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Facial Plastic Surgery Questions and Answers: Part 9

Question: Rhinoplasty: 10 months post-op, swelling, bulbous, uneven. Is this my final result? 
Answer: From the limited photograph, it appears that you have very thick skin in the tip of the nose which cannot be reduced with a rhinoplasty procedure. There’s a limit as to how much cartilage that can be removed from the nasal tip without creating further problems. Consider going back to your original surgeon for placement of some steroid shots in your tip to reduce the current swelling that is present. An alar plasty performed under local anesthesia can reduce the size of the nostrils.

Question: Rhinoplasty & septoplasty together or separate for best results?
Answer: It’s very important to both procedures be performed together, not separately, in case there’s septal cartilage needed from the inside of the nose for grafting purposes on the cosmetic rhinoplasty.

Question: How can I improve the appearance of my nose with rhinoplasty? What should I ask for/is it possible to achieve a cuter nose?
Answer: A closed rhinoplasty approach can accomplish refinement of the nasal tip cartilages, narrowing the bridge line, and shaving down the dorsal hump with all incisions placed on the inside of the nose. No external incisions are required. No painful packing is required. An alar-plasty can accomplish narrowing wide nostrils with an incision at the base of the nostril sill. Thick skin in the tip of the nose prevents refinement in that area, so it is important to have realistic expectations regarding your nasal tip. Digital computer imaging would be helpful to understand what can be accomplished with the procedure upon your facial features. Rhinoplasty is a difficult endeavor, so choose your plastic surgeon wisely based on experience producing natural results.

Question: What is making my nose look big and would I need a full rhinoplasty to make it smaller? 
Answer:  Much more information is needed, such as a full set of facial photographs from all angles, since the nose is a 3-dimensional structure, and rhinoplasty is performed in all 3 dimensions. A physical examination is going to be required to make a determination about the bulbous nasal tip, which can be caused from thick skin, or wide cartilages. It is impossible to tell from the limited photographs.

Question: My tip is too bulbous and my nostrils might be too big. What treatment should I seek? 
Answer: A revision rhinoplasty can accomplish reduction of the bulbous nasal tip with a combination of suture techniques and conservative cartilage removal. The thickness of the skin must be determined at the time of the consultation, and this can be an impediment seeing refinement in that area if there is thick skin present. The nostrils can be narrowed with an alar-plasty. It is also important to know how much cartilage is left over on the inside of the nose for potential grafting purposes, if needed. Obtain copies of the operative report for your next surgeon. 

Question: Am I a good candidate for a liquid nose job to slope down my bridge a bit?
Answer: The side profile photograph demonstrates an overly projecting nose, and an under projecting chin. A closed rhinoplasty procedure can accomplish decreasing the overall projection of the nose and shaving down the dorsal slump in addition to narrowing the bridge line and refining the nasal tip. All the incisions are placed on the inside of the nose. Consider placement of a chin implant to augment your chin forward for better facial balance and proportions, especially with respect to the overly projecting nose from the side profile. You can perform just a chin implant alone under local anesthesia, since the chin can be augmented forward more than nose can be de- projected. In our practice, we do not recommend a liquid nose job since it is not FDA approved for that application, will make the nose bigger( not smaller) on a temporary basis, and can have significant complications such as skin necrosis.

Question: What can I do about my forehead, nose, and chin to look more feminine?
Answer: If you trying to bring her hairline down, probably best to do hair transplants and avoid the placement of a large scar across the top of your forehead. A closed rhinoplasty procedure can accomplish decreasing the overall projection of the nose, refining the nasal tip, shaving down the dorsal hump, narrowing the bridge and making the overall nose smaller. All the incisions are placed on the inside of the nose. No external incisions are required. Placement of a chin implant can augment the recessive chin forward to help with better facial balance and proportions, especially from the side profile with respect to the overly projecting nose. placement of a chin implant is performed through a small incision underneath the chin. the size, the thickness, and the shape is best determined at the time of the consultation and examination. A Closed rhinoplasty and chin implant are frequently performed together under one anesthesia with one recovery period.

Question: What kind of rhinoplasty procedure is best for me?
Answer: A closed rhinoplasty approach can accomplish reduction in the hanging columella by trimming back extra skin and cartilage in that area. The nasal tip cartilages can also be refined as well. It’s important to release the depressor septi ligament which pulls the tip downward dynamically when smiling.

Question: Are my rhinoplasty goals realistic? 
Answer: The Photographs demonstrate a convex and concave side of the nose. Depending on what’s causing the issues , you may or may not be a good candidate for rhinoplasty procedure. If there is very thick skin in the tip of your nose, you’re not a good candidate. If this is crooked nasal bones and upper lateral cartilages with thin skin, then a rhinoplasty can be entertained.

Question: Small bump on nose, is this easy revision?
Answer: Revision rhinoplasty is more difficult than a primary rhinoplasty, therefore a full set of facial photographs from all angles are required due to the fact that the nose is a three-dimensional structure. Once the hump has been shaved down, osteotomies are going to be required to be placed in the nasal bones to Close the open roof deformity created from the hump removal itself. It’s also important wait at least one year after your previous procedure before undergoing a revision.

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