Ask Dr. Garcia - The Archives

• Does rib cartilage work for a collapsed nose? They say Michael Jackson had multiple nose surgeries becuase they could never seem to fix his nose. Hence, I do not know if he was asking doctors to make his nose as thin as it was or if the surgery just failed. I want to fix my collapsed nose, but I just don`t want the same complications as Michale Jackson. Will my nose look thinner and thinner each time I have surgery. Again, will rib tissue work for collapsed nose. I have no more cartilage in nose or ear for graft.

  Answer:  I think Michael Jackson`s case is different due to the multiple prior surgeries performed, I do think in many cases the rib graft is successful but will make the nose potentially larger or thicker. Best of luck. JG 6.29.09

• Hello, How often is it safe to get kenalog injections? I got 0.2ml of Kenalog 10 into the tip of my nose for post-op swellling about a week and a half ago with really no results. Is it ok to inject a little more? Thanks.

  Answer:  I would only do 2-4 sessions. JG 7.1.09

• If someone`s nose collapsed froom rhinoplasty surgeries, can it be corrected so it is not longer collapsed? If so, how is that generally done or what is used the nose?

  Answer:  can be attempted with cartilage grafts but does not work in 100% of cases. JG 6.28.09

• Hi doctor, thanks again for your time. 5 months ago i had an open revision rhinoplasty. I`m thinking in having another revision, of course after waiting few more months, i have 2 questions for you, first, can i had a close surgery this time or because my last surgery was open has to be open surgery?, i`m just thinking in having a re-touch on my tip and nostrils. Second question is, when is the earliest i can have another revision?. Thanks.

  Answer:  in some cases, if the revision is small it can be done closed the second go round. I would not consider a revision for at least 12 months after the last surgery. Best of luck. JG 6.23.09

• Hello, This may seem like a silly question but I do not think it is my imagination... I had an open rhinoplasty in March 08 and a very minor revision in Jan 09. My nose seems to be noticeably more swollen a few days before my period. Could this be happening because of hormonal changes/retaining fluid and will anything help? Thank you.

  Answer:  yes, not uncommon for that to happen, even without the surgery, but an open rhinoplasty can make it more visible. JG 6.21.09

• Hello Dr. García: Thank you for your answer. I had a revision rhinoplasty for the fourth time, my nose has a graft, I don`t know what kind of graft but it is falling down, I feel that it is pulling my eyebrows and the skin near my eyes down, I see my eyebrows lower. Is this posible? Is there a way to secure the tip in place or can this be lifted?

  Answer:  might have slipped and is pulling the skin down, I suggest seeing the last surgeon and assessing if they can relocate it higher. Best of luck. JG 6.12.09

• Hello, Two weeks ago, I had a filler (restylane) injected in small quantity to the left side of the nose only. Is it safe to get a small amuont of kenalog injected into the tip? (away from where the filler was placed) Thank you.

  Answer:  should be OK to do so. JG 6.10.09

• 12wks ago I had closed surgery to help lower my bridge and also narrow the width. I am now left with a wider nose and a bum on the right side. I went back to my Dr and he said that it could easily be corrected in office via a small puncture would at the side of my nose. He will then insert pliers to squeeze the bones together. Is this advisable. He said it would be silly to go into the operating room for a simple fix. Im also worried about the scar it will leave if I go this route. Thanks in advance.

  Answer:  there will be a small scar and can be relatively easy to do that way, all depends on your pain tolerance. JG 6.6.09

• Hello, Thank you for answering all these questions! It is so helpful. I am about 14 months post op open rhinoplasty and 5 months post op very minor closed revision. I have an odd spot on my nose that I can only describe as loose skin . When I push on the area, it feels as if it is hollow beneath - like the skin is not lying flat is that makes sense. Is there a way to correct this? Would any type of laser treatment be helpful? Thanks again.

  Answer:  lasers will not help and I think in time the skin should readhere, if it does not and you are not happy with it, it can be filled in with the same fillers we use for nasolabial folds or lips to elevate the skin. JG 6.4.09

• Hello, I had restylane injected to nose about 7 days ago. It does look smoother; howerver, the tip now looks more rounded and less defined. It looks diffusely swollen. Would kenalog help if this continues or would there be some reaction with the filler? Thanks!

  Answer:  sorry, but it would not help and I advise against it. JG 6.4.09

• Hello, I am wondering about restylane fillers in the nose. I had some injected to smooth out some bumpiness on the left side of my nose. My question is, are the final results apparent immediately, or is there some swelling involved? When will the final result be evident? Thank you for your advice.

  Answer:  with Restylane it will swell about 30% more after the injection so what you see after 5-7 days should last a few months. JG 5.31.09

• Hello, I posted the question yesterday about kenalog injections after a filler is used. The dents on my nose are not from kenalog use; the filler will be used to smooth out an area of bent cartilage on the left side. My question is, will kenalog have any effect on cartilage? My PS injected kenalog into this bent cartilage and said that it would help make the area less prominent; however, I asked a different PS and he said that kenalog will have no effect on cartilage. What is you opinion? Thanks again!

  Answer:  it will have no positive effect on bent cartilage whatsoever. JG 5.27.09

• Hello, I posted the question about the non-surgical nose job. I am wondering if I would be able to get any further kenalog injections after the fillers are injected? If so, how long should I wait to do kenalog? Thank you.

  Answer:  not sure why you would get kenalog injections if you are doing the fillers as the kenalog can likely create more indentations that will need more fillers. JG 5.27.09

• Hello, I am considering a non-surgical nose job to correct some problems from a past rhinoplasty procedure. The surgeon has suggested restylane and botox. I know the fillers are used to smooth out dents; how is botox used in this procedure? Thank you.

  Answer:  you got me, have never seen that used and cannot imagine what they can accomplish with that except pad their wallet. JG 5.27.09

• What can be used to reconstruct the nose that will not twist? (If there is no more nose or ear cartilage available). What can be used besides rib tissue?

  Answer:  silicone struts or Gortex. JG 5.17.09

• You answered that using rib tissue for rhinoplasty can warp with time. Do you mean that it can dissolve with time like fat injections? If there is not enough tissue to take from ear, what do you think of using it from the rib? I heard that rib tissue is softer than ear tissue so it will give a softer look. Tissue from the ear seems to last so why would not tissue from the ribs last?

  Answer:  no, it will twist, not resorb like fat. As to ear cartilage, it depends on how big of a piece you need for the nose, but that cna also warp. Tissue from the rib is last as it is very stiff and the nose is normally not as stiff as a rib. JG 5.17.09

• What do you think of using rib tissue to graft for rhinoplasty?

  Answer:  rare to be neded, can warp with time too. JG 5.16.09

• I had nose job about 5 months ago, bumb shaved and tip revised. i think i still feel swelling in either side, above outside fllare of nostrils and my tip is still numb and gets pink occasionally for no reason.I know it takes up to a year for final result. sensations/swelling/ redness normal at this point?

  Answer:  all normal at this time, yes. JG 5.12.09

• hey dr garcia, i was on dr kotlers website for revision rhinoplasty and he talks about medical grade liquid silicone.. i have a very small dent on the side of my nose above the tip from a previous revision rhinoplasty. i have heard some scary stories about silicone..is it risky or unsafe? he claims to have 35 years of experience with it and that it has 50 years of safety record till now? is this true? and is it okay to fill that little dent with that stuff?

  Answer:  well, in Nevada, where I practice, silicone is illegal to inject so I think that should tell you something, regardless of what he promotes. JG 4.30.09

• Hi,it is now 23 months since my revision tip rhinoplasty. I am starting to see the results & refining now after 2 years. Can it take 2 years for revision rhinoplasty done only in the tip ?

  Answer:  in some difficult and swollen tips, yes, it can take that long. JG 4.28.09

• Hi Dr. Garcia, want to commend you for something I haven`t seen many other docs do online. I searched my doctor and found good things you said about him, Guyuron. I am going to him soon for rhinoplasty and I have been so nervous. Your affirmation goes a long way putting my mind at ease and I have great respect for you. You have a lot of character and confidence to speak openly well of others. Thank you.

  Answer:  I wish you the best, your are in skilled hand with him, and thank you for the kind words. JG 4.24.09

• i had rhynoplasty 2 weeks agon. its looks great. 10 days after surgury i just barly hit my nose. the bone is fine but i ripped to dissolving stiches in the upper right nostrol. it still looks fine, but this never happened to my dr before so he said it should be ok but he wasn`t sure. has this happend with you? would it effect my tips appearence. im really parenoid. it is 2 weeks after surgury and i only have a litte swelling and it looks fine but i ripped the stictch on the 10th day. im freeked cuz i don`t want anything to go wrong.

  Answer:  have not had it happen but is should be OK, the tissues have some semblence of being glued together by then. JG 4.22.09

• Hi Dr Garcia, About six months ago,I came into your office for a consultation regarding a rhinoplasty. A month later, I found out that I was pregnant. I believe that I have to wait until after my delivery in order to carry on with my project. My question is: how long do I have to wait after having my baby to be able to get the rhinoplasty? Thanks Dr! KB

  Answer:  I normally suggest you wait until you are done breast feeding so the medicine used before and after the surgery is not transfered to the baby through your milk. Best of luck with the baby! JG 4.22.09

• Hello, I posted the question earlier about the kenalog injection and my nose looking puffy afterwards. Well, I got the injection at 10am and now at almost 5:30 it still looks the same, does not appear that any of it has been absorbed. Is this anything to worry about?

  Answer:  nothing to worry about, since there is scar tissue there prompting the need for the shot to begin with, that slows the absorption. JG 4.20.09

• Hello Doctor, hope you are doing fine. I`ts been 2 months and 1 week since my open revision rhinoplasty. As time passes i supposed to see little by little at least a small change, but my nose is still big, i can`t see any change at all, my doctor already gave me 3 kenalog shots but nothing changed. Doctor i have 3 quetions, first of all, by now if i didn`t see any change do you think my nose specially my tip will get MUCH MUCH smaller or just a little bit smaller?, my second question is about the kenalog shots, i know is not good getting too much shots but my doctor says it`s ok and he wants to give me more shots but also i can`t see any change so i don`t understand why he keeps giving me shots. My last question, my doctor told me to tape my nose every night, but does it works?. Thanks again.

  Answer:  I think revision rhinoplasties take a long time to soften and shrink, very frustrating. I do think getting three shots of kenalog by two months is a bit much as it takes weeks for the changes to be seen or evaluated. I do think you will get smaller, no way to tell how much more though. I think taping effects at this point a e transient and not long lasting, but it will not hurt, wish I had more to offer. JG 4.20.09

• Hello, I just had a kenalog injection to the nose about 2 and 1/2 hours ago. The nose looks all humped up where he injected the medication. I am hoping you will tell me this is just the medication? How long before it will be absorbed? It looks REALLY funny right now! Thank you

  Answer:  it is just due to the shot and will get better in a few more hours. JG 4.20.09

• Hello, Dr. Garcia. I had rhinoplasty about 2 years ago. When I twist my mouth to the left, the tip of my nose clicks. It is an uncomforable feeling until it clicks back into place. Is something wrong? What can be done about this? Thanks for your reply.

  Answer:  nothing bad, likely the cartilage moving over another piece of cartilage, surgery might and might not be able to fix that. JG 4.15.09

• Dr Garcia, I had septoplasty and turbinate reduction at the beginning of September. I am currently in month number eight and the pain due to the cold climate has indeed decreased since november and december. The weather is still cold and my nose hurts at times when I go outside and I notice that when I`m hungry my nose hurts as well. How much longer should I expect the minor pains. Thanks in advance!!!

  Answer:  might take a full year, can consider using some saline nasal spray, it might help. JG 4.14.09

• I have had two nose surgeries in the past two years. The profile has improved but the width of my nose has not. I have had kenalog injections and although they appear to begin working my nose returns to its previous size. Now when i smile my nose looks somewhat swollen and the tip protrudes downward. My PS prefers not to remove any more cartilage and instead wants to take some cartilage out of the inside of my nose and place it at the tip to keep the nose from drooping down and give it a narrower appearance. Also some silicone was inserted between my nostrils to fill in a small indentation. My question is what do think about this type of procedure? Do you feel it will do what he says and do you feel the silicone is also playing a role and should it be cut out? Thank you so much for the service you provide!

  Answer:  it is hard for me to say without seeing you and feeling the tissues, but I think the nasal bones will likely need to be broken in order the thin the bridge of your nose. Cartilage grafts will give the tip more definition but will not stop the muscles that pull the tip down. As to the silicone, it might be able to be removed during the other surgery but it can be difficult at times to perform that. I wish you the best. JG 4.13.09

• Hi,I was injected with restylane on the side of my nose where I have an indentation which was left after a revision rhinoplasty. It looked good the 1st day maybe due to onsite swelling then it didn`t really show that much just a little, it filled in a little. The doctor said he could not put any more in that day because it was at it`s max and the extra was coming out of the pores he said. Now 4 months later it is all gone. Is there anything better than restylane for the side of the nose (it is not the bridge). How often can I do it ? Is there any danger of a piece of my nose falling off by doing this ? thanks so much.

  Answer:  can try Radiesse, might last a little longer in some patients. It can be done as often as desired and it was coming out the pores because it was injected too superficially is all. No danger with your nose falling off. JG 4.9.09

• Hi Doc, thanks for your response. I forgot to ask you one more thing, as i told you i had a revision rhinoplasty 2 months ago and i got a deep scar on my tip, when you touch it you can feel like my skin is eleveted or something, and also it looks pretty bad, my doctor told me it will go away in 3 months, but it doesn`t look like it will disappear. What you think doctor?... Thanks

  Answer:  hard to say without actually seeing you in person, I will say that swelling in revision rhinoplasties can take a very long time, I suggest giving it some time and following your surgeons instructions and seeing what happens over the next 2-4 months. Best of luck. JG 4.5.09

• Hi Doctor!, hope you are having a great weekend. Doctor, i had a revision rhinoplasty 2 months ago, after having my dorsal bones broken to narrow my bridge how long does it takes to get it completely narrow?, i know that the tip takes longer to get smaller, but what about the dorsal bones?. Thanks again.

  Answer:  maybe 4-6 months or so to get close to the final result. All the best. JG 4.5.09

• Why does the tip of nose become sensitive to hot and cold temperatures becoming swollen a year and 1/2 after a rhinoplasty revision? What can be Done to correct this?

  Answer:  only time will help and it is because it is the most dependent part of the nose and harbors the swelling for the longest time. JG 4.2.09

• I had my third rhinoplasty 18 months ago. Unfortunately, the ear cartilage must have warped, because I have a big bump on the bridge and it shows under the skin. Can anything be injected to shrink the cartilage? Do you think it will shrink on its own?

  Answer:  do not think it will shrink on its own and there is nothing injectable that will dissolve the cartilage, sorry. JG 3.31.09

• Hi Doctor, thank you for your quick response. You don`t know how much you are helping us with this wonderful site, thanks. Doctor, as i said before i had a revision 7 weeks ago, but my nose looks big as before the surgery, my doctor told me it will get much smaller, he said that during the surgery he injected me something to make my nose NOT to swollen so he can see if my nose looks good, he said it looked pretty and small as i wanted, so he said that i have to trust him that my nose will look good, that now it is all swollen what i have. Doctor, is it true what he is saying, do all surgeons use this kind of injections during surgery so they can see the results without swollen?. Thanks

  Answer:  yes, it is true, give it some time and have a little more patience. JG 3.31.09

• Hi doctor, thanks for your time. 1 months and 3 weeks ago i had an open revision rhinoplasty to make my tip smaller and also broke my dorsal bones to get the bridge narrower, same things were done on my first rhinoplasty 2 years ago but with no good results. I know that i`m still swallen and that it needs time to get all the swallen go away, but shouldn`t i see at least a little change?, right now my tip is big as before the surgery, also noticed that my tip and my whole nose is getting a little bigger every day, today is bigger than 3 weeks after the surgery, i don`t understand, it should be the opposite, it supposed to get smaller and smaller every day. Doctor, talking about avarage, what`s the porcentage of swallen gone in 2 months after the surgery?, also how long it takes for the swallen of the dorsal bones to go away completely?.

  Answer:  at this point I would expect to see a little change if it was the first time, the degree of swelling on a second go round is significantly more. On a secondary rhinoplasty I would estimate 30% of the swelling in two months, maybe a little more. JG 3.30.09

• I had a basal cell carcinoma removed on the side of my nose, and the surgical and stich scars look awful. I had this done this past August. Will applying a copper peptide cream onto the scar help improve it? If so, how long should it take? How many times a day can I apply the copper peptide cream?

  Answer:  I do not think copper peptide will help the stitich marks, that is usually a matter of time, and in some cases it requires a laser to smooth it out. I will say that in most cases, insurance will not cover the laser for that because it is deemed cosmetic in nature. Sorry. JG 3.12.09

• Hi Dr. Garcia. I am 3 weeks post op from my rhinoplasty revision. I had my bridge broken to have it narrowed, and some tip refining, the first rhino just didn`t do much. I have experienced days where there is more swelling than other, which I know is pretty normal. My PS, whom I really trust, has told me to continue to gently press along the entire bridge of my nose a few times a day to remind the bones to stay together and to help get the swelling out. I notice that this really does make a difference and almost feel as if I am molding my nose. So odd! I guess my question to you is, is this normal? Have you ever advised a patient to do this and do you personally think I should continue? I want to make sure this time around that my nose gets/stays narrow, but do not want to damage anything.

  Answer:  normal and we have our patients do the same thing. Should not damage things. Best of luck. JG 3.12.09

• Hi my name is julio, my wife had nose surgery on 3-6-09 the firs two day she was not swollen but for the third day she is swollen from her chic is that normal

  Answer:  can be normal, yes. Ice and keep her head elevated on some pillows and it will go down. JG 3.7.09

• Hello Dr. Garcia. I actually have a consult with you in about a month, but I would like to ask you a few questions ahead of time too. I have a really high nose bridge with a tiny bump, a little bulbous tip and a somewhat wide nose. Is it possible to have my bridge bones narrowed, the bridge also lowered significantly along with the bulbous tip refined? I also think I have thick skin so I am not sure how effective the tip refining would be. I am also keeping my ethnicity in mind (Jewish and Vietnamese, mostly Jewish features) and if having these things done would even be considered because of my bone structure. I can also send pictures if that would help. Even though I am going to be seeing you in a month I would like to ask for a quote? Or an estimate, that would be awesome and very helpful because it happens to be one of my main concerns. Thank you. -JB

  Answer:  that can be done and the thicker skin might limit the degree of how much smaller or defined the tip can be made. Fees for all of that, all inclusive wouls be about $6300, see you soon. JG 3.6.09

• would not wearing sunscreen on nose and being out in sun cause the cartilage to grow?

  Answer:  no. JG 3.5.09

• I HAD NOSE SURGERY 5 YEARS AGO WHEN HE WAS DOING THE SURGERY HE SAID I DIDN`T HAVE CARTILAGE IN THE TIP OF MY NOSE SO HE TOOK CARTILAGE FROM BEHIND MY EARS WELL THE RIGHT SIDE LOOKS GREAT BUT THE LEFT SIDE IS THICKER AND MAKES THAT SIDE LOOK DIFFERENT FROM THE RIGHT SIDE WOULD STEROID SHOTS HELP OR WHAT?THANK YOU

  Answer:  it is worth a try but I would not expect much change at this point. JG 3.5.09

• Do you perform revision rhinoplasty?

  Answer:  I am sorry but at present, due to my schedule, I am not undertaking revision surgery of any kind that has been done elsewhere. JG 3.4.09

• I`ve gone back and forth on having a tip (of the nose) reduction as my nose is not ugly by any means. Are there things I should now or be weary of before doing such a procedure? Thank you!

  Answer:  well, the biggest thing is that the tip shape and size is controlled by the cartilage but also by the thickness of your nasal skin, so in some cases a smaller tip cannot be achieved in thicker skinned individuala, even if most of the cartilage is removed. JG 3.4.09

• Do you have to have an open nose surgery if you have scar tissue? Also, can you have local instead of put to sleep for twisted tip? Thanks.

  Answer:  I think those are issues you need to discuss with the surgoen that will do your surgery and we all have different opinions on how to do it, there is no single correct answer. JG 3.1.09

• Can a twisted tip be fixed? Instead of fixing the twisted tip, the doctor rearranged cartlige. However, it still looks twisted. I have hard scar tissue on my nose= can a twisted tip be fixed. This doctor said it is too hard to fix a twisted tip, but are there doctors who can? The doctor also added too much cartlige at the end of tip so it looks too heavy. He said it could not be chisseled away since it is hard scar tissue. However, can it be chissled away?

  Answer:  well the twist is due to the cartilage being twisted so the tip cartilage and in most cases the septum needs to be straightened also. Scar tissue can typically be cut and carved without too much problem, but scar tissue can also reform too. JG 3.1.09

• I had a rhinoplasty 6 weeks ago and it looks worse than before surgery. My PS shortened the tip and width of the bridge but failed to narrow the tip. The result is that the tip looks very wide from the front with a smashed appearance. Also from the side, the tip to nostril ratio is 1:1. Could you briefly explain the revision procedure that would correct this problem? Lori from Knoxville,TN

  Answer:  he might have done work on the tip but the improvement on the tip can take months and even up to one year for the final resutl so it is not uncommon when other things are changed that the tip looks out of proportion until the swelling dissiaptes. I would not suggest any type of revision until one year has passsed to allow the swelling to go down and the tissues to soften up, what will be required at that time is too hard to predict at this time, sorry. JG 2.27.09

• Hello. I had nose surgery a little over four weeks ago for a crooked. For my post-op the Dr. recommended that I push in the spot where the cartilage is going back to it`s pre-operation shape. Is this common and do these exercises really work? Also the inside of my nose is hard and I`m having a difficult time breathing. I had a turbenictomy done? Is it common for the swelling to interfere with the breathing?

  Answer:  it is common and will help the end result to a degree. The inside of the nose is commonly swollen and congested and can take time to breathe better. If there is swelling it will definitely affect your ability to breathe. Best of luck. JG 2.26.09

• I had a deviated septum repaired in early August `08 along with turbinate reduction. It is now Feb`09. I can breathe better now, but I still have bloody crusty things in my nose. I use saline wash constantly, and vaseline inside my nose, but still have a dry, crusty nose. My HMO doctors have said that I have had enough follow-up visits, so I don`t know how long this crustiness is suppose to continue, or is it?...but it is very annoying. Is it a complication that will always be there? What occurred in my surgery that caused this? What else can I try to eliminate this crusty, dry, bloody nose? Thanks for your help.

  Answer:  should not be happening at this point in time, some of the things that can cause it is a septal perforation or overresection of the turbinates causing excessive intranasal dryness and therefore bleeding and crusting, or a retained suture. I think you are having complications from the surgery and the ENT surgeon needs to see you again as it is certainly not normal to still have those issues. JG 2.24.09

• Thank you for your advice, Dr. Garcia. I just did 3 washes with the saline solution and after the third one a 2 cm crosta came out! What a relief!! Thank you so much!

  Answer:  all the best. JG 2.23.09

• Dr. Garcia, I had septoplasty, turbinectomy, sinusisitis, dorsum and depressor muscle done. For the depressor muscle the incision was intra oral, I had not swellen much.There was no external incision. I think my skin is thin. I´m in the 41th day after surgery and it´s been a week now that my nose became very dry stuffed. I don´t know the word in english, but in portuguese I would say it is crostas . I feel that something moves from a nostril to the other if I try to gently clean wiith a cotton tip but it doesn´t come out. I imagine it´s about 1cm or more diameter. I´m afraid I was touching a piece of cartilage, althouth my PS did not tell me about cartilage besides working on the depressor muscle. What shoul I do? It´s a 5 day holliday in Brazil and probably my PS is not in town. Thank you so much for your help. I don´t find a site like this in my country.

  Answer:  I would use some saline spary for your nose, it might just be a costra that is stuck to one of the old incisiosn, I hope you do not have a hole in your septum, that would be another cause. See your surgeon after the holiday is done. Best of luck. JG 2.23.09

• Hello, I had a septoplasty & turb red 6 months ago and I have been having problems ever since. My upper lip twitched for 2 months everday. After the twitching stopped now I have a pulling sensation on my front two teeth when I bend, yell or sneeze. Also notice some blood when blowing nose. been back to My surgeon three times nasal scope done each time with no answers. ps also went for brain mri to rule out anything nureo and had a ct scan day before surgery. Any advice....thanks

  Answer:  I think the pulling and pain is due to scarring that will get better with time, as to the nose bleeds, might want to try some saline nose spray to keep the moisture up inside the nose. JG 2.23.09

• Hi Dr. Garcia, my rhinoplasty looked nice in te begining. The nose tip got higher and the dorsum became straight. However, after the 4th week the dorsum started to look as if it was going back to the previous shape. Is there a chance that it´s just transitory?

  Answer:  likley just swelling, give it time, things are going to change quite a bit, hang in there. JG 2.21.09

• Hi regarding dermal fillers for non surgical rhinoplasty if your injecting a small amount of filler just for one side the nose tip can the filler be injected and moulded into the side of the nasal tip to give it some definition and symmtery or will it just cause a random shaped lump, i heard that one the filler is injected into the nose tip it can be moulded?

  Answer:  the ability to mold it after it is injected is small, so the shaping is done with the individual shots.JG 2.20.09

• Hi can a dermal filler be used to define the side of a nose tip as on one side of my nose tip it seems slightly pointed and flat, lacks the fat to give it that curve towards the nostrils, if so how accurate is it to detail and what filler is best?

  Answer:  it can be tried but injecting into the nose is difficult as the skin is thicker and may not distend and fill the way you desire. JG 2.20.09

• Hi doctor, I would like to know what`s the difference between an L-shaped nasal implant and an i-shaped nasal implant? I am not satisfied with the L-shaped implant that was performed on my nose because it made my tip pointy which looks unnatural on my face. I was wondering if getting a second nose job using the i-shaped implant would only make my bridge higher and not change the tip of my nose. I am happy with my round tip, but only want the upper part of my nose higher. Thank you.

  Answer:  I think your thought process is correct, the L-shaped one will have more of a point on the tip. JG 2.18.09

• Has it ever been normal procedure to have a breast exam when a person goes in for a rhinoplasty?

  Answer:  never, that is not needed and not the standard of care. JG 2.16.09

• Hi I had nose surgery 2 years ago - I continue to have swelling on the tip of my nose - the days it is not swollen which is not too often, it looks the way i like it, i hate this swollen tip. My dr. said they are now discussing this with other plastic surgeons because it seems to happen and they don`t know why. I did have a corrective surgery because at first my dr. said i had scar tissue there - but it did not correct it. I don`t know what to do from here! Please help

  Answer:  not much that cna be done, injections of kenalog are tried but do not always work. JG 2.15.09

• would taking antacid calcium carbonate make calcium deposits on the nose?

  Answer:  no, it should not. JG 2.9.09

• I had septoplasty and turbinate reduction 5 months ago. My nose is still sore and it throbs at times and I have small minor pains in my head. I live in Chicago and over the course of the last 3-4 months we have had very cold weather. Could this delay the healing process. What is the average time to heal from the abovementioned surgery and what would be the longest time to heal from this surgery if you take into consideration cold climates. Tim

  Answer:  it can cause the symptoms you are having due to the excessively dry air,and it is worse when it is cold. Using some saline nasal spray and a humidifier in your bedroom should help. I think if it is not better in another 6-8 weeks I would see your surgeon to make sure all is healing well inside with the turbinates. Best of luck. JG 2.9.09

• In your experience, does Flonnase nasal spray help at all with internal swelling from rhino? PS prescribe it for me at my 6 week post op, said it may or may not help. my swekking is mainly at either side of bridge, about halway up, i guess due to some tip cartlidge being removed. When he looked up thete, he saw considerable swelling, but outside , it doesnt look so bad, but my nose appeards wider than before there. Plus my breathing hasnt been so good(snoring)

  Answer:  It can to some degree. But it cannot be used more frequently than as described by the manufacturer. I think what you are describing though is swelling between the skin and the internal mucosa and the Flonase really helps only the mucosa, so I would not think it would be too helpful. JG 2.5.09

• Hello Dr, I am 15 days postop on my 3rd rhino. I think I will luv my new nose, BUT the skin around my incision line is very uneven. Like it was not reconnected & stitched evenly. The columella doesn`t connect level so the skin hangs down further on 1 side of the stitch line than the other. I never had this after the 1st open surgery, can you tell me if it`s normal & if not how will he go about leveling my columella? I just don`t think I can bare another surgery!! Thanks!!

  Answer:  it is not unusual for the edges to be uneven at this point from swelling and there is much more swelling after the third rhinoplasty than the first two, so I would say to give it some time. If it does not, revising those scars is pretty easy. JG 1.28.09

• Hey Dr. Garcia, I recently had open rhinoplasty about 3 weeks ago and i had a bump (bone) removed from the top of my nose and the top was also narrowed and that looks fine now. But what I am concerned about is I also had my tip deprojected or shorter because it stuck too much and now it looks the same length or almost a little longer (due to the narrowing of my nose). Is this due to swelling in my tip? Will my nose become shorter (balance out) and deproject over time? because my doctor did say before surgery he was going to deproject as much as he could...please i would like your opinon. Thank you

  Answer:  the tip takes a very long time for the swelling to resolve, so at this point I would not expect to see much of a difference, in fact it might be a few months before you do and final shrinking can take up to one year. JG 1.28.09

• How long before cosmetic surgery(nose) do i need to stop drinking 1 glass of wine at dinner or do i need to stop at all? Does this apply to other alcohol or only wine??Thanks

  Answer:  a week or so would be good. It applys to all alcohol. JG 1.24.09

• Hi dr garcia i sent you an email a few days ago with some attached photo`s regarding revision rhinoplasty i was just wondering if you receieved them, thankyou

  Answer:  I will get back to you after I have reviewed them. JG 1.24.09

• i hit the humpy region of the nose with a qtip. is this hard enough to cause a hump? should i have put ice at the time?

  Answer:  no, just apply ice for a little while. JG 1.22.09

• I am not sure but a tiny tiny piece of juice from garlic may have squirted in my nose. i can wipe it out with a qtip as it is in the squeezed area. do you think garlic juice would harm the inside of nose or just burn a little until it wears off? no serious damage? also the same thing with toothpaste, it sometimes seem to splash in nose thanks

  Answer:  no damage, just rinse it out with water. JG 1.22.09

• Hello Doctor, I am almost ready for an chin-augmentation and rhinoplasty. The problem right now is that i cannot decide between 2 plastic surgeons.. Both of them are Certified by the American Board of Plastic Surgery and the American Society of Plastic Surgery but one of them is also a member of the American Society for Aesthetic Plastic Surgery but is expensive... Does that mean that the other doctor wont do a good job in my procedures?

  Answer:  just because the other is less expensive does not mean he will not do a good job, the more expensive one might have a little more experience though. Best of luck. JG 1.22.09

• Hi i was wondering if you can help me i had a rhinoplasty done in 2002, initally my nose was hooked at the bottom and slightly larger. The surgeon lifted my nose and made the tip look pinched and not as round. Im not happy with the outcome of my rhinoplasty as i feel that the tip and septum of the nose is lifted too high and the tip seems pointed and pinched. Im thinking of getting a revision rhinoplasty done to lower the tip and septum so its more horizontal and for the tip to be slighty more rounded so it doesnt look as pinched, pointed and small. However i want the changes to be subtle and im only concerned with the tip of the nose im fine with the rest. Ive done my research and it seems probable that some grafting may have to occur inorder to build the profile of the tip and to lover the septum/nose, i think. I have also been hearing that Dr Bassim Matti is one of the best rhinoplasty Surgeons in the UK he may be slighly more expensive but he does a good job ive heard. Can i have your email address so i can post you some pictures to give you a better idea of what i mean, thanks

  Answer:  certainly. Please send them to drgarcia@lvcosmeticsurgery.com

• Hi Dr.Garcia, i`m almost 3 months post op. and i`m concerned about the swelling.i still have from the middle of the nose to the tip swollen area as ifthe nose isn`t shaped yet and i have white bumps on the two sides and at the center of the tip.my PS asked me to give it ime!should i go for injections or wait? and what could it be?

  Answer:  I think if you can wait, I suggest that rather than injecting the steroids. JG 1.20.09

• Dr. Garcia, Had a quick question. Had revision rhinoplasty about 9 months ago. Was kicking a soccer ball around and got hit in the nose. It hurt, but looks ok. DIdn`t feel anything shift. How long before the nose is as strong as it was before surgery or is it always a little weaker after surgery. If you could let me know I would appreciate it. Thanks.

  Answer:  I think you are likely as strong as it is going to get, hopefully it is just swollen and nothing shifted. All the best. JG 1.20.09

• Hello, I have read/heard of arnica gel and bromelain pills used to help treat inflammation/swelling post rhinoplasty. Are these safe and if I were to use these, how long should I apply the gel and what is the dose for Bromelain? Thank you very much for this site and all your help!!

  Answer:  yes, I have heard of it, they work, we have been using them for many years in ourr practice. They are safe to use. We apply the gel for about two weeks and the Bromelain we use 2 capsules twice daily.Best of luck. JG 1.20.09

• dr garcia, i want to send you a picture to your email and get an opinion from you regarding my nose. What email can I send it to? and the pictures stay confidential correct? thank you so much!

  Answer:  please send it to drgarcia@lvcosmeticsurgery.com it will remain confidential. JG 1.18.09

• For a basic rhino, bump shaved, tip made a little smaller, and sides of bridge chisled in a little, how long does it take for most of swelling to subside? I know it takes a full year for final results, but i am talking majority of swelling. Thank you.

  Answer:  about half is gone in about 6 weeks and the other half takes months. JG 1.18.09

• Hello, I posted the question yesterday about ice to the nose for 24-48 hours post op. I am curious if any damage could be done (to the skin) if ice used beyond this time or if there is just no more benefit to ice therapy after the first 48 hours? Thanks

  Answer:  no, as long as it is intermittent use you do not want to get frostbite. I think the benefit after 48 hours is small though. JG 1.15.09

• Hello, I had a minor closed revision yesterday. I do not have any tape or dressing on my nose. I have been icing it for about 15 minutes every hour. How long is it beneficial to use ice. I have read 24-48 hours post op/injury. Is this correct? Thank you

  Answer:  yes, 24-48 hours. JG 1.14.09

• Whats the difference between adenoids and turbinates?and which is responsible for not beng able to breathe? i know my son had his adnoids removed when he had tubes put in his ears when he was like 3 years old, because they were enlarged. Never asked why remove when enlarged, but he breathed quieter when he slept after that. When i first went to my consult for the whole face thing in September, when the PS looked up my nose, and had me sniff, he asked if i had trouble breathing, if i was always a little stuffy. anwer, yes. Thats when he said my turbinates were enlarged and he could fix that. Then in my papers on what was done surgically, it had that i was getting only 30% air intake thru my nose, a 70% blockage before surgery. I know he trimmed my turbinates(hence, all the drainage first night in center, down my throat, into my stomach causing projectile vomiting of blood) I have read that sometimes one is removed? can both be removed like adnoids? or are they the same thing, different name?

