Tag Archives: better breathing

Botched Nose Jobs

"A Rugby player shows his thrice broken nose in a close up"
Twisted outside = Twisted Inside

The most recent episode of Botched, the E! Channel’s latest offering of plastic surgery tales in the “Golden Ghetto,” (Beverly Hills) introduced Paul, a late 20 or 30-something married guy who had suffered, not one, but two botched nose jobs.

The most recent left his nose twisted to the left; moreover, he had a noticeable hump on his nose. So he was in for a revision nose job.

          (See some before and after revision nose job pictures.)

Among plastic surgeons, a common saying is: “A nose twisted on the outside is almost always twisted inside, too.”

Besides looking a tad strange, it means that Paul’s breathing is also affected. Additionally, he suffered chronic migraine headaches that left him tired and unable to play with his children as much as he would like. Functional surgery straightens out the breathing channels

          (Read more about functional surgery.)

But aren’t two botched nose jobs unusual?

Actually, one of the major professional societies for facial plastic and cosmetic surgeons estimates that 20 to 25 percent of all nose jobs are botched. Rhinoplasty is immensely difficult and not a job for beginning surgeons.

          (Read more about the high rate of botched nose jobs.)

So many botched nose jobs creates a huge need for revision (medicalese for a surgical re-do) nose jobs, which are harder yet. And even some of the revisions are revised. Top Beverly Hills nasal surgeons often see patients with anywhere from three to seven previous failed nose jobs.

         (Learn more about revision rhinoplasty.)

Sure enough, when the plastic surgeon duo stars of Botched peered into Paul’s nose, they found his septum leaning far into a breathing channel.

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On the first  picture panel  Paul shows his crooked nose. The second before  and after profile panel  shows the hump removal. (E! Channel Photos)

Botched-Nose-Paul

 

 

 

Botch-nose-Paul-2

 

 

 

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Paul thought the surgery was going a little far because the surgeons needed some rib-donated cartilage to straighten Paul’s nose. It’s commonly done in rhinoplasty surgery, but Paul’s wife was a bit alarmed.

Said one of the Beverly Hills plastic surgeons: “Paul is a handsome guy, but his nose is basically on the left side of his face!”

True enough to the half hour T.V. segment, Paul’s cosmetic and functional nose surgery features were all resolved in thirty minutes.

In real life, a patient like that can go out in public again in, say, five days after a nose job while your revised nose should be pretty presentable within eight days including bruise remediation, if any. Still more healing goes on for a year.

Septoplasty & Turbinate Surgery = Good Breathing

"A surgeon works during turbinate reduction surgery"As a fitness and nutrition coach, 27-year-old Whitney DeLong could tell her bodybuilding students to breathe deeply, although she couldn’t follow her own advice.

In fact, she could barely breathe at all. Whitney found out she was on the wrong track when her allergy specialist told her he, the specialist, could do no more for her and that she should find a good ENT (ear, nose and throat) specialist.

Due to allergy complaints, Whitney had been getting allergy tests, allergy shots, prescription nasal sprays, pills and breathing treatments. All without relief.

“I was used to people constantly asking me if I had a cold or needed a cough drop,” Whitney says. “There was rarely a day in my life I COULD breathe normally.”

Many people with breathing woes often go down the wrong path because they think the problem is sinus.

Whitney did know from one CAT scan, she had a severely deviated, or bent, septum leaning strongly to the right in her nose.

“I later learned a deviated septum can block the breathing channel,” Whitney says.

It must have been a serious block because nose surgery was scheduled on the same day as the initial consultation with the surgeon who added another procedure.

Due to Whitney’s allergies, some internal nasal structures – the turbinates — in her nose had also been swelling and adding even more blockage to her breathing channels.

The procedure, turbinate reduction surgery, slims down the problem blockage. Skin covering turbinates is especially rich in blood so usually some bleeding follows the procedure.

(Read more about Whitney’s turbinate reduction surgery.)

Most nose surgeons apply a thick absorbent pad just under the nose across the lip in turbinate reduction. The patient then changes the pad at home.

(Learn what to do after turbinate reduction surgery.)

Turbinate skin is like no other in the human body. Because the job of the turbinates is filtering, warming and moisturizing the air you breathe, skin covering the turbinates can swell up tremendously and then shrink later.

(Read more about septoplasty and turbinate reduction surgery.)

Functional Surgery: Most Patients Rue Waiting

"A young woman is shown in her office burying her head in her hands"
Why Did I Wait so Long?

Some of the most common remarks made after nose surgery by “functional” surgery patients are: “Why-oh-why did I ever wait so long!” or “I wish I had this done years ago!”

(“Functional Surgery refers to nose surgery procedures that makes the nose better able to perform its basic function – breathing.)

Some waited for a long while because they were born with a breathing blockage and knew no other way. So for them it was not a question of getting older and more decrepit.

Suffering the effects of bad breathing for many years is fairly common among patients who have:

  • A deviated septum
  • An uncorrected broken nose
  • Allergy-enlarged turbinates

Along the way, the usual suspects show up: snoring and irate bedmates, frequent sinus infections, sleep apnea and perhaps use of a CPAP (Continuous, positive air pressure) machine.

(Read more about the relationship between the need for functional surgery and CPAP machines.)

Part of the problem rests with the so-called “gatekeeper” doctors who are family practitioners or internists in charge of referring their patients on to specialists, if needed.

Those “gatekeepers” should be able to recognize a deviated septum, a twisted nose or enlarged turbinates in the upper nose and see that a blockage of healthy breathing is possibly present.

