Tag Archives: Nasal Surgery

Nasal Grafts in Rhinoplasty

"A woman undergoes the final step of her nasal grafts during rhinoplasty"Many a patient when going in for a first nose job or a revision rhinoplasty has asked about nasal grafts.

Because the nose is three-dimensional, it requires internal support in various areas. Some supports can come from synthetic materials like Silicone or Gortex. But, in most cases, your body’s own cartilage taken from the septum, (the thin wall separating your two nostrils) the ear or the ribs are best.

Structural grafts are used for support — as in a pinched tip – or when a bridge is too thin and affecting the patient’s breathing. Contour grafts help make the outside of the nose smoother or to change the shape of the nasal tip.

Cartilage donations are carefully shaped and almost always very small. The grafts replace weakened places in the nose or replaces cartilage that has been damaged or taken out in previous nasal surgeries. In other cases, cartilage donations can be used to build up a small nose or a nose that has a flattened bridge, something that is common to many ethnic rhinoplasties.

Other types of nasal grafts include:

  • Shield grafts: projects and defines the nasal tip
  • Spreader  “   : help make the nose wider, improve breathing and gets rid of a pinched nose look
  • Columellar strut: supports and straightens a nasal tip. Also used to increase projection, or how far a nose sticks out from the face
  • Alar rim graft: helps stop pinched nostrils and improves nostril shape
  • Dorsal onlay graft: repairs the scooped out nose or the nose in which too much tissue was removed in prior surgery

There are other cases  in which a nasal graft can’t help.

For instance, when a nose is severley twisted, a procedure known as Osteotomy is used; a nasal bone is shortened, lengthened or changed in alignment to the nasal pyramid so the nosse can be rebuilt to allow for healthy breathing and to be a more attractive, natural nose for that patient.

But any graft placement requires a Master Surgeon who has spent decades operating on noses and then watching how they heal over time to know what size graft is needed and where.

After Rhinoplasty: When to Call the Doc Back

"A handsome, friendly doctor takes a phone call in the clnic"
May I Help You?

After rhinoplasty, many patients have a situation in which they are not sure if they should phone their surgeon. They don’t want to be a pest and phone for nothing, but what if something serious is going on?

Our own personal policy is to give patients our home and cell phones with instructions to call anytime questions pop up after surgery. Better to make a call for nothing than take a chance!

If you’ve selected a board-certified cosmetic plastic surgeon, don’t worry. He or she has seen every post-surgical complication you can imagine, including some in which patients resumed their intimate lives too soon, raising their blood pressure too much and causing some otherwise unnecessary bleeding.

In cosmetic surgery, the usual, typical complications besides bleeding include:

  • Infections
  • A solid swelling of clotted blood just under the skin (medically, a Hematoma)
  • A small pool of watery blood right under the skin, medically known as a Seroma
  • Very, very rarely, an allergic response to anesthesia

The bleeding we mention above is not a spurting or gushing, but usually just a little trickle seeping under the bandages.

Virtually all plastic surgeons provide a handout sheet on signs to watch for after surgery. Be sure and read them all.

As for infections: that is the reason your surgeon wants to see the morning after surgery. Best to jump on infections ASAP. The red warning flag – and an excellent reason to call your surgeon — is red or sore skin near an incision.

Some face lift, neck lift or other patients may notice some numbness in the treatment area. That happens when minor nerve endings just under the skin are severed. But sensation returns to normal in several to four months.

For rhinoplasty, most of the motivation for patients phoning their surgeon is nose bleeds. We’ve complied a list of seven handy tips for handling post-rhinoplasty or internal nose surgery nosebleeds, if any.

Protective guards come off nose job patients in four to six days.

If you have had what nose surgeons call functional nose surgery, that is, surgery for a deviated septum or turbinate reduction surgery you will be back in the office four to six days to take out the Kotler Nasal Airway and the medication-laced tampon which helps your nose heal immensely.

It’s a painless, easy procedure.

Watch a video in which a Kotler Nasal Airway is removed from a patient’s nose.

"A lovely woman tries to see her septum in a hand mirror"

Deviated Septum – Readers’ Top Questions

"A lovely woman tries to see her septum in a hand mirror"
Is My Septum Straight?

Many nose job patients are surprised to discover the very middle of their noses – the septum – can present problems in how your nose looks and how it passes air on to the lungs.

You may already know the septum, a thin wall of bone and cartilage, divides the two nostrils, sitting in the middle of the nose. But knock the septum one way or another a tad too much and you may problems like constant nasal congestion, frequent sinus trouble and more.

Q: What are the signs of a perforated septum?

A: Signs of a perforation, or hole, in the septum may be obstruction in the upper nose, scabs or bleeding. Hearing whistling while breathing is a sure sign of a septum hole. For only nasal congestion, try a nasal saline spray and bedroom vaporizer.

Q: What if I do have a hole in my septum?

A: You may not hear whistling from a small hole. But a medium-size perforation causes bleeding and crusting while larger holes can block the breathing channel through the nose.  When ignored, the bigger holes can lead to collapse of the nasal bridge, a condition known as saddle nose.

(Read more about saddle nose.)

Q: Can I push my deviated septum back on my own to where it should be?

A: Just after a fracture of the septum, you could, but it would hurt tremendously. Plus, the risk of bleeding and bruising are present. After a few days, the septum heals in its broken position, meaning you can’t move it back by any method except surgery. Whatever the case, if your ability to breathe and function well are important, let an experienced nasal surgeon handle new and old septum fractures. Surgery to restore a septum to the middle of the nose is known as septoplasty.

Q:  What causes a hole in the septum besides cocaine?