  Answer:  those are questions for your ENT surgoen, this is a cosmetic surgery site, sorry. JG 1.12.09

• i had nose bump shaved down and turbanate trimmed 3 weeks ago. my nose was not broken per sey, but chisled in at sides to prevent broadness. The part that bothers me most is right between my eyes, which is just above where the splint ended, so i am thinking it shouldnt have been touched, yet it is swollen and i to touch it feels a atd tender, but the wideness there makes my eyes look closer together, totally different look for me. It is a hard place to treat with ice. tell me its swelling? I go to PS Tuesday for a 3 week check up. i specifically told him i didnt want my nose wider, and to do what he has to do to make sure of that. last time i asked him he said it was swelling because when he pressed on it it went down. any part of you goes down when you press on it, except bone! Is massage god for tip swelling? Technigue for this? thanks!

  Answer:  most likely swelling, yes. Maasage is good for tip swelling, just a light pinch of the tip and then press it up and over onto the cheeks. All the best. JG 1.11.09

• I had septoplasty and turbinate reduction about 4 months ago. The ENT doctor shaved my bump on my nose instead of breaking it, because I had a very large nose to begin with. I was wondering how long the swelling takes to go down, my nose is a lot more wide and the bone/bump is still there, but almost more noticable than before. & If the swelling doesn`t end up going down, how long should I wait before I have another surgery to reduce the bump?

  Answer:  the final result is 12 months after the surgery but after 3-6 months you should see some significant improvement. It is very common when the hump is reduced and the bones not broken for it to look wider, that is why the bones need to be broken and pushed narrower to avoid that if any significant hump reduction is performed. JG 1.11.09

• Hi, Dr. Garcia. I had surgery on December 17th. This was my THIRD surgery. I had a deviated septum, and a micro valve collapse in my left side. I couldn`t hardly breathe out of my left nostril. I had to have spreader grafts, and strut grafts I think put in. My surgeon took cartilage from the front of both ears. It is now 3 weeks later and its still really swollen. How long will this take? I tape it at night, and I was wondering if I should just tape it during the day too? Does taping really work? Also, when he went in, because of the scar tissue there is an indentation on the outside of my nose. It`s small, but I have to go in next Thursday for him to laser it. Have you heard of this happening before? Thanks in advance for all of your feedback!

  Answer:  the swelling will visibly start to show a difference in 4-6 weeks in most cases. I am not sure taping will do mcuh as there is stil swelling internally that cannot be improved with the taping. As to the indentation, it can happen on repeat rhinoplasties, the laser should help though. Best of luck. JG 1.8.09

• i want to know if it is possble to remove fat from your nose tip with just with a needle with out surgery cause i already had two nose surgery , i just want my nose tip to be my smaller

  Answer:  surgery is the only way, and the amount of fat is really small. JG 1.6.09

• Hello - I posted the previous message but forgot one question. I know I am supposed to stop taking ASA, ibprofen before my procedure but is there any reason to stop a MTV and biotin? Thanks again.

  Answer:  no, the MTV and biotin are OK. JG 1.3.09

• Hello Dr. Garcia, I hope you had a happy holiday season! I apologize for writing a lengthy post, but I have several questions. I had an open rhinoplasty in March 2008. I seem to have had some prolonged swelling issues - this may sound silly but is it ever possible or necessary to somehow remove or aspirate the fluid under the skin of the nose? I am also scheduled for a very minor revision (this will be a closed procedure with a straight local to smooth out a bump on the left side of the tip - PS says it will take about 15-20 min). What can I do to help minimize swelling after this procedure? Thank you!!

  Answer:  the fluid that is there is impossible to aspirate, that can only be done in a localized area where a seroma would form and that does not happen in the nose, it is diffuse in the skin and tissues I am afraid. I think the best thing after the touch up will be to apply ice and minimize anything that can cause bleeding, all the best. JG 1.3.09

• Hello Dr, I wanted to ask you if having 2 surgeries performed simultaneously is safe. I don`t have a lot of time off from my job and can`t afford to take off so often. I want to get a nose surgery and a breast enlargement. What do you thin? would you perform these two at the same time? Thanks, Happy New Year!!!!!!!!!!

  Answer:  that is OK to do together, yes, and Happy New Year to you also. JG 1.3.09

• I just want the tip of my nose refined, it`s somewhat balbous(sp?). In terms of recovery from a rhino would this be relatively easy.is it on the easy side from the doctors perspective as opposed to shaving bone etc? What about being able to breath through nose afterwards. Are there docs that just specialize in noses or would that just be a head and neck doc? thank you for continuing to answer our questions. Happy New Year Dr Garcia!

  Answer:  recovery is easy but swelling persists for months. Breathing should not be affected from the surgery. There are no doctors that specialize in one aspect of rhinoplasties though. Best of luck. JG 1.2.09

• I recently underwent rhinoplasty. It has been a little over 2 weeks since the surgery. Everything turned out wonderful and i was very happy with the results. Then last night my friend got too drunk and accidentally head butted me pretty hard right in my nose. Can you imagine my luck? I am so worried..my nose seems to be growing before my eyes. I am so afraid that she has ruined my nose all over again. What are the possible consequences of this incident? I cannot afford to have another surgery..please help me i am so upset and scared.

  Answer:  impossible to tell, it hopefully is just swelling and will get better, but it is so soon after the surgery that bones might have shifted, not much you can do except to let the swelling go down and see how it looks. JG 1.2.09

• Hi Dr.G! I am contemplating a nose surgery and was curious to know 1) how many rhinoplasty have you got under your sleeve? 2) knowing that the result of a rhinoplasty isn`t garanteed, can you show the patient an idea of what his/her nose could look like after the surgery based on your expertise? Thanks so much for this helpful forum!

  Answer:  we show pictures of our previous patients but we do not use computer imaging as what you can do on a computer cannto always be reproduced in real life. As to the number of rhinoplasties I have perforemd, it is about 400-450. JG 12.29.08

• Are there any possible negative side effects or results from getting kenalog or cortisone injections after a rhinoplasty? Will my nose get worse before it gets better? Can it change the shape or just the size of the tip? Thanks!

  Answer:  very small to no negative effects if used just a few times, in long term use you could develop broken blood vessels. The effects on the tip are usually small. JG 12.29.08

• when splint and tape removed from nose at 1 week post op(tomorrow thank God)will ps suction it out before or after tape and splint come off? and the smaller the job the less swelling or quicker time to final result? just had bump removed and tip refined.

  Answer:  unless ther is a intra-nasal splint there is no need to suction anything, most times, even then, it is just removed with no suctioning. The smaller the surgery, typically the shorter the recovery in terms of swelling, yes. You had a pretty standard rhinoplasty though, it will take months to see the final result. Merry Christmas and Happy New Year. JG 12.27.08

• Hi! I had my nose cosmetically corrected almost exactly one year ago. I am unhappy with the results, as the tip of my nose has hardly changed. My doctor recommended the Kenalog or cortisone shots, but I am unsure about this because it has been so long since my surgery. Is this worth a try? Or can it have negative effects?

  Answer:  it is stil worth trying, yes. Not sure how dramatic of a change it would make though, especially in thicker skin. Merry Christmas and Happy New Year. JG 12.27.08

• i posted a really long nose question and it wouldnt go thru. so breifly, had nose done monday alng with several other facial things. PS trimmed my turbinates(sp) to help me breathe better. j guess i only had 70% air intake.i stayed the nite in facility by choice and had projectile vomiting of large quantities of blood i was coughing up and swallowing during thenight. shoul i hv been warned about this? is this comman? what if my poor husband had had to deal with that if i had stayed at home???

  Answer:  well, it can be common, certainly not unusual, especially when turbinates are trimmed. I do not think anything bad would have happened by staying at home though. Merry Christmas and Happy New Year. JG 12.27.08

• Hi - How soon after a closed rhinoplasty is it safe to get a kenalog injection? Thank you.

  Answer:  would not do it for at least 6 weeks. Merry Christmas and Happy New Year. JG 12.27.08

• thank u so much for the quick response! well can the skin of the nose be thinned somehow? maybe injecting steroids? because i feel that the tip of my nose it well shaped it would look a lot better if the skin or fat whatever is under could be thinned..?

  Answer:  I am sorry but that skin cannot be thinned out safely. JG 12.21.08

• hey dr garcia! what can be done to the tip of the nose to make it more defined? I understand that if you have thick skin its hard to show definition in the tip.. what can be done to make the skin there a little thinner and make the tip appear less bulbous?

  Answer:  sometimes it requires cartilage reshaping to include a graft of cartilage to push on the skin to give hte appearance of more definition but it can be larger then. JG 12.20.08

• Doctor, I understand you do rhinoplastys, could you also do septioplastys? My septum is deviated at the nostril opening only (one nostril is closed to 95 percent due to a deviation). One p/s that I saw stated that the deviation is only at the front and that its a 20-minute procedure. I would be grateful to be able to see you in LV (I am in NM) for this procedure and schedule surgery with you.

  Answer:  I am sorry but I do not perform septoplasty surgery when doing a cosmetic rhinoplasty, your best results would be with an ENT surgeon for that. JG 12.18.08

• If you have a lot of scar tissue in nose due to nose surgery, can another nose surgery be done? See, my first nose surgery caused a twisted tip. Is it complicated to correct a twisted tip. I do not know if a twisted tip means a twised septum or what causes a twisted tip. Its like my tip points to one side. Just wondering if this is difficult to correct and if it can be corrected if you have scar tissue All around tip)? Also, can this surgery only be done through open nose surgery? Thanks.

  Answer:  the more surgeries you have had the more difficult it is to correct the problem I am afraid. JG 12.16.08

• Dr Garcia- I recieved my 3rd rhinoplasty surgeron in January08. The first two were from the same doctor and the last one was from a doctor I really trusted. I have alot of scar tissue buildup and I already recieved 3 kenalog injections and it did not seem to help much. I just wanted to know if there is anyway this scar tissue can be removed? would a stronger injection help? would another surgery help?? and is there certain ways to heal after surgery to prevent this buildup? thank you for your help

  Answer:  I think more surgery will likely not help or could make it worse and I think the injections might be worth trying once or twice more but if no change by then, it will not help. JG 12.15.08

• Hello, I am about nine months post op from an open rhinoplasty procedure. I had a funny bump on the left side of my nose. My PS felt it was skin related and suggested a laser treatment to the area. When I went in for this, the technician used a diode laser to treat the area. The left side of the nose is now quite swollen where she did the treatment. Everything I read is that the diode laser is used for hair removal so I am confused as to why she would use this laser on my own. Do you think the swelling is transient? Could any permanent damage have been done? Thank you for your assistance.

  Answer:  diode lasers are used for many different things but swelling is common after that treatment, I do not think anything permanent has happened nor anything negative. JG 12.12.08

• Hello, Thanks so much for you service and the ability to get honest opinions! I had rhinoplasty surgery about 7 months ago. I have difficulty breathing on my left side (and my eyes are still watering, but this is a less significant issue). My doctor has recommended spreader graft surgery to help my breathing. Having read up on it, it seems this is probably the correct suggestion. My concern is the surgery itself. The physician has indicated it’s a fairly straightforward/easy surgery and that it will not impact the look of my nose. Can you help me understand how challenging this surgery is (for the physician and the patient) and the degree to which it will impact the “look” of my nose? Again, many thanks!

  Answer:  well, it usually does not alter your appearance much but in a small number of cases the area where the spreader graft is placed will look a little wider in a straight on shot, but it is needed to allow you to breathe. Best of luck. JG 12.9.08

• Hi Dr Garcia, Please help. I have had 4 rhinoplastys, 10 years ago. After the 3rd my skin had thickened, and then I had another to have it thinned and had kenalog injections. The problem is, is that the skin around the tip had thinned while the skin around the middle of my nose is still thick. The thick skin around the middle is very soft and does not seem to be attached to the bone. Is this scar tissue, and what are my options. I dont think I can go through anymore surgery. Can I have kenalog or laser, after such a long time. Does massaging the skin help lessen the tissue? Thank you for your help. Eva

  Answer:  I am not sure the kenalog will help and a laser for sure will not help, sorry. I do not think massage will help either, I wish I had something to offer but I think anymore would be risky. JG 12.7.08

• Dear Doctor, when doctors say botox can be used to raise the tip of the nose, does that mean that botox injected at the base of the nose will a) actually raise it (does the depressor muscle pull down the nose tip at all times in some people??... or b) just prevent the tip from being pulled down *when the person is talking or smiling? I want to know because I would not be willing to pay for an entire vial just to have the nose tip not droop when I talk or smile, I would like to have it a bit raised at all times. Is that possible or not with botox? or with fillers, in some way?

  Answer:  in an extremely small number of patients will that ever work. Fillers will not do anything I am afraid. JG 12.5.08

• Hi Dr Garcia, I had a revision rhinoplasty with the same surgeon who did my primary. My complaint with the primary was an inverted v deformity. My surgeon took a dermis graft from the front of my ear leaving me with a scar in front of my ear measuring about 4 centrimetres. My questions are is this a graft that is commonly used and is it effective? And would you take it from the face? It has now been 4 months and my bridge has a lumpy appearance not sure what this is and a red patch full of little broken capillaries. Do you have any advise for me. I trust your expertise and look forward to your response.

  Answer:  well, there are many options, a dermal graft is certainly one of them, the skin can be taken from behind the ears at times but is thinner, also in some cases injectable fillers can be used, a surgen will typically use what has given them the best results over time in their hands, I think much of the irregularity will get better in time though. JG 12.4.08

• Hello, Dr. Garcia. I am having a minor(at least thats what PS said) nose job in a few weeks. Simply the bumped shaved and tip lifted a tad, and bridge widened to balance things out . He said the bones neednt be broken. I have 2 weeks to recover. I am wondering what is used to widen a bridge and lift a tip? if it is my own cartlidge, am i to assume that comes from other place in my nose? Is cartlidge used for those things really that moldable, like clay? seems like PS is over simplifying the surgery, at least in his explanation to me. I see him tomorrow to get some more details but wondering if what he says sounds right? I am really hoping for a quick recovery with very little swelling. In my case, what causes the swelling, the relocated cartlidge or just the whole surgery?

  Answer:  well to lift the tip it is usually a trimming of the cartilage that is done and in many cases when a hump is removed and the bones are not broken and pushed together then the bridge looks wider. I think recovery will be short but final result might be months although you wil look better in a few weeks. JG 12.2.08

• Thanks so much for your quick reply, I asked earlier about an elbow to the face causing a fluctuating hump on the bridge- would a CT scan be helpful in showing that this is swelling? (I think you said to someone else earlier, that a callus wouldn`t show up b/c it would blend in with the bone)

  Answer:  might give you some information but it will not affect what can be done. JG 12.2.08

• Hello Dr. Garcia, I am considering rhinoplasty because I was elbowed in the face in May 2008 and since then a small bump has formed on the upper bridge of my nose. My nose did not bleed nor was there any real bruising. I even got x-rays done and they said it was not broken. From reading these posts I am assuming that it could be a callous, but I am confused b/c it appears to change in size on a daily basis. If I touch it a lot, it becomes bigger, sometimes its bigger when I wake up in the morning or if I have a cold. Do you have an idea why? Is there any hope that it will resolve? (Its been about 6 months now) Also, if it is a callous, is my only option surgery? Would massage or steroid injections be helpful? Thank you so much for your help. I have already seen two ENTs and their responses after speaking to me for 5 seconds were I don`t know what it is, you probably need s nose job

  Answer:  well, thre might be a small callus underneath, but the fact that it changes in size means there is also swelling because callus does not fluctuate in size. The swelling normally totally abates after one year. I do not think massage will help and I am in general opposed to steroid injections. If the callus persisitas after one year, the only remedy is surgery, but any scraping of the callus can result in further callus. JG 12.1.08

• Sorry to post an additional question in the nose forum, but it related to my question (below) about upper arm lifts ... I`m sure you`ve been asked hundreds of time if there is anything you would suggest for chubby upper arms. As mentioned, mine are borderline. I do a LOT of arm work (and there is muscle there but the fat hides most of it.) I was trying to use toning rather than lipo (or the dreaded upper arm lift) but it doesn`t seem to work. While I`m mostly tone everywhere else, the fat on my arms doesn`t budge (thereby ruining all the hard work when I put on a nice t-shirt). I had a little bit of lipo done on the arms a few years ago, but I think that is why the skin underneath looks somewhat hangy (I have crappy skin that doesn`t ever tighten - would love to know how Anna Nicole Smith went from 300 lbs to 140 with everything looking so tight - and I looked for arm scars!) So I think more lipo is out. Is there anything like a bicep or tricep implant? Thanks!

  Answer:  sorry but I do not think there is anything short of the arm tuck that will help. More liposuction, if it failed the first time, will not help and can make it worse. JG 12.1.08

• Dr. G, what do you think about tip (nose) reduction? I have a nose that, although my last two boyfriends threatened leaving me if I changed (they thought it was cute) I want to make a little slimmer (my nose is a bit upturned, too but I don`t think I should mess with that) but I think it would look better slimmer at the end (not a full rhinoplasty or anything) but (like my somewhat chubby upper arms) I always seem to fall on the borderline (really not bad enough to warrant a big scar, like that in an upper arm lift but almost wishing these problems slanted one or the other so I`d know what to do.) But I know the nose is tricky. Thanks.

  Answer:  hard to advise you without seeing you in person I am afraid. JG 12.1.08

• Hi Dr. Garcia, I received a shot of kenalog 50 about 2 1/2 months ago on the side of my nose to correct some assymetry post rhinoplasty. It helped to balance it out with the other side of my nose. However, it has left a slight indentation, crease and mild hypo-pigmentation. My PS said that he can inject a filler (radiesse), but I`ve heard about bumps, redness and all sorts of possible complications from fillers. I guess I`m wondering if I should wait a while and see if the indentation/crease and hypo-pigmentation resolve on their own in time vs. risking making the area look worse from a filler. My skin is pretty thin there. What are your thoughts on this? Thanks for your time, and Happy Thanksgiving to you and yours.

  Answer:  I think it best to give it 6 months and the see what if anything is needed, I think the bumps of Radiesse are a low risk on the nose part, hopefully you will not need it. Best of luck. JG 11.26.08

• Hi Dr.Garcia I really dont like nose it is high and not straight. and i dont have too much money to fix it . do know a place i can go in bay area san fransico that cost me chaeper then ather places i will be happy ? thanks.

  Answer:  sorry but I do not know of any place. JG 11.24.08

• what benefit to widening nostrils? My PS said he was going to do this for me. How is it done? In my computer generated after photos, he didnt do it. I dont have any breathing problem, just naturally small nostrils. wouldnt lifting the tip a little naturally make nostrils more noticable?

  Answer:  in over 21 years of private practice doing rhinoplasties I have never widened nostrils on a patient. JG 11.22.08

• Hi Doctor, first thank you for your time. Two years ago i had a rhinoplastic surgery. I did my tip, to get it smaller and my nostrils. Now i`m planning to have a revision for my tip, my doctor told me he will do a close surgery. My question is, i heard that after the first surgery all revisons should be done with open surgery, is it ok if he does the revision with close surgery?. thanks

  Answer:  it is OK to do subsequent surgeries clsoed, it is at times easier to perform as an open procedure in order to visualize things but if the needed revision is small, the closed technique is stil fine to use. JG 11.20.08

• Hello Dr. García: Is it posible to lift or elevate the nostrils and base of the nose as to make the nose shorter? And maybe this could elevate also the upper lip zone and the nose tip. Thank you very much.

  Answer:  the illusion of such can be done by reducing the septal cartilage so to allow the skin to shrink up some, although this will be limited by the amount of work on the cartilage. JG 11.19.08

• Hi Dr.Garcia, I need to go for a 5th revision surgery on my nose. I would like to email you pictures of my nose to see if you think my problem can be corrected. Please let me know if this will be okay with you. Thank you very much.....as I am a long time reader of your site.

  Answer:  certainly, please send them to drgarcia@lvcosmeticsurgery.com, include as much information as to what was done and the problems now as you can, all the best. JG 11.17.08

• Hi Doctor, how`ve you been?, hope you are doing fine. I have a question regarding nose tip surgery. I had a nose surgery 2 years ago, and I`m planing to have a revision for the tip of my nose, when i first got my surgery i wanted to make the tip smaller, but after the surgery the tip was the same, it didn`t change at all. The doctor who did my surgery offered me to do a revision but i din`t, because i didn`t trust his ability, so i went to another Doctor, and he said he does tip surgery with nose cartilage instead of ear cartilage to make tip smaller, 2 years ago the other doctor put me ear cartilage. My question is, does nose cartilage make tip smaller than doing it with ear cartilage?, and aslo is there any danger or any other bad consecuences doing it with nose cartilage? Thanks

  Answer:  I really cannot see how adding material, no matter the source, to the tip can ever make it smaller, it might give it better shape, but not make it smaller, also the end result of the tip in many cases is limiteed by the thickness of the skin and scar tissue, so the more times you operate on it, the harder it is to make it smaller. Hope you are well too.JG 11.17.08

• a revision rhinoplasty to remove a ball of scar tissue on the side of my nose left me with an indentation and a small crease and tiny elevation on the outside of the nose (external scar tissue). I am indian color skin. Should I risk doing CO2 laser ? Will the spot be red and more scarred after the CO2 ? Thanks

  Answer:  CO2 would not be my choice, I sugest a YAG laser for the redness. JG 11.16.08

• Dr. Garcia - I have been diagnosed with rosacae. It isn`t too bad just some broken capillaries around the nose and a little on the cheeks. What is bothersome however is that I can see an enlargement in the tip of my nose and slightly in the chin. The end of the nose feels spongy. I am presently taking some laser treatments called Laser Genesis for the redness. I believe that the nose condition is called rhinophyma and I am really frightened by some of the pictures I have seen. I am 60 yrs. old and the rest of my skin is in good shape. What would you advise me at this time. I have been give microgel by the dermatologist that I was seen by but she didn`t really address the nose condition that I asked about (I am really bothered that my nose looks big to me). Should I be thinking about surgery before I look like the people in these pictures, who are mainly men. Thanks for any light you can shed on the subject.

  Answer:  as to the Rhinophyma, a CO2 laser used to trim the thickness down works well, IPL will usually control it after that is doen. Best of luck. JG 11.16.08

• Hello, I have posted several questions in the past and would like to thank you for your advice. I am about 8 mos post op from an open revision rhinoplasty. I guess I am feeling a little frustrated with all the swelling issues I am still having. Some days, my nose looks nice and I think the swelling is finally resolving and then the next day it is all puffy and feels squishy again. Is this part of the normal healing process? I am waiting (impatiently, I suppose) for this swelling to be gone for good. Any advice? Thank you.

  Answer:  all normal, especially in revision rhinoplasties and for open technique, all you can do is wait, the fact that it looks nice some days is a good sign, hang in there for a little longer. JG 11.14.08

• Hi Dr. Garcia, I am 7 days out of rhinoplasty, and one nostril seems to be cut higher up than the other and therefore is a bigger nostril than the other one, and you can see inside my nose on that side more. I feel like the side with the bigger nostril looks like I`m a pig and the other side is perfect. What can be done to correct this?

  Answer:  at this point it is due to swelling and the sutures that are still in place, give it time, nothing to do for awhile until it all settles down. JG 11.14.08

• Hello, I am about 8 months post revision rhinoplasty. My dermatologist prescribed Aldactone for hormonal acne. Until I began taking this (which I know is a diuretic) my nose was still quite swollen and felt as if fluid was under the skin. However, after about one week of taking this medication, my nose is much less swollen and the fluid seems to be gone. Is this a result of the medication, or is is likely just a coincidence? Thanks.

  Answer:  could be a little of the medicine, but mostly coincidence. JG 11.12.08

• If i have only tape over my nose for swelling, no bones have been broken, would it be ok for me to take the tape off 3 days later for a couple hours and then put some back on? I am only getting the bump shaved and tip raised a tad. It is scheduled for the 22 of dec and i am expecting some family to drop by christmas day, dont want them to know i had nose done if possible. Probably bad idea, but just want your opinion if it would hurt anything. PS said i wouldnt have a splint or packing, internally, anyway.

  Answer:  well it can be done but you might get a little more swollen during those hours, I prefer to leave it on. I think you will have some small amount of swelling and likely some bruising so they will probably be able to tell something was done with or without the tape. JG 11.11.08

• Dr. Garcia, I had rhinoplasty 7 months ago with a good result. Nose has been itching and have picked it a couple of times. After 7 months is the nose completely healed as far as being set. Can I do any damage by picking my nose. Thanks.

  Answer:  cannot do any damage but it will have small improvements for another couple of months in most cases. JG 11.3.08

• I had septoplasty 10 months ago. Just for the inside of my nose, not the outside. Every once in awhile I bump my nose and it is very very painful. I can feel it from the roof of my mouth through the middle of my head. It hurts for a half hour or more. I can feel it with every movement of mouth or nose. My doctor says he has never had a patient with this complaint so far after surgery and that it will go away. I am concerned though and it doesn`t seem to be going away. Do you have any idea about what is causing this?

  Answer:  could be some small nerves that were trapped in scar tissue from the septoplasy it is a hassle but not a dangerous thing, not much you can do about it though. JG 10.27.08

• Hello again Dr. Garcia :) I`m now 8 days post-op from my revision/reconstruction on my nose. My check up 2 days ago went beautifully. However, last night, I noticed a lot of pain and swelling in the lymph node (pea size) behind my left ear where my surgeon harvested some fascia. It wasn`t like that before. However, the incision still looks as if it`s healing well. No extra inflammation, pus, or discharge. I took my last antibiotic 2 days ago. Should I call my surgeon and see him; ask him to prescribe more antibiotics; or should I just let it be and wait for the node to go down on it`s own? It`s really painful, and I`m due to fly to a convention next Monday. What do you think? Thank you so much.

  Answer:  it usually goes down on its own, no need for antibiotics unless there is an infection. Warm packs and tylenol will make it feel better in time. JG 10.23.08

• Hi Dr. Garcia, I wrote approximately 1 year ago regarding facial twitching and mild spasms after upper bleph, rhinoplasty, septoplasty and turbinectomy. I still have mild twitching periodically and wonder if you think it would be safe to have some botox, fillers, laser etc. now. Thanks so much for you great advice.

  Answer:  I think they would be safe, the Botox might even help the twitching. all the best. JG 10.21.08

• Hello Dr. Garcia, I am 4 days post-op from my 3rd reconstructive nose surgery to remove scar tissue and reposition a graft. I had kenalog injections 2 months ago to try and correct some asymmetry, but it was unsuccessful, so this time my surgeon used the open technique to perform extensive tip work, and used more fascia from behind my ear. The swelling is much better this time around. However, I`ve noticed that certain parts of my nose tip and around the columnella incision seem to be a paler color in comparison to the rest of my nose. I am concerned that these pale areas are not getting blood supply since they are not as pink as the rest of my nose, and I`m paranoid about tissue necrosis. Should I be worried? Thank you for your wonderful gift Dr. Garcia, not only as a surgeon, but as a comfort. Bless you!

  Answer:  I think a little paleness is OK at this point, not unusual, and at 4 days if it was going to go bad, it would be hard and black by now, so just give it some time. Best of luck!JG 10.19.08

• I am planning my rhinoplasty and am not sure how to word a question for my dr. I want the sura tip narrowed..not the actual Tip...is that the area right above the tip..almost in the middle of the nose?? also.. I want this area narrowed..but don`t want a dented in look...its smooth there now...can this look be kept? (Basically..i want my same nose just a bit smaller)...is this possible to have same nose...just a bit thinner?? thanks dr!

  Answer:  the easiest way is to make a little mark there with an eye liner pencil so you can both agree, it washes off very easily. Without seeing you in person I cannot tell if that is acheivable in your case or able to be maintained. JG 10.17.08

• when a bump on nose is shaved, is this cartlidge or bone? my bump feels like bone, but PS says he wont break it, can bone actuall be shaved/filed. How does a PD see in there for closed surgery?????? And how does he widen nostrils? He says mine need to be widened.

  Answer:  in most cases it is cartilage. Bone and cartilage can both be shaved. Widening nostrila requires cartilage support and at times external incisions, as to a closed technique, some of it is done by feel. JG 10.17.08

• Dr, how do i find out if doctors have had complaints or complications in case or have been sued in the past. thanks

  Answer:  you can contact the state medical board. JG 10.15.08

• Dr. i am planning a rhinoplasy. what are good ways to find out if docs is successful doctor besides his years of experience (if that is factor)? Doc`s years of experience is an indictor that doc is successful at all? or there is another factors i should consider when asking the doc questions? thanks

  Answer:  ask to speak to his patients, check with the state medical board to see if he has had any complaints are good places to start. JG 10.15.08

• Dr Garcia, i asked about the nose splint with no breaking of bones for removing hump. I guess its smallish to medium, but head on my nose is really narrow and he said he will actually widen it with my own cartlidge? Would this be reason to have splint or maybe just tape? Thanks!

  Answer:  I think if he is not going to break the bones the reason he is using the splint is to try to reduce the swelling, it will work, for a week as long as you have the splint but that is about it. No harm in using it though. JG 10.15.08

• Dr Garcia, I Had a rhinoplasty on August 27, 2008. I had a open rhinoplasty, the doctor removed a litle bump on the bridge and refined the tip. For the first 4 weeks everything was fine, but now I start to notice a litle bump on the bridge, My doctor told me it`s just puffiness. It`s been 3 weeks now and the bump it`s still there. It`s possible to be just puffiness? Do You think the bump will eventually goes way? Thank you very much!

  Answer:  it can be puffiness, yes, and it can also be a small amount of callus that forms when the cartilage is scraped and might take months to flatten and remodel. In time it usually goes away. JG 10.14.08

• I am having the bump on my nose shaved down and tip lifted a tad, PS said no packing and no internal splint will be needed. I assume outer splint is all. Is this because there will be no breaking of the bone? Also, will i be able to breath at all thru my nose during that fiest week before outer splint is removed? And since the bone wont be broken, will i be able to avoid the black eyes?

  Answer:  I usually use an outer splint only if I am breaking the bones to narrow the nose, if it is a small hump, I only use tape on the nose. I think you will be able to breathe out of the nostril soon after surgery but not perfectly due to swelling. Black eye risk is less but not zero. Best of luck. JG 10.14.08

• I had septoplasty and turbinate resection 6 months ago. The septum now appears to be fine, and I breathe out of my right nostril without difficulty. However, the left nostril remains, at best, clogged, and at worst almost sealed shut. My doc says the turbinate is very swollen. Recently I have started getting spasms in the left corner of the nose. Do you think these spasms could be caused by a swollen turbinate? thx, dave oldam

  Answer:  the spasms are not related to the surgery, sounds like the allergies are still making your turbinates swollen, likely not due to the surgery. JG 10.12.08

• Dear Dr. Garcia I had a rhino tip on 9/15/08. This morning I woke up and I had 2 small pustular blisters just inside my nose and the tip of my nose was red!!!! This is Friday and my doctors office is not open. Is there anything I can do? I`m worried it may be staph or something.

  Answer:  clean it gently with half strength peroxide and apply neosporin until they can see you on Monday, should not be a big problem. JG 10.10.08

• Dr. I had septoplasty and turbinate reduction a month ago. I am back at work and working out. I still feel fatigue at times. Could this be part of the healing process.

  Answer:  it is part of the surgery after effects in terms of the anesthesia, the medicines and the having to do nothing for awhile, it will get better in time. JG 10.10.08

• Recently had a revsion rhino. I bruised a lot from this last surgery--including a dark bruise on my wrist from the IV. My main concern is my nose, the tip is purple-ish. I`m at day 10 post-op. Should I be concerned about necrosis. No other signs except darker tip. Thanks

  Answer:  I think with what you are describing, that is not uncommon, give it time, the nasal skin is very resilient. JG 10.9.08

• Hi Dr. Garcia, I am six months post-op from revision rhinoplasty. My tip still has more projection than I would like. I think I do still have some swelling because I notice swelling throughout the day on the width (sides) of the nose. Any chance my tip might still be swollen too? Thank you!

  Answer:  yes, tips are the last to change after a rhinoplasty of any sort. JG 10.8.08

• Hi dr, I went for septoplasty and turbinectomy on the 15th Sept. After taking out the splints in my nose 1 week after, my breathing improved tremendously. However, since a few days ago(3weeks after op), i keep having mucus buildup in my nose, especially on the left side(which was blocked before the op). every few hours i could dig out a big piece of solid mucus, and after a while they build up again, causing blockage. Sometimes the mucus could be a little bloody. is it a cause for concern?

  Answer:  no, all the normal response and it should slowly get better wth time. JG 10.8.08

• Dr. Garcia, I was wondering how long I should wait after childbirth to have rhinoplasty and restaylne injections?

  Answer:  once you are done breast feeding is OK. JG 10.6.08

• I am getting a nose job during a lower face/neck lift. It should be pretty simple, never bothered me before, but PS and hubby(they are friends) said it would improve overall result. Its basically just a bump. Its narrow and fine head on. Doc said he will have to make it a little wider head on after smoothing the bump. And he will raise the tip. He siad i will have no packing or internal splint, just outer dressings for a week. I have computer altered pics that he did, i notice the widening in the afters, head on, no one else would. Why is that necessary? why cant it stay thin?

  Answer:  it can stay thing if they break the bones to keep it narrow. JG 10.6.08

• How can a rhinoplasty cause a CSF leak? How do you know if you have one?

  Answer:  rarely, but it can. The quickest way to check for a leaf of CSF is made by checking the glucose content in the nasal fluid. JG 10.6.08

• I had septoplasty/turbinate reduction about a month ago. I stopped taking advil two weeks prior to surgery. I took some advil for a headache three weeks after my surgery and I experianced a very weird/nauseas feeling. Does the body react to medications/vitamins differently after you have surgery.

  Answer:  yes, but not that far afterwards. JG 10.6.08

• Dr., I had septoplasty and turbinate reduction on August 27, 2008. As of October 6, 2008, I still have numbness in one of my teeth and my nose is still somewhat tender and sore. At times I feel a tremendous amount of pain/pressure that comes and goes. Could this be the nerves healing and how long could it take. Thanks in advance!

  Answer:  it could be the nerves and if it is it might take months I am afraid. Best of luck. JG 10.6.08

• Hi Dr Garcia, First of all I would like to thank you for replying to my previous question I think it is so fantastic that you take the time to answer questions from patients who you haven`t even treated. My question is I have had a dermal graft applied to improve an inverted v deformity on my dorsum and have developed a raised bump where the graft is. My ps has advised me that it will go away and that it`s fluid/swelling I tried a course of antibiotics but they didn`t help. It is quite hard to touch and my mother who is a nurse thinks it`s a seroma?? I`m wondering if you think that is possible and is there anything I can do to fasten the healing process.

  Answer:  if it is a seroma it could be aspirated with a needle, but dermal grafts get very hard during their normal healing due to the body`s normal response to that type of graft. Warm packs and light massage might help. Best of luck.JG 10.6.08

• hi dr. garcia, i had my 2nd rhinoplasty 3 weeks ago. just curious the bone on the left side of my nose has a bump that was not there after my first rhino. my ps rasp down the hump on my nose this time around. could it be swelling and if it may be swelling does bone swell and how long? thank you.

