request
• You have reasonable goals (i.e. don’t ask for Anglie Jolie’s nose!)
• You are mature enough to deal with nasal plastic surgery, a little post-op discomfort, having black and blue marks on your face for perhaps seven days and can give up sports for three to four weeks.

Before and After Teen Rhinoplasty

Before Rhinoplasty

When two Big League baseball players were chatting in a locker room in the summer of 2011, one heard his pal saying he would like to have a rhinoplasty along with correction of a deviated septum.

A septum is the thin wall of cartilage separating the nostrils. And we’re talking really thin – as in egg shell thin. Sometimes, people are:

•    Born with a deviated septum
•    Injured
• Hit in the face with a baseball
• Dive nose first into a base

Met pitcher and Lefty Jonathon Niese had his site set on a cosmetic rhinoplasty that included fixing his crooked septum. Trouble is, if the septum is bent out of shape that affects the breathing. And you know how it is with sports stars – they just gotta breath right.

But Niese seemed to be getting along O.K. and said he would get around to the nasal surgery someday. The cost of the rhinoplasty and septum repair would be about 10 grand, according to a New York plastic surgeon.

“Oh yeah” says Carlos Beltran. “What if it was already paid for? Would you do it then?”

“Of course,” says Niese.

So teammate Beltran pipes up right out of the blue and says to Niese: “Well then, go ahead and get the nose job. I’ll spring for it.” Beltran and Niese were with the Mets from 2008 to 2011.

And then a wrinkle crops up. Beltran gets traded to the St. Louis Cardinals.

Meanwhile, the New York papers get involved and report that Beltran recommended the plastic surgery, a supposition Beltran — who doesn’t know beans about cosmetic plastic surgery — denies.

Says Beltran, fully aware his pal is with another team: “I will have a check ready when the teams met.”

Niese had the nasal surgery in October, 2011, now notices a major league improvement in his breathing (as well as the appearance of his new nose, below!) and looks forward to receiving a  $10,000 check from Beltran who has announced his check is as good as his word.

Sometime after the national anthem is played on March 1, the two teams will face off during Spring training in Jupiter, Florida and Beltran will fork over the nose job money in person.

How’s that for a new high sportsmanship?

After Rhinoplasty

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.