A: The typical causes of septum perforation include intranasal cocaine abuse (“snorting”), blows to the nose in contact sports, fistfights, past nasal surgery, including nose jobs (rhinoplasty) not done well, auto wrecks and other trauma. Some people are just born with bent, twisted or crooked septums. A hole in the septum is repaired with a small plug made of silicone during nose surgery.

If you suffer from allergies, a nasal spray or antihistamines may help. Plus, the surgical repair of a deviated septum may – or may not – improve snoring.

Q: What is deviated septum surgery?

A: Read about deviated septum surgery including what happens before, after and during surgery.

Rhinoplasty Revision: Top 5 Reasons to Choose BevHills

"A lighted Beverly Hills city sign is shown on a lawn at dusk"With America leading the world in the total number of first nose jobs – 242,000 in 2012, says the American Society of Plastic Surgeons (ASPS) – it follows that a fair number of those rhinoplasty procedures unfortunately result in unhappy patients.

Sometimes, Mother Nature is at fault and the nose doesn’t heal as expected. In some cases, the surgery was done by a young, unqualified or inexperienced surgeon. In other cases, the really difficult part of the surgery like – refinement of the nasal tip — is lackluster.

Whatever the reason, as many as one-fifth to one-quarter of first rhinoplasty patients start the process over, looking for a Master rhinoplasty surgeon to make the nose look attractive and fit the patient’s face and profile via a rhinoplasty revision.

But why come to Beverly Hills? Sure, it’s known as the globe’s Mecca for all cosmetic plastic surgery  procedures, but that must make it unaffordable, right? Not necessarily. A skill set exists in Beverly Hills not found in other U.S. locations.

So what are the top five reasons for journeying to Beverly Hills for a second rhinoplasty?

  1. Unhappy experiences with first nose jobs. Beverly Hills surgeons specialize in certain procedures – like revision rhinoplasty – and do the same few procedures for decades. Yet the costs of plastic surgery are affordable, thanks to competition among many, many specialists in one place.
  2. Unhappy nose job patients now know nose surgery is far more difficult and want surgeons who concentrate on the nose. You could do pre-surgery consultations in one Beverly Hills building for a week.
  3. Beverly Hills is a dedicated travel location, with a wide selection of hotels and even professional plastic surgery recovery hide-a-ways with nursing staff and rides to and from a surgeon’s office. (Learn more about cosmetic plastic surgery for patients in states other than California and abroad.)
  4. Beverly Hills is only 20 minutes away from the Los Angeles airport (LAX.) Some patients include the kids on the trip, making it a short vacation. After several days, virtually all patients are able to be out and about to world-class museums, hitting top spots like the Norton Simon Museum, world-class beaches, fine restaurants and top theaters offerings.
  5. Consider permanent, non-surgical rhinoplasty. While many cosmetic plastic surgeons offer the procedure, the vast majority use facial fillers that dissolve within about one year. But only in Beverly Hills can you often repair a botched nose job permanently without surgery.(Read more about permanent, non-surgical rhinoplasty.)

Nose Jobs – with Your Own Fat

"A syringe approaches the nose of a lovely womanA leading trend, non-surgical cosmetic surgery is huge in rejuvenation surgery, according to a new report released by the American Society of Plastic Surgeons (ASPS.)

With an incredible 5.7 million Botox treatments leading the way, annual statistics reveal that about 90 percent of all cosmetic surgery was minimally invasive cosmetic treatments like Juvederm for facial injectables.

Surely, cost is a driving force; while the price of an average invasive surgery runs well over several thousand dollars, many non-surgical procedures are closer to several hundred.

The second most performed cosmetic surgery in 2011 was nose reshaping. According to 1,286 RealSelf.com patient reviews, Rhinoplasty averages about $6,000 nationwide. But a non-surgical nose job – done via syringes only – is pegged at a U.S. average of seven hundred.

Eighty-one percent of surgical rhinoplasty patients checked the “worth it” box while 88 percent of 44 reviewers did the same for non-surgical rhinoplasty. One caveat: non-surgical rhinoplasty is only for depressions and other marks on the outside of the nose. (Continued below.)


In the photo below and left, note the long, disfiguring groove on the patient’s left side of her nose. The right photo shows the results after permanent, non-surgical rhinoplasty. (Photo, Robert Kotler, M.D.)

"A lovely young woman tilts her head to show the results of nose surgery"






Now, several plastic surgeons, writing in the professional journal, Plastic & Reconstructive Surgery report on a study of 59 patients who had surgery and nose reshaping by injecting the patient’s own fat cells. But 12 had only non-surgical rhinoplasty, injecting fat into nasal tips, bridges and bases. Some had fat injected into the forehead, making the nose look better by comparison.

(Read more about non-surgical rhinoplasty via fat grafting.)

Fat has been added to the face before. It starts with liposuction, filtration, preparation and then injection. But once injected, it is there to stay and cannot be removed. But the unknown item over time is that donated fat cells can grow.

If so, where does that leave balance and symmetry? What if only one side of the nose grows? Additionally, clinical experience has shown that fat “takes” better in the young. However, older people usually need the help.

All the while, we have permanent, non-surgical rhinoplasty with a 50-year record of safety and science that can do the same for a nose with marks, grooves or divots. (Read about the science of permanent injection rhinoplasty.)

A big plus for this option: it can also be tested before going permanent. Currently, we inject saline (sterilized salt water) into the marks on the nose for patients to see. The saline absorbs  back into the body shortly, but not before we take before and after photos.

Our patients take on permanent, non-surgical rhinoplasty? They love it with more requesting it.