  Answer:  could be swelling, yes, or a small callus on the bone that should settle down. Can take months to get to see a difference. JG 10.6.08

• Hi Dr. Garcia I live near Chicago and I went for a consultation appointment Dr. Toriumi and paid the $250.00 fee. I read good things about him on via internet, but at my consultation he was sort of rude and not really listening to anything I had to say, he basically stayed in the room with me for about 8 minutes or so. I tried to show him my xrays-wasn`t concerned; however, I did manage to show him three photos of what I wanted my nose to look like and he tells me....they all have different bone structures, but his body language was showing something different-almost like he was in a big hurry. I was so dissapointed. I am an african american female very healthy-no medical problems and no issues with keloids or scar tissue. In June 2005 I had to have a lefort 1 and bsso (orthognathic surgery) of both jaws and the surgery left me with a wider nose than expected. Dr. Toriumi`s total fee was $21,000.00. I thought the fee was outrageous. My question to you is what is a resonable fee for rhinoplasty? Your response would be greatly appreciated.

  Answer:  I think in Chicago it should be about $8000, go see someone else. JG 10.6.08

• Hello Dr. Garcia. I am 17 months post-op from a 2nd revision septo-rhinoplasty that required a lot of reconstructive work utilizing cartilage and fascia from behind my ear. A little over 4 weeks ago, my Dr. injected kenalog-40 on either side of my nose to try and correct obvious asymmetry that is still present. He advised that I come back after 6 weeks to assess the results, and to determine if he needs to do another minor revision. There are inentations (and a crease) where the Kenalog was injected, and the skin in both areas is slightly paler than the rest of my nose. I`m hoping that these issues will resolve in time. There is also a very pointy piece of cartilage on the underside of my tip that he did say he would need to shave down if it still bothered me, because the Kenalog would have not affect on it. If I do require another surgery, is it safe to do so only a couple of months after Kenalog has been injected in my nose?

  Answer:  yes, I think that would be safe, best of luck. JG 10.5.8

• Hello, I am six months post-rhinoplasty and have a sort of silly question. I have noticed that whenever I have a glass of wine of beer with dinner, my nose gets stuffy and feels (and actually appears) more swollen. Can alcohol do this, or is it my imagination? Thanks for your input.

  Answer:  it can do that during the healing process during the first year. JG 10.5.8

• Hello dr Garcia. About the question i had before about the blood pressure and rhinoplasty,I just read sth about internal bleeding. Can it have caused internal bleeding and if yes what are the consequences of it? Thanks.

  Answer:  you can bleed under the skin, around the cartilage and cause visible nasal swelling. JG 10.3.08

• Hi dr Garcia. Can a rise in blood pressure after rhinoplasty,even if not followed by a nosebleed still cause problems? Thank you.

  Answer:  it can increase the swelling. JG 10.3.08

• I wrote the question regarding the nose surgery directly below. The procedure I came in was a simple procedure. Again, the surgeon suggested all these extra nose surgeries for me I tried to let go after my last surgery. I`m trying ot accept my nose as is, but it`s hard when a surgeon tells you your nose looks bad. Anyways, I suggested he only do the minor nose surgery involving adding a little cartilage to the bottom of my tip. However, he says he charges the sam eprice for all nose surgeries no matter how minor or major. Considering he does surgeries out of his own office, I am surprised he would charge as much for minor surgeries. I didn`t mention this ti him, but is it common for doctors to overhcarge like that? Also, if I wanted only the simple nose procedue done why can;t he do just that instead of saying I have too many nose problems (he wouldn`t have to touch those problems). My intuition felt really bad about this doctor. Maybe I should trust it. I just didn`t like him at all.

  Answer:  go somewhere else. JG 10.2.08

• Dear Dr. Garcia, Is it odd that a facial plastic surgeon does not participate with any insurance considering he mostly does rhinoplasties (which are covered by insurance for deviated septums)? He does surgery at his own office. Anyways, I went to him for a minor nose procedure- just to add cartilage at the bottom of my tip. However, he pointed out all these problems with my nose he thought needed to be corrected. He thought my nose looked unnatural so now I feel I should do more to make my nose look more natural (from prior nose surgery). Since I`m a student, he said he didn`t think I had the money to pay for surgery. He charges double what most surgeons charge so I said not right now I don`t. Then he said he wouldn`t bother talking to me about surgery then or I can come back when I was ready. I needed an explanation of what corrections he wanted to do to my nose (how he wanted to correct my nose). I sent an email with that question since he did not answer it at the office. He didn`t respond to my email so I called his office to see if he received it. I was transferred to him and he said he didn`t think he could be my doctor- to find another doctor because I have too many problems. Well, I only came in with one minor problem, but he pointed out all these other problems I didn`t bring up. During my consultation, he raved how patients travel out of state to have his nose surgeries. He said he was the best and now he is telling me to see another doctor with more experience. He wanted to know the name of my prior surgeon so I gave it. He didn`t know who he he was, but I wonder if he called him. My prior surgeon thought all the things I saw wrong with my twisted nose were all in my head, but I think he just didn`t feel like correcting it. Then this new surgeon confrims everything I saw wrong. However, I was not going there to have those things corrected. Actually, I was hoping he would say my nose looked fine. Again, it was just to add a little cartilage at bottom of tip. I kept questioning the new doctor if he could do the corrections he thought I needed since my prior surgeon didn`t bother since he said I have hard scar tissue. Then he said these other surgeons weren`t as skilled as him. My prior surgeon also corrected a deviated septum, which this nose surgeon said was still deviated. Sorry for the long question (just want to tgive you all the detials). What the heck is goign on with this doctor?

  Answer:  I think the old one does not feel confident he can help the small problem and the new one is an arrogant idiot, find someone else. JG 10.2.08

• hello doctor, i read that after an open-rhinoplasty, there is some minor swelling in the tip of the nose which goes away in 6-12 months...does that mean that 3-4 months after the surgery, his tip would appear the SAME as before the surgery. or it will appear improved BUT with a little swelling? I have a bad nasal-tip and i would like to know if i will see an improved tip (comparing with my pre-surgery tip)in 3-4 months after surgery, even though with the minor swelling.. Thank you in advance!

  Answer:  in many cases at three months it can look the same as before, yes. JG 9.30.08

• Is it possible for a rhinoplasty to cause a twisted tip (tip pushed to one side)? My tip seemed straight or not twisted prior to surgery. If surgery can cause a twisted tip, how does it cause it? Does a twisted tip have to do with a deviated septum (which I got corrected)? How can a twisted tip be corrected? A surgeon added cartilage on th epushed in side, but the tip still has that twisted/pushed in one side look.

  Answer:  it can happen when cartilage is removed and the remaining cartilage is too weak and it then twists, or it can be from stitches placed in the cartilage to try to obtain a certian shape and the sutures are tighter on side side than the other, also if grafts were placed they can shift and give a twisted appearance. It is most common though to have a twisted tip if the septum is deviated. If one has a twisted tip due to the septum being deviated adnd the septum is nor corrected, it can be difficult to straighten the tip. Twisted tips, the majority of the time, require repeat surgery if it persists for months after the intial surgery. Best of luck. JG 9.29.08

• Are some people born with bulbous tips? See, my tip was too narrow so cartilage was added ont he sides to make it more full. I wanted a round shape to the tip since the sides were straight instead of round. Now, another doctor thinks my nose looks bulbous. My bulbous doe she mean wide? I wanted to widen my tip so it was fuller than the width of my bridge. I don`t know if is suiggesting to make the widht of my tip more narrow than the bridge of my nose?

  Answer:  bulbous can mean wide, or round or ill-defined, it is difficult as many people describe bulbous nasal tips differenlty. I think you can show him a picture of what you want, not that they can give you that nose because they cannot, but it will give them an idea of what you desire and then they can tell you if it is achievable. JG 9.29.08

• If you have a low dorsom or maybe its called dorsal (bridge?) on the nose, can it be raised? If so, how?

  Answer:  yes, by placing some type of implant, either your own cartilage or a synthetic material. JG 9.29.08

• I had a rhinoplasty done by a plastic surgeon who does body and face. However, I went to plastic surgeon who only does rhinoplasties- mostly correction surgeries. Anyways, I saw this facisl plastic surgeon to see about addig a little tissue to the tip of my nose. A simple procedure. However, before I mentioned I was there for nose surgery, the plastic surgeon knew I was there for a rhinoplasty. He does other skin beauty procedures. He told me all the things wrong with m,y rhinoplasty without me saying a word. Actually, the doctor who did my rhinoplasty said my scar tissue is too hard to make more corrections. In contrast, the facial plastic surgeon said he was used to working on hard scar tissue. Are doctors who specialize in rhinoplasties able to work more skillfully with hard scar tissue? The doctor who did my surgery said he would not be able to chiel it neatly since it was hard scar tissue. Will my nose collapse if I have too many nose surgeries? Does correcting a deviated septum cause scar tissue to show on nose? Past nose surgeries involved removing lots of scar tissue on my nose- it was scar tissue removal instead of rhinoplasty. I want my nose to look natural and it nother me the facial plastic surgeon said my nose looked unnatural. It is probably true, but my question is my nose will get more scarred ot is hard scar tissue can be sculpted (the tip area)? He said my tip looks bulbous.

  Answer:  well, I am afriad not, they might encounter it more often and might employ more dramatic techniques to get a desired result, but they do not have special magic for scar tissue. The nose collapsing is due to loss of structure so as long as they leave the supporting cartilage it should not collapse. Septum surgery should not affect the cartilage on the outer parts of the nose typically. It is impossible to tell whether what you desire is acheivable, but I will say that a bulbous tip can be commonly caused by scar tissue and thick nasal skin and that might not be changed with more surgery. Best of luck. JG 9.29.08

• I had rhinoplasty 4 weeks ago, i had my nose narrowed,and my ps did this through external insicions on each side of my nose. The only problem is one side seems harder and more swollen and leaves like a deep eye trough. I wondered if this is still swelling and how long it will take to go down, i have been massaging it, but do you think it would benefit from cortisone injection?

  Answer:  still swelling and might take another few weeks to see a noticeable difference. I would not do cortisone injections for swelling in that location, just wait it out. JG 9.27.08

• Hello, I am six months post-op from a revision rhinoplasty with tip graft. I am very worried that I will need another surgery. Right now, my nose is bigger than before surgery and has several odd bumps - just is not smooth. Is there hope that this could still be swelling and with more time it will smooth out and begin smaller? Thank you for your help.

  Answer:  I think in revision cases I would not make a determination for one full year. JG 9.27.08

• hi dr. garcia, i had a revision rhinoplasty 2 weeks ago. i am very congested probably due to a combination of allergies and sweeling. i have been blowing my nose for 3 days now is this ok? when can i safely blow my nose? i have some nasonex can i use this? also what are the chances my tip droops down. my doc raised it and tucked it in. i am afraid it might droop. can taping help?thank u

  Answer:  well, it can cause some bleeding at times but if you need to blow it then proceed. I think you can go ahead and use the Nasonex too. I do not think this will affect your tip. Taping can be done but likely not needed. JG 9.27.08

• Hi Dr Garzia I dont mean to bother you,,, In my rhinoplasty i had an implant put in my nose,,, this was 4 years ago,, can picking your nose cause part of the implant or grafts to fall out, would i know if it did,,,also, can you for certain say that nose picking does not altar the size of one`s nostrils post rhino.. Thankyou

  Answer:  the liniing of the nose on the inside should provide adequate protection for the implant. Picking your nose should not change the results of your rhinoplasty but I am not sure why you are picking your nose to begin with. JG 9.27.08

• How successful are rasping revisions usually? I keep hearing they are a simple procedure done under local but I also keep hearing that there are many risks with any revision. Is it really just a simple quick touch up that usually gives a happy result?

  Answer:  well, although simple to do I will say that the smaller the hump is the less likely of a significant change because as it heals there is no callus that forms. JG 9.27.08

• How long can swelling on the bridge persist after rhinoplasty? I heard that the swelling on the bridge goes down quicker than the tip.

  Answer:  can take 6 months or more. JG 9.27.08

• With a rasping revision to remove a tiny bump, what are the risks? Can the bump come back?

  Answer:  there can be callus that forms that will make it look the same, or if too much is taken out then there can be a depression. JG 9.27.08

• I had rhinoplasty 4 months ago, and as soon as the cast came off there was swelling where the hump used to be. It has gone down a lot but there is a tiny hard projection there. How can I tell if something is a callus or scar tissue or bone? Will massaging it help it go down? Is there still hope it may resorb or disappear? I have tiny bony projections on the side of the bridge and was told that these will disappear when the bone fills in, could this tiny projection in the front be due to something similar? Thank you.

  Answer:  no way to tell, but if it is swelling it will go up and down throught the day and with activity, the callus or bone cannot be distinguished from one another. Massage will help and that is normal after a rhinoplasty, need to give it a full year. JG 9.27.08

• Hi Dr Garcia, I had a revision rhinoplasty 8 weeks ago and my ps who also performed the primary used a dermis graft taken from the side of my face leaving a small incision in front of my ear to improve an inverted v deformity on the bridge of my nose. I now have a red area and a bump on the left side of the graft, my ps said it is the edge of the graft and that it is swelling and will eventually go down, the redness should improve however I may need to treat it with laser. I haven`t seen any improvement at all over the last 4 weeks. How long can it take for this type of swelling to come down and will I still see some visibility of the graft. Any feedback you could give me would be greatly appreciated as I am starting to feel quite anxious about the final result.

  Answer:  well, it can take weeks to get better, when you use a dermal graft it goes through a significant amount of swelling and it can last a while, the redness might also benefit from a course of antibiotics to make sure it is not infected. The end result will take up to one year. JG 9.25.08

• I had rhinoplasty and septoplasty 8 years ago. I have a small indentation just below the bridge of my nose and what feels like a very small ball of tissue on the outer part of my bridge. What is that dent and the ball? Also, the last time I had a cold was 2 years ago. Could something cause an inability to create mucus?

  Answer:  the ball could be scar tissue and the dent could be where too much tissue was removed. It would be really rare for a rhinoplasty to decrease nasal mucosa production. JG 9.24.08

• I had open revision rhinoplasty 10 weeks ago. The stiching on the side of the columella and inside my nose, long white pimple like lumps or bumps can be seen and felt, especially when I want to wipe my nose. whta can be done about it to get it to go away. Thanks

  Answer:  try to apply some mild pressure with a Q-tip to see if you can get them to open up and drain, otherwise the surgeon can open them with a needle for you. Nothing dangerous though. JG 9.21.08

• Hello. I had a septoplasty almost 5 weeks ago to fix a pretty severe deviated septum. 5 weeks later I still can`t breathe any better and I looked inside my nose with a flashlight and it looks just the same as before the surgery. The right side is almost swollen shut. How long does it take to unswell so I can breathe? Should I be concerned that it somehow deviated again?

  Answer:  I can take 6-8 weeks in some cases. I would give it to the end of the second month and then see your surgeon. JG 9.20.08

• Hi dr. Garcia. I had a rhinoplasty 14 months ago. I think that the middle part of my nose is collapsing. It`s becoming thinner.But I can breath through my nose though. If that part of the nose collapses(i mean the part above the tip and under the bone), does it necessarily cause problems with breathing? Because I don`t have any, does it mean that it hasn`t collapsed? Thank you.

  Answer:  collapse of the bones and valves are different and both can cause difficulty on forceful inhalation, you should g back and see your surgeon to see what is going on. JG 9.18.08

• hi dr garcia, i`ve caugth a cold and i feel a runny nose and some sneezing, it looks a little more swelling than the last week,but i don`t feel pain just like a super-cold, you think it could affect the healing?

  Answer:  I doubt it. JG 9.16.08

• I have a small crease down the center of my nose. It is not very noticeable when i am warm, but when the weather gets cold or i get cold, it becomes significantly more prominent and splits my nose down the center making it have the appearance of two noses. When i`m cold, the side of my nose on both sides produces like two bumps which causes the split down the center and once i warm up it gets less hard, softens and the split down the center is not as noticeable. It is very noticeable in certain lighting (when cold). What is the cause of this and can it be corrected. Is there some sort of topical cream that can make it disappear and have the appearance i always have when i`m not cold or is there some sort of relatively minor procedure that can be done to correct it with a quick recovery time. Thanks for your help.

  Answer:  I have to be honest and say I have never seen nor heard of that, I guess a filler could be used for when the line is there but I am afraid what it would look like when warm then. JG 9.10.08

• hello dr, do you think take prozac(fluoxetin) at 3 months poet op, could affect the nose healing process?

  Answer:  I do not think so, no. JG 9.9.08

• Hello, I have two questions: 1)Is there anything that will counteract the negative side effects of a kenalog injection, and 2)If a graft were infected, what would the signs/symptoms be? Thank you for your help.

  Answer:  As to the kenalog, no, just need to wait and see how the body responds. As to the graft, it would be red and swollen usually. JG 9.7.08

• I HAD SURGERY 27 YEARS AGO ON MY NOSE, RECENTLY I HAD A LARGE CIST IN MY MALLOXY SINUS THAT HAD TO BE REMOVE. THE DOCTOR WAS GOING TO STRAIGHT MY NOISE WHILE HE WAS IN THERE. IT HAS BEEN ONE WEEK AGO I HAD SURGERY. I`M DOING VERY WELL BUT IT DOESN`T LOOK LIKE MY NOISE IS ANY STRAIGHTER. COULD THIS STILL BE FROM SWELLING OR SHOULD I STILL BE ABLE TO SEE A DIFFERENCE NOW?

  Answer:  still too early, got to give it some time. JG 9.5.08

• Hi, you answered a question about callus after rhinoplasty last week and it really helped me. But I forgot to ask... can callus become calcified and boney and still be absorbed eventually? I`ve read that an acidic diet prevents calcification and breaks down calcium, would it be wise to increase acid in my diet? Or Vitamin D helps calcium be absorbed, should I take a supplement to increase the chances that callus will go down? Sorry i`m just panicing that I have a worse hump on my nose since having surgery. Thank you.

  Answer:  it can become calicified and boney, yes. I do not think the callus would be changed to any significant degree with an acidic diet but your bones might be affected as they have much better blood flow and cell turnover is greater. There are no supplements that will help the callus go down, sorry. Got to hang in there for a bit more. JG 9.3.08

• Dr...how difficult is a second rhinoplasty in the hands of the same surgeon? My daughter will be going back to have the remnant of the hump she originally had removed; the ps could not get as good result as he opted for due to some bleeding complications. This time he said he will refine it more, but our main concern is that it be straight from the profile view which now it is not (it bears a small bony protrusion). He said in order for him to take it down some more he would need to break it again...scary. I have thought to leave it alone, but truly the profile needs fixing. Is this relatively easy since nothing else needs to be done (no tip work, no narrowing) or is it just as difficult?

  Answer:  it is relatively straightforward to perform. JG 8.30.08

• Thank you for the answer about callus and the quick response, it has really helped me. Is there anything I can do to help increase the chance of callus going down?

  Answer:  massage is about all, best of luck with it. JG 8.27.08

• Hi, I had rhinoplasty 6 weeks ago to remove a hump from the bridge of my nose and straighten the overall look. The nose is straight but at the bridge where most of the work was carried out there is still a little bruising and a bump. The bump feels hard and my surgeon said it is possibly callus. What are the chances of this callus dispersing? Is it likely that it will go down? If it doesn`t go down can I have surgery in a year to correct it or will it form again, posssibly even worse? If you are a person that forms callus after an operation is it likey you will form it again?

  Answer:  I thik in most cases it will go down, slowly though. If it does not, in a small percentage of cases, it might need more surgery and I prefer to wait one full year. There is a possibility though that a callus will form again, yes. JG 8.28.08

• Does insurance cover any part of the fee to have tip of nose revised? What if there is hard scar tissue you want removed from the tip of the nose.

  Answer:  no as there is no functional problem involving the tip scar tissue. JG 8.22.08

• How long can you return to work after the tip of your nose is revised?

  Answer:  if no lifting is invovled 7-10 days. JG 8.22.08

• Hi Dr Garcia, I have recently had revision rhinoplasty 3 weeks ago to fix a deviated septum and v shaped indentation formed after removing a slight bump during my primary rhinoplasty. My plastic surgeon advised he had to use 4 grafts with some tissue taken from the front of my ear. A lot of swelling has come down and overall i am pleased with my nose as it is a lot straighter although I do know that cartilage has memory and it may bend again. I do however have a red mark on my nose which is not going away and a raised section on the top of the bridge of my nose which follows down the left side of my nose which is clearly visible as from one side angle it appears I now have a hooked nose. I have done a little research on the internet and feel it may be cartilage graft extrusion or scar formation. I am situated far from my surgeon and phoned to advise of my concerns to which I was informed it is early days. Is there a chance it could be swelling and will reduce in size or will it remain?? I suffered depression from my first rhinoplasty and am now feeling very anxious about this result. I don`t want a perfect nose just a nose similar to my original nose without bumps. Also I have suffered a loss of pigmentation from my primary rhinoplasty is that permanent damage?

  Answer:  I think with revision rhinoplasties that the swelling is more likely the culprit, I think scar formation can happen but it usually takes at least 6 weeks to even start forming, patience at this time is indicated. I think that the pigment loss from the first one if stil there is likely to be permanent I am afraid. JG 8.22.08

• Hi Dr. Garcia, I had my second revision rhinoplasty in January 2008. It is now August 2008 and I still have alot of swelling and my tip looks very bulbous. My doctor gave me two kenalog injections and I do not feel like it made a difference. Is this probably scar tissue? do you recommend getting another shot or considering getting another surgery to have the scar tissue removed? Thanks for your help!

  Answer:  it can be scar tissue and I think kenalog is about all you can do, repeat surgery does not remove the scar tissue as new scar tissue will form. It can be swelling and to some extent the kenalog would help that also. JG 8.15.08

• Dr 7 months ago my daughter had rhinoplasty. Initially, she had a hump on the nose and the top of the nose had almost bull-horn bony areas making the nose appear quite wide. During the procedure, the nose was broken to bring the nose width at the top closer together. She had a great deal of trouble with scarring on either side, and due to some unforseen bleeding the doc could not rasp the hump in her nose to a nice even plane. It does look much better, but now it is as if the upper part of the nose has a nice slope but we can see some bony area (perhaps that which he could not rasp enough)starting to show through now that it has been quite a while and all swelling appears to be gone. Would it be your opinion that he may try to go in and try to rasp it to a more even plane, or would you (as a surgeon) simply leave it as is and not take a chance going back in to fix it. She is rather thick-skinned and the problem during surgery was excessive bleeding when he broke the sides of the nose. Since this would not involve that, could he go in an do a closed procedure to get that more symetrical profile?

  Answer:  in some cases with thick skin I will say to leave it alone, especially on the tip, but up higher it might be worth doing a little more, best of luck to her. JG 8.15.08

• Is a minor revision tiplasty generally much simpler than an initial rhinoplasty?

  Answer:  not necessarilly. JG 8.14.08

• My nostrils are uneven. Is there an easy way to make them more even?

  Answer:  there are occasions where surgery can be done to make them look more even, usually they will end up closing them off a bit. JG 8.14.08

• Dr. Garcia- I had an initial rhinoplasty in 91` which to narrow and lift my nose. It is cute. But for years I have wanted to fix the assymetrical tip. It is as if I have 2 profiles- since from the right side it protrudes a bit and looks turned up. I have very thin, fair skin and was told the assymetry may have been due to either surgeon technique or pre-existing assymytry. Is the risk with thin skin worth trying to shave the tip to even both sides?

  Answer:  if it bothers you every day then it might be a good idea to see a surgen to see what can be done, when they explain what would be needed and the risks, then you can make an educated decision. JG 8.13.08

• taping method question. years ago after my 2nd rhino, i was told to do tape every night. so now after my third operation, i had remembered about the taping. i did not do this right after surgery it had probably been a year or little more. should i have not done taping. i feel as if i damaged my nose or pulled something out of place. i have an ear cartilage graft in the tip of my nose. could removing the tape accidentally pull the graft out of place? i can not see my same plactic surgeon as i live in a different city now. i recently heard that taping the nose shouldnt be done because it could lift the skin off of the underlying nasal structure and or dislocate grafts and rupture the suture line. is this true? if so and this did happen to me, would the outer appearance look different? could it be droopy or longer stretched out or just not as refined? thank you

  Answer:  I think if you started taping your nose one year after the surgery that it will not make anything shift or move araound. We use tape for the first week and then remove it as I have seen little help with it after that time period and it can irritate the skin, it is difficult to dislodge things below the skin after a few weeks. JG 8.13.08

• Dr Garcia, I had a rhinoplasty 7 months ago. I still have swelling in the tip and my nose is rounder looking.originally i had a defined tip and just wanted it much pointier.now it looks too round.will the tip change, i thought by now it would be close to the final result. MY Dr has advised me to have a Renacort injection into the tip, Do you think it would help, will it change the tip? or could it leave and unwanted indentation? Thanks!

  Answer:  well, if the roundedness is due to swelling it should get beterr, the tip of the nose is the last to get better, but if they put in grafts, it might not be any smaller and might stay round, impossible for me to say without knowing what they did and what you had to start off with. The Renacort will help if it is swelling. JG 8.13.08

• Hi, two years ago I had a nose surgery in which my hump on my nose was removed. Now my nose looks much wider. Do you think the surgeon did not a good job?

  Answer:  well, in most cases if a significant hump on the dorsum is removed the nasal bones need to be fractured and pushed in to close the top dorsum of the nose in order to narrow it, not sure whether that was done, it can be done now though if it was not done then. JG 8.8.08

• I forgot to ask something...I get my nasal splints taken out tomorrow (I have them on the inside) and I was wondering if that will immediately reduce some of the swelling and the nostril size? Thank you!

  Answer:  that will help a good amount, yes. JG 8.6.08

• Hi Dr. Garcia: I had a septo/rhinoplasty 6 days ago and while the bruising under my eyes is going away, my nose looks a lot bigger than it was initially. My doc and I agreed that all I needed was my bump taken out (small bump so he didn`t break the nose) and my septum straightened. We also agreed that he would bring my nostrils in because they had some flare to them especially when I smile. Anyway, I`ve done lots of research on the internet because my nostrils are so big and the part between my nostrils that hangs down is so low so you can see how big my nostrils are from my profile. It doesn`t look natural and my tip should be lower to cover up that part. Anyway, I understand that it cand take months for swelling to go down but every site I come to on the internet says you will see the end results within 2 weeks even if some of the swelling doesn`t go down for months. Basically, I feel like I have a week for my nose to change and I`m worried because it hasn`t changed much since the surgery. Thanks in advance for your help. I`m a fast typer so I could go on.....:)

  Answer:  well, without knowing more about what they did in there I really cannot tell you much, but I will say that although at this point you are quite swollen, many patients can see a sizeable change during the second and third week, the tissue will help get the swelling down, give it some time before begining to worry. JG 8.6.08

• Hello Dr. Garcia, I am about 4 1/2 months post op from an open rhinoplasty with tip graft. I am still very swollen. I know swelling is normal but by 4 1/2 months shouldn`t it be going down a little? I read some information that by 3 months post-op 80 to 90% of the swelling should be gone but then read some conflicting info that with tip work and especially with a tip graft it can take up to 6 months before any definition in the tip is apparant. What is your experience/opinion on this matter? Thank you

  Answer:  I think in open techniques it takes longer and the more work is done the longer it takes, in your case with grafts being used it adds to the time. Got to give it more time I am afraid. JG 8.4.08

• If you had yournose tip revised, how long does it usually take for the swelling to go down to notice results? I don`t know if my tip is still swollen or if not much was revised during surgery.

  Answer:  soonest change will usually be seen at 6-8 weeks, final results one year. JG 7.31.08

• Hi Dr.Garcia. Can the bones or the cartilage post op shift in a way that make the nose bigger?

  Answer:  might cause a bump but would not make it larger really. JG 7.30.08

• Hi Dr. Garcia I had a rhinoplasty 20 months ago my nose is still swollen I know it sounds impossible but I can actually feel it I have tingly sensations and the inside of my nose burns worse some days than others the way I know its still swollen is because If I tape it up before I go to bed at night the next day it looks perfect but if I don`t tape it it looks swollen definetly in the tip what do you think? driving me crazy sick of taping up my nose to get it to look good. Seems like tip has gotten bigger in the last 6 months plus I have a bump on the right side of the bridge feels like gravel in there if I press on it it goes down for a while do you think its little bone fragments and can I do something for that?

  Answer:  wish I had something to offer, hard to say without seeing you in person though. JG 7.30.08

• This is concerning the bridge of my nose= the area right inbetween my eyes. On one side it looks to slightly indent in or it isn`t as straight looking as the other side. It would need some kind of filler to fill in the slight indentation. Have you added tissue tot he side of the bridge before (I don`t knwo if the area between eyes is called bridge)? Is this a simple procedure. Can you make the incision right there at bridge of nose or would you have to make the incision inside tip of nose?

  Answer:  injecting something like Radiesse would be a good option to avoid surgery. JG 7.30.08

• Hello Dr Garcia. Is it normal to hear my bones snapping when I move my head? I had a rhinoplasty 9 months ago. I can`t remember if this was happening before surgery,I just noticed it the last few days,is it normal or not?

  Answer:  I have not seen that happen that far out from surgery. Not sure what would cause that. JG 7.28.08

• In oct 2007 i had nose tip work done (revision). Since summer started my tip swells to one side, especially when its hot. Doctor says come back in the fall for more surgery. I have had 3 surgerys already. All i have wanted is to have my nose less projected, less bulbous, and a lifted up a little. Is what is happening due to scar tissue? Will more surgery make it worse?

  Answer:  scar tissue does not come and go, as to the swelling, that is also unusual after this much time. The thing also is that you might not ever have a smaller tip due to thicker skin there and also the repeated surgeries can make achieving a thinner tip difficult at times. More surgery might help in some cases but not all. JG 7.26.08

• Hi Dr.Garcia, I had a rhinoplasty six weeks ago and still have swelling and pain and pressure in that area. My question is: when can i start exercising? Running? Could physical activity slow down the healing process? Thanks....

  Answer:  you can start now. Should be all safe now. JG 7.24.08

• Hi Dr. Garcia.....I have decided after many years to have a rhinoplasty. I have read & researched much about this procedure & although I believe you would do an incredible job, you are quite a distance from my home in the Philadelphia suburbs. Can you refer anyone in my area who you know for sure has done beautiful work & is in the profession not just for the money. I read that you referred Dr. Toriumi in Chicago, but this is also a little far for me. Thanks again!!

  Answer:  I am sorry but there is no one in that area that I know well enough to send you to and feel comfortable. Might want to look on www.surgery.org for a board certified surgeon. All the best. JG 7.20.08

• wow, thanks how fast you aswered. rally thanks Doc, i wish yo was my dc, ja.

  Answer:  all the best. JG 7.18.08

• hello DR garcia, my q is why we must avoid sneeze or cough after a rhinoplasty, it can cause bones or cartilague shiftiing or is about the swelling, how long we heve to be carefull??

  Answer:  no, it just might start bleeding and that can be hard to control at times after a rhinoplsty, need to be careful for about 7-10 days or so. JG 7.18.08

• Very soon I will be getting a Nose job...I was wondering If the procedure is normal, because I went in for a free consulatation a couple days ago, and he said his staff would call me soon to set up a date for surgery....I was wondering if this was normal, or if a second visit prior to surgery was more common. Also, is there anything you would recommend I do prior or even after the surgery...anything at all?

  Answer:  well, a second visit will be required in order to perform the preoperative visit, if you have questions then you can ask them then, or if not then a second consultation can be performed. As to doing certain things prior to the surgery, your pre-op visit should alert you to all of that, all surgeons have their special things they do. JG 7.13.08

• Dr. Garcia, I had a rhinoplasty more than 10 years ago, mostly removing excess cartilage, and improving length. The nose wasn`t broken. Doctor uptilted the tip, without my knowledge. Ten years later, it is still swollen and still seems to change shape, with an even higher bridge than pre surgery. Is it possible that swelling exists after ten years and can injections of some sort help that issue? Thank you. JMG

  Answer:  I do not think that what you have now is due to any swelling. It might require more surgery though. JG 7.12.08

• Dr.Garica, Hope you are well. I am 5 months pregnant and wanted to undergo rhinoplasty before delivery. Please advise.Also are fillers safe for pregnant women? I had restaylne injected under my eyes 3 months back but I feel it has already dimished and ready to go again. Thank you.

  Answer:  I do not think a surgical rhinoplasty should be done while pregnant. As to fillers, they have not been studied for safety in pregnant females so I would hold off on those also. JG 7.10.08

• I had a nose injury about 3 years ago that made my nose asymmetrical and ugly...i have about 5000 dollars in the bank and i would like to get it fixed now, i was wondering if 5000 is close enough..mind you i live in new jersey if that helps. also, would insurance help out at all?

  Answer:  it all depends on what it is you need, it sounds like it should be enough, but I will say that New Jersey prices are higher, close to New York City prices at times. If you have insurnace, that might cover some of the issues. JG 7.10.08

• Dr. Garcia, first I just want to thank you for all the questions you have answered for me so far. You have been a great help! I have a few more questions. I had a closed rhinoplasty 4 weeks ago and I still have a lot of swelling especially on the tip. Also I noticed that my nose is asymetrical and one nostrill is a lot thinner and a little longer than the other. The nose also leans to one side and is turned up a lot. I want to know if all this could be due to swelling and when can I expect to seen some results??? Again, thanks for all your help.

  Answer:  all could still be due to swelling, a little massage and head elevation will help it decrease, but slowly. That type of asymmetry is common at this point in time. Final results will take up to one year but you should start seeing things looking better after three months, got to hang in there for a bit. JG 7.7.08

• Does a strong TCA peel or laser work better for freckles? If you have the area lasered, will the freckle be permanently removed? What I mean is if that freckle lasered will never come back again. Perhpas a new one might come back, but will that same size freckle return?

  Answer:  a laser is better. Nothing will remove the freckle on a permanent basis. JG 7.5.08

• Hi there I had surgery for deviated septum and turbinate reduction in Feb 2008, I saw my consultant this week who advised the reason for seeing no benefit in breathing is that I may suffered a minor collapse of my nose and that I should consider rhinoplasty to fix this. 1: is this common after septoplasty to require some rhinoplasty surgery and if so wuold this be minor surgery 2: my nose is still tender after having the initial surgery (4mths now) is this normal - my surgeon said no all swelling should have gone by now. Appreciate your advice. thk u Lou

  Answer:  it is not common and it is not a minor revision to resuspend or graft the nose to help with breathing due to collapse. Tenderness can persist in some patients for up to one year. Best of luck. JG 7.5.08

• Hello Dr. Garcia, I had kenalog injected post-rhinoplasty approximately two months ago. I now have a small indentation where it was injected. I believe my PS used 0.1 ml of Kenalog 10 which I believe would be a half mg of the drug? Does this sound like a reasonable amount to you? If too much was injected, could this cause the indentation? Thank you for your assistance.

  Answer:  it is a common dose but it can still cause atrophy, what you have at this point might fill in on its own over a few months too, so give it some time. JG 7.3.08

• Dr. Garcia, I was wondering if you think that sleeping a certain way would help a little with the swelling. I`m not sure if I should sleep with my head elevated on couple pillows or sleep with my head flat?? (I had a rhinoplasty 3 weeks ago) Thanks for all your help

  Answer:  I certainly think that elevating your head above the level of your heart will help with swelling on the face, yes, and would continue it for 6 weeks after surgery. JG 7.3.08

• If a plastic surgeon that is board certified in general plastic surgery, and that surgeons speciality is hand surgery. how can a surgeon perform a rhinoplasty, or another facial surgery if they are not Facial and Reconstructive certified? How is this possible,? eventhough a proctologist is a medical doctor, it would be wrong for him to perform open heart surgery!!.