Simply put: it’s not normal to have lousy breathing.

The next step would be referring that patient to an expert nasal surgeon who would know what to do.

Some patients who have bemoaned a long period of extended bad breathing then become the happiest patients on earth when:

  • The deviated septum is corrected
  • Enlarged turbinates are trimmed
  • A crooked nose is straightened
  • A rhinoplasty is also done

All the above only takes a single, two-hour session to better the person’s quality of life for the rest of his or her days. Plus, the patient’s facial appearance is vastly improved.

One patient actually explained why he had waited so long to have functional surgery to improve his breathing.

He heard from other rhinoplasty patients that the nasal packing inserted into the nose after nose surgery was pure misery, causing mouth breathing for five days.

After seeing many patients turn away from surgery due to nasal packing (which is great for holding everything in place and delivering medicines that help the nose heal better) we invented a slim airway known as the Kotler Nasal Airway.

Nasal packing is now wrapped around the airway, allowing the best of both worlds – breathing and healing.

Plastic Surgery’s Only Real Plastic

"A woman lifts her head to show a septum leaning into and blocking a nostril"
Deviated septum, left. After surgery, right.

Plastic surgery articles almost always carefully point out that the “plastic” in plastic surgery comes from the Greek word plastikos which means, “to mold or take form.”

Nonetheless, many blog authors use the word plastic in the sense of artificial.

But there is one place in reconstructive plastic surgery  (as opposed to cosmetic plastic surgery) where actual plastic is used – in nose surgery to restore healthy breathing.

Your nose is divided into two breathing channels we know as the nostrils. The septum, a thin wall of cartilage and bone separating the nostrils, is often found to be warped, twisted or otherwise bent like in the before and after picture above.

Nose surgeons then refer to it as a deviated septum and dislike it intensely because it interferes with healthy breathing by limiting the air you breathe through at least one nostril.

And because the nose is a three-dimensional structure, the septum also acts to support the nose.

Some people are just born with a deviated septum while blows to the nose in accidents and sports create many more.

So where does the real plastic part come in?

When doctors repair a deviated septum in nose surgery, they often use stitches to restore the septum to the midline of the nose. To hold everything in place during healing, nose surgeons use plastic splints, a type of rigid implant made of soft silicone plastic. But the splints don’t stay in the nose forever; they are usually removed in one to three weeks.

Yet another condition known as nasal valve collapse also uses real plastic. In some cases, too much of the septum has been previously used as a building material during previous cosmetic nose surgery.

(Read more about deviated septum revision and nasal valve collapse.)

In other cases, the nose has been hit especially hard and collapses into a so-called “boxer’s nose” or a “pug nose.”

In both cases, breathing troubles are usually present. Besides, it looks bad.

Some surgeons take cartilage from patents’ ears or from between the ribs to use as supports in the nose. But that creates more surgical wounds.

Other nose surgeons now use polyethylene plastic inserts to repair a nasal valve collapse. The inserts are measured for each patient’s nose and then stitched to the septum for extra support.

In a 36-month Veteran’s Hospital study of 18 patients who had noses repaired using the technique, 15 had excellent results according to a recent article in The Archives of Facial Plastic Surgery. In one patient, the plastic graft poked through the nose skin and two were removed.

The remainder said their breathing was significantly better.

(Read the nose surgery report.)

Nose Surgery & the 5-Day Afrin Test

"A lovely woman is shown holding her nose due to stufiness"
                Constant Stuffy Nose

Many patients come into the office for a cosmetic rhinoplasty appraisal and are surprised to learn they have conditions inside their noses impairing healthy, normal breathing.

While getting the patient’s medical history some clues emerge: Usually the patient (along with the bedmate!) is plagued with loud snoring and sleep apnea. Maybe a CPAP is used.

Many are sensitive to allergies that cause upper nose structures known as turbinates to swell and again block breathing.

(Turbinates: bony structures in the upper nose that warm and filter your air. The turbinates are covered by a unique type of skin that can swell many times its normal size.)

Some patients have suffered a broken nose that’s healed in the broken position, again blocking good breathing.

But which is it, deviated septum, sensitive turbinates or a twisted or crooked nose? And who wants to undergo internal nose surgery for only slight relief?

A simple at-home test helps pinpoint the bugbear: the five-day Afrin test. For a short while, that test mimics the results of surgical enlargement of the nasal passages.

The demonstration could use any decongestant although Afrin, the most popular and common, along with its generic cousins, shrink the nose skin of the turbinates and the septum.

Watch for the following signs: if the patient:

  • Sleeps better
  • Has less daytime fatigue
  • Snores less or none

an inner nose procedure to improve breathing will most likely go well and be effective.

Here’s how the five-day Afrin test is done:

  1. Assign somebody at home to report on snoring
  2. Patient starts by sniffing five sprays into each nostril
  3. Watch a clock and let five minutes pass
  4. Repeat step 2.
  5. Do that for five days
  6. Separate the spraying episodes by eight to 12 hours

If, after five days, the in-house observer reports less snoring while the patient has more daytime energy, less nasal blockage, fewer headaches and a halt or reduction in sleep apnea, the Afrin has worked.

It’s because the decongestant reduces all the tissues lining the nose’s inside. However, Afrin has proportionally more effect on the lowest turbinate, the one that is usually surgically reduced in size for airway improvement.

So?

Surgical correction of the deviated septum and trimming of the lower turbinates is almost assured to improve all the energy-draining symptoms of bad breathing listed above.

Of course, the 5-day test won’t do anything for the appearance of the nose; rhinoplasty is required for nose shaping.