How is a hanging columella following rhinoplasty fixed?
Posted March 07, 2010 11:38 AM in Rhinoplasty
Question:
How is a hanging columella following rhinoplasty fixed?
Answer:
First of all, we have to find out what has caused the hanging columella. If it is due to soft tissue, our goal would be to excise excess vestibular tissue, which is the tissue that is inside the nose, and then stitch it back up. If it is due to hanging cartilage, we can either shorten the cartilage or do a procedure called a "tongue and groove" where we place a suture through the hanging cartilage and then stitch it up to a higher position on the nasal septum. This is a good way to really help fix a hanging columella. In addition, if the reason why the columella is hanging is due to a very long septum, we do a septoplasty and trim that cartilage. That should also help to remove the hanging columella. One other thought to consider is that if the ala or the columella are not at all hanging, this could be due to a retracted ala. I hope this helps and thank you very much.
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My nostrils appear very asymmetric since my rhinoplasty
Posted March 06, 2010 9:21 AM in Rhinoplasty
Question:
My nostrils appear very asymmetric since my rhinoplasty. What are my options for fixing this?
Answer:
First of all, it depends on when your rhinoplasty was performed. If it has been less than a year, I advise you to wait and see how your nose heals. If the nostrils are raised up higher and you can see a good amount of the nose, alar rim grafts which decrease the cartilage can be placed on the nasal rim to lower them. There is also a composite graft which is made out of ear, skin and cartilage that can be placed in the nostrils to lower them. If it is severe and the skin is not elastic, then we use a composite graft. If it is a mild case of alar retraction and asymmetry, we will just use cartilage. It is never easy to make the nostrils and ala completely symmetric but our goal is to improve them.
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What is a supra-alar pinched tip?
Posted March 06, 2010 7:44 AM in Rhinoplasty
Question:
What is a supra-alar pinched tip?
Answer:
A supra-alar pinched tip refers to the collapse of the corners of the tip that rest above the nostrils. This could be caused by over aggressive removal of tip cartilage. Reconstruction is achieved by placing supra-alar batten grafts to relieve the pinching.
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I had a nose job a week ago
Posted March 05, 2010 4:47 PM in Rhinoplasty
Question:
I had a nose job a week ago, I know it is still too early but my nose now looks unnaturally upturned. Should I be concerned about revision at this point and will it change?
Answer:
It is extremely early to even look at the results of your nose. The upturned result that you see now should improve. If it continues to stay like that after six months or so, please let your doctor know that you are unhappy. The earliest you can revise a nasal tip would be in one year.
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What can I do before and after my nose job
Posted March 05, 2010 8:27 AM in Rhinoplasty
Question:
What can I do before and after my nose job to minimize bruising?
Answer:
First of all, we recommend that you stop all blood thinners approximately two weeks before surgery. Examples of blood thinners are anti-inflammatory agents such as Motrin or Advil, in addition to aspirin and vitamin E. It is also recommended that patients take vitamin K five days before surgery. Some alcoholic beverages can thin the blood, so we recommend that alcohol is stopped approximately one week before surgery. During surgery, to help minimize bruising, we can use a product derived from the patient's own blood called platelet gel. The platelet gel is comprised of concentrated platelets which help decrease bruising and bleeding and also help the healing process go a lot faster. After surgery, arnica pills and arnica cream in addition to hyperbaric oxygen are a great way to reduce bruising. We can also use the intense pulse light laser to zap the areas that have been bruised. This will reduce the degree of bruising dramatically. Thank you very much.
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Since my nose is too round
Posted March 04, 2010 7:11 PM in Rhinoplasty
Question:
Since my nose is too round, can this be corrected with rhinoplasty?
Answer:
Yes, it can absolutely be corrected. Technique used will depend on what is causing the roundness, whether it is cartilage or very thick skin. If it is cartilage, we can contour the cartilage to improve the appearance. If it is due to thick skin, we will not be able to correct the roundness. However, we can improve it by doing some nasal tip contouring. Sometimes we have to increase the projection of the cartilage in the nose to get rid of the rounded look. This is an example of what I do in an ethnic rhinoplasty, when the tip is poorly projected and round. When I project the nose it appears more sleek. Hope this answers your question.
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Since my nose job six months ago
Posted March 04, 2010 7:48 AM in Rhinoplasty
Question:
Since my nose job six months ago I feel the bridge of my nose is too high and I want to lower it. Rib grafts were used to raise the height. What can fix this?
Answer:
First of all, I recommend you wait another three months. If the rib graft is too large, we would have to shave down the rib graft. In my scenario, I would remove the rib graft, dice it up, wrap it in tissue or fascia, and then replace it back in the nose. With the diced up cartilage, I can change the height of the nose and make it any size I want to. That would be the best recommendation but I urge you to wait nine months.
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I have a pinched tip since my nose job
Posted March 03, 2010 1:14 PM in Rhinoplasty
Question:
I have a pinched tip since my nose job. Can this be fixed?
Answer:
Absolutely. A pinched nasal tip can be due to aggressive nasal tip suturing or removing too much cartilage. We would use cartilage either from your septum or rib and place alar batten grafts or lateral crural strut grafts. Putting in this cartilage would replace the cartilage that was removed and relieve the pinching. This will also relieve any nasal obstruction. I hope this helps.
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Since my rhinoplasty four months ago the swelling seems
Posted March 03, 2010 9:41 AM in Rhinoplasty
Question:
Since my rhinoplasty four months ago the swelling seems entirely gone from the bridge. However the tip still looks very swollen as a result compared to the rest of the nose. Is it normal for the swelling to fade disproportionately and should I be concerned about revision at this point?
Answer:
Thank you for your question. It is extremely normal for the nasal tip to be the last part of the nose that goes down in regard to swelling. It could take a good year for that swelling to resolve. Please do not be concerned and just have patience with it.
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I have a hump on my nose that I would like to have removed
Posted March 02, 2010 8:11 PM in Rhinoplasty
Question:
I have a hump on my nose that I would like to have removed. Is this done by filing down the hump or by breaking the bones? Can it be performed through a post rhinoplasty?
Answer:
Well, you are right on both counts. We have to file down the hump initially. Following filing down the hump, we have to fracture the nasal bones. Fracturing the nasal bones is called osteotomies. When rasping down the hump leaves an open roof deformity, it is then necessary to close the open nasal bones with osteotomies. This can be performed with either a closed or open rhinoplasty.
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