  Answer:  the certification in general plastic surgery includes all of those procedures. One can do additional training and get additional certifications but the board certification in plastic surgery includes all of that. I will say that Ear Nose and Throat specialists like to claim what you have just decribed to imply that they are the only ones that can do facelifts and rhinoplasties, etc. whereas the plastic surgeon should not but that is a self-agrandizing claim. I know because I was certified first by the plastic surgery board, the generla one, and then I was invited, one of a very small number, to take the certifying examination in Facial Plastic and Reconstructive surgery so I am certified by both. Having said that, there are ear nose and throat specialists that take a weekend course on breast augmentation and liposuction and then perform those procedures too, so they are guilty of cross pollination also. JG 7.2.08

• Hello, My PS ordered a medrol dose pack last month which seemed to be quite effective.(post rhinoplasty). He wants to do another dose pack this month. I know there can be side effects with oral steriods. I am wondering if this is common and if you think this would be ok/safe? Thank you for your help.

  Answer:  well, two dose packs is not alot,but in general it is not used post rhinoplasty as the swelling goes down in time on its own. That is pretty strong stiuff and its effects do not last long. JG 7.1.08

• Hello,Dr. Garcia! I was seen by you a few month ago. I wanted to have my nose done,but due to some finacial difficalties I had to postpone my surgery. I have been doing some reading online, and I found out that simple filler could improve the apperience of your nose. What is your take on it and do you perform this? I have a bump on my nose and I know it`s hard to tell without looking at me,but do you think it could improve my profile? Thank you for being here from all of us! Have a great day!

  Answer:  well, fillers can be used to smooth profiles out but understand that will make the nose larger, or higher if you will as the low areas are being filed up to meet the higher spots. I do perform it on patients that desire it. JG 6.30.08

• HELLO AGAIN, I tried to get an appointment with you and it`s to far off, I could be vacationing at the time or out of town on buisness. A month ago I talked to you about the un-natural look on the right side of the bridge and wanted I met with a surgeon who was two weeks off of appointments and he recomended a filler but he was not a specialist and recomended someone who charged 200 consoltation and I never booked that. Can you recommend someone who you know of who can do a good job.

  Answer:  Due to potential legal issues, and some doctors wanting to know why I referred a patient to someone else and not them, I think you are best to go to this website and look for a plastic surgeon in the area you desire. I wish you all the best. JG 6.30.08 www.surgery.org/public/findasurgeon.

• this is not a cuestion just to de grateful to take the time to help us, i am 7 weeks postop of my nose job and i`ll be snezzing some the the last 2 days, i was very worry but now i am ok wirh your answer, and in this world plenty of egoism is very recomforting find someone like you. hope the best for you. johan roberto, Italy

  Answer:  thank you for the kind words and best of luck. JG 6.30.08

• hello dr garcia, dr, how long we have to be careful with sneezing after a nose job? and how many weeks we have to wait to return to the gym??`, thanks for the answer.

  Answer:  2 weeks.3-4 weeks before the gym. JG 6.30.08

• Hi Dr. Garcia! Two questions. (1) My radix bone is higher on one side. Is there any way that the doc can make a slit on the outside of my nose (to avoid surgery) without requiring stitches and rasp that area down. Needle rasping was unsuccessful. (2) What are your thoughts on fillers for the nose. I am particularly interested in widening the lower nostrils and base of my nose and raising the dome area. What are your thoughts on restylane, juviderm, radiesse or other injectables for these TWO areas? Any referrals in South Florida? Thanks so much!!!

  Answer:  that would still be surgery and stil leave a scar. I have used fillers for the nose and Radiesse can give a good improvement in certian cases, I have no referrals for that in Florida though. JG 6.29.08

• Hi- Thanks for this service. I`ve been having Kenalog shots since my rhinoplasty to discourage scar tissue buildup. The latest injection seems to have caused atrophy in the area of the alar crease, causing it to deepen and increase in length. I`ve heard that saline injections can release the steroid crystals and facilitate regeneration of the subcutaneous fatty tissue. Is this true? If so, are there any risks?

  Answer:  I have never seen that work, in time some of the atrophied tissue does grow back on its own though. No risks to the saline injections that I have heard of. JG 6.27.08

• dr. Garcia, I had a rhinoplasty exactly two weeks ago, when I touch the tip of my nose it feels numb and looks really swolen. The tip is also turned up a lot. I`m kind of freaking out since I`m not sure if all this is normal. So my question is: is all this pretty much expected and when will the swelling start to go down? Thanks so much.

  Answer:  all normal and too early to get worried, there is lots of swelling right now and things are going to change lots with time. JG 6.24.08

• Hi Dr Garzia I`ve been reading on internet sites that because cartilage can be easily manipulated, picking the nose will in fact make the nostrils bigger especially if one had a rhino. Scientificly is that possible? Thankyou

  Answer:  I do not think that is possible, cartilage cannot be altered in that way. JG 6.24.08

• Hello, Just wondering if it is safe to get an IPL facial treatment 15 weeks post rhinoplasty? I am having no pain and the healing is thus far normal. Thank you for your help and avise.

  Answer:  should be OK to do, all the best. JG 6.24.08

• Hello dr Garcia. Can physical exertion soon after rhinoplasty lead to trauma of the nose?

  Answer:  not truly trauma but can cause more swelling than normal or desired, prolonging the time to end result. JG 6.23.08

• Hello Dr. Garcia, I recently had a post op appt. with my PS and he said that the cartilage on the left side of my nose was curved and that it may need to be released in the future. This is causing a visible bump. I am wondering if there is any way to train it to go straight? Would taping or a splint possibly work? I am about 14 weeks post op. Any advice would be greatly appreciated.Thank you.

  Answer:  nothing from the outside will do that I am afraid. No harm in taping it, but the forces of the cartilage are too strong typically to be affected from the outside of the skin. JG 6.23.08

• Hi Dr. Garcia, First of all, thanks for your service!! I am 6 weeks post Rhino/Septoplasty and have developed a bumpy texture in the supratip area of my nose. I’m so sad because I can see the what it could have been, but the area “filled in” and I have thick skin to make matters worse. My doctor injected a small amount of steroid on my last visit and plans to check it in a month. He anticipates using more after he sees how my skin reacts. I have some questions. 1) In your opinion, what is the likelihood that my supratip area can be “smoothed out” long term, 2) How long will it be until I see results from the steroid injection and do steroid injections sound like the best approach and 3) I have been reading about manipulations as a way to reduce the swelling and/or soft tissue formation, but my doctor said messaging wouldn’t help. Do you agree? And if I did manipulate/message the area will it hurt (it’s hard for my not to mess with it)?. Again thanks so much!

  Answer:  if it was smooth after the surgery and then the tip got larger after the cast came off there is a good chance it will get better in time. It might take a full year though to get back there I am afraid. Steroid injections do help and massage helps some with swelling only, but it is relatively small. Massage should not hurt anything as long as it is done lightly. All the best. JG 6.23.08

• Hi doc, The surgeon is not close. If it is scar tissue or collapse of the internal structures that support my nose, how long do I wait before revision surgery. Does this happen often? This is my first nose job. How long before I know that it is not going to come right? 6 weeks? 3 months?

  Answer:  well, if it is scar tissue it might improve over the next 2-6 months, if it is loss of cartilage and therefore lack of support, that will not get better and usually requires repeat surgery with cartilage grafts to restablish the support. It is not common, but at times can be predicted depending on what is done for the nose at the original surgery. Some people have weak valves to begin with, or even normal ones, and certain maneuvers we do while performing a rhinoplasty can cause loss of support. In many case we will put grafts in at the first surgery if we intend to perform maneuvers that will potentially weaken the valves. JG 6.11.08

• Hi doc. my nose job looks pinched on one side. That side is blocked and I can hardly breath through that side. could it be scar tissue inside? what should I do?

  Answer:  could be scar tissue or collapse of the internal structures that support your nose, hard to say without seeing and examining you in person. I suggest going back to the surgeon who saw you and letting them examine you to determine what is needed. JG 6.11.08

• I`ve been reading the posts here about kenalog and wish now that I had seen this material before I accepted the suggestion of my surgeon to inject a very small amount of this steroid into my supratip to soften some scar tissue. Unlike you, he suggested massaging it, which I did (vigorously and often). Now, four weeks later, I have a curved indentation about 2-3 millimeters in width that runs from the supratip to the nostril, just below the tip defining point, on one side of my nose. It`s also slightly hypopigmented. I am writing to learn 4 things: 1) Can I can expect to see this situation worsen significantly,? 2) If so, for how much longer will the atrophy progress? (He told me that after 6 weeks, the material is neutralized, but I am reading here that many people see such atrophy continue for many months. Am I just now, at four weeks, BEGINNING to see the damage that will continue?!); 3) Does the tissue in the nose regenerate as well as you seem to suggest that it can on other parts of the face following these injections, and if it does, how long will it typically take to repair itself? ;and 4) If the tissue does not regenerate, whether you would suggest cartilage grafts in the future (or some other form of repair). I am frightened that one side of my nose may actually collapse in time if this continues. Thank you very much for your time and compassion. You are a blessing.

  Answer:  I doubt it will worsen and actually might improve with time, but I am not so sure about the loss of pigmentation though. The atrophy can progress for 6 months in some cases. Scar tissue can reform in most locations, yes. As to what can be placed there if it does not regenerate, it varies, could be cartilage grafts or Alloderm or just a filler in some cases, got to hang in there for a bit. JG 6.10.08

• Hi Dr J I`m 5 weeks post op from a nose job. My nose has a lot of scabbing inside. Is it ok to pick it because it is uncomfortable and blocking me up? How can I clean my nose out?

  Answer:  do not pick it as it will bleed, just do some normal saline sprays and let them fall out on their own. You can use a Q-tip soaked in hydrogen peroxide at the rim only, not deeply inside though. JG 6.9.08

• Hi, I had nose surgery three weeks ago (deviated septum and rhinoplasty) and I now have an issue with my left eye. It is filling up with water and tears are running down my face. Is this a common occurance post surgery? It is very uncomfortable and I can`t see as well in that eye as a result of the water. Any suggestions?

  Answer:  many times due to swelling at the location where the tear duct empties into your nose that can happen, but it is temporary. JG 6.3.08

• Who are the top nose doctors in the country for secondary rinoplasy?

  Answer:  Due to potential legal issues, and some doctors wanting to know why I referred a patient to someone else and not them, I think you are best to go to this website and look for a plastic surgeon in the area you desire. I wish you all the best. JG 6.1.08 www.surgery.org/public/findasurgeon.

• Hello dr Garcia. I`d like to ask you: if a suture has broken or a bone or cartilage is shifted or it`s about to, is the surgeon able to tell? I had a nose surgery nine months ago and I have noticed some changes in my nose. I went to my surgeon and he said that everything is fine. (He is a top surgeon in my country ) I would really like your opinion. Thank you.

  Answer:  it is not always something we can tell from the outside unless there is a large amount of motion. JG 5.30.08

• Hi Doc. I had a nose job 3 weeks ago. There is a smell from one of my nostrils and it still blood in it when I clean it, not dry blood, fresh blood. Is this normal? Also when can I wear sunglasses?

  Answer:  all normal and we allow patients to wear sunglasses in 4 weeks. JG 5.29.08

• thanx for the answer dr, must i leave the dr corrct the problem or i must search another dr, the dr is an ENT and he said thas the asymetry is beacause he corrected the bend and this is why mi nose looks crooked,and he daid my surgery was very well, but i don`t see the swolen is better, i see that the same,what to do, other surgeon or the same, sorry i know you ar a busy man, thanks for youre help. the south american...

  Answer:  if the doctor does not see the problem, you might need to be seen by someone else. JG 5.26.08

• Hi Dr Garzia. This not a question but rather a quick thankyou for your help and advise much appreciated.

  Answer:  you are very welcome. JG 5.26.08

• hello dr garcia, you`re a kind person, who cares about other peoples problems, dr, if i smoke 2 days before the rhyno, how it can afects the recovery progress?

  Answer:  it will slow it down some, but it will not make as much of a difference as in a facelift. JG 5.26.08

• hello dr Garcia, sorry formy english, i`m from south america, and i`ve foudn your page too intresting and too helpfull,dr, i have had my rinoplasthy 2 weeks ago and mi nose look bend to the left side and the rigth side is swollen,the nose looks asimethrical looks so bad,like crooked, must i worry or is it normal?one nostril looks bigger and down than the other, what can i do, maybe some kenalog, here i kwow it like kenacort.thaks for your time, believe me, your page it`s the only one helpfull, this is why im here, thanks

  Answer:  I am afraid that what you describe is going to need more surgery. JG 5.26.08

• Doc,I posted a question and u replied right away. Thank you. U said that u doubted that the hit could have pushed the silicon out or get pressed down since it is sitting directly on the bone,tendency is,for the bone to block the silicon from goin down,is that right? doc,do u mean that there is no way that a hit, regardless of the amount of force,can change the height of the bridge. Because 1 surgeon told me that if the nasal bone gets broken then it could bring the silicon`s height down. How do u really know cuz i had two pretty massive hits. Also i have got some swelling along the lining of the silicon (around that area) is it because the force made the silicon injure the tissue around it so they got traumatized or something? Does it take long for the swelling to go away? Thank you for your time.

  Answer:  it could have broken the bone, but if you say it goes down wen you press on it and then it rises up again, it is not a broken bone issue it is a temporary displaceemnt of the silicone and then it returns when the pressure is relieved. JG 5.24.08

• I HAVE NOT EXTRA FAT ON ME, BUT MAYBE I WILL AFTER I GET PREGNANT. IF I DO HAVE EXTRA FAT THEN TO USE, HOW LONG WILL THE FAT LAST IF IT IS INJECTED IN BUTTOCK CREASES? i WROTE THE QUESTION ABOUT TOO MUCH FAT BEING REMOVED DURING LIPOSUCTION.

  Answer:  it might last a few years. JG 5.22.08

• Hi Dr. Garcia, My question is: How long does it take to go back to work and back to normal after a rhinoplasty?

  Answer:  back to light duty in 1-2 weeks and full duty in one month usually. JG 5.21.08

• Thanks for the information. I`m not to concerned with the collapes because I really dont see that in the mirror,and Main concern is the bridge and to get the right side looking natural like the left side, so I guess a filler is the way to go. When is the soonest you can have a look at my nose?

  Answer:  you would need to call the office. JG 5.21.08

• Hi dr Garzia Hope you can bear with me. To start with iam 4 years post my rhino and really not pleased at all. I have thick skin and its as if with time my nose began looking less and less refined and somewhat fat, If this is due to scar tissue curious to know is there a way i can know what scar tissue looks like because nothing in my nose seems to have changed at all. Also prior to my rhino i asked my ent surgeon if he could reduce the size of my nostrils and he said he could not. Is that due to him being incompetent or simply other reasons. Can a revission rhino make a substantial difference in your opinion. Thankyou greatly.

  Answer:  at this point it is all due to swelling, not scar tissue, that takes time to form. In terms of reducing the nostril size, in some cases the base of the nose or the lateral part of the nose can be reduced some, it involves an external incision and can be done in many patients. As to a revision of the rhinoplasty, I think you should wait 10-12 months and let the swelling go down so a surgeon can evaluate your tissues and see what can be done to improve your appearance. JG 5.21.08

• Hi dr Garzia Hope you can bear with me. To start with iam 4 years post my rhino and really not pleased at all. I have thick skin and its as if with time my nose began looking less and less refined and somewhat fat, If this is due to scar tissue curious to know is there a way i can know what scar tissue looks like because nothing in my nose seems to have changed at all. Also prior to my rhino i asked my ent surgeon if he could reduce the size of my nostrils and he said he could not. Is that due to him being incompetent or simply other reasons. Can a revission rhino make a substantial difference in your opinion. Thankyou greatly.

  Answer:  I am sorry, the previous posting you made I thought you said 4 weeks, at four years I think it is enough time that you can see a surgeon for a discussion about the revision, and in many cases the nostrils can be made smaller but it involves external incisions and I will say that in thicker skinned individuals, making the tip smaller is not always possible. JG 5.21.08

• Hello, Do you think you can fix my nose and what would be the plan for it? I had the rhino about 15 years ago and I think it`s beginning to show. Over the years I sometimes dont think twice about it and now after some conjestion when it calms down it actually fills in the bridge slightly to even it out with the left side bridge. Then later it looks plstic and I might as well stay inside. Over all it`s a borderline acceptable rhino because it is not natural looking on the right side bridge. Is there such thing as just filling it in on the right bone with maybe some calcium injection or does this require a skin graft? Do people think I do cocaine because of this nose even though I never have? Recently I noticed a very high definition picture of myself and never realized the left lower nose looked a bit collapesed. I dont even see that in the mirror why did this show up in that picture?

  Answer:  I do not think a skin graft will help and at times fillers can help it. It sounds though that with the collapse you will need something surgical and involved, not an easy operation I fear. JG 5.20.08

• I just have a question for you. I had a rhinoplasty to augment my nose 8 months back. The doctor used silicon for the bridge and cartilage to project the tip. Weeks ago my sister accidentally lost her grip on the cellphone she was holding and it fell on my nose head-on as i was lying on her lap. Could that have affected my nose in any way? I have got a hump but I don`t know if it was because of the hit because I never really paid too much attention to my nose before. Also,does the silicon sit on the nasal bone and is very secured or just on the tissue that any hit can make the silicon dig or get pressed down into the tissue making the silicon bridge`s height go lower? Because I am really concerned about this since having my nasal bridge augmented is the reason why I got the surgery in the first place and I`m just concerned that that hit could have affected it. Thanks a lot. Hope u can help me clear my mind. I have read somewhere that silicon could migrate, that is, it can deviate to the left or to the right, but can it go down by force and decrease the height? because one doctor told me that it won`t since it is sitting directly on the bone of the nose so it wont go down cuz it is seated on the bone. but is it true that the silicon sits directly on the bone of the nose so there is no way it will go down even after a hit..that only it can slide to either side but not go down? Thanks.

  Answer:  In most cases it will not cause any problems, it can cause some swelling or brusing but that goes away in time. The silicone is placed in a pocket and typically is not secured with any sutures or anything like that. I doubt the injury would push the silicone out or down. Normally we place the silicone directly on the bone, yes. JG 5.19.08

• Hello, I have posted several questions before and would like to thank you for your time and help. I had septo-rhinoplasty with a septal tip graft about 9 weeks ago. The swelling is not any better and in fact my nose is bigger than it was at about 2 weeks post op. Also, when I touch the supratip and tip area it feels squishy. Almost like a water blister would feel. Does this sound like normal swelling and will it eventually go down and get smaller? Thank you.

  Answer:  I am afraid it all sounds normal, it will take months for the swelling on the tip to get better, give it some time. JG 5.18.08

• Hello dr Garcia. Are columella grafts safe?

  Answer:  in most cases, yes. JG 5.16.08

• Iam quite relieved that it is not necrosis because the colour is not black. Just to mention that I am the one with post op nostril widening. I hear some pop in my nose and the the nostrils get wider. It has happened about ten times within this 11 months. Could this have caused the damage? And what doctor should I see, a dermatologist maybe? Thank you.

  Answer:  I do not think there is any damage, might just be some scar tissue loosening up. All I can suggest is seeing the doctor who did the surgery, they would know the best as they have seen your nose before. JG 5.14.08

• Dr Garcia. I am 11 months post op rhinoplasty.I think I have skin necrosis. I visited two doctors, a plastic surgeon and an ent surgeon and they didn`t find anything. The skin around my nostrils becomes a yellow crust and falls, resulting in more nostril show. Is there any case that they didn`t find out because it is very rare?

  Answer:  I am not sure what is causing it, I do not think there is any necrosis as that would be deep blue or black. Not sure what is going on in your case, sorry. JG 5.14.08

• Hi Dr. Garcia. The bones of my nose feel hot. I had a rhinoplasty before 10 months. What it may be?

  Answer:  hard to say, I do not think it is related to the previous surgery unless an implant was placed and has gotten infected. JG 5.13.08

• Hello dr Garcia. I am 10 months post op rhinoplasty. A very thin fibre has comen off my right nostril. That must be a suture, right?

  Answer:  it certainly could be, some sutures placed in the tip can take months to totally dissolve, should not have any repercussions from it coming out though. JG 5.12.08

• Hi Dr. Garcia: I was wondering why Kenalog-10 must be injected into the nose to be effective, but Kenalog cream, if rubbed into the nose following rhinoplasty, is not effective? Why is Kenalog cream, then, prescribed for swelling, such as hemorrhoids? Thank you, Doctor.

  Answer:  the medication would be absorbed into the blood stream and not reach the tissue below the skin if applied onto the skin directly. JG 5.12.08

• Hi Dr. Garcia, I am just curious as to how long it takes scar tissue to form. Is it possible to determine if scar tissue if forming vs. normal post-op swelling? Can anything help prevent excessive scar tissue formation? Thank you for all your help.

  Answer:  it starts after one day but for it to be true formed scar tissue it will take at least 6 weeks to consolidate. Once the injury has occured, avoiding excessive bleeding is about the only thing that can be done in terms of prevention. JG 5.10.08

• Hello dr Garcia. On the first days after my rhinoplasty I wasn t very careful and I had some activities. I am now two months postoperatively and everything is ok with my nose. I am worring if this can cause any problems in the long run. Thank you.

  Answer:  I do not think there has been any damage if you have not seen it by now. JG 5.8.08

• Hi Dr. Garcia, I have several questions/concerns regarding recent (8wks ago) open rhinoplasty. I had a septal tip graft to fill a dent on the left side and a bump rasped off on the right side and septoplasty. My breathing is much improved. However, my nose is more swollen now than at two weeks post-op. My PS injected dilute kenalog into the supratip area which has decreased the swelling in that area quite a bit. Now, the very tip of my nose appears even larger and from the side it looks like the tip is sloping upward more. Would it help to inject kenalog into the tip to help bring that down? When would it be safe to get another kenalog injection? How long does it take for kenalog to begin working? Thank you so much!

  Answer:  I think it best to let nature take its course so that the kenalog will not affect the graft that was placed. Kenalog typically takes a few weeks to start to work and continues for weeks after. JG 5.8.08

• I developed a callous after rhinoplasy. Will this go away on its own or will it have to be removed?

  Answer:  if still there after one year it will need to be removed. JG 5.8.08

• Hello dr Garcia. I`ve posted again about my nostrils` reduction that are getting wider and wider post op. I visited my surgeon yesterday and he said that everything is ok, but I think he is just too optimistic or inattentive. My nostrils are getting wider and pull the whole nose. Can this lead to skin or tissue necrosis because of the exerted force?

  Answer:  there should not be any necrosis, no. JG 5.7.08

• thanks for all the advice. Have you or have you had a paitent or have ever heard of a revision rhinoplasty that could regain the appearence of a Roman Nose from a previous surgery that left the nose small and upturned.

  Answer:  it will usually require a graft of some sort but it can be done, yes. JG 5.6.08

• Dr. Garcia, I had rhinoplasty done in Sep. 2004. My plastic surgeon has been using Kenalog-10 to try and soften the tip; he claims that even after 4 years the steroid will reduce some of the residual swelling. I`ve been to him for 2 injections spaced 6 weeks apart, but I have noticed no substantial differences, although there may have been a slight reduction. Would using a higher dose of Kenalog be helpful? I asked him about this, and he said atrophy might result. What are my alternatives at this point?

  Answer:  I think at this point the changes will not occur in most patients. JG 5.6.08

• Hello Dr Garcia I have been very interested to read the letters on your website and would really value your advice on a problem I am experiencing with cellulitis. I had a rhynoplasty operation two years ago to correct a childhood accident and had a nasal implant fitted. There were no complications whatsoever with the first operation however although i was happy with the bridge of my nose it accentuated the fact that one nostril was much bigger than the other. I tried to get used to this but after a couple of years I decided to go ahead with a revision septorhynoplasty which took place at the end of Feb 2008. It was a minor operation compared with the first op and on the whole I am happy with the outcome. The surgeon had to shave part of the implant so that the nose became more asympetrical. The week after the op when I went for plasster removed there was an angry red mark on the end of my nose where the implant had been shaved. The surgeon said to keep an eye on this and visit my gp if if it didn`t improve. It did seem to get worse but then after I had applied sudocrem the inflamation went down. However, just over a week ago the same area became inflamed and I thought I had got sunburned. I visited my GP and he has said that I have cellulitis. The area has a blueish hue to it like a bruise and a yellow blister/boil formed which has burst and lots of puss has come out of it. I have taken five days of penicilin antibiotics and have another couple of days to take. Do you think that it is likely to calm down ? Having read lots of information on the net I am worried that I might have to have the implant removed.

  Answer:  more likely the implant will need to be removed to allow the infection to abate, and then replace it in 6 months I am afraid. JG 5.6.08

• Dr. Garcia, I am about 2 1/2 weeks post-op from a revision rhinoplasty (open) and septoplasty. My first doc did a closed rhino and and the results were miniscule (my nose was still too big from the profile and I didn`t have much space between my tip and upper lip when I smiled as the tip curved over). My second doc shortened the actual length of the nose (I guess by pulling the collumella up?) and turned the tip up a bit. From the front everything looks good, but from the profile my tip still goes out too far. It feels really numb...could it be swelling and if so, how many milimeters? I`m hoping it will shrink at least a couple of milimeters but I`m not sure if that is possible. I`m kind of depressed because I spent so much money on the revision and nose still looks too big from profile. Is 2 1/2 weeks too soon to be worried about final outcome? Thanks so much.

  Answer:  way too early to tell, it should shrink quite a bit over the next few months. JG 5.6.08

• Hello dr Garcia. Revision rhinoplaty,alar base reduction, bones will be rasped and not cut. In your opinion, can this surgery be done by local anesthesia and without splint?

  Answer:  in some individuals it could be done under local anesthesia and if the lateral nasal bones are not cut the splint might not be needed, but it does help lessen swelling in some cases. JG 5.6.08

• Is the splint necessary after rhinoplasty? I am going to have a revision and I don`t want my parents to find out. Thank you.

  Answer:  if the bones are going to be manipulated I strongly suggest it. JG 5.4.08

• Is there any medication to reduce swelling after nose surgery?

  Answer:  Medrol pack can help. JG 5.4.08

• hello, i had a question the issues of skin falling loose post nasal surgery? i had rhinoplasty surgery and the skin was tight on the bone in the bridge area, tip, and around the nostrils. Since the sugery post 2 years, the skin has become really loose and fallen off line espcially around the nostrils. I used to massage the tip to make it less pointy would touching it over time do this or does this naturally happen over time after a rhinoplasty. I am scheduled for a revision rhinoplasty what techniques or what not to do, to prevent this from happening again and to keep some refinement to the nose?

  Answer:  I have to say that I have nor heard of tha being a problem after a rhinoplasty, sorry, not much I can offer. JG 5.3.08

• Is it unusual for a ps not to ask a patient to come back for follow up in several month. I am asking because upon my suggestion my daughter went back to see the PS about her rhinoplasty...we are about 5 months out, and due to my concerns I asked her when her PS would like to see her again. She said he never said. She also never asked. She thinks that his attitude was basically still healing, and let me know if you have any problems . Is it customary for you to tell your patients (after rhinoplasty) come back in 6 months, 1 year, etc . I think I am reading too much into this: he knows it did not turn out so well, and out of sight, out of mind attitude. I hope I am wrong. What is your take on this situation? And also would you consider evaluating what has happened even though we know you do not do revisions?

  Answer:  I think seeing the patients at 3-6 months and then again at 1 year is the standard follow up. Hard for me to tell why the did not ask the patient to come back, it would be all speculation. I could see her, but without the operative report and the before pictures I may not be able to tell much. JG 4.30.08

• Thanks for all your help, now one more question! If Radiesse has been injected, but didn`t do as well as expected, can Restylane be injected in the same area (nose in this case) after a month or so?

  Answer:  I would wait at least 8 weeks to allow the carrier gel in the Radiesse to dissolve. JG 4.28.08

• Does Restylane stay where you inject it better than Radiesse (for injections in the nose) or does Restylane have any advantage in this area over Radiesse other than the fact that Radiesse lasts longer? Thanks.

  Answer:  it does stay, it lasts likely a little less time than Radiesse but can be injected more superficially than Radiesse. I think for the nose it might be wise to use the Restylane first to make sure what is needed can be accomplished with a lesser longevity filler and then move to the Radiesse if it works well. JG 4.28.08

• Dr Garcia, I am wondering at what point (6 months, 1 year)does a PS entertain the idea of touching up a rhinoplasty. I have posted before and said that my daughters rhinoplasty appears to have profile problems. It is almost as if the tip comes too far away from the face and the profile has an almost very elongated S curve to it. The most bothersome part is that the PS has not had anything to say other than he thinks it is still healing. Is there something he knows that we don`t (like maybe he knows that in another 8 months it will not have that look?). I don`t go in there and make any presumptions or say it looks like this, or that because I assume he is the one who would tell me if he thinks this will need to be revised. Am I wrong? Should we bring this up?? This is very uncomfortable situation for us because he has done such fabulous work for so many people we know (not rhinoplasties, though). Shall I wait it out or address something about it ASAP? Thanks so much and sorry for all the questions. Good day.

  Answer:  I think for rhinoplasties most surgeons would like to wait 12 months. I think at that time, honesty is the best policy, ask to have the before and after pictures printed on the same piece of paper and then discuus what has occurred and what he suggesst could be done for further improvement. Best of luck. JG 4.28.08

• Thank you.

  Answer:  you are very welcome. JG 4.25.08

• Read the one on the top,I have made a correction.

  Answer:  OK.

• SOS! I had a rhinoplasty 9 months ago and nostrils` size reduction. But my nostrils are spreading day by day.( I have posted again about it). But as they pull the nose, me small pieces of tissue are falling, i mean they fall off, I can speak english very well i`m sorry, I hope you understand what i am trying to tell.A quite big piece of tissue is about to fall! i can`t visit my doctor because he is in another town right now. I don`t know what to do. Thank you very much.

  Answer:  I think just try to keep some antibiotic ointment on the piece inside and see your doctor as soon as he returns. JG 4.25.08

• How long does it take for swelling to go down after surgery on the nose tip? If you only had one side of nose tip done, would your nose be swollen just on one side?

  Answer:  the swelling will extend to the other side and it can take a full year to go down all the way. JG 4.23.08

• When injecting Radiesse in the nose to fill a depression, should the needle be placed within the depression, or just under the area? I hope this question makes sense!

  Answer:  under the derpression. JG 4.20.08

• I don`t know what the cartilage inbetween your nostrils (at bottom of nose)is called. With some people, that tissue curves over. Do most plastics surgeons shave off the cartilage there so it is straight instead of curved? I did not ask a plastci surgeon to shave it down, but he said it was considered a defect. However, I thought it made my nose look more natural since people who don`t have nose jobs have that curved cartilage there. Again, just want to know if most plastic surgeons consider this to be a defect so they shave it. And if it is shaved, is it hard to add cartilage back to make it look like it used to look?

  Answer:  it depends on what the patient desires it to look like. JG 4.19.08

• Dr Garcia, in the event that a revision rhinoplasty needs to be done, since you no longer do them, can you recommend anyone in LV that would have a great ability in this area? If not LV somewhere close, Utah/California. I am hoping things resolve in one year, but just judging from right now, it almost seems impossible. This seems so depressing after having spent so much money initially.

  Answer:  Due to potential legal issues, and some doctors wanting to know why I referred a patient to someone else and not them, I think you are best to go to this website and look for a plastic surgeon in the area you desire. I wish you all the best. JG 4.19.08 www.surgery.org/public/findasurgeon

• Hello, I am very interested in ethnic rhinoplasty.I am a 26 year African American Female. I would like to know how many of rhinoplasties have you performed on African Americans and what is the average cost of the procedures.

  Answer:  I do perfrom it but I cannot give you a price unless I see you and deiscuss what all needs to be done as that will affect the fees. JG 4.17.08

• Thank you so much for addressing the swollen nose tip concern. Assuming that this is not just swelling, and it is scar tissue what can be done/injected to soften the scar tissue, and would it not be a more proactive approach to do this soon, rather than to see what it all looks like one year later?

  Answer:  kenalog injections might help a small percentage, but nothing dramatic. JG 4.15.08

• Hi Dr. I recently addressed a question of swelling at the tip of the nose since my daughters rhinoplasty. In looking at pictures taken about 2 months after the surgery, I noticed it seemed LESS swollen then, than now. Is that possible? Could this be due to the fact that she is constantly picking it because she says she blows her nose and nothing comes out. Last week she had her follow up with her ps and he seems extremely unconcerned...says still healing. Why is it that it is taking so long for this to get a final result. She does have thick skin, and we were told from the beginning that this type of skin does have its drawbacks. Is this one of them? It is making the profile look strange.

  Answer:  if it is larger now than at two months, then it is likely scar tissue and not swelling and the swelling would not increase after two months. It takes a long time to see the final result because the tip swelling only goes down when you are flat on your back. The thicker skin on the tip is certainly aggravating the issue. JG 4.15.08

• Dr., at what point does an ethical/professional ps admit or consider that a rhinoplasty has not had the desired effect and will he usually redo it at no cost? The profile still bears a hump, more on one side than the other and the tip is, in my opinion, still swollen causing a very off looking profile (almost like an elongated/horizontal s , but subtle). At this point the nose does not have a nice straight plane. Should we point these things out or would a surgeon who is ethical and professional do that himself. Seeing the surgeon this week, for follow up, and surgery was done 4 months ago. I don`t know how important this is but the front view looks rather good...just the profile seems to be askew. Thanks so much. I am hoping not to have to come up with any more money.

  Answer:  well, fisrtly, it might take a full year for all to settle in and heal, secondly, if it still looks that same after that time, in most cases the doctor want you to be happy and if he thinks it can be altered safely, they will usually go ahead and do it, all doctors have policies on touch ups though and some offer it for free while others offer it at a reduced fee. I wil also say that some desires the patient wants are either not able to be achieved due to underlying structure problems or are too risky, but they should be able to explain that to you. Best of luck. JG 4.14.08

• Another question about Radiesse in the nose! Can Radiesse somehow attach to old scar tissue from previous surgeries, always stay there and not dissolve completely like in the rest of the nose? In other words, make the scar tissue bigger and never go down like it was before the filler injections? Thanks!

  Answer:  it is highly unlikely that it would not dissolve in time. I do not think it will make it permanently larger than it was before the injection. JG 4.8.08

• Dr Garcia, Thank you for answering so quickly! Would you mind answeing the first part of my question? Do you frequently see asymmetry of the nose after a rhinoplasty during the healing process? My left nostril is higher than the right and it also seems more swollen on the right side of the nose.

  Answer:  sorry, I thought I had, yes, it is almost universal to see asymmetry. JG 4.7.08

• Dr Garcia, I was wondering your thoughts on asymmetry of the nose after a rhinoplasty during the healing process. My left nostril is higher than the right and it also seems more swollen on the right side of the nose. My doctor told me asymmetry is normal during the healing process, but while doing research I did not find this was a common thing mentioned. I actually found most research stated 80 percent of swelling should be gone by the 3-4 week. I am now 3 weeks post op and the asymmetry looks the same to me. I went to someone HIGHLY recommended and very costly so I am hoping this resolves. What is your input on this? Thank you so much! AE

  Answer:  I have been doing rhinoplasties for over 20 years and I think the swelling will decrease but it will not be by 80% in 3-4 weeks, more like 6 months, especially on the tip, there it can take a full year to resolve. Give it some more time. JG 4.6.08

• In December my daughter had rhinoplasty to remove hump and just relatively large nose. There has been great improvement since the bridge of her nose used to begin quite prominently between the eyes. It now has a nice slope, but the tip continues to look swollen to me kind of ruining the effect of the slope. She is very thick-skinned and I understand this has something to do with the swelling aspect and thus the final outcome. Also, she is constantly picking at her nose because she says she feels like there is always something in there which bothers her, but I say she should stop because she could be causing the tip to stay swollen/scarred somewhat. Am I correct, and how long do you think we should wait before approaching the ps on this matter. Thanks.

  Answer:  you are correct on all of it, it wil take time, up to one year to get it all to decrease, and irritating it will make it stay swollen longer. JG 4.6.08

• I have had two rhinoplastys and my tip is still a bit bulbous and I have quite a bit of scar tissue that makes it even bigger. My second rhinoplasty was about three years ago. I have heard that kenalog injections can help with scar tissue. Is that true? or is it too risky to have a third rhinoplasty?

  Answer:  to a small degree, yes. I think the difference from a third rhinoplasy will likely be quite small to none. JG 4.6.08

• I have another question about Radiesse in the nose. Can manipulation of the area after injection cause it not to work as well? Also, does the same hold true for lifting heavy weight or exercising heavily after filler is injected in the nose the same as it does for rhinoplasty? Thank you for your help!

  Answer:  it will flatten it a small amount, but not to flatten it totally. I do not think lifting will shift the Radiesse. JG 4.6.08

• Shifting of the cartilage too?

  Answer:  possibly. JG 4.5.08

• Dr. Garcia,It is said that strenuous activities such as jogging and lifting heavy objects should be avoided for the first days after rhinoplasty.What can strenuous activities cause?

  Answer:  bleeding and shifting of the bones, and excessive swelling. JG 4.5.08

• Dear Dr. Garcia, I had rhynoplasty and septoplasty four month ago. There`s still considerable oedema iside of my nose. I was prescribed a nasal spray synarel (gonadotropin-releasing hormone analogue ) for the treatment of Endometriosis. One of the side effects is an irritation of nasal mucosa. Given that I still have post.operative oedema, is it safe to proceed with this spray? ( I didn`t yet start a treatment ). Thanks

  Answer:  the spray might make it all worse I am afraid. JG 4.5.08

• About 14 months ago I had Radiesse injected in my nose to correct deformities from a botched nose job (the surgery was for deviated septum and cosmetic as well). The plastic surgeon who administered the Radiesse did an excellent job. I never thought my nose would look that good ever again, so I was very happy with the results. I went back to see him in March and he did a follow-up. The result was not good. I went back a week later and he injected a little more in another area to try and counteract what happened from the week before (he didn`t inject in the same place on the 2nd visit). It appeared to help slightly but now it seems all the good he did over a year ago is gone and the look is regressing. Actually when I went in March for the follow up I was satisfied with what I had, but felt I could have used a touch up. I have scar tissue in my nose and I`m wondering if it reacted negatively with that? It didn`t before however, so I don`t know. I am supposed to go back the end of April, but now am almost afraid to. I know he knows what he`s doing as he is very well respected and a good surgeon. I just don`t understand what happened. Any thoughts?

  Answer:  injections into the nose can be very tricky due to the scar tissue from the surgery, I think the material can be hard to get to stay in one place and having a good result one time is no guarantee it will go as well the next time, I think small touch ups are a reasonable thing to consider though to get it smoother. JG 4.3.08

• If it the sutures were the problem, the surgeon would have seen it? Thank you for your attention and thank you for the website, it is very infomative.

  Answer:  in most cases they should. All the best. JG 4.3.08

• Dr Garcia, I posted a question before about my nose not been stabilized. If the sutures accidentaly break earlier, the negative effects appear immediately and the doctor can find it out when examines the nose, or in the begining everything seems ok and then gradually the shape of the nose changes? My doctor had seen me on day 7 and also one month post op and said everything is ok, but it isn`t. Could the cause of the problem be an early suture breaking?

  Answer:  the bones are not held in place with sutures so that cannot cause it, cartilage can be sutured to maitain its shape but not its position, so I do not think sutures are or were the problem. JG 4.3.08

• Dr Garcia, I had a nose surgery 7 months ago. The problem is that my nose is not stabilized at all. I had facials some days ago and the shape of my nose changed. Just a little pressure on my nose and it changes. I don`t think that it`s just a swelling movement. What can be the cause of that? Thank you.

  Answer:  the bones might not have healed well enough and they are floating. Not sure what they can do though. JG 4.3.08

• Do you recommend and do you perform nose implant? I am asian wanting a little bridge. Have you perform this procedure befORE?

  Answer:  I have used Gortex for that purpose. JG 4.1.08

• Dr Garcia, I had a rhinoplasty 8 months ago,including nostril`s width reduction. I noticed that gradually my nostrils are getting wider,as time passes. Is there any case than the sutures broke? and if so, could this cause any furher damage to the rest of the nose? Thank you, and sorry if my english is not so good, but I am from Greece.

  Answer:  they can break but in most cases tissue is removed at the same time to prevent that from spreading. It should not cause any further damage to the nose though. JG 3.26.08

• Which is better in revision rhinoplasty for heightened definition to the nasal bridge... A Rib Graft or a Goretex implant?

  Answer:  I feel the Gortex is better as it will not warp. JG 3.25.08

• Dear Dr. Garcia: Is is true that, other than a tiplasty, there is no other medical alternative other than Kenalog for reducing swelling in the nasal tip area? Is there anything available to thin out very thick nasal skin, and would repeated injections of Kenalog over time actually thin out the nose? Thank you.

  Answer:  I do not think it will help thin out thick skin, it might help soften scar tissue ia about all. No other options I am afraid. JG 3.10.08

• Dr. Garcia, I`m a male who had a rhinoplasty in Sep. 2004, but the tip has remained very bulbous. My surgeon injected a little Kenalog in the middle area of the nose, just above the tip, to try and make my profile more linear. Do you know, on average, how long it takes (if at all) for the area injected to thin out? Also, is there a way to change the size and angle of one`s nostrils without doing a revision rhinoplasty, or is it necessary to bring in the skin over the nostrils? My nostrils don`t have a specific shape to them, and I would like them to be more defined. Right now the nostril shape resembles a very wide upside-down letter U. Carl

  Answer:  if it is going to help it likely takes 4-6 weeks but many times one shot is not enough. The only way I can see to change the nostril orientation without surgery would be a filler to the tip to elongate it but it will make it larger too. From what you are describing I feel that your desires will likely never be met, the skin on your nasal tip is probably thick, that will limit much of what is troubling you, and there is not much that can be done for that and repeat surgeries can thicken it with more scar tissue. There are limitations to the end result that can be predicted before the inital operation. JG 3.8.08

• Earlier I asked a question about narrowing the nose. I said that I had hump removed in 2000, but I am sure they did nothing else. It could be narrower, not just up high, but from the middle to the tip. Is this possible or too risky due to scar tissue enlarging it there afterwards, defeating the purpose? thanks

  Answer:  nor risky, I do not think there will be much scar tissue making it worse. JG 3.8.08

• I had rhinoplasty surgery in 2000 to remove hump. I am happy with profile. Could be a little narrower though, but from reading other posts here, it seems like this may not be possible due to scar tissue causing swollen look. Is there a way to tell if the problem is scar tissue or not. If I could tell or ask the proper questions upon being evaluated , it would certainly help. Is one just throwing the dice when having rhinoplasty, if scar tissue formation is an unknown factor that could leave one worse off afterwards? Thanks

  Answer:  no, it is possible, but it will require your nasal bones to be broken in order to narrow the bridge. At times when the hump is taken of, some doctors will not break the bone to narrow the bridge and then it needs to be done later. JG 3.7.08

• Hi, Dr. Garcia, I`m want to have rhinoplasty but afraid that I have yet to find a surgeon I feel confident about. I was wondering if you know a surgeon in the bay area, northern Ca, who has expertise on Asian rhinoplasty? Also, I want to know if Gore-tex is better and safer to use to build-up bridge in an Asian nose over silicone because I read contradictory reports from different surgeons, some say that some patient’s don’t develop immediate reaction with the implant and has satisfactory cosmetic results during the first years. However, because of the force exerted by the hard silastic silicone implant on the nasal tip it results in pressure necrosis and eventual migration of the implant upwards (pig nose look) . I`d like to know your take on this? Thank you.

  Answer:  I prefer GoreTex and may you can see Dr Sam Kao, best of luck. JG 3.4.08

• Hi DR. Garcia. I would like the tip of my nose to be a little more up. Can that be achieved with restylane? Just wondering because the tip is so much thicker than the rest of the nose. Thanks in advance for your reply.

  Answer:  possibly but it would need to be made larger at the same time. JG 3.2.08

• In Dec. I had rhinoplasty. I thought that it was kind of crooked so I was massaging it to train it to become straighter. Now, there seems to be a white sore on the tip of my nose. I saw my doctor and he said it may be caused by pressure. He said that if I was massaging it there might of been bacteria still around the implant and that it might of inflamed it. That is why it is red around the small lighter colored sore on the tip. He gave me antibioties to see if that will work. Or he said he may have to take out the implant. Have you encountered anything like this... also, do you think the sore is temporary????? What can i do to help it heal??? I am really worried that the implant will need to be removed. I love the way it is right now.

  Answer:  well, I doubt you caused any of the problems, it is well known that that nasal implants that extend to the tip will occasionally break through the skin due to pressure from the implant and in those cases they have to be removed. I would finish the antibiotics and not massage it and hope for the best. JG 3.1.08

• hi dr, i had restylane injected into my nose and it has been 4 months and im wondering how long the restylane can still be there for? does it usually start dissolving right away and by 6 months be gone, or does it START to break down after a few months and then rapidly go away after that? Can you explain?

  Answer:  it might take a year in some people for it to dissolve. It stays stable for a long time and then when it starts to dissolve it goes fast. JG 2.28.08

• I was the one writing about the fillers injected into my nose, I was unhappy with the outcome How long will Radiasse (sp) last? And what about that sore bump. Will it go down and should I do anything to speed the bump along. Thanks.

  Answer:  it can alst a year at times, and in some cases longer, but the gel carrier dissolves in 6-8 weeks so there should be a reduction after that time. Not mch that will speed it along though. JG 2.24.08

• I had revision nose surgery, and after the dr preformed the surgery, it he injected some filler in a follow up. Mainly between the eyes at the top of the bridge to facilate my wishes of wanting a very youthful cute nose. I was very unsure, but it did make it more youthful. I had a follow up appt two days ago (9-10 monthspost op) He wanted to do it again, I agreed without hesitation - he did the same thing, and added some along the bridge and also in the front. I hate it. I want it out. there is alos a sore bump. I know he used radiance. What can I do to get it out sooner and will the bump go down. It is a bit fustrating since I really really want a super small nose and he doesn`t agree with my `ideal` snose. In therory I understand it could make it look smaller, but it doesn`t Thanks in advance. Thanks

  Answer:  I think it best to let it dissolve on its own, it is hard to remove the small amounts injected. If he persists in not agreeing with your vision I do not think you should keep allowing him to proceed with his desires. JG 2.24.08

• Hi Dr. in my last post, you said that my skin over my nose implant may be thin.... I read something about pressure ulcers. What is that and is it temporary? I had my nose implant surgery just this last Dec.

  Answer:  a pressure ulcer is when the pressure applied over tissue is greater than the pressure in the blood vessels and then the blood vessels and the blood flow is lessened and then the skin can break open. JG 2.22.08

• Hi Dr Garcia, Quick question. I have had a rhinoplasty 2 years ago and have a cartilage tip graft (sheen graft). No other grafts. I have this recurring deep pimple on the bridge of my nose that causes me a lot of pain and it came back again today and I went to a dermatologist. She prescribed some antibiotics and injected a dilute cortisone shot in the pimple. The shot was not really near my tip. more towards the upper third of my bridge, but it caused the bridge to swell considerably immediately after the injection. She said it was the fluid. The swelling went away after a couple of hours but it got me thinking. Could that dilute injection on my bridge compromise my tip graft that I had put in two years ago? It didn`t occur to me till now bc I forgot they use steroids to help with scar tissue and that it can also eat away at grafts. What is your take? I`m a bit worried now. Thank you.

  Answer:  I do not think it will affect the graft at this point. JG 2.20.08

• hi,I had revision rhinoplasty 6 months ago and I have a small elevated mark on the side of the nose. the dr said it was scar tissue on the outside. There is also an indentation around it. So it shows alot. can anything be done at this point to smoothen out this scar tissue that is elevated, like what or should I wait. thanks !

  Answer:  could inject a filler to lift it up until the healing is done and then re-evaluate it. JG 2.19.08

• Dear Dr. Garcia, I have a preference to not have rhinoplasty. Though as I am 47, my nose seems to have changed shape over the years. The bone in the tip area has broken down or separated slightly. Is there a filler that can be injected, to give me a more defined tip to my nose? If so, what type, how long does it last and cost? Thanks, JD

  Answer:  could use Restylane or Juvederm to fill it in. Might last 6-12 months, costs will vary from surgeon to surgeon but likely in the $500-600 range. JG 2.10.08

• Hi Doctor Garcia, I have had a septal nasal graft from my ear to nose the only problem is my tip is a touch too long now not much but it definatley makes a difference to my profile.Is it possible to have kenalog injections to shorten it.

  Answer:  I do not think it would make any difference. JG 2.7.08

• What are the dangers of using alloderm in Rhinoplasty? Are there any? Does it last?

  Answer:  very low risk, might last a year or two. JG 2.5.08

• SCAR TISSUE QUESTION. DOES SCAR TISSUE SHRINK IN THE COLD WEATHER. MY NOSE SHRINKS IN COLD WEATHER AND I WAS WONDERING IF THERE IS SCAR TISSUE IN THERE WOULD IT JUST STAY THE SAME OR CAN IT TEMPORARILY SHRINK ALSO WITH THE COLD WEATHER?

  Answer:  it does not shrink in cold weather but it becomes more stiff and less pliable. I think your issue is more of the cold just getting blood vessels and posssibly swelling to go down but not a change in scar tissue. JG 1.30.08

• adding to my previous question whether it`s better to have thick or thin skin...I`m considering a rhinoplasty.

  Answer:  the thicker the skin potentially the greater degree of limitation in getting a greater refinement of the tip. JG 1.28.08

• Hi Dr. I have been contemplating rhinoplasty. The Dr. I consulted with said I don`t have thick skin. I think I do, especially after reading this site. You say if you have visable pores and can pinch skin then you probably have thick skin. This is important because if I have thick skin, I hear it can have a negative effect on the results. My question is, I read people here posted before that they have thick skin and their nose seems WIDER. Could that somehow really happen, or do you think they were just experincing swelling?

  Answer:  well, the negative effect with thicker skin is that the degree of refinement of the tip is less dramatic. I do not think it will look any wider but it might not yield as dramatic of a change as you desire. Swelling seems to be more in thciker skin too and that might be what certain people see afterwards for a period of time. JG 1.28.08

• Dr. Garcia, I`m thinking about getting a rhinoplasty and in addition fix my deviated septum. This is a longshot since your practice is in NV, but have you heard of a NYC plastig surgeon by the name of Dr. George Beraka?

  Answer:  sorry but I have not, sorry. JG 1.28.08

• My sister in law wants to have a face surgery but he always saving and saving and she still can not do it..I have a carecredit card for this procedures my question is can I pay for her surgery as a gift to her...??

  Answer:  yes, that is allowed. JG 1.24.08

• Dear Dr. Garcia: I had sinus and septum surgery 5 weeks ago. Today after rinsing my nasal passages, I used a Q-Tip to clean out my nose and went up pretty deep. I noticed fresh blood on the Q-Tip. Do you think I did something with the Q-Tip that could have caused this?

  Answer:  you should not be putting a Q tip inside your nose that deep, just do not do it again, it is just from you tearing the tissues in side and it should heal on its own. JG 1.20.08

• Thanks so much dr for just answering my question,about the nose widening when I smile...just wondering, right now,when I smile, I sometimes sort of move my nose down (I know this sounds wierd) when I smile, it sort of makes my nose look slimmer. My question is, if those muscles were cut to attempt to make the nose slimmer, would that make them permanantly stuck the way they are? I mean, would I not be able to do what I do now by flexing the muscles? (I apologize for the odd question, thanks Dr)

  Answer:  you would likely not be able to pull the tip down if the muscle were cut.JG 1.16.08

• Hi Dr. I have slightly bulbous tip and thick skin so am cautious to have rhinoplasty. If I did refine the tip, does this HAVE to change the slope of my nose, I like my profile, I just don`t like the oblique and front views. Also, if my nose is wider when I smile, can surgery stop that? I don`t like how wide it gets. It gets wider in the center of my nose, above the tip area, if that makes sense. Thanks for your advice!

  Answer:  the profile can be left alone, yes. As to the bottom of the nose flaring when out smile, that can be reduced some by cutting the muscles that insert on the skin but there will still be some widening after it heals, just less. JG 1.16.08

• Would a bull horn lip lift have any other benefit besides shortening the upper lip. Would is possibly help with nasolabial folds since it is removing skin in that general area?

  Answer:  no effect on the naolabial folds, sorry. JG 1.15.08

• Dear Dr Garcia, I had a nasal cartlidge graft about 5 weeks ago because my septum was collapsing and i had large holes in it causing a deviated septum ,breathing difficulties and deformaties to the nose.The surgeon said he would put some cartlidge from my ear on both sides of my nose some on the tip and some in the septum to strengthen it. now the swelling has gone down i have a lump of cartlidge on one side i think he put the larger amount on the wrong side as i had a big dent in the left side and my nose was and still is leaning to the right with a bump on the right side also it now seems longer than before because of the extra cartlidge at the tip. Do you think that it might be possible to straighten it and shorten it with what i have told you or do you think there is a big chance of my nose collapsing.

  Answer:  I think you need to see your surgeon and discuss when it is possible to reposition it, best of luck. JG 1.14.08

• hello doctor garcia, when someone`s got thick nasal-skin, is there any technique for thinning it in the rhinoplasty so the will good results in the procedure?

  Answer:  sorry but nothing safe. JG 1.14.08

• Dr. Garcia, I have had 3 unsatisfactory rhinoplasties, the last one about 6 years ago. I am thinking about getting a 4th, is it still possible to make an improvement?

  Answer:  the more times you have had surgery, the less differences in general that can be made due to scar tissue I am afraid. JG 1.7.08

• Dear Dr.Garcia. Thank you for your answer re-sun blocks after rhyno-septoplasty that was done 6 weeks ago. I moved one week ago from the cooler climate to Australia. In spite of my using sun block +50 and a cap, the skin on my nose became red, like a blotches of redness and it looks like sun burn. Is this redness will stay permanently? What to do to reduce this redness and to prevent future sun burns in addition to sun block and protective hat? Another question. Shall I continue to do a nose message or to wait until this redness will subside ( hopefully ) Thanks again for your help.

  Answer:  I doubt the redness will be permanent, just sun damage and should go away like a sunburn would in time. To treat it now, just use some aloe and avoid the sun and use what you have been using. I would wait for the skin to heal some before any massages though. Be well. JG 1.7.08

• Dr. Garcia, I had a Rhinoplasty 14 months ago and have unfortunately suffered a collapse in my right nostril. This has been an extremely traumatic experience and I am desperate to find a excellent doctor to correct my breathing and abnormality. I am not sure how to begin to find a specialist and was hoping you could please offer a possible beginning point. The surgeon who originally did my surgery has not made any recommendations and I am on my own to seek further treatment. Many Thanks!!

  Answer:  There are only a handful of reconstructive rhinoplaty surgeons in the US, all depends on where you live. JG 1.3.08

• Happy New Year, Dr. Garcia, I had a rhinoplasty, turbinectomy and septoplasty a year ago. I developed some facial twitching this summer which has now been diagnosed as synkinesis. The neurologist said I could try neurontin, but it wouldn`t cure it. I have been seeing an acupuncturist to calm the nerve down and it has helped minimally. Do you think the neurontin will help and do you think the synkinesis will go away or get better? Thanks for your help

  Answer:  I feel it is worth a try, best of luck. JG 1.3.08

• Dear Dr. Garcia, From your site I`ve learned that after rhynoplasty the sunblock should be worn. Here`s a questions. Would SPF 30 enough or it shoud be higher? I have a lot of internal sweeling in my nose after septorhynoplasty almost six weeks ago. Is it normal? If yes, what is the maximum time for the swelling to subside? Do I still need to use an Ocean spray at this stage and if yes, for how long and how often? Thank you so much for your previous answers to my questions.

  Answer:  I prefer a total sunblock and SPF 30 is a sunscreen, so it is only a partial block. Need a real Sunblock or an SPF of at least 50. Swelling can be quite extensive after a septorhinoplasty and can take months to get better I ma afraid. There will be small amounts of swelling for up to one year after the surgery. You only need to saline nasal spray if your nose feels dry. If you need it, it cna be used every two hours without a problem. All the best. JG 1.2.08

• I had septoplasty six months ago and since then a callous has formed all around where the bones were broken. At my follow up visit the doctor who preformed the surgery said basically my body overreacted in the healing process and he will file it down after a year. It seems that over the last couple of months it has gotten worse especially on the sides. Is this possible? Could it continue to grow?

  Answer:  it can happen and the best way to correc it is for the area to be shaved down, he is correct about that, all the best for the touch up. Happy New Year. JG 1.1.08

• Is nose implant safe? What should I know about having a nose implant> I want my nose bridge a little higher.

  Answer:  nasal implants to the bridge are relatively safe, safer than those meant to lift the tip. There is a risk of infection and movement of the implant but it is a low risk in experienced hands. JG 12.31.07

• Hello Dr Garcia - I had septum surgery (and had the nose straightened) approx 2 weeks ago. Two related questions for you: 1) do the internal splints cause much of the swelling at 2 weeks (they are still in)? 2) one side of my nose looks different than the other. Could this just be swollen? You don`t think that by straightening the bottom of the nose it caused some disfigurement now? One side is more defined than the other. The difference of the two side makes the nose seem crooked. The side that seems more swollen is on the stitch side. Thanks for any info you can provide.

  Answer:  actually the splints keep the septum straight but their bulk does cause the sides to push out in some individuals. At this point in time the difference in sides is most likely due to swelling, yes, so just hang in there. JG 12.30.07

• hi doc, how do i know whether i have a thick skin on my nose?

  Answer:  pinch the difference between the tip and the bridge, also if you can see pores and there is also no definition of the cartilage, it is thicker. JG 12.30.07

• Dr. I`m thinking about getting my 2nd rhinoplasty for a few adjustments, I healed well from the last one almost 2 years ago, is the healing process the same, or is it different with each individual surgery? Also, can you recommend a good doctor in Minnesota? Thank you!

  Answer:  in general it will be about the same healing time, yes. Due to potential legal issues, and some doctors wanting to know why I referred a patient to someone else and not them, I think you are best to go to this website and look for a plastic surgeon in the area you desire. I wish you all the best. JG 12.29.07 www.surgery.org/public/findasurgeon.

• Dear Dr. Garcia. I`ve asked you a few questions already and really appreciate your answers. Here`s another question. I am five weeks after septo-rhynoplasty ( as an open procedure ). I still have a lot of swelling at my supro tip area. My surgeon advised me to message my nose. He didn`t explained me how to do it and how often. Could you, please, direct me where I could obtain an instructions how to do it? Another question. Could unskilled manipulation of the nose lead to the unfavarable outcome? Thanks

  Answer:  unskilled manipualtion at this point will not do any harm, as to the massage, start at the bridge and press the skin down onto the bridge of the nose and then towards your cheeks with your thumb and index finger or using both index fingers, do that ten times, then gently squeeze the tip and then slide the finger up to the bridge and down again onto the cheeks, again ten times. Do that twice per day, morning and night. JG 12.29.07

• Dr. Garcia, I went to a consultation for a doctor about Revison Rhinoplasty. I have very thin skin on the bridge of my nose and he said he would use Alloderm there. Is this the same thing as Fascia, just not from my own body. Will it look different than if I had fascia from my own body. Could you please let me know. Thanks.

  Answer:  There is a product called Fascian but it does not last too long. Alloderm is thicker and more stable and longer lasting than Fascian. Using your own tissue is also possible but then leaves a scar where the tissue was harvested from. JG 12.29.07

• Dr. Garcia, Why is it exactly that exercise is not recommended for several weeks after rhino/septoplasty? Are there any risks associated with doing moderate physical exercise a week or two after surgery (other than the risk of nasal trauma) that could affect the outcome of the operation? Thanks.

  Answer:  to avoid elevations in blood pressure that can lead to nose bleeds and excessive swelling. JG 12.29.07

• Dr. Garcia, I had my (1st) septorhinoplasty done 9 days ago, with work done pretty much everywhere on the nose (not sure what exactly). My nose leaned to one side, and I had what you could describe as a pollybeak before the surgery (not pretty). I took off the cast after 7 days, expecting to see a much improved (albeit swollen) nose, but the pollybeak seems just as bad if not worse than before (side profile), and the nose also still appears crooked (front view). I`m not terribly concerned about the nose still appearing crooked, because I can imagine swelling being responsible for it to appear that way; But can post-op swelling account for a pollybeak after only 9 days? Or does it sound like the surgery just didn`t fix it? After relatively extensive surgery, does the swelling ever tend to mimic the pre-operated nose? I am concerned because my surgeon went on vacation and will not be back for almost 2 weeks (so I won`t be able to see him for 3 weeks post-op), and it sounds like any correcting of this pollybeak issue must be done so in early recovery. Any input is appreciated, thanks.

  Answer:  swelling alone can certainly give one the appearance of a polly beak deformity, yes, especially in thicker skinned people. I would keep your head elevated, apply some ice, and do some light massage until he/she comes back, likely it will improve, albeit slowly, and in some cases it requires some kenalog shots into the area to help the swelling go down, hang in there. JG 12.27.07

• Dear Dr. Garcia, I have just had cartlidge taken from my left ear to strengthen my nasal septum and to correct two dents in eithe side of my nose.The surgeon also straightend the lower part of my septum (beneath my nostrils) as much as he could because he did not want to weaken my septum any more. My question is should I have had tape put on my nose directly after the operation? I did not have anything put on and I have swelling on the left side at first I thought he had put more cartlidge on that side. It looks odd and I am worried it will look more deformed than It did before. Is there anything that can be done now to stop the swelling and help my nose set properly? I only had my operation yesterday and I was wondering If I should tape my nose myself in the evening until I can speak to the surgeon on Monday. What do you think?

  Answer:  the tapes are a personal preference and I think the swelling does form to a lesser extent with the tapes but the swelling will eventually go away, so the differences you see early on are typically just short term ones. I would not tape it until you see your surgeon. Best of luck. JG 12.22.07

• Dr.Garcia. How to differentiate an early signs of pollybeak and swelling at early post opearative period ( four wks post rhynoplasty )? If nose in profile looked straigt one wk post cast removal and then last two wks develped supra tip fullness, bump and small depressed area at dorsum, would it sounds like a pollybeak ? Thanks for your reply. PS My procedure was the closed one, included tip repojection and dorsum reduction. I have a thick skin.

  Answer:  really no way to tell, need to wait for the swelling to go down. What you are describing sounds more like swelling though. JG 12.20.07

• Dear Dr.Garcia. I am three and a half weeks post Rhyno/Septoplasty. I have a supro tip swelling that is worse compare with two weeks ago after cast was off. The area looks meaty and not defined. At night my nose looks better. Why is that? Does it mean that it is oedema less at night time and there`s a hope my nose eventually will be smaller? Another question is that from recetnly I`ve noticed a hump and a dent and there`s a small horisontal area of bluish color on the bridge, just near the hump. I was told that this mihgt be haematoma. I was told not to worry. I am still concerned. Is any hamatoma should be drained? If not, may it resolve by itself and how long it takes? Thanks in advance for your reply. PS I really like this site. Unfortunatley I don`t live in USA. I envy your patients.

  Answer:  correct, due to swelling/ edema and it will go up and down, that fluctuation will be less in time. I think in time it will be smaller, yes. The other area of concern is not an uncommon thing and it dissolves and does well without aspiration, the needle placed to remove it can cause bleeding too, so unless it is very large we refrain from aspirating it on the nose. Should be better in 4-6 weeks. JG 12.19.07

• Hi Dr. Garcia: Can you tell me how long you would recommend waiting to wear sunglasses after an open rhinoplasty? I am 4 weeks post op. Thanks!

  Answer:  should be OK to do so now, if they bother you, then get a lighter pair or wear those Croakies straps on the legs and keep it tight to keep pressure off of the nose. JG 12.18.07

• hi doctor i broke my nose a couple of years ago after slipping and landing nose first on the side of a desk. the bridge of the nose was the point of impact and it had to be stiched up. i went to a doctor a couple months after breaking the nose who injected cortisone to reduce the swelling that had formed on the bridge. the scar is still there. would getting a rhinoplasty remove the scar and the small remaining bump near the scar that formed after the break? a dermatologist i went to said the scar itself can`t be removed using dermatological mehtods. thanks

  Answer:  the lump can be reduced but the scar is forever. JG 12.17.07

• Dear Dr.Garcia, I am 3 weeks after rhynoplasty and don`t like results of it. I know it takes time for the final result to be seen. Still I can`t imagine that big meaty nose will shrink eventually. My nose before the operation wasn`t as whide and meaty as now. Would it be OK if I could send you my photos before and after operation? If yes, what is your e-mail adress I could send my photos? Thanks a lot. Bella

  Answer:  please send them to drgarcia@lvcosmeticsurgery.com and please include what they did to your nose during the operation as best as you can. JG 12.14.07

• Dr.Garcia, I`ve sent you a question yestarday re-hump and dent after septoplasty and rhynoplasty two and a half weeks ago. Thank you for your reply. Here`s another queston. I have problems with nasal breathing at night. It seemed getting better last week and now is getting worse. My plastic sergion is not approachable. Any suggestions? Thanks

  Answer:  well there is swelling that will come and go after a septoplasty,it typically is worse at nigth when lying down, but if it persists and is always on one side, an evaluation by another surgeon, possibly and ear nose and throat specialist, might be a good idea. If the breathing difficulty alternates between the two sides it is likely due to swelling and might benefit from some nasal spray. JG 12.12.07

• I have a small pointy tip that has come up on the end of my nose. Does this need surgery or do you know what it might be?

  Answer:  hard to say wihtout seeing you I am afraid, could be a fold in the cartilage, or a cyst. JG 12.12.07

• Dr. Garcia, How long to wait until taking a long 24 hour flight after rhynoplasty + septoplasty?

  Answer:  I would prefer 7 days if possible and take some decongestants prior to the flight. JG 12.12.07

• Dear Dr.Garcia. I had closed rhynoplasty including tip work, dorsum reduction and septoplasty two and a half weaks ago. A few days ago I`ve noticed a bony bump on the upper part of the bridge and a dent just under the hump. There`s discoloration of the skin over the dent. Would it go away or it might stay permenent ( a bump and a dent plus skin discoloration ).? Thanks in advance for your reply.

  Answer:  likely will get better on its own in time, might be some small amount of blood under the skin where the rasping was done, if not, I think it best to wait 6-12 months before deciding if a touch is needed, most likely it will be fine without anything further. JG 12.12.07

• Dr. Garcia, I had a deviated septum fixed back in August I still have trouble breathing and still find that I still have a lot of the same pain at the bridge of my nose is that normal because it kind of really still hurts. They did find a cyst that they removed and that took some of the pain away. Do you suggest I go back and have it looked at by another doctor? Also I would like to speak to someone about a filler I broke it as a teen and now it has a grove and looks crooked..what should I ask for and how much does that run?

  Answer:  a filler migth be an option, the syringes usually go for about $500, and I do think you need to see a surgeon about the breathing problems if they are still there, best of luck. JG 12.12.07

• Hi Dr Garcia After having restylane injected in your nose, will it usually return exactly as it did before the restylane was injected after 6 months or so? Or does it form scar tissue?

  Answer:  yes, it returns without scar tissue. JG 12.9.07

• Dear Doctor, I`ve seen a diagram of botox injection points in a website. I was surprised to see dots (as in injection points) alongside the nose, not just on the tip of it nor beside the nostrils where the smile lines start, but in the sides of the middle of the nose. What would be the use of injecting botox n such an area? The smile lines don`t start there, and it`s not a point to treat bunny lines. What is it used for?

  Answer:  there are alternate ares to treat extended bunny lines. JG 12.9.07

• Dr.Garcia. I had recuction of dorsum, tip reprojection and septoplasty ( closed procedure ) two weeks ago. A cast was removed one wk ago. I am 43 years old and my recovery is slow. My nose is still swells. Even though my nose in profile looks good, in frontal view it looks very wide with assymetric nostrils. I have a few questions. 1. How long should I wait when most of the swelling will be gone and semi-final result will be seen? Is it still early to be dissapointed about result of the opeartion ( two wks post.op )? 2. How long after above mentioned procedure I should wait until doing eye brow tatto and what is your opinion about eye brow tattoing? Thank you in advance for your reply.

  Answer:  semi-final result in maybe 6-8 weeks. Still early to be dissapointed. I think you can do the eye brow tatooing at any time. JG 12.9.07

• Dr.Garcia, thank you for your reply re swelling post cast removal. Here`s another question. How to diagnose post rhynoplasty/septoplasty haematoma? If it is radiologically only? If yes, what is the best way, is it by X-ray or by CT? Re-removal of crusties inside of my nose by the hot water steam, would it not increase the swelling? If not, shall I use Q-tips again after making it more soft under the steam? Thank you.

  Answer:  hematomas are not seen on X-ray, it is a diagnosis made by looking and examining. The small crust inside of your nose will fall off when the incision inside have healed, using the steam to remove them should not increase the swelling. I would not use the Q-tips as that might knock the scab off before it is ready to fall off. JG 12.5.07

• Dear Dr.Garcia. I had closed rhynoplasty and septoplasty nine days ago. Two days ago the cast was removed. I feel that the swelling in my nose and now on the one side of my face is gradually increasing. There`s a neurologic pain in my eye, chick, and jaw on the side of the more prominent swelling. The nose is three times bigger than it was before. Is this neurologic pain expected? Is it normal that swelling is getting worse? If it is, what is the maximum time for swelling to subside? There`s another question. Inside of my nose theres a very thick and hard crusties. I was trying to remove it with Q tips but it it started to bleed. So I left it alone. The problem is that I can`t breath throgh my nose for already 10 days. When and how to remove those crusties without causing harm? My plastic surgeion is not approachable and I am on my own. Your advise will be very much appreciated. Thank you.

  Answer:  it is normal for some swelling to increase after the splint is removed but you might want to see the surgeon to make sure there is not a hematoma that needs to be drained, all of that can cause the pain, yes. I think getting over a sink with running hot water and a towel over your head to let the steam soften the custs inside your nose is the best for now. Good luck. JG 12.5.07

• Have you heard of Dr. Charles S. Lee in Beverly Hills for asian rhinoplasty?

  Answer:  sorry, but no. JG 12.5.07

• Hello! I`ve always wanted to get a nose job since I was in middle school. I`m filipina and my nose is flat and slightly wide. I went to a consultation (in California)where they will perform open rhinoplasty using silicone implant on my bridge and ear cartilage for my tip. I`m very nervous on how I will scar though since there will be 3 visible scars from the alarplasty and the open rhinoplasty technique, and from keloids forming. I had a friend who went to the Philippines and got rhinoplasty but they used a closed technique rhinoplasty so there were no scars and used an L-shaped silicone implant only. Their results turned out nice. Which is better for asian rhinoplasty: open or closed rhinoplasty? How about L-shaped silicone implant vs. using ear cartilage at the tip and a silicone implant at the bridge? I just don`t want to end up with ugly scars and minimize swelling and complications. Also,is it always necessary to get alarplasty or can the implant help enough to decrease the width of my nostrils? Thank you Dr. Garcia!

  Answer:  the chances of poor scars on the nose is small, as to the implant versus cartilage, the cartilage can warp so thee implant might be easier. If the nostrils are too wide there is no other way to reduce them besides an alarplasty. JG 12.5.07

• How long will it take for the swelling to go down after open nose job so I can see a final result?

  Answer:  at least one year. JG 12.4.07

• Hi! I had a open rhinoplastic done 10 months ago. My nose tip is still very big and so are my nostrils. I understand that no skin has been removed and I wondered about that but was told my nose would be smaller little by little and the skin would adjust. I cannot see mush of a change before and after. My skin on the nose is still numb does that mean that the nose is still getting smaller? Do you think it will get smaller at all after all this time and how long will it take? Will the doctor fix it for free if it will remain this big?

  Answer:  I do not think they will fix it for free and if it is still numb there is a chance of further shrinking possibly. JG 12.4.07

• Hello! Do you have any recommendations for a revision rhino surgeon in SF/Bay Area? Thanks!

  Answer:  Due to potential legal issues, and some doctors wanting to know why I referred a patient to someone else and not them, I think you are best to go to this website and look for a plastic surgeon in the area you desire. I now I have made exceptions in the past but those are cases where there are certain circumstances prevailng.I wish you all the best. JG 12.2.07 www.surgery.org/public/findasurgeon.

• Hi Doc. Have you heard of Dr. Francis Palmer in beverly hills? He is supposed to be great at rhinoplastys. I was just concerned becuase I was checking out his website and he lists medical grade silicone as one of the ways to augment lips. I thought that was strange. Is this a good Dr then?

  Answer:  well, let me first say that in 19 years of practice in Las Vegas, I have never heard of him, never heard his name even mentioned. As to injecting liquid silicone into lips, I will say it like this, I think it is illegal to use that product in that way, the purchasing of liquid silicone intended for a different use and then using it for a cosmetic reason when other well-proven safer products are available is likely based on an attempt to get an edge over other physicians who will not do un-approved procedures. In Nevada it can result in the loss of your medical license. If it is not safe here, I cannot see how it could be safe 350 miles away. So my question would be, where else has a physician like this compromised on some other issue in order to make money and potentially put a patient`s health at risk? JG 12.2.07

• Dr, I read somewhere that botox is sometimes used for nasal flare. Does that mean that it can make the flare of the nose narrower in a normal nose, or does it mean it can only work for people who have a problem with opening too wide their nostrils as a tic? can a normal person with a rather large tip of the nose because of the nasal flare have that reduced? but what muscles can be injected to reach that and not hurt the breathing process? Hugs

  Answer:  if injected in the correct place it will limit the amount of flare, correct. A larger tip will require surgery to reduce it though. I think if the flare is reduced during exertion there will be a limition of the ability to take a deep breath though. JG 11.28.07

• Hello! I had what was called open and closed rhinoplasty about 4 months ago. During the first week, when the splint was still on my nose, I was putting some neosporin inside my left nostril with a q-tip and I felt something give-way and felt my left nostril swell. The surgeon mentioned that he used glue and well as sutures. I think I disturbed the glue. My left nostril has more flare and is less defined than my right. It is also a little larger. How complicated is this to correct surgically? Can it be corrected using a closed technique? I am wondering if the flare can be corrected by using glue again? Otherwise, my nose looks fine. Thanks very much for your opinion.

  Answer:  hard to say how complicated it would be without seeing you in person, I wil say that particular portion of the nose after a rhinoplasty can stay swollen for one year and the swelling can cause apparent asymmetries that correct themselves in time. I seriously doubt that anything you did could have caused any damage. JG 11.28.07

• Hi Dr. Garcia, I posted a few days ago after having my rhinoplasty- I had to have my cast of 4 days post-op due to allergic reaction to the steri-strips under the cast. Today I saw my Dr., and he suggested I go back on another 6 day course of Methylprednisolone to perhaps help with the extra swelling. He said there was a slight risk that the fine tuning of the nasal tip may be affected by the early cast removal, that sometimes the body will make extra scar tissue when there is increased swelling, but we would just have to wait and see. He did say he got an excellent result in the operating room. Do you think the extra steriods are necessary? Will they help my chances of having less swelling and a better result? I am still worried about my long term result due to the early cast removal, even though I have seen nothing on the internet that indicates it should be a factor. I even found one Dr. that says to not worry if the cast falls off early...Thoughts? Thanks so much!

  Answer:  I think they might help and in an otherwise healthy person will yield very little downside. It would have been nice to leave the cast on in the sense that your final result might have shown up earlier but I think eventually when the short increase in time of swelling abates it will look better. JG 11.26.07

• Hi Dr. I found out that the rhino Dr I am interested in has done over 5,000 nose surgeries in the past 30 years, which sounds great.(he only does surgery on the face) Except for one thing, he is adamant that he only will do closed rhinoplastys. The only thing is I have a bulbous nose, is it possible for him to fix that during a closed procedure? I didn`t think it was. Thanks so much.

  Answer:  yes, it is doable, best of luck. JG 11.25.07

• Hi Dr. Garcia. I had my rhinoplasty 5 days ago. My Dr. had to remove the external cast on the 4th day post-op due to an allergic reaction I was having to the steri-strips under the cast. I still have internal splints. He normally removes the external cast 10 days post-op. Will the early removal of the cast in any way effect my result? Thanks so much in advance.

  Answer:  it might make it a little more swollen short term but likely not negatve effects long term. Leaving it on could have caused greater problems. JG 11.24.07

• I had rhinoplasty 8 months ago and I am satisfied with the results except I have a small lump on one side of my nose that my doctor said is a piece of cartilage. He said it should go down on its own but if it doesn`t do I have any other options besides another surgery which I really don`t want to do?

  Answer:  just surgery I am afraid. JG 11.22.07

• hi,1. my doctor used teosyal on a depressed scar on my nose 5 months post rhinoplasty. It seems better. What do you think of this method ? 2. Also if I have another small elevated bump like scar from rhinoplasty can co2 laser help or anything else ? thanks so much

  Answer:  a reasonable thing to try. I think in many cases a CO2 laser smoothing of a scar can give a nice result too. JG 11.21.07

• Hi Doc. I know rhinoplasty especially tipwork, which is what I am interested in can be complicated. Is it best for one to go to a dr who specializes in rhinos for this? Also, have you ever heard of Dr. Theodore Golden, hes supposed to be very good at noses. Thanks, your opinion is very valuable to me and many others.

  Answer:  not familar with that doctor, and I do think experience is important so I think someone who at least does a large number of them is a good idea, look for at least 20 per year. JG 11.21.07

• Dr. Garcia, I have small bulbous nose with a small hump on the bridge, that was cute when I was younger. Now the hump seems larger and the bulbous part seems droopy. Can this be fixed with some kind of non-surgical treatment (have you heard of this)? Maybe filling in the bridge to the bulbous part to make less obvious? Now it looks like a hook ball nose. Weird, because I loved my nose when I was younger. -k

  Answer:  well, doing it with a filler will make the bridge higher to hide the bump, but will likely not be able to do much for the bulbous nature of the tip as it looks worse because the skin has gotten thicker. JG 11.19.07

• Hi Dr. Garcia, I was just wondering approximately how many rhinoplasty you do each month and/or year? Also, do you do many secondary rhinos? Thanks

  Answer:  I do about 25 primary rhinoplasties per year and I no longer accept patients for secondary rhinoplasties where the first was done elsewhere. JG 11.19.07

• Hello, Dr. Garcia. I have heard about non-surgical rhinoplasty but i have also heard that a patient should not have this procedure, if the patient is considering having a revision rhinoplasty? Is this non-surgical rhinoplasty (filler) create any internal scarring or preventative measures that would prevent a successful revision rhinoplasty. Thank you for your time.

  Answer:  I do not know of any filler that would prevent a revision surgery being performed down the road. JG 11.18.07

• Hi Doc. I asked previously about massaging my alar outwards to loosen the connection to the base of my nose (i got alarplasty) but it seems some keloids have been developing as you advised me to continue because of my concern for nostrils that are too small. What should I do now? (3.5 weeks post op) I`ve been applying scar serum with vitamin e and shark oil just in case.

  Answer:  may want to see the surgeon and see if kenalog injections might help. JG 11.16.07

• A few years ago I had rhinoplasty and it went very bad. The doctor broke off a piece of bone and tried to cover it with artificial cartilage. It didn`t accept the cartilage and it got infected and ate the cartilage away. Then the scar tissue started to fill in the hole. Well the scar tissue has fused to my skin and now my nostrils are very uneven and it is really embarrassing. I don`t know what my options are. I would like to see another doctor and have it fixed. I am very afraid that future surgery will cause more damage. What do I do?

  Answer:  I think it is hard for me to say what could be done but it sounds like some surgery might be required I would say, all the best. JG 11.13.07

• **After having a 3rd revision rhinoplasty for the tip, I would like to know is: If I get scar tissue over time will the nose go back to looking about the same as before the surgery? Does leaving the taping on longer improve the chances of not getting too much scar tissue? What about excercise? Does excerting yourself contribute to the scar tissue? I am asking because right after the surgery before the Ps has taped my nose it looks better but then after a awhile may be 3 weeks it starts to look about the same? Thanks

  Answer:  if the scar tissue becomes thick it can make you lose the definition you are hoping for in the tip. The tape will help control swelling in the very short term but I do not think it will influence scar tiisue formation. No exercise either that will help. JG 11.12.07

• Hello Dr.Garcia, I`ve just underwent rhinoplasty 3 days ago to define my nasal tip and also had a silicone implant inserted for my almost non-existent ethnic bridge. My nose looks like a pig snout now as when I look straight forward, I can see right into my nostrils! Can you tell me if the nasal tip will drop and that my nose is just going thru the swelling/recovery phase??? Thanks in advance

  Answer:  way too early to tell, lots of swelling at this point, give it time, it will look better soon. JG 11.12.07

• Hi Dr. Garcia- My nose bridge is very thin at the top (between eyes) and somewhat thin down to the tip. Is there a permanent filler I could use to widen the bridge area between the eyes? I keep hearing about non-surgical nose jobs and was hoping I could resolve it that way. Thanks!

  Answer:  well it can be increased with Radiesse or Artefill. JG 11.10.07

• how long it takes to fully recover your nose from swollen etc. and take its final appearance after a rhinoplasty ?

  Answer:  one year for a final appearance. JG 11.8.07

• Dr. Garcia, THanks for taking questions. I have had 3 surgeries on my nose. I have a deviated septum still and the last surgeon destroyed some of the skin on my nose, so I have very very thin skin on the bridge. I know that I need to have a 4th surgery and most doctors have talked about putting fascia there to thicken my skin. I am a male and would like to know of a great revision rhinoplasty specialist in the Southern California area. I know Dr. Daniel only operates on women. Could you recommend someone in the area that you think could do a great job. Definitely want your opinion. Thanks.

  Answer:  Ron Gruber but he is up in northern California, or maybe Steve Hoefflin in Santa Monica. JG 11.6.07

• Dr. Garcia, although it has been a little while since I have been on your site I have always appreciated your straight forward, honest and at times satirical wit in your replies to all those questions. You have also given me some invaluable professional advice in the past that really did help, thanks for that. I am seeking your expertise again and I have enclosed some background information (so I hope you can bare with me) I am considering having a 3rd revision rhinoplasty, primary was over 25 years ago, although I was not happy with the result I did not bother to have my 1st revision till over four years ago. With the 1st reviosn my nose started out nice and straight, however over a period of months my nose developed an obvious dent particularly on the right side. The 2nd revision was done January of this year by a different doctor who claimed the problem was due to a deviated septum. Since this procedure my nose over several months has developed an an obvious dent again. The middle vault section has also separated which gives the appearance of an inverted v and unfortunately the gap and dent seems to be getting bigger as time goes by. The tip of my nose also seems slightly lose and tends to move when I lean my head in either direction. My doctor back home feels he can fix my `little` problem with a small piece of cartlidge from my own nose which he claims is a minor procedure and he can do this under local anesthesia. However before I go through this minor ordeal I have decided to get a trusted second professional opinion basically to assess if this is a viable option for my particular problem, discuss alternative options, or whether I should call it a day. I really have a fear of having the over done `Michael Jackson` look (sorry Michael). I also tend to have dark circles around my eyes and with age (menopausal middle aged woman) seem to becoming more prominent. As I recall, you were working on some cream that may help with dark circles so I very interested in purchasing that as well as other treatments you think would be beneficial. (I already use your dmae eye and face creams). We are planning a family holiday, which includes Las Vegas and L.A. in late January/early February 08 for a few weeks, so with regards to the above information do you take appointments for people who just need a second professional opinion? If you do, great, who do I speak to or email to set up an appointment? If you are too busy, no worries, could you recommend someone either in Las Vegas or L.A. during that time. Thanks

  Answer:  might want to see Rollin Daniels MD in New Port Beach,Ca. he is a great revision rhinoplasty surgeon, sounds like you need what are called spreader grafts. As to the creams, I am getting there, I made it too strong and people were getting irritated so I am slowly decreasing it to see what will be effective, all the best. JG 11.6.07

• Hi. How many days after rhinoplasty should we start applying hot compress? Does it even help the swelling? Thank you! I am 2 weeks post-op.

  Answer:  48-72 hours afterwards is OK I feel. But not too hot, just warm is OK. JG 11.5.07

• Doctor, do non surgical nose jobs have tricks with fillers to correct (optical illusion, of course) a large nose tip, as to make it narrower? (without making the whole nose larger, of course :) with the filler). I can`t believe you don`t get tired of answering our questions. You are someone out of this planet and I mean that in a good way.

  Answer:  nope, it will need to be larger if it is being done with a filler, no way around that. Bringing the bridge up can make the tip look smaller in relation but it is not truly smaller, as to being out of this planet, sometimes I feel a little alien, yes, but I am an alien as I was born in Cuba, but thanks. JG 11.5.07

• Hi! I`m wondering what Glucosamine can do for a rhinoplasty? I am taking some for my 2nd rhinoplasty and had some cartilage cut out. Does taking glucosamine help in any way? Thank you!

  Answer:  will not do much, sorry. JG 11.4.07

• Hi Dr. Garcia, I asked about the alarplasty regret. I just have one more question, if I get the rotation of my alar flaps done again, would it be better to get it now while the connection has not fully healed or wait awhile till the wound has reformed so they can cut it again?

  Answer:  I would wait until the tissues have softened some to also make sure it will not get better on its own as the swelling goes down. JG 11.4.07

• Hi Dr.Garcia, I have just gotten cartilage taken out which is perfect but also I got alarplasty which ruined the whole look. I look like a pig from upfront. I am in so much regret and sadness. I am 1.5 weeks post-op and wanted to ask you what my options are? Also, I have been massaging my nostrils inside at the base outwards. Will that help a little? I am hoping the connection will loosen up while it is still healing making the nostrils a bit wider again. I hope you will answer my 2 questions with some detail. Thank you so much for guiding all of us.

  Answer:  I think there is likely lots of swelling and the flaring should get markedly better, keep up what you are doing and give it some time, worst case scenario they could do a small flap rotation and replace some of the skin that was removed but I do not think that will be needed, all the best. JG 11.3.07

• Hello Dr. Garcia. I have realized that my nose pores become unnoticeable if the skin is tightened. Otherwise, all the pores and scars are very visible. Is there any surgical procedure so that the skin of the nose can be pulled from the middle to the sides, so that the skin is stretched and then the tighetened skin sewn somehow around the nostrils or something? as in a face lift, only that only of the nose? Is this too crazy? does that exist? could it be ambulatory?

  Answer:  the only thing is to do microdermabrasions on a regular basis to keep the pores clean, or beta hydroxy acid peel, and nothing is long term, can also try Retin-A too. JG 11.3.07

• Dear Dr. Garcia, I had my rhinoplasty done a month ago using the L-shaped silicone implant. Healing is going great and not alot of swelling anymore. But since the surgery I would wake up and my eyes are burning. I am starting to think that the silicone is causing this and afraid of any damage that may cause to my eyes. Do you think this is due to swelling after rhinoplasty or an adverse reaction? I would really appreciate your thoughts and advice. Thank you. P.S. Do you still recommend the use of these L-shaped silicone implants despite the risks and complications?

  Answer:  I really do not think the silicone which is solid would be causing it, might be somethig else, like allergies. JG 11.2.07

• Hi doc. I am on my 3rd rhinoplasty operation which i had last week. I have noticed that my nose is at its best during the first month of the surgery then after that it seems to get less definition. What can I do to keep it the way it is now? I`m very satisfied with it at the moment and hope it will stay that way this time... Thanky you. You are very helpful.

  Answer:  I think it will be hard to keep it that way as it is likely scar tissue forming that makes it lose the appearance and that is almost impossible to control, especially after that many surgeries. Let`s hope the scar tissue has maxed out in its formation. JG 11.2.07

• Dr. Garcia, I had rhino/septaplasty surgery 20 days ago. The Dr. was to remove the hump from the bridge of my nose. There`s still a hump, it is worse on one side than the other (profile). In the last few days a hard bump/knot has appeared at the very top of my nose, now there`s two humps. The Dr. said when he chiseled my nose a small part of bone broke off causing a small dip in the bridge so he added some cartidge to fill it in. Should I be concerned? Do you think this bumps/knots will go away? Could it be the cartidge and does cartlidge swell? Thanks so much for any info you could send my way!

  Answer:  at this point so soon after the surgery I would not be concerned, things are still healing and will take time to settle down. JG 11.1.07

• Hi doctor. I had just gotten surgery 1 week ago and my face i still a bit full. I`ve been drinking ginger brew because i thought it might help with the swelling of my nose. I get flushed everytime i drink it becaude it`s strong so i wonder now if it really helps or should i stop? Thanks!

  Answer:  I would stop it and let nature take its course. Yes, stop the ginger brew. JG 10.31.07

• Hi one last question (From hemangima patient), When I had gone to the first dr he said to get the result you want we will have to cut down your nose and can not lift it like a regular rhinoplasty. The dr I had however, said no we can. I am curious if you can give your advice, if the nose had been cut down the middle and stitched up like the first doctor suggested would I not have all this scar tissue now, that has resulted in a bulbous tip?

  Answer:  I think scar tissue would still have been created but since tissue would have been removed it likely would be smaller, the trade off is the small scar. JG 10.31.07

• Thank you. Yes the dr says the reason I have the scar tissue is because I had the hemangioma. I`ve had 2 shots before but this is the first time having one in the tip. We are hoping that this will reduce the size of the tip and decrease the scar tissue. I can only pray!

  Answer:  best of luck. JG 10.30.07

• I just posted below. Do you recommend massaging the tip now that the Kenlog has been injected?

  Answer:  for a day or so, couple of times per day. JG 10.30.07

• Hello, 2 years ago I had a rhinoplasty to reduce a bulbous tip that was a result of a hemangioma I was born with. The nose was small and I was happy with the result but as time went on the tip continued to increase. I have finally went back to the dr and he is giving me kenalog shots, he said that there is little he can do for a revision since all that has grown back is scar tissue in the cartildge. Have you ever heard of scar tissue being taken out, also how long does a Kenalog shot take to work? He gave me a shot in the tip, something he doesn`t tend to normally do to patients. He tells me two months. I am considering going to a hemangioma dr to see if there is anyting he can do to reduce the size of the tip of my nose. It is almost unbelieveable to look at the nose after surgery and the nose now.

  Answer:  It could be cut out but it could return, kenalog works by slowing the creation of new collagen. The kenalog can take weeks to work and in many cases requires more than one shot. I think likely the hemangioma has made the formation of scar tissue worse. JG 10.30.07

• Hi Doctor, I`m the one with the dent in the nose/fullness at the supratip. I was finally able to work out an appointment to see you this week, but since I will be flying down, I wanted to know if I can fly the same day that restylane or radiesse (whichever we decide is best) is injected? Can I fly back the same day? Also, about how long can I expect to be bruised and swollen from the injection?

  Answer:  can all be done the same day, the bruising should last no more than 2-5 days. JG 10.29.07

• Dear Doctor, I am almost ashamed to ask about this because it sounds so ridiculous to me, but since the gadget actually exists, I wonder if there is anything true to it. (I bet not. But then why would people sell that?) A relative is staying China and told us about curious things he saw there. He said many stores sell nose pinchers (!) which are supposed to be worn many times a day and doing so will in theory make the nose narrower. I thought he was kidding me but he says not. It must be a product based on a lie, right? Is there any way other than rhynoplasty to get a narrower nose??? I know fillers can even out bumps and correct optically for a while some defects, but this sounds insane. How come it is so popular in China, then? Or does it work in some weird way??? Isn`t that like putting a tweezer on my nose and imagining that that will change its shape????

  Answer:  sorry but it does not work and can actually cause problems with the skin. JG 10.25.07

• i heard that once you get a rhinoplasty, your nose will be swollen for a year or more...what can we do to reduce faster the swollen?

  Answer:  not much that will speed it up I am afraid. JG 10.25.07

• Good Afternoon, I had rhinoplasty 3 weeks ago and today I accidently bumped the tip of my nose on my boyfriend`s cheek after giving him a kiss. It hurt enough for me to yelp a little bit and it throbbed for a few minutes afterwards. Do you think I did any damage to my nose? How hard would you have tobump it for it to do damage?

  Answer:  I doubt it, I think it should be fine. JG 10.23.07

• I had sinus surgery, septorhinoplasty and chin implant 5 days ago. My doc. took my cast off yesterday. Today I have noticed that inside my right nostril it is almost swollen shut. Is it normal after surgery or is it a possibility that my nostril collapsed?

  Answer:  all normal, just swelling, it will get better over the next few weeks. JG 10.20.07

• Hi, can I use nasonex a corticosteroid nasal spray in my nose 3 months post op. Is it safe ? can it reduce swelling and help with healing ? Will it cause scar tissue ? thanks

  Answer:  yes, OK to do if you need it for breathing or allergies but it will not affect the scar tissue, swelliing or healing. JG 10.20.07

• Doctor, You seem to have a pretty good understanding of what is going on in my nose. I don`t know if I feel comfortable going to a random local surgeon here to do filler injections in my nose. Is this something you would be willing to do? Maybe at the beginning of next month I can fly down and would you be willing to inject Radiesse into the dent in my bridge?

  Answer:  please call my office and speak with Kerry, explain to her we have spoken via the message board and she can get you in when it is possible for both of us, see you soon. JG 10.18.07

• Hi Dr Garcia, I guess you are right. I didn`t think it could be this swollen after 13 months, either. I guess my only other question is, since there is a dent in my bridge behind the area that is full and swollen looking, I`ve had it filled in twice, but the results did not last very long, a few months from the restylane and a few months from fat injection. Do you think that a more longer lasting filler like Radiesse can still be used to fill in the dent, even if the front part of my nose isn`t sticking down properly? Or will the radiesse not stay in place? I guess you`d have to see me first to answer that?

  Answer:  I think Radiesse or Artefil are options, yes. They both should stay put. Best of luck. JG 10.18.07

• Hi Dr Garcia, I think I will be visiting your clinic soon to get your opinion of this in person. I have asked a couple of questions before, I hope you don`t mind. My supratip area is quit soft and thick since my rhinoplasty. I believe I had some overresection. I notice that if I press down softly for maybe a minute, the fullness in that area goes away and looks much better. It`s been 13 months since my operation. Do you think this really could still be swelling? Would another kenalog injection help? I`ve had two dilute kenalog injections and they helped before a bit. This fullness though does not seem to be going away. If I don`t apply pressure in that area for a couple of days, the swelling returns. You mentioned before that this could be swelling, but I wasn`t as detailed about it. Do you still think this could be swelling? The area is very soft. I don`t want it to turn into scar tissue. I was thinking maybe I could fly down to Vegas to have you take a look and see what you think could be done.

  Answer:  to be honest I do not think kenalog will help and I do not think it is swelling. You likely, at this point since it persists, have a space where there is no cartilage and the skin, due to it being scarred, cannot shrink or contract so it is bridging the gap rather than lying supple into the dperession. There is likely little to do I am afraid. JG 10.17.07

• Hi Dr.G. It`s been about 5 months now that I did my 4th Rhinoplasty for functional purposes. My right nostril I can`t breath from. If looking up into my nose, the right side looks closed with just a tiny little space that allows air in. My left side is fine. I don`t know what the inside of the nose is called where the walls look so swollen, but it`s not swollen. I think it`s scar tissue. I had this problem after my 3rd operation and the 4th one was to fix that which in fact it is now worse. It`s getting so bad not being able to breath, I want to know if there is there anything that can be done to open the nostril. If I touch the outside of my nose on the right above the nasal crease, it feels hard, but I can push it. And when you look inside you see the swelling look. Can the nostril be burned open with a special instrument or any injections I can use to make this go away? When I ask my PS about it, he say to give it time. However after the 3rd operation, I gave it 2 years and it didn`t go away. Thank you for your advice!

  Answer:  possibly some kenalog injections inside to soften the scar tissue. JG 10.17.07

• I had a nose job fixing a deviated septum about a year and a half ago. About six months after the surgery, the swelling had gone down and i was happy with the way it looked. Over the past year though, the tip has expanded, getting thicker (scar tissue growing?) What could i do to make it go back to the way it was? If getting a revision surgery is the best way to grow, and the growing scar tissue was scraped out, would this just cause more to grow? Thank you.

  Answer:  revision surgery might not help, could try small injections of kenalog or 5FU into the tip. JG 10.17.07

• Hope you`re having a nice evening Dr. Garcia. I had a complex rhino revsion (5th one) 11 weeks ago with a well known rhino revisionist in Cleveland. I`m mostly happy but at the 10th day I formed a dent above the tip from scar tissue removal and a shot of cortisone at the suratip (very thick skin here). It filled in quite a bit but the area below the bridge and above the suratip I formed a huge hump of scar tissue. I saw the doctor 3 weeks ago and he seemed very, very distressed about the result. He gave me a shot of cortosone into the hump and now the profile is perfect. He said he may want to add a bit more cartilage to the tip. The dent is now faintly noticeable. Do you think that it will fill more? And do you think that I`ll form scar tissue evenly in the next few months when it peaks at 6 months? I think the skin at my tip has been pushed to it`s limits.

  Answer:  I would wait 6 months at least before doing anything else just hang in there. JG 10.16.07

• Hi Dr Garcia, I recently read an article written by a prominent rhinoplasty surgeon about how filler injections (non-surgical nose jobs) in the nose are very dangerous and about how a lot of damage can be done if the fillers are not injected deep enough. He said there is a lot of risk for skin necrosis when the material stays in the skin layer superficially or something to that affect. I was going to get a dent on my bridge filled in and am now extremely worried after reading that article. Do you know anything about this and the risks? Thanks for your time

  Answer:  low risk if injected deeply as he says. JG 10.15.07

• Hello, Do you think it is ok to do levulan- blue light acne treatment 4 months after rhinoplasty. Otherwise I will have to ask them to cover my nose with protective gear from the light ? thanks so much !

  Answer:  I think it is probably safe. JG 10.14.07

• doc, I had Rhinoplasty 2.5 years ago,and was wondering,does picking your nose make the nose wider or bigger? since my surgery,i have had to pick it,because when i blow it,nothing comes out,but just sticks to the inside walls. thanks.

  Answer:  no it does not. JG 10.11.07

• good morning! i had a rhinoplasty done in 2004. i recently moved to my first home where we have a storm door and i am not familar with storm doors so the other day i was pissed off at my boyfriend and as i got up from the steps in the front of the house, i headed to go inside the house not noticing the storm door was closed ( as i could see inside the home and the door is glass and very clear) i banged my nose really hard. Now I have a lump in the middle of my nose ( more or less the same place where i used to have a hump) the lump has went down a little but still there a week later and a little red. do you think this will go away or do you think the lump will remain?

  Answer:  most likely it will go away, probably a little blood under the ksin that will take time to settle down. JG 10.8.07

• Dear Dr. Garcia, I had a complex rhino 2 months ago with Guyuron. I had severe alar retrction which he corrected...however at 2 months the right side has retracted slightly again. He told me that because he did so much to my nose, I may need a little touch-up. Can he fix the retraction again without a big, open rhinoplasty? Do you think that it will retract further at this point? Thank you very much!

  Answer:  hard for me to tell, it might be able to be done closed but it will vary depending on what needs to be done. JG 10.7.07

• I HAVE A QUESTION ABOUT MEDERMA. I HAD PUT MEDERMA ON MY NOSE 1 YEAR AFTER HAVING RHINOPLASTY. I HAD A SCAR ON NOSE I WAS THAT`S WHY I WAS TRYING MEDERMA. HOWEVER, I PUT IT ON MY ENTIRE NOSE, THOUGHT IT WOULD HELP WITH SWELLING. I DIDN`T NOTICE ANY DIFFERENCE, BUT RECENTLY I NOTICED THAT THE SKIN ON MY NOSE LOOKS A LITTLE LOOSER ON ONE SIDE, DID THE MEDERMA DO THIS. I KNOW MEDERMA IS SUPPOSED TO BREAK DOWN COLLAGEN, MAYBE IT BROKE DOWN COLLAGEN ON MY NOSE AND MADE THE SKIN A LITTLE LOOSE. FOR EXAMPLE, WHEN I CRINKLE UP MY NOSE, ONE SIDE IS NORMAL BUT THE OTHER SIDE HAS EXTRA UNLESS IT`S SWELLING.

  Answer:  have never heard of that effect happening, not sure what has caused it. JG 10.7.07

• Hello: My husband has a cyst on the right side of his nose towards the tip. Can it be drained or is surgery his only option?? Also are there any home remedies for treatment. Thanks very much......

  Answer:  no home remedies for a cyst, it can be lanced but if the wall is not cut out it will recur and eventually will likely need to be cut out if it is a cyst and not a mole. JG 10.4.07

• Hi Dr Garcia, After my rhinoplasty, my bridge was very straight. A week or so after the operation, I noticed that I could feel a bit of a dent underneath all the soft swelling. A year later, there is a significant dent. My doctor used septal cartilage to make a tip graft. My questions is, why did my bridge look so straight at first, when the cast came off, and then afterwards develop a dent? Does cartilage swell also? My doctor is very renowned and I wonder how he could have made such an error. Is it just poor judgment?

  Answer:  it probably looked straight due to the swelling and as it decreased the dent became more visible. A cartilage graft to the tip would not cause a dent on the bridge. Could use a small amount of filler to fill in the dent. JG 10.3.07

• Hi, I had closed rhinoplasty 3 months ago. I have a small scar in the form of a tiny bump on the outside of the nose. Will this go with time or do I need a cream or laser. Does elastoplast scar treatment work or anything else ? thanks

  Answer:  can try ScarGuard or Mederma. JG 10.2.07

• me again. That means that if I clipped off one of my stitches thinking that it was a nose hair then what will happen. The nose will not hold in place or the operation is completely ruined ? thanks

  Answer:  everything will be OK. JG 10.2.07

• Hi Dr. I had written you before, I was the one who used a clothespin on my nose and it made the bump on it, luckily you were right and it went away, but now I notice that my nose seems wider when I smile. Could this be because of the clothespin or because I`m gettng older (i`m 27) and it seems like If I look at pics its wider now. Could it be cause of the clothespin, or could you offer any explanation? Thanks dr (oh I hope this doesn`t post more than once, it wasn`t showing up)

  Answer:  no, I do not think the clothespin did that. I think you just got used to it being thinner and when it went back it looks wider from what you got accustomed to. JG 10.2.07

• hi, what is the danger of swimming underwater 4 weeks after a rhinoplasty operation. If I am alone in my pool and noone will hit me on the nose. Is it bad to go underwater will this affect healing and cause something to go wrong? tks

  Answer:  not a problem. JG 10.1.07

• Hi, I forgot to ask. Is there any way to get rid of nose hairs near the nostril which show for a woman ? I don`t think if would be recommend to put laser near the nostrils after a rhinoplasty to get rid of nose hairs ? thanks

  Answer:  have to cut them somehow. JG 10.1.07

• Hello, how long does it take for the dissolving stitches to completely dissolve after a rhinoplasty operation ? I have a few nose hairs near the nostril which I clipped 3 weeks after rhinoplasty with tiny scissors and I am worried that maybe one of those hairs could have been stitches that I would have snipped off. Is that possible ? thanks so much

  Answer:  migth take a month or sometimes a little more on the inside. Removing them after 3 weeks will not be a problem. It is possible you clipped one of hte stitches, yes. JG 10.1.07

• Hi again Dr.Garcia, I am still battling the irritated facial nerve and saw the ps again today. He doesn`t think the upper bleph or rhiniplasty has anything to do with it. In your opinion, does retin a or other topicals irritate facial nerves enough to cause twitching and spasms?

  Answer:  no I do not think they should cause that. Stress can though, or a nervous tick. JG 10.1.07

• I am 6 months post surgery and I just bumped my nose at the bridge and now there is a big bump there. Could I have rebroken it?

  Answer:  possible but doubtful unless it was quite a strong blow. JG 9.30.07

• Hi Dr. Garcia, Is it normal to have twitching under the eye and corner of the nose and mouth 9 months after rhinoplasty? My nose feels tight underneath the nostrils. Thanks so much.

  Answer:  it can be, but twitching comes form either irritated nerves or also a nervous twitch form stress, so it might not be related. JG 9.29.07

• i have wrote to you regarding my nose job that i done 7 weeks ago and now is swellen and red is that sinus infection or the bone is infected as all my nose is so red and swellon i am now in antibiotic is this dangerous

  Answer:  should not be dangerous, no. I doubt there is a bone or sinus infection but you should see your surgeon for some antibiotics to help it heal better and faster. JG 9.29.07

• Do you know of some great Rhinoplasty Revisionist in the L.A. area?

  Answer:  Rollin Daniels MD. JG 9.27.07

• i had a nose job 7 weeks ago i had swelling all my face now suddenly all gone and just sudenly my nose only swellen is it normal or an infection in my nose is the reason i am very worried

  Answer:  doubtful it is an infection, could have come from something as innocent as blowing your nose, it should all go back down in time. JG 9.27.07

• hi dr i am the lady that had a nose surgery with botox inject to my fore head the same time, as i told you my eye lids dropped after botox, which now 85% better however i have noticed that all my swelling in face gone and suddenly my nose is swollen very much is that normal?? now is 7 weeks gone from my operation. i am now worried. i had also on my left side of my nose from start like bump swelling that does not look reduced aswell. thanks for listening

  Answer:  all normal, nothing to worry about, nose swelling is a long term issue but does get better, final results will not be there for 10-12 months though. Glad the droop is getting better. JG 9.27.07

• Thankyou Dr Garcia for your quick response regarding the big lump that has formed right down my nose. Could this alredy be scar tissue forming? Towards the tip it is fairly hard but the rest i can squeeze it and push it around, although it does also feel hard to. The lump that is on the bridge of my nose definelty moves away when pressed so i know it`s not bone. A year hey, wow, what a long time, very depressing but guess there`s no other choice. I can`t understand how my surgeon didnt tell me to wait longer before redoing yet another one, he said it waS A walk in the park. He is a top surgeon in australia here to we did our research extremely well. If I had read this site before hand i would not of had that third revision, it was only the one ninor thing and all else was perfect, should of just lived with it! Anyway dr, do you think that i should continue on with steroid shots or something other than that to help along, i just dont want to use it to much and it have the other effect. I massage my nose everyday hoping that will do something little along the way. If you know of any way to minimise swelling quickly please let me know. Anyway thankyou so much for your time, the answers are really greatly appreciated.. AMANDA (australia)

  Answer:  scar tissue is difficult to compress so that area is likely swelling, the scar tissue should feel firm. Well the surgery might have been a walk in the park for the surgeon, but the end result is you have to cut the grass and heal and that takes time. I think steroid shot should help though. Just not too big of a dose to avoid tissue atrophy, your surgoen will be aware of that, best of luck. JG 9.26.07

• Hi Dr Garcia,Thankyou for your site, it helps reading and knowing that there are other people going through the same thing! Okay i first had open rhinoplasty done in Thailand in february this year, he removed the lump on the bridge of my nose and also took cartilage from my ear and did something with the tip, which i didn`t know about, it didn`t actually seem to make any difference though. Anyway after the splint was removed and i had come back to Australia i developed a lump on the side of my nose. I went and saw another surgeon here in Australia and he said that it wouldn`t go away without a revision done. Had closed revision done in April this year as my surgeon said there was no swelling visible still from previous one. Nose was perfect for about two months but then developed i think it was cartilage (it was really white) right on the tip which was very noticeable. So have just had another closed revision done, coming upto 7 post op now. My nose now has a big lump that has formed right on top of my nose, from the bridge til just before the tip and there is a lump on the bridge once again. I have had two steroid injection shots but it seems to have done nothing. I can pinch the lump, it feels squishy and soft. Just wondering what it is and if it will eventually go away? My surgeon showed me the photo he took just after he put the splint on after the operation and my nose looks perfect, will it go back to that ever? I realise now i should of waited longer before having the third operation done, if i knew it would make it heaps worse i wouldn`t of done it! Thankyou for your time, greatly appreciated! Amanda (Brisbane Australia)

  Answer:  it likely will, sounds like just a lot of swelling due to frequent surgeries close together, but to get to the look you had in the photo may take a year or more, just give it some time, best of luck. JG 9.25.07

• does cartilage hurt if damaged? inside my nostril where it starts to flare out, it feels like it would be a pimple, but i don`t think it is. it looks like a white scar or where the incision was, but it`s kind of hanging when touched. is this normal, or does it sound like cartilage may have collapsed? possible ingrown nose hair? i know it`s hard to understand what i`m talking about without actually seeing my nose.

  Answer:  it can be normal, and cartilage usually does not hurt too much. It likely is the edge of the incision inside is just still swollen. JG 9.25.07

• Hi Dr Garcia, I wrote to you last week about restylane in the dent in my nose following a rhinoplasty. Is this a kind of procedure most rhinoplasty surgeons can and will do? Is it something you would be willing to perform? Or is it a specialist kind of thing?

  Answer:  I think it is a straightforward thing for any surgoen to do. I would certainly be willing to do it for people that would benefit from it. JG 9.24.07

• Hello, I am 3 months post op after a tip revision rhinoplasty. My tip is still very swollen. I have been wearing sunblock and a hat but it is hot outside and hot in the car and in the house. Does summer months increase the swelling in a rhinoplasty. Is this permanent swelling or can it cause scar tissue ? How do people manage staying out of the heat for one full year in warm countries. I am not lying in the sun but I do have to go outside to pick up the kids from school and do errands ? What is the risk and is it permanent swelling ? thanks

  Answer:  heat can increase swelling a tiny amount but nothing excessive. It cannot cause anything permanent nor cause scar tissue.JG 9.23.07

• I send you an e-mail attached a picture of mine. I am interested in having a non surgical nose job. I need a little bridge. Please educate me on the different typse of filler and how long they will last and your price too. Thank youvery much for your time Doctor.

  Answer:  let me look at the picture and then we can see, but the fillers are all about the $650 range or so if we use Perlane or Radiesse, they woudl last about one year, maybe a little more. JG 9.23.07

• sorry I just post about the non surgical plasty. How much do you charge for a non surgical nose jobe I need a little bridge I had a tip plasty and narrowing of my nose almost 2 years ago.

  Answer:  depends on filler chosen. JG 9.22.07

• I had a tip plasty and narrowing of my nose almost 2 months ago. I did not have my nose bridge touched. If you perform non surgical rhino plasty on my bridge what is your initial charge or how my do you charge?

  Answer:  well we charge in accordance with the filler used so it is by syringe, approximate cost would be $650 or so. JG 9.22.07

• blood vessels in upper back of nose,connected to the septum. if this accidentally poked and bleeds, will it ever be normal again or permanently damaged? i mean permanently swollen or cause scar tissue growth

  Answer:  nothing permanent should happen. JG 9.22.07

• Oops i made a typo in that last message! What I meant to say was, for whatever reason, I ended up with a dent in my bridge, probably due to the overresection Sorry!

  Answer:  got it. JG 9.21.07

• Hi Dr Garcia, I have two questions. I had a rhino a little over a year ago and for whatever reason (another doctor told me over resection). I was told that Restylane injections will help but that they are temporary. My doctor told me that sometimes it turns into scar tissue and becomes permanent. Is this true? Also is there such thing as a permanent filler and if so, would you recommend this instead? Thank you

  Answer:  I do not think Restylane will become permanent with scar tissue. There are permanent fillers that can be used off-label like Artefil, but Restylane is a good place to start to see if what needs to be corrected can be done with fillers. JG 9.21.07

• Dear Dr. Garcia, Is there anything that I can do to INCREASE scar tissue formation in the suratip area following revision rhinoplasty? I`m 2 months post-op. Thanks!

  Answer:  not that I know of. JG 9.19.07

• is there skin inside nose or is it something else. for some time now i have been having dry nose inside and i peel off dry flaky white see thru skin or at least that;s what i think it is. but it always grows back in a couple of days time. should i just leave it alone? this wouldn`t be scar tissue that i`m pulling off? also is this skin supposed to hold up the nose because sometimes it looks as if the tip is a little droopy after this but when skin grows back the tip lifts back up. is this possible or just coincidence? nose

  Answer:  it is called mucosa and is not as strong as skin. Just leave it alone. I think the lifting is coincidence. JG 9.19.07

• REGARDING THE NOSE PICKING/SCAR TISSUE QUESTION. I HAVE PICKED WITH A TWEEZER, SOMETIMES UNTIL IT BLEEDS. IF I DID CAUSE SCAR TISSUE, WILL THIS EFFECT THE SHAPE OF MY NOSE? WILL IT BE THICKER LOOKING,ETC?

  Answer:  should not if you have not had a chronic problem with it. It will not affect the thickness. JG 9.19.07

• IN RESPONSE TO THE QUESTION ABOUT NOSE LUMP, POSSIBLE CYST. WILL A CYST EVENTUALLY GO AWAY OR IS IT PERMANENT. DOES IT HAVE TO BE SURGICALLY REMOVED? OR IF THIS LUMP ON BRIDGE OF NOSE IS SCAR TISSUE, CAN MEDERMA OR ANYTHING LIKE THAT HELP SINCE IT KIND OF RAISED UP?

  Answer:  it might need to be cut out. Topical therapy will not help a cyst. JG 9.19.07

• Hi Dr. Garcia. Is it true that the surgeon can see if there is cocaine use during rhinoplasty by a certain type of scar tissue that forms in the nose? Thank you.

  Answer:  the most common cause for a septal perforation is either cocaine abuse or a traumatic septal hematoma that was large and went undrained, so they can at times tell, yes. JG 9.17.07

• in the middle of the bridge of my nose, i have a lump which is soft, so it`s not a hump. at times my nose will look almost straight and then it swells back up.when i touch it, it presses down. over a year ago, in that same area i had picked at some dry skin/pimple, maybe the new skin grew back with scar tissue????

  Answer:  could be, hard for me to tell mroe without feeling it, could be a cyst also. JG 9.17.07

• if a person overpicks their nose inside, can this cause scar tissue?

  Answer:  potentially yes, especially if it bleeds. JG 9.17.07

• Dear Dr. Garica, I wrote before about cortisone shot in the nose at surgery time (very thick, oily skin) that left me with a small dent. It`s filled some but has seemed to stop or slow down. I`m now 6 weeks post -op. Will it continue to fill in or slow down? It wouldn`t be noticable but I`m forming scar tissur above the indention, so it stands out more. If were your patient, how you treat this? Thank you for being so patient

  Answer:  I would not do anything to it for 6 months and see what happens, hang in there for a little longer. JG 9.17.07

• What does it mean that scar tissue retracts or subsides? Does that mean that some scar tissue will form after surgery and some of it sometimes slowly goes away?

  Answer:  in time it usually flattens and softens in the healing phase, it never totally goes away though. JG 9.17.07

• I have an nose operation and botox was injecyed to my fore head the same time when i was under annestetics(uncounsios)on 08/08/07, afetr 3 day i had a dropping eye lids in my right eye and also my mouth in my right side is dropped. now 6 weeks is gone i am 30% better i am worried that am i get fully recoverd from this.why this happened?? is the nose operation make my nerve like this or botox or the swelling make all of this. thank you for listening

  Answer:  it can happen form the Botox migrating, it can happen if you lie on your side after the injections, should all wear off and not be permanent. JG 9.17.07

• Hi Dr. Garica. For patients with very thick scar prone nasal skin: when does scar tissue peak and then subside follwing revision rhinoplasty? Thanks

  Answer:  final softening and shrinking will be 12-18 months. JG 9.16.07

• THIS IS A GENERAL QUESTION ABOUT NOSES, NOT RHINOPLASTY. IS THIS TRUE? SUNLIGHT ENCOURAGES THE NOSE AND/OR CARTILAGE TO GROW OR GET THICK? IS THAT WHY ELDERY PEOPLE HAVE THICK NOSES?

  Answer:  no, sunlight does not affect it, it just happens with age as the oil glands tend to enlarge and thicken the skin with time. JG 9.16.07

• Hi Dr. Garcia, I am very frightened and need your professional opionon. I had my first Rhinoplasty procedure done 8 weeks ago. I was noticing pain inside my nose and stiches sticking out. I went to a ENT specialist and they took out a quarter inch of prolene sutures from the skin side my nose. They said they could not get it all out because the doctor had threated it into the tip of my nose. Is this common to use this type of permanent suture? I went back to him several times and he just said it was dissolvable sutures that did not dissolve yet. Now I know he is not telling the truth. What do you suggest?? Thank you for your help! Sandi

  Answer:  well some doctors do use prolene in the tip, I think you should ask the surgeon who did it and try to get the answers from him as they are the best to know what is in there. JG 9.16.07

• Hello Doctor Garcia I had septo/Rhino 6 months ago. One of my concerns was my bridge was too wide and I had breathing problems. I had to have ear cartlidge placed as graphs and now the bridge looks even wider which does not fit with my face. Ny nose still feels somewhat numb. Will this possibly narrow in time and if not what type of revision surgery would you recommend? Thank you

  Answer:  it might narrow some in time but not a large amount, the narrower bridge can cause difficulty in breathing though. JG 9.16.07

• how do people get uneven nostrils after rhinoplasty? is this noticed right after surgery or several months/years?

  Answer:  it can come from treatment of the cartilage, it is usually noticed after the swelling starts to go down. JG 9.16.07

• can you please describe what is a callus on the nose. does this appear similar to a hump? also, when people put ice on nose after it`s hit to avoid getting hump/swelling, does this really help out? my nose was hit on the side of the tip, i didn`t put ice on it, seems to be more rounder or this side now, hope this will go away but i think it is permanent.

  Answer:  callus is extra cartilage after treatment of the bone or cartilage, it can fell and look just like a hump. The ice does not affect callus, just swelling. JG 9.16.07

• Hi Dr Garcia, I wanted to let you know how much I appreciate your taking the time to answer questions. It`s a very generous thing you have here. I am appx. 1 year post op from an extensive rhinoplasty with extensive tip work done (including a tip graft). In the morning, my supratip area is slightly swollen. It goes down through the day, however, if I apply very gentle pressure (not much at all is needed) to the supratip area for maybe 10 seconds or so, the swelling goes away. I can almost make a miniature dent in the swelling. Could that area still be healing and improve in time? The swelling in that area was a lot worse a few months ago and two kenalog injections helped significantly. Thanks for the time.

  Answer:  yes, very likley due to the extensive nature that there is still swelling, might take up to 18 months after surgery to slow down. Hang in there. JG 9.6.07

• I had a rhinoplasy/septoplasty in Dec 2006. Seven months later I developed a bump on the bridge of my nose. My PS gave me a kenolog injection that helped but didn`t fix it completely. A month later (a week ago) he gave me another one and now it is actually worse. It`s like a big soft pimple on the bridge of my nose and feels sore. My PS thought this one would work but now I`m super upset. It there a chance it will eventually work or can I get a revision? Thank you!

  Answer:  I would give it a few months and I think the bump from the shot will go away, but what was there before the shot might not. JG 9.5.07

• Hi Dr. Garcia. I`m 1 month post-op open rhino and septoplasy and 3 month post-op bullhorn lip lift. So you can imagine the area is very stiff and feels like cement. Should I do smile exercises to loosen tightness and break up scar contracture? I heard tension is the worst for keloids.

  Answer:  I think just giving it some time and light massage is all I would suggest. JG 9.4.07

• Hi Dr Garcia, How long after rhinoplasty can kenalog injections be considered effective (for scar tissue/edema?) Is 1 to 1.5 years too long to have any effect?

  Answer:  I think the longer one waits the less effective they will be. JG 9.3.07

• Hi Dr Garcia, A quick follow up question, how long does it take for the skin to properly drape over the frame? It wasn`t so much the tape I was worried about, but the tape pulling the skin off the cartilage framework a week after surgery. You`re saying that that should not have caused any damage longterm?

  Answer:  it takes months for the swelling to go down so the skin will not really re-attach to the cartilage for a long time, you are safe. JG 9.2.07

• Dear Dr Garcia, I have two questions: a week after my rhinoplasty, they removed the cast and taped my nose, told me i can remove the tape at night and then tape at night again. They didn`t tell me how to remove the tape. I kind of had to yank and pull the tape off and it peeled off. Could the pulling of the skin (as I removed the tape) cause any long-term damage? I didn`t know that the skin adheres to the cartilage until later, and I felt like they should have told me how to remove the tape. They told me afterwards and then I used a solution to remove the tape after about a week of having to peel the tape off. Could I have caused any long-term damage? Or just short term swelling? I continued to tape at night for almost a year afterwards and used a solution called detachol and was very gentle afterwards. But it was only the first week that I didn`t know how to remove the tape.

  Answer:  I do not think the tape coming off will cause any long term problems. Just peel it from one side ot the other. The detachol or nail polish remover will get the glue off. JG 9.2.07

• Hi Dr. Garcia. Does answering questions also help you get an idea of what works for patients and what`s problematic? Also, I asked last week about a dent in the tip after cortisone injection during surgery (3 weeks post-op) and it`s filling in a little already (I think). Thanks for putting my mind at ease.

  Answer:  I always learn from all of the questions. Glad your issue is improving and best of luck. JG 8.31.07

• Is it possible to have a revision surgery after having depression filled with Radiance? Will it create complications or is it OK once it reabsorbs?

  Answer:  well it is probably best to see if it dissolves, but it will not cause any problems. JG 8.27.07

• Hi Dr. Garcia. I`ve had a few rhinos. and had a revision 3 weeks ago. I always form a thick band of scar tissue above the tip. The surgeon removed the scar tissue and gave me a shot of cortisone at surgery time. Now I have a slight dent at 3 weeks. Every other time i had cortisone, it shrunk initially and sprang back up a little. Since I form a lot of scar tissue in general, do you think the dent will fill in...especially because I`m only 3 weeks postop and scar tissue peaks at 6 months (right)? Nervous here. Thank you so much!

  Answer:  yes, it should fill in over time. Give it some time. JG 8.26.07

• question about humps on nose. i know humps are genetic but can they come from trauma, hitting? is this permanent or resides over time? if hit on the top boney part? i have a tiny raised lump where a tweezer hit the upper boney portion of my nose, is this possibly just swelling or permanent since bone?

  Answer:  trauma can cause humps too. If it is hard most likely it is permanent and would need to be surgical reduced. JG 8.24.07

• Hi Dr. Garcia. I was reccomended to Dr. Guyuron for a rhinoplasty revision. Do you know much about his techniques? Thanks so much. You really help to ease peoples nerves. Invaluable service you provide.

  Answer:  I think you are in great and talented hands. Best of luck. JG 8.23.07

• how about radiesse or artecol to fill in nose indentation? Or is restylane still better and safer? Thanks!!!

  Answer:  I would try the Restylane first and then switch to the other once the Restylane has absorbed, just to make sure it can be filled in to your liking. JG 8.21.07

• Also, one of my nostrils is rounded and the other pyramid shaped on the top, 2 straight lines like. what can be done? fillers?

  Answer:  For that it might require more surgery to balance the cartilage out. JG 8.20.07

• Dr Garcia I had a rhino several yrs ago and now there`s an indentation near the tip and it`s a little red. would restylane help?I see this alot with those who`ve had rhinos.

  Answer:  yes, I think it is a good option. JG 8.20.07

• Hi Dr. Garcia. I had the bullhorn lip lift (which I love) and a rhino revision 8 weeks later with a top revisionist. The doc who did my lip lift put in dermal fat grafts in the philtrum columns. The left side healed out of place. Can these be easily corrected through an internal incision (mucosa) ? I don`t want to cut under the nose again. Thanks much!

  Answer:  I think it is better to do it from the outside so the muscle does not have to be cut through. JG 8.20.07

• Hi Dr., I just had a question about the dressings (steri-strips) on my nose from my tiplasty...What are they for? and will my nose change if they came off and i put them back on?

  Answer:  no probelm if they came off, they just help minimize the swelling. JG 8.17.07

• Dear Dr Garcia, I had my nose done about 3 years ago and am very very happy with the result. My plastic surgeon had placed a silicone along the bridge of my nose to raise the height and also at the tip of my nose. I have a few questions though. 1)How do I avoid the inplant getting infected? 2) Is having the silicone in the nose area more prone to infections than having it elsewhere? 3) What causes the silicone to get infected? Thank you so much in advance for your answers, Regards, Rini.

  Answer:  the only thing you can do to avoid the implant form getting infected is to not pierce the skin with anything. I think since there is more bacteria in the nose the chances of infection are higher than in other places of the body. The pocket around the silicone gets infected when bacteria gets into from a surrounding infection. JG 8.15.07

• Hi Doctor, I am a year post op from a complex rhino, and thick skinned. I still notice that sometimes my nose is a bit more swollen than othertimes. Is this normal and how long can swelling persist for?

  Answer:  that can happen in some people for up to 18 months I am afraid. JG 8.13.07

• thanks for answering about Iam 17 yrs old.. can I just send you some pictures so you can asses? Ive been looking for a celebrity look near me and Adriana Lima got my eye, maybe its because of her wide Alar but her bridge is really pronounced that made her look better.. so where can I send my pic? Thanks a lot!!

  Answer:  please send them to drgarcia@lvcosmeticsurgery.com

• How many Kenalog shots can a person safely get in their nose? I`ve had two with minimal results. It`s been 11 months since my rhinoplasty and the tip and cartilages are still hard. Granted, they have reduced some, but not as much as I would like. I am contimplating another Kenalog shot but am worried of the consequences.

  Answer:  it all depends on the dose given each time. JG 8.11.07

• Iam still 17 years old and asian with an oval face, big almond eyes and full lips. the only problem is that I dont have a prominent nose bridge and both my alar hang low, I also believe I have thick oily skin on my nose, so what can be done with it, I am thinking about alar trimming only, or will a bridge also be necessary? my nose is my only problem please help! thanks

  Answer:  might need both I fear but hard to say witout seeing pictures. JG 8.11.07

• Hi Dr.Garcia! I wrote recently regarding a facial tic. I had the upper bleph, rhinoplasty, septoplasty and turbinate reduction. The tic is still bothering me, but I have found if I hold my nose shut and breathe through my mouth, it goes away. What are your thoughts on this? Thanks so much.

  Answer:  I am sorry but i really cannot say awhy that is happening, a puzzle for me too. JG 8.11.07

• Dr. garcia, Can a ski lift type nose be straightened out?

  Answer:  in most cases it can. JG 8.10.07

• I had a rhino revision 2 weeks ago, where ear cartilage was slipped into a pocket in my bridge. The cartilage is warping a little creating a bump. It is springy when I push down. Will taping my bridge help and how long before scar tissue forms around cartilage?

  Answer:  taping will only help a smal amount, I think you should return to the surgeon and be examined. JG 8.10.07

• I have had a previous septoplasty and rhinoplasty in early 2006. I have noticed that my deviated septom has returned and my nose started to regain a swinging door apparence. Should I have a sense of urgency or can i wait another year before getting this taken care of? Also, can a septom be straightened?As well as, what can be done to round of rough edges around the tip of the nose and raise the bridge of the nose, i have heard about grafts and implants but which would be best for gaining a natural loose looking nose?. Thank you for your time.

  Answer:  I think waiting is OK and in many cases the septum can be straightened but not in all. Cartilage grafts are commonly used to raise the bridge of the nose. JG 8.10.07

• Hi Dr. Garcia, I just had rhinoplasty and septoplasty yesterday. It was my second operation. I was promised not a piggish nose, but in my cast that is exactly what it looks like. While before i had 2 tips at the end of my nose, i know have one which is what i wanted, but my nostrils are much more exposed than before. Is this just the cast and swelling or will this be a problem? Im very worried about this and thank you!!

  Answer:  I think at this point it is likely due to the selling and the cast and should settle down quite abit, just hang in there. JG 8.9.07

• Hi, I asked the question about the tip rhinoplasty a few post ago. Are there any questions I should ask? People say I shouldn`t mess with a problem that is not that bad. People have actually said I have a cute not. But it is Pug . I`m not messing with making it longer. Just want to thin the tip. I assume no nose breaking is necessary? Any thoughts or warnings? Wish you practiced in my town! :)

  Answer:  well the only thing to remember is if your skin is thick it might not show the detail of the cartilag2e cahnges so your skin will limit the end result as much as the surgery. JG 8.7.07

• What is the range in price for Rhinoplasty?

  Answer:  in our office it can range from $4000 to $6300, depending on what is done. JG 8.6.07

• Hi How long after a septoplasty can I start going back to the gym? My operation was three weeks and three days ago. Thanks

  Answer:  2-4 weeks. JG 8.6.07

• Are there any concerns I need to consider with a *tip* rhinoplasty? I`ve hemmed about it for years, as my nose is not too bad. It is just wide at the base (and a little tipped up) but people are always saying that there can be major problems when you start messing around with the nose.

  Answer:  well in experienced hands it should be OK to proceed. JG 8.3.07

• I`m a 50 YO male in very good shape. I`ve decided after all these years I really do want a nose, chin aug, lipo and possibly pec implant. Crazy at my age? I mean physiologically do difficulties arise because of my age? I do not foresee any complications such as deviated seps, etc. Probably the only problem might be that I only need less than 4 lbs lipo`d from the belt line.

  Answer:  well I think the issues might be loose skin after the liposuction and at times a pec implant can have an unnatural appearance when your own pec muscle flexes. JG 8.3.07

• hi me again, i had asked about ice on nose. i dont think i have frostbite, but if i did what would be the symptoms? would the swelling be permanent?

  Answer:  constant pain and the skin would look very white. JG 8.3.07

• is it possible for a person to get a collapsed looking nostril from hitting. i used to see both of my nostrils when looking into mirror, now one side is half noticeable. i have a cartilage graft in tip and i hit it hard, when i hit it my hand hit the tip down and then back up. ever since, i noticed my nostril looked different, never noticed before. probably from hitting.

  Answer:  could be from the cartilage or boens caving in, yes. JG 8.3.07

• i heard about using epsom salt on pimples so i tried it on my nose because of blackheads, well it made my nose swollen. i hope this swelling goes away. i hope it didn`t do anything to the cartilage? i have a graft in tip.

  Answer:  all temporary, will all go away, you did not do anything to the tissue below the skin. JG 8.3.07

• P.S. on my epic revision rhinoplasty question (blister-like cartilage showing through skin, strut bowing): Is there any possibility that, if a graft was placed too superfically in the nasal tip, it could resolve on its own? Doesn`t sound promising from other poster`s experience. Again, thanks.

  Answer:  all depends on how thick you skin is, the thicker the better. JG 8.2.07

• I had revision rhinoplasty 5 weeks ago (open with ear cartilage grafts) to repair 20+ year old rhino gone bad (tip too turned-up, right side collapse so no breathing, notching of nostrils so inside of columella visible on one side). Originally thrilled, could breathe for first time in years, very straight, swollen of course, but I was glad to see some volume back. Now, swelling going down very fast and, while breathing still great, two things have me fearful that things are going very wrong. First, a round red spot has appeared on one side of the tip (maybe half-dime sized). I see that you discussed with another poster that this could be the result of a graft placed too superficially. Second, the PS placed what he referred to as a floating strut in the columella below the septum. While he assures me that he inserted a straight piece of cartilage, it is bowing BADLY to one side and, I think, pulling the whole tip out of line. Worse, I can actually feel the tip of the thing kind of poking out (not through the skin . . yet?) on the end closest to my face. Of lesser but cosmetic concern, I don`t think the tip got rotated down very much, though its better. My PS has poo-pooed my concerns on these fronts so I have lost trust and made appointment with out-of-state top revision specialist (who was on my original list and who I probably should have gone to in the first place, but was convinced by this doc`s credentials). Long wait, however, and I am very concerned about the possibility of irreversible damage (tissue loss?) if these things are left alone for several months. Thank you for your kind and informed responses. You cannot imagine how helpful and calming it is to have an honest, straight forward and impartial opinion and to read that others have similar fears/problems.

  Answer:  I think the potential of skin damage is small so I think you are safe in waiting a bit, but I understand your concerns, hopefully with time they will settle in without further surgery. The skin will tend to thicken up in time and some of what you are seeing now will look better but I am unsure as to the deviation getting better, hang in there. JG 8.2.07

• Do perform non surgical nose job? I need a little bridge on my nose.

  Answer:  yes we do, please feel free to call the office for a consultation appointment. JG 8.1.07

• Hi again I forgot to ask you the following. I had revision rhinoplasty done 4 weeks again (closed) and I have a bump or maybe it is a scar on the outside of the nose on the side near the nostril. The doctor just told me to put vitamin E on it. He said it formed because he had to come so close to the skin and bone to remove the ball of cartilidge that I had (it was all closed rhino). Do you suggest something else I am 4 weeks post op and it really shows alot ? thanks alot

  Answer:  I think just a good moisturizer and stay out of the sun is the best. JG 8.1.07

• thank-you for you website. I had revision rhinoplasty done 4 weeks ago to remove a ball of cartilidge on the tip that had formed. The doctor said it was cartilidge the nurse told me it was scar tissue. Now 4 weeks post-op there is still a ball at the tip not at the exact same location but still too much cartilidge. Is this swelling or am I doomed again ? What can be done ? thanks so much

  Answer:  sounds like swelling, need to give it a number of months for all of that top go down. JG 8.1.07

• Do you have to be put to sleep for open nose surgery? I had nose surgery before which the incision was made inside the nose going all the way up tobridge. The doctor chisseled my nose too bold so he did a revision to chissel it down softer. I did okay. So, would I do okay with open nose surgery just for work at tip area? I have a step down on my septum which was never corrected so there`a hard lump there.

  Answer:  I only do general anesthesia for my rhinoplasties, especially complex ones like yours. JG 7.30.07

• sorry Dr., forgot one question...if possible to correct the current positioning of the cartilage, would it be better if done through open surgery?. 1st was closed, perhaps that is why the result was so poor & uneven. Is the healing of open much longer than a closed one?. Thank you again.

  Answer:  placing the alloderm can be done closed too. I do not think the closed technique caused the cartilage to show though. An open technique has longer swelling time on the tip. JG 7.30.07

• Awesome site!!. Had surgery 11 months ago to correct a slightly bulbous/soft tip, however, result is that all cartilage shows through skin so I will have revision surgery, but I have been so disappointed with the results of the 1st surgery that I am considering to just ask Dr. to remove the whole thing as I fear poor results again. OR is there a way to correct the current positioning so that it won`t be visible through the skin, if so, how accurate is that procedure?. I absolutely do not want a 3rd surgery so the 2nd one must be it. Also, is it possible to take cruise to Egypt 4 weeks post-op?. I would avoid sun, but i could not avoid it 100% due to excursions. You`re a gem Dr. and a wealth of information. Thank you & God bless your kindness.

  Answer:  well I think if the cartilage is easily seen something will need to be added, not taken away, maybe a sheet of alloderm to thicken the tissues over the cartilage, I think going on a prolonged vacation so soon after surgery might limit your activites during the vacation too. All the best and thanks for visiting and also for the kind words. JG 7.30.07

• I had a septoplasty on 13 July 2007 and it is uncomfortable to wear my glasses. I want to check is it ok to wear my contact lenses (day and night ones) please?

  Answer:  OK on the contact lenses. JG 7.15.07

• I had a septoplasty on 13 July 2007 and it is uncomfortable to wear my glasses. I want to check is it ok to wear my contact lenses (day and night ones) please?

  Answer:  yes, OK on the contact lenses. JG 7.15.07

• HI. CAN I HAVE A NOSE JOB AS I AM 18 YEARS-OLD?IT REALLY BOTHERS ME PSYCHOLOGICALLY!!

  Answer:  at 18 you can have it but we must determine that your are psychologically stable in order to do it for you. JG 7.13.07

• If you have a bullnose lip lift, can you (at the same time) straighten crooked nostrils? The nostrils are not cemetrical and the nose is slightly slanted.

  Answer:  it could be done at the same time,yes. JG 7.12.07

• i was recently hit in the nose so i applied ice to ice, but then i found out that ice should not be applied directly to skin of nose and that`s what i did. i just placed an ice cube on nose. did i just further damage my nose. it seems more swollen?

  Answer:  no damage in most cases, you just should not leave it in direct contact for long periods of time to avoid frostbite. JG 7.12.07

• Hi Dr. Garcia, Thank you very much for this site. I had a nose job 9 weeks ago. My nose was long, had a large bump, very long nostrils (I could put three finger in it.) The doctor left some of the bump which is okay, but pulled it up so that I now have the columella pointing up and the tip of my nose is high. My nose now looks short and you look at my nostils. It is a nice nose but too short so I now have to walk with my head down to make it appear that my nose looks lower. Can my nose be lengthened and the columella be brought down so that it is pointed at a normal angle/level. This has also effected my speach as my upper lip now curles around the nose when I smile. Thanking you in advance for your experience and time.

  Answer:  it can, it is more involved, it might require some cartilage grafts to maintian it too. All the best. JG 7.11.07

• HiDoc, I see. Do you still think that stitching the skin down might help,or notreally?

  Answer:  it might, if you can get the skin to readhere and create a thin layer of scar tissue that will hold it there. Need to see your surgeon to see if it is possible. JG 7.9.07

• Hi Dr, Puffy tip guy. You said it could possibly stay this way. Could kenalog or anything at all help? You mentioned stitching it down possibly. Would kenalog do anything?

  Answer:  If it gets better with tape then it is not scar tissue causing the appearance so I do not feel Kenalog will help. I think the issue is your ksin is thick and will not re-attach and adhere to show the underlying definition you desire. JG 7.9.07

• Hi Dr Garcia, I posted previously about a puffy supratip area. Well, my doctor has given me a couple of kenalog injections. I had a big injection about a week and a half ago. I haven`t really seen any improvement yet. Basically, when taped, the area looks nice. but when I go to sleep and wake up, it`s swollen like a balloon. Throughout the day, the swelling *feels* softer and less firm. It`s been 1 year and I`m tired of this. Will it always be this way? Should I give the kenalog more time? Could the kenalog even work?

  Answer:  I am afraid it might be, yes. JG 7.9.07

• Good Evening, Dr. Garcia. I am a 39-year-old male who had a rhinoplasty in Sep.`04 and a tiplasty in Sep.`06. I still am not crazy about my side profile; the nasal skin on both sides appears thick, and my nasal tip still appears bulbous. Also, I wish I could refine my nostrils a little more; they`re kind of pear-shaped. Would full-strength Kenalog-40 do anything to reduce the size of the tip, thick skin, and the size of the nostrils? If not, would a second revision be needed to achieve thinner skin, a more refined tip, and more refined nostrils? Thank you.

  Answer:  I do not think the kenalog will do much to reduce skin thickness and I feel that is the limiting factor in your end result. The desired end resualt you have pictured in your mind might not be possible due to the thickness of the skin and more surgey may not be abe to achieve it as more surgery can only reshape the underlying structures but cannot thin the skin. JG 7.7.07

• I have another questions, I had Septoplasty and shaving of hump 4 weeks ago. The tip of my nose has started to droop meaning there is a lump appearing where I believe my septum was re-aligned. Is it too long after surgery to start taping up the tip to supprt it? How many hours a day would be sufficient to wear the tape?

  Answer:  I think taping it at night might help some. JG 7.6.07

• I had a Septoplasty and shaving of hump on 06/06/07. I did have an infection in the septum following surgery and was on antibiotics. After the tape splint came off my nose looked very straight and smooth, now I have devloped a raised hard lump on the left side of the bridge of my nose where the hump was. My nose look worse than it did before surgery. I have tried putting ice on it regularly but nothing seems to be working. Is this swelling or overgrowth of bone? Or could the infection have caused it. Is there anything I can do to get rid of it? I have read you tell people to massage-how is this done, how often and how much pressure should you use. I don`t seem my surgeon for another 3 weeks

  Answer:  it is mostly swelling as it will take one year for all of that to go down and the reaction on the cartilage to soften andd flatten. Light pressure massage is OK, daily, and tincture of time. JG 7.6.07

• 8 weeks out of revision now, nose is just as wide as before had a small bump on right side of bridge rasped down now there is a very noticable dent on left side of bridge what can be causing that can the rasped part be swollen and thats whats making a dent on left will it ever go away its the same as it was when cast came off

  Answer:  well swelling form revisions can take months to go away, it is hard for me to tell you why you look that way without knowing everything the surgeon did. JG 7.5.07

• Hello Dr.Garcia, Okay i was wondering.. My sister and I both have a consultation with you on the 30th and we`re both getting a Rhinoplasty,the lady we spoke to told us it`ll cost around $6200 something..the only thing is that with my nose im not really worried about any hump on it,im mostly only concerned about my nostrils and tip done,(unlike my sister)...How much would you say that would cost??For me i mean.

  Answer:  It would likely be less but I would need to see you to give you an accurate quote. Sorry. JG 7.2.07

• Hi Doctor, I had a second set of kenalog injections in my supratip area yesterday. The area injected got pretty swollen! Is this normal, and does that mean it`s working?

  Answer:  normal, it is from the marterial injected, it does not mean it is working though. JG 6.28.07

• Hi Dr. Garcia: have you ever used skin from the scalp for a rhinoplasty surgery (tiplasty)?. Thank you very much.

  Answer:  well, no, I have never used it nor heard of it being used and really see no reason to use scalp for something like that, I think the potential negatives are too high, like anbormal hair growth if it survives. JG 6.25.07

• Hello Doctor, I was wondering is revision Rhinoplasty surgery more difficult for you to perform? And also, how much do you charge for this? Thank you.

  Answer:  it is more difficult because there is scar tissue and much of what was done at the first surgery might not be able to be reversed. I do peform it but I would need to see you in person to determine a fee. JG 6.15.07

• I am 10 months post op from a rhinoplasty and septoplasty. My tip is now quite bulbous and still hard - especially the columella. I have had one Kenalog injection into the tip. Will the Kenalog injection complicate revision rhinoplasty? How much massage should be done after a Kenalog injection? It`s been 5 wks since the injection with little results. Also, I had quite a bit of swelling after the surgery that took at least 7 months to dissipate. Do you think the swelling will be as severe with a revision rhinoplasty?

  Answer:  the shot should not complicate the revison. As to massage, a little maybe three times per day for a few days is all. I think the swelling unfortunately will be at least as bad for the revision. JG 6.15.07

• I HAVE ADVANCED ROSESEA WITH BUMPS ETC. CAN THIS BE CORRECTED?

  Answer:  IPL and topical antibiotics will help. JG 6.15.07

• I had a rhinoplasty surgury conducted of an interm of three years ago to buff it down to attain a slightly straighter visualised result incorporated with a slight lift on the tip inreduction of the natural dropiness that was primitivally there to commense with however i was still extreamly satisfied and optimistically assured thateverything resulted as expected because the ssurgant mentioned that it does actually take up to two years for the shape of the bone to result in a finanl outcome now it is the third year and it looks almost as big as it was before the surgury and the slight lift that was there has gone back to its previous form. Finally my quierie to yourself is this common, reasons as to why it might have possiably resulted as such and is it also true that scientifically that the nose is the actual one aspect of the human body that continuosly grows other than the ears? i would very much appriciate a response pertaing to my issue of concern, thankyou very much in this respect.

  Answer:  well, not common, but not uncommon, there are limitations and at times those are not surmountable, such as thick skin. It might require more surgery at this point. As to the nose growing, what does grow is the thickness of the skin of the tip and that can give the appearance of a larger tip that droops with time. JG 6.15.07

• I had some cartilage/bone bumps shaved off on one side of my nose. The Dr. put a thin piece of Alloderm over the area to supposively help to achieve the look that the two previous bumps had produced as white coming out of the side of the bridge of my nose. They are still there. That is not the issue. The issue is that where the tissue had been lifted on the 45% angle of the bridge is out farther than before and is hard dense sponge like and i can`t distinguish if it is the Alloderm or still swollen. They can tell me what I want to here and cringe possibly if this has done more damage that help (I don`t want to call them). I look like an ex-boxer. Not me. The surgery was done on may 1st. Today is June 13th. Some say swelling can take many months. I am upset at this point and feel like it is going to stay like this. Does this sound like still being swollen or Alloderm gone wrong? I can feel on the other side of my nose my usual thin skin and bone. The alloderm side I feel less through to the bone if more like numbed nothing. I want to feel the ridge edge of my bone again (!) Thank oyu, Judy

  Answer:  most likley it is the Alloderm and in most cases in a year or so it dissolves, otherwise they would need to go in and remove it. JG 6.13.07

• DO YOU HAVE ANY PICTURES OF COLLAPSED NOSES THAT YOU CAN PUT ON HERE?

  Answer:  no photo releases from those patients, sorry. JG 6.12.07

• QUESTION ABOUT THE OUTER NASAL BONES WHERE THE NOSE AND UPPER PART OF CHEEK MEET. CAN THAT PART GET SWOLLEN IF HIT? LIKE A HUMP, SINCE IT`S BONEY OR JUST SWELLING. KIND OF JABBED IT WITH A Q-TIP BY ACCIDENT. WHAT ABOUT CLEANING THE NOSE OUT WITH WARM WATER /QTIP? I HIT THE INSIDE OF MY NOSE AS WELL IN THE UPPER OUTER BONEY PART. COULD THIS CAUSE DAMAGE TO THAT BONE

  Answer:  Q-tip will not create much swelling I feel. A large blow to the outside could though. JG 6.12.07

• Hi Dr. Garcia, My husband has a deviated septum, and has unknowingly lived with it for years. Because he was experiencing a lot of problems(coughing, gagging), especially after eating certain types of foods, he went to an ENT. They suggested a surgery that was fairly invasive and after being through 2 recent knee surgeries, he was not up for it. Now, about a year later, the knee surgeries are behind him, but he still does not want to have surgery. Mainly because he is worried about the potential for brain injury, the uncomfortable recovery period and the possibilty that it will not work(his dad`s surgery did not take). He was told that there was a procedure involving balloons that has not yet been put into practice, and I was wondering if you can elaborate on the most minimally invasive, safe and effective procedures available today for deviated septums? Thank you

  Answer:  I have not been impressed with the amount if improvement with the balloon surgery. As to the septum, you are correct, it does not always stay straight, and the septum is not causing the gagging and coughing, tough call, but as long as he is willing to live with it he can continue to do so. JG 3.7.07

• Dr. Garcia, One side of my columella hangs down a little lower than the other. I have a cartilage graft to hold up one side of my nose and it`s just natural on the other side. It looked great coming out of surgery, but over time, the side of my columella with no cartilage graft began to droop and now it is noticeable. Is there anything, outside of surgery, that can be done to shrink it up, or make it even with the other side. Will a steroid shot do, or what are your suggestions? Thanks for taking questions.

  Answer:  hard to say without seeing you, doubtful a steroid shot will help though. JG 2.2.8.07

• Kenalog follow up: What do you think is the smarter move. To have surgery to fix or to take the kenalog injection? Its been 1.5 years is that going to affect the injection? Is the exess scar tissue fixable?

  Answer:  I think at this point the surgery might be better. JG 2.25.07

• My follow up to the Kenalog injections after a rhinoplasty. If injected does the kenolog specifically target scar tissue or does it target all tissue? Secondly the physician who did the surgery said he could cut out the scar tissue, is that a smart move being that tissue will just form again? Is it cut with lasers or other tools of the trade.

  Answer:  it will affect all the tissues in the area. Cutting scar tissue out will heal with new but possibly less scar tissue. It is cut out with a scalpel or scissors. JG 2.25.07

• I had rhinoplasty about 1.5 years ago. Bad move. I have soft scar tissue on the left side of my bridge. What that does is makes my nose look crooked and larger. What are my options to fix. Kenalog i heard could help, but how much and does it only target the scar tissue and what is the radius it covers? Also what would be the best dose to use 5mg 10mg or even less. It looks horrible and I feel like I`m getting desperate again. From my second and third consults with 2 of the top 5 surgeons in the country they say it was caused by the physician not lifting the tissue from the bone when rasping. Is this also true?

  Answer:  the radius that kenalog will cover depends entirely on the amount or volume injected. I think one or two shots migth be a good idea though, as otherwise it might need more surgery. I usually use 5 the first time and ten the second. As to the skin not being lifted for the rasping, that is not entirely correct, the rasp will not fit if the skin is not lifted, it can from from blood pooling there and creating scar tissue or from the production of callus which is how the cartilage heals when rasped. JG 2.22.07

• Good Afternoon, Dr. Garcia. Can you tell me whether Fougera steroid cream has the same properties as Kenalog? I was wondering whether Fougera can be used to reduce nasl swelling following a rhinoplasty. Thank you.

  Answer:  sorry but no, topical creams will not help the swelling below the skin. It needs to be injected. JG 2.21.07

• Hello Dr. Garcia, I am 7 weeks post rhinoplasty and 2 weeks ago I noticed a bump on my left side of the nose. I saw my doctor and he told me that I was feeling the edge of bone (something like that) and the bone will eventually mold itself. I haven`t really seen an improvement since I last saw him. I am worried because the bump is quite noticeable.

  Answer:  it would normally take months for that to smooth out. JG 2.19.07

• Hi Dr. Garcia, I will try to keep this as short as possible- bear with me! My left nostril has been bleeding for close to a month. Sometimes it`s like a real nose bleed and other times, it`s when I blow my nose, there`s blood (not old blood either). If I go too long without blowing my nose, I get all stuffed up on the left side. I am having a very hard time breathing out of this side whether or not I blow my nose. It`s happened very suddenly. It`s even getting painful when I breathe b/c the inside is so raw. My regular M.D. said I have a popped blood vessel and to treat it with saline spray and bacitracin. She also asked me if I ever broke my nose b/c I have a deviated septum. I never broke it, but it was once banged pretty hard and then swollen thereafter for about a week. Can breathing problems due to deviated septums have such a sudden onset? Is rhinoplasty the ultimate cure for such a thing? Please give me your advice! I`m desperate to breahe! Lauren N.Y.

  Answer:  sounds likes one type of surgery will be needed, it might be a place on the turbinates that has a non-healing area that scabs and bleeds. I think you need to see an ENT and have them examine you after they have numbed you up, posssibly they can cauterize it at that time. Best of luck. JG 2.15.07

• Good Evening, Dr. Garcia. I had a rhinoplasty done 2 years ago, but this past fall I had a tiplasty to reduce a bulbous tip. Before the tiplasty, the bridge of my nose was quite thin, but the doctor performing the tiplasty said my nose would look more uniform if he injected silicone to the bridge and mid-area. Since he injected silicone, my nose appears wider at the top and middle. Is there any way to make my nose look narrower, after having the silicone injections to the bridge and mid-area? I heard that the effects of silicone can be temporary sometimes. Thank you.

  Answer:  silicone is permanent and most likely the only thing that can be doen is to surgically remove the silicone. JG 2.14.07

• It`s me the shifted cartilage girl again. Your answer has helped me tremendously, thanks so much. May I ask another shifted cartilage question, please. Can removing this cartllage cause any denting or misshaping?

  Answer:  if too much cartilage is removed, yes. JG 2.13.07

• It`s me with the shifted cartilage. I forgot a question. What if I do nothing about this shift? Will it get increasingly worse. Thanks again

  Answer:  it might get worse for a while, yes. JG 2.13.07

• Thank you for your help, I really appreciate it. I am 1 yr out from my rhinoplasty and 2 months ago discovered a small red pimple like bump on the right side, at the tip of my nose. My doctor says the cartilage has shifted and he needs to do an in office procedure under a local to remove some of the cartilage. In your opinion, is this the best solution and could it cause scar tissue that will create difficulty in breathing? Also, could this cause a dent in my nose or a mishappen appearance? Can cartilage shift at anytime and could this happen again? Once again thank you for your time.

  Answer:  shoudl be straight forward and should not affect your breathing. Cartilage can shift due to scarring for years after the surgery. Best of luck. JG 2.13.07

• Hi! I have a quick question regarding my nose. I had a septoplasty done about 2 years ago. Since than, my breathing has improved a little, but I still have extreme difficulty breathing through my left nostril. If I look at my septum in the mirror, I can see that it bends towards the left side of my face, than hooks back towards midline. I thought the septoplasty I had done would`ve solved that, but it didn`t. So, I`m not sure what the surgeon did, but I have a feeling he didn`t actually straighten my septum...he just took pieces out to open it up. My question is this: If I have another septoplasty done, would straightening out the septum be the best option? I really hate to get repeat procedures because of the risk of losing too much cartilage. If the septum is straightened from the inside, is it usually straightened from the outside as well? And one last question: If it`s straightened on the outside as well, does that count as cosmetic and not covered by insurance? Thank you! - Mike

  Answer:  the septum is made out of cartilage so commonly it will spring back to the old shape, might need some more cartilage taken out. If it is a septal procedure and the outside straightens because of the septum it is not considered cosmetic. JG 2.11.07

• Thank you for your time, it is generous of you. I have had a primary rhinoplasty surgery, due to a nasal fracture. I used to have a Roman nose with a dorsal hump. Since, the surgery my nose appears to be shorter, flatter, wider, the tip has become more upturned, as well as, flarred nostrils. I was wondering your opinon on non-surgical rhinoplasty with injection fillers? to raise the bridge of the nose and to make the tip fuller. Ultimately,I would like to regain the appearence of a Roman nose, now that my nose is straight. Thank you again for your time.

  Answer:  I think that is a very reasosnable approach, just go slow with the injections, you can always put in a little more, that is easier than taking too much out. JG 2.10.07

• My sister-in-law had basal cancer on her nose. She had surgery for this 2 days after Christmas 2006. She has been severely depressed ever since and we are extremely worried about her. Is there anything you can suggest to help her appearance? She has a small bump on her nose and also an indentation.

  Answer:  hard to say without seeing here, I think in most cases with time the surface does even out. JG 2.8.07

• Hi Doctor, How`ve you been, i hope you doing fine.I just posted my question but i think it did not go through. Doctor, remember I did my nose surgery 6 months ago, but my tip is still big, I already had 2 shots, kenalog shots, one 3 months ago and the other one 1 week ago, if it still doesn`t go down, how many more shots can i get?, is there any limits of shots?, and also is there any danger in getting these shots? I mean can my tip get disfigure or something like that?. and also shouldn`t i get the shot in the middle of my tip, to get it smaller? Thank you

  Answer:  I think once every 4-6 weeks for 4-6 times is OK, all depends on how much they inject. The biggest fear is to thin the skin. Hang in there. JG 2.8.07

• why do we have to enter our email address everytime we ask a question? Also, i was wondering what qualifies a person to get insurance coverage for a rhinoplasty. I have a disfigured nose from a past fracture, but my ENT told me that insurance more than likely wouldnt pay for it. I was also watching the news the other day about a teeneage girl who died getting a rhinoplasty. that alone gets me thinking, but they said that she had gotten in a car accident a year ago, but her family still had to pay to get her nose fixed. Maybe she didnt have insurance, i really dont know, but what would qualify a person for coverage. everytime i touch my nose, i hear a crack, and one of my nostrils is smaller than the other now.

  Answer:  I will speak with my webmaster and see if we can set it up to give repeat visitors a passwaord to make it easy, but in short we had to start the email issue because the site was getting spammed by unsavory sites. As to insurance coverage for a rhinoplasty, if the nose has suffered a fracture AND there is a breathing problem, then at times the insurnace will cover the correction of that and only that. If the fracture has not limited the breathing and only the appearance it will not be covered. Hope that explains it. JG 11.29.06

• DR.GARCIA. HI, I AM A 51 YEAR OLD FEMALE. WHEN I WAS 17 I HAD RHINOPLASTY. I NOW LOOK AT MY NOSE AND I SEE THAT THE BUMP THAT WAS SHAVED DOWN SEEMS MORE PROMINENT AND MY NOSE SEEMS CROOKED. IS THAT NORMAL SINCE IT HAS BEEN SO LONG SINCE I HAD THE PROCEDURE AND I ALSO HAD A BREAST AUGMENTATION WITH SILICONE BREAST IMPLANTS AND THEY HAVE STRETCHED AND I HAVE NOT HAD THE MONEY TO CORRECT THIS PROBLEM CAN THIS BE DANGEROUS. I HAVE CLOSTROPHOBIA CAN ANYTHING BE DONE WHEN YOU ARE IN THE RECOVERY ROOM TO RELEIVE THIS PROBLEM. EVERYTIME I HAVE SURGERY I HAVE TROUBLE LYING DOWN FLAT IN THE RECOVERY ROOM .

  Answer:  stretching of the breast skin is not dangerous and at times with passing years some cartilage warping can occur after a rhinoplasty. I think you can certainly be sat upright on the gurney in the recovery room. JG 11.28.06

• Hello Dr. Garcia, sorry to ask again about bsaically the same thing but I want a little more information. how is it possible to deproject a tip, add definition to it, and at the same time make the upper lip stay the same and not drop over the teeth? I didn`t know thi was possiblem are there new and safe techniques that have been developed recently for this? and are there new techniques that make alar base escisions safe in the long term? with a fairly forseeable outcome? thank you dr.

  Answer:  yes, that is possible, by refining the lower lateral cartilages and by trimming the caudal septum. JG 11.28.06

• Hello Dr. Garcia, thank you for your site, it`s a blessing. can the tip of a nose be fairly deprojected while maintaining the upper lip position and shape and maintaining tip definition and maybe making it more defined? I know this is very hard, but is it impossible? maybe reducing the alar base? because I have thick skin. is this possible? maybe for Dr. Toriumi? or is it really far out? (of course the bridge may be built more projected, do you think this will stretch the skin of the tip to make the tip more defined?)

  Answer:  firstly, thank you for the kind words. As to the tip of the nose, yes, those issues should be able to be achieved. Not far out and certainly within the realm of Dr Toriumi`s talents. I think in certain cases the tip needs some skin stretching to have more definition. JG 11.27.06

• Hello Dr. Garcia another Q about rhinoplasty. can a slightly convex dorsum be achieved with rib grafting?.

  Answer:  yes, it all depends on how you carve it. JG 11.27.06

• Good Evening. I had nose surgery in February 2004 to correct a deviated septum, and to also contour the nose for a more appealing look. I was very pleased with the look I received after the surgery, however after several months I couldn`t breath from the left side of my nose. I went in for surgery again just a couple of weeks ago...after my doctor began the surgery (it was explained to me later!) he found that the left side of my nose was shattered. He had to completely rebuild that side of my nose, and ended up using some synthetic materials to help build it up. I`ve felt pretty good since the surgery - lots more pain than last time, but nothing unbearable -- I`m HORRIBLY bruised (my nose) and it`s extremely swollen. Correct me if I`m wrong - I assume this is because of what all he had to do. Over the past couple of days I`ve noticed that I have a spot inside my left nostril-fairly far up inside that feels very, very tender - almost raw. I`ve also noticed that my nose is slightly curved to one side. Is this just because of the swelling going down unevenly, or is it something that should be checked sooner rather than later? Thanks for your help,

  Answer:  all normal and should all settle down in time, best of luck. JG 11.27.06

• Hello Dr. Garcia, I was reading about rib grafting by dr. Toriumi and read that rib grafting can cause the lung to collapse... is that a high risk? and also, how much time could it take to happen? or does it happen immediatly?.

  Answer:  that risk is very low with the techniques used now, but still a very small possiblity. If it is going to happen it happens in the operating room and is usually recognized there and treated. JG 11.26.06

• is it possible for hanging columella to show up after 1 year since rhinoplasty? at first it looked like my nostrils were looking quite larger than usual and now i noticed what appears to be hanging columella.

  Answer:  at times when the swelling goes down it can make it appear more visible. JG 11.23.06

• dear doctor, my daughter broke her nose while playing basketball. she is twelve. she has a depressed fracture in the middle of the nose. when i took her to a plastic surgeon two days later he stated it was a good break , and she has no deviation. she now though, has a drop or no bump in her nose, is this going to cause her any problems either physical or mental? thanks, elizabeth

  Answer:  not mentally but as she grows she might, and I stress might, encounter some breathing problems, only time will tell, not much I would suggets now unless she cannot breathe as it could stunt the growth of her nose to have surgery at this age. Best of luck. JG 11.21.06

• I`m quite puzzled with my nose. I have been taking pictures of it to track it`s improvement. However I noticed my nose is so much larger now (4 months) as compared to my nose a few weeks after surgery. That was when it was at best shape. Shouldn`t it be the other way around? My tip has been getting larger although I only had bridge work done and closed rhino. Am I developing scar tissue? How do I get it back to the 3 weeks post-op look?

  Answer:  I am afraid it is just a matter of time and a little masage might help. JG 11.20.06

• that 1.5 years below is really 1 and a half years, just to make sure

  Answer:  correct. JG 11.18.06

• Its me again, i asked about the scar on my nose, and i was telling you about my self esteem problems, and one reason i have self esteem problems is because 1.5 years ago, i was happy with muy image, very happy. and out of nowhere i break my nose, fracture but i was told to leave it alone because they told me it wasnt fractured (even though i didnt get xrays and it wasnt even a specialist, it was just my normal doctor who told me it was fine). i really should have got it taken care of, but my doctor did tell me to leave it alone. then it got bigger and asymmetric. i hate it, especially the hump i got now. on top of that, i end up getting a scar on the Tip of my nose, which is already broken. Way too many bad things hapening all at once really shot me down. I`m trying to work everything out one at a time. my ENT is trying to tell me that my nose was always like this, so I would have to pay for my own nose surgery, even though it was never like this before, and i was never a patient of his before so he would never know. can you give me some advice on how i would go about getting my old appearance back, the cheapest way. Its really not fair that i would have to pay forr nose surgery, even though i just want my old nose back. when it first happened, i had constant headaches everyday i woke up. im telling you as much as possible because i want the best advice i can get, please. my nose isnt even, straight or as narrow as it used to be, and it looks WAY different than it used to be. my parents are even lying to the ENT, just so they wouldnt have to pay, they are telling him that they havent noticed a difference in my nose`s appearance, but why would i make this up, i cant even make this up i wasnt born with a crooked nose. this has just got me all riled up, because i know that if i got my nose fixed and my scar taken care of, I would be back to the way i was before all this. Sorry for the long query, but I NEED HELP!!

  Answer:  I am afraid that as there is no medical probelm with the nose in terms of breathing that you will need to pay for it I am afraid. JG 11.24.06

• Dr. Garcia, hello. I had a rhinoplasty about 4 months ago and yesterday I walked into a glass door as if it wasn`t there,and all the impact was received by the tip of my nose... it hurt a lot and I bleed a little, but it wasn`t the kind of dark blood that comes out when a nose bleeds...it was a lighter colour blood...and now what hurts is my upper lip and he upper bony part a litte too... but what I hit was the tip structure...you know, that pyramid like thing... now it looks like it didi before, only a little more swollen , but it`s imperceptible... as I have a strut/graft to raise my droppy tip... I am worried about getting skin necrosis now out of this trauma that my nose received yesterday. how long does skin necrosis take to manifest? and after which time should I stop worrying and discard the possibility of SN occurring?. also...will this make my revision attempt harder? (I have had just one primary and plan to have a revision by Toriumi wich will hopefully be my last). thank you Dr.

  Answer:  I do not think that type of injury would cause tip necrosis, the worst case scenario is that the tip graft might have shifted. Should have no efect on future surgeries. JG 11.17.06

• I had a nasal bump removed along with some tip work done (from pointy tip i now have a round tip), I`m 2 months post up and noticed a piece of suture erupting on the top of my nose the middle area of my nose. Should I be concerned at all? I just used a nail clipper to clip it so it doenst show and its not red and shows no signs of infection but why did it erupt and will this effect the outcome of my new nose

  Answer:  I think you need to see your surgeon, maybe they can just trim it off. Should not pose a big problem. JG 11.16.06

• Hi Dr. Garcia. I had a rhinoplasty a year and two months ago. He fixed a slightly deviated septum, narrowed the nose, got rid of the hump, shaved off cartilage from the tip to get rid of bulginess and I think gave me an implant at the tip. Bottom line is that I am really happy with the results. It looks really natural to the point that people cant tell. Problem: My breathing isn`t as clear as before and I almost always have a runny nose. Somedays its very light and on some I feel clogged up. Also on occasion, I take out really stringy/rubbery clear mucous which gives me temporary relief(though I cringe when I do so). Ive used ocean spray but I did not feel a difference. Its not as severe as some of the other posts but do you think there is something wrong? or do you think it will it go away in time? What do you suggest?

  Answer:  might be allergies, I would suggest seeing your ear nose and throat specialist. JG 11.16.06

• Hi doctor. I had rhinoplasty 5 months ago and it`s revision 4 months ago. Most of the swelling has gone down considerably and I only had an implant inserted at the bridge. I now want some improvement on my tip and nostrils though and I only have this month left for a procedure as my family is out of the country. I know about a years waiting time is advised but after much deliberation I`ve decided I really want the tip work. Given my surgery record, what are the risks involved in getting a third rhinoplasty this early?

  Answer:  I think the biggest risk is that since the tissues are swollen they may not be able to be accurate in what they do and it might end up not different enough or too dramatic of a change. JG 11.16.06

• My nose has been nothing but an embarrassment for me my whole life. I avoid many situations in life because of my large nose, I do not like to sit in a way that provides anyone a glimpse of my profile, kissing my own husband of 12yrs is humiliating to me... my nose gets in the way. I am in the beauty industry and I am always self conscious around people, I feel they are starring at my nose it is large with an over pronounced hump and it is very bulbous at the end. I hope to one day have surgery but at this point I cannot afford it. I have delt with it my whole life but for some reason it is really bothering me at this stage in my life. I was wondering is there ever an instance that insurance will provide coverage for rhynoplasty and are there any programs such as medical schools teaching plastic surgery, which may provide surgical procedures at a discount and if so can you trust to go to a place like that?

  Answer:  I am sorry but not that I am aware of. JG 11.15.06

• How are you Doc? Last year I had revison work done on a botched rhinoplasty/deviated septum procedure from 10 yrs previously. My NY doctor did a BEAUTIFUL job straightening the septum and refining the nasal tip. The only thing bothering me is some collapsed cartilage on the left side from the first rhinoplasty that breaks up the line of the bridge and gives the impression that my tip `leans` to the side. My doc suggested Restylane injections and even demonstrated the result by shooting this `dent` full of saline. I loved it! I asked about grafts so it would be permanent but he seemed hesitant because he said it`s not such a big dent anyway and the graft could be incorrectly sized, it could shift, be absorbed, show through or create more scar tissue that could potentially block out the nostril (the septum wall needed extensive repair on the left side and the collapsed cartilage apparently already leaves me little room for breathing properly) Do you believe that grafts are so risky and injectibles are better options in such a case? I`d like the effect to last as long as possible, obviously. All my thanks

  Answer:  I agree wholeheartedly with your doctor, best of luck. JG 11.13.06

• hello....I has a nose revision 6 months ago. In that time I have noticed the tip of my nose feels like I have 2-3 uneven bumps. The bumps are not visible but I can feel them. What could they be? Also, is it possible to make my nose wider...I feel that it looks to narrow and doesnt fit my Lebonese look. I am uspet that i ever even touched it. PLEASE ADVISE.Thank you for your time.

  Answer:  the hard lumps may be swelling or scar tiisue and it can take a long time to soften. It is possible to widen the tip at times by placing cartilage grafts onto it. JG 11.13.06

• Hello again Dr. Garcia, is it true that Dr. Toriumi tends to make noses very large? and also... do you think he can give me a veruy natural result and fashion a hump with cartillage without much risk of warping?. thank you! also, how much time do you advise for me to wait before having my second surgery and hopefully my last with Dr. Toriumi?

  Answer:  well, I think that is a matter of likes and dislikes, at times, to correct a previous problem one needs to add cartilage support and that can make the nose look a bit longer. As to the risks, he wil need to tell you what he can do after he examines you. Best of luck. JG 11.12.06

• Hi Dr. Garcia!! I had rhinoplasty done 2 ears ago and the DR. shaved down the tip of my nose to make it less bulbous. About 3 months ago I developed a cyst on the tip of my nose with mucous. I got a biopsy and it turned out to be benign. The dermatoligist said it was most likely from fragmented cartilidge from the rhinoplasty procedure. I still have the cst and wonder what can be done to minimize scaring. Thanks, Chris

  Answer:  might need a wider cut to remove the cyst, let it heal and then maybe 6 months later a light laser to fade and smooth the scar. I seriously doubt the cyst is due to the prior rhinoplasty though. Cartilage shaving do not cause cysts in the skin. JG 11.9.06

• Hi Doc.: Blood staining (under eyes) continues 6 weeks post op. Besides use of arnica montana, would applying hot compress help? Do I need to prepare myself that this might turn out to be permenant? With my thanks.

  Answer:  should not be permanent, warm packs might help, and also avoid sun exposure. JG 11.9.06

• Hello Dr. the bony part of my nose looks flat from the front, and lower than the cartillage part, so it looks like I lach something in the upper part of my dorsum... can this be fixed by a revision? or all rhinoplasty procedures tend to leave this result?. also, if I request a hump in a revision, what is the most likely material to be used and will it appear natural?. thank you.

  Answer:  I think you will need something added there, either a cartilage graft or a small short implant, either silicone or gortex can be used. Another alternative would be an injectable filler like Radiesse to build the area up and that could also be injected to give you a hump. JG 11.7.06

• Thank you for your previous answer Dr. Garcia, you are the best!!! I have another question about rhinoplasty, I am 4 moths post op and the outcome is horrible, I prefer my other nose. I will wait a year and try to get a revision with Dr. Toriumi in Chicago though. do you think he can give me a totally natural outcome and maybe a natural well defined hump? or it`s only possible to augment the bridge in a straight way?. am I at a high risk of skin necrosis with an open aproach for a revision having already had a primary rhinoplasty, and a stitched strut to raise the tip? I am 20 years old, in a relative good health and don`t smoke. thank you again Dr. Garcia, I admire you!=) all the best.

  Answer:  humps can be replaced, it does not always have to be a straight dorsum. I do not think the open approach is any riskier than the closed approach. Best of luck and keep me posted. JG 11.5.06

• Hello Dr. Garcia, I have had a rhinoplasty 4 months ago and had a cartillage graft placed at the tip to lift it. the skin of the lower part of my nose is darker than the rest of my face now now and I am worried about skin necrosis. what signs should I look for to see it it is? and how can the dammage be stopped and/or reversed if it is indeed skin necrosis?. thank you.

  Answer:  necrosis if it is going to happen would have happened a long time ago, it is not uncommon for the swelling in the tip to make it look darker and should get better in time. JG 11.5.06

• Hi Dr. thanks for your response on 10/6/06 re: rhino. I am wondering if I can e-mail picture and tell me if grafting or lift is possible? I had narrowing of nasal but tip seem round and bigger than before. Surgery was done on 3-15-06

  Answer:  please send the photos to drgarcia@lvcosmeticsurgery.com JG 11.4.06

• Hello Dr. Garcia My question is about perception. Is how we appear in a mirror how others see us?

  Answer:  yes, I think that is pretty accurate. JG 11.4.06

• i injured my nose a year ago and i was told by my doctor that it was fine. He told me not to worry about it, so I didnt. Then about 3 months later, I noticed that my nose was crooked, wider, and bigger, and I had a hump. Then, about 2 or 3 months ago, I went to an ENT, who told me that I had a nasal fracture that has since closed up, and caused my nose to set crooked. He told me that if I had come to him when it happened, they couldve avoided this whole thing, but I was told to not worry about it. Now I`m worried about the cost of surgery, and the surgery itself, and especially the recovery time. How much would it cost, and should insurance cover it. How long would the recovery time for a straightforward nosejob be, no tricks, just back to normal.

  Answer:  insurance should cover it and you should be back to normal in 4 weeks or so. JG 11.3.06

• I had rhinoplasty done one week ago. a break was fixed as well as some refinement of the tip. a piece was placed to turn t6he tip up slightly. about 3 days after sugery i took the tape off as i had an event to go to. i was not bruised at all. I noticed the tip was not any different. It did not appear that the tip was raised whatsoever. I DID NOT put the tape back on. today i visited with my doc who says i was at fault for removing tape and it could cause problems with the tip. he re taped it, said to keep it on there for a week. Has this potentially caused a problem with the tip raising?

  Answer:  all it does is reduce the swelling but long term it has no effect. JG 11.2.06

• I had rhinoplasty done a year and half ago because my nose was wide, very minor change. Two weeks after surgery I felt a bump on the left side of my bridge my surgeon said to wait to see if it disappears but it never did. The doctor wants to do a revision he said he needs to file down the bump but I`m scared. Will filing down the bump work?

  Answer:  it is the the best way to remove it. JG 11.2.06

• hi, i have another question. how is it that when i use a facial cleansing mask on my face,when i put it on my nose after the mask dries my nose looks completely different. it is extremely short and upturned looking rather than my usual long nose. it looks how i wish it would have looked after surgery. is it because of the oils in the skin shrinking,because when i put the same facial mask on someone else their nose doesn`t change at all. it is very weird. also, do you think that after 3 surgeries and my nose still isn`t close to my face is because i have thick oily skin in the nose area. if it try a skincare products to reduce oil production would my nose be smaller? thanks

  Answer:  a facial mask can very often dehydrate the tissues and that can make it look smaller until the swelling returns. Thick nasal skin, especially on the tip cannot be changed with topical treatments, the oil can but not the thickness and that will limit the eventual look of the tip of the nose. JG 11.1.06

• i had rhinoplasty when i was 16 years old to remove the hump; however 2 years later i wanted it to be closer to my face so i had a 2nd surgery. this time the doctor used a graft from my ear. the outcome was that my nose was longer, still not close to my face and now the tip is sharp, pointy looking and droopy. so, i am now 26 years old and i had my 3rd operation done last august 2005. it was supposed to be shorter,lower(closer to my face, lifted up and hump removed again. 2 weeks after surgery my nose still looked long, with hump, the only difference was that it was piggish looking. i asked why it was still so long and protruding,he said that if it was small right now that would be a problem because in a year it would be too small. i think that even though the nose was extremely swollen it still should have been shorter. anyway, it`s been a year now and my nose looks almost exactly the same as before. it looks as if nothing was fixed. i originally wanted the ear graft cartilage removed because i think that is what`s making it long and pointy sharp, but doctor said he didn`t want the tip to get infected or rotate out of shape. it seems like i`ll never get the nose that i want. i just wanted to have a shorter nose that`s close to my face and not a pinnochio nose. my nose is now longer than my original birth nose. it seems that my nose just looked different because of the tape that was on it after surgery and once the tape came off it slowly started to go back to the way it was before. is it possible to remove ear graft cartilage from nose or at least round it off so it wont be so sharp,harsh looking? thanks tricia

  Answer:  cartilage grafts can be removed and it might or might not affect the tip, all depends on what it was placed for and where it was placed. With all the surgeries you have had I will be honest and tell you that some of your desires may not be possible due to the scar tissue that has developed below the skin and there is nothing safe that can be done to remove it. On whether anything can be done to make it look better, I am afraid I cannot say without physically examining you. JG 11.1.06

• Dr. Garcia, my daughter wants to get her nose fixed. We don`t know anyone who has had this done, so don`t know who would be a good doctor. We can`t afford the fees they charge for consultations for numerous doctors. How do we find a doctor who does great nose jobs in Tennessee?

  Answer:  Due to potential legal issues, and some doctors wanting to know why I referred a patient to someone else and not them, I think you are best to go to this website and look for a plastic surgeon in the area you desire. I wish you all the best. JG 10.31.06 www.surgery.org/public/findasurgeon.

• Dear Dr. Garcia: If a person has had a cortisone injection in the nose, but as a result the nasal tissue has atrophied just a little, is there anything that can be done to fill in the atrophied area?

  Answer:  well, if time has passed and it does not fill in on its own then you can inject collagen or Restylane. JG 10.29.06

• Dr. Garcia, I recently had a silicone injection at the bridge of my nose because my doctor thought the skin surrounding the bridge on both sides was not straight. He said the silicone would fill in any contours. Now, when the light hits the bridge of my nose, it looks like the silicone can be seen under the skin as a horizontal rubberband across the bridge. Is this a permanent effect of the silicone injection, and is there anything that can be done to get rid of, or minimize, that effect? Would a dermabrasion get rid of that effect, or perhaps a laser? Thank you for your help.

  Answer:  if it is silicone it is permanent unless you have it cut out. No way a laser or an abrasion will help. JG 10.29.06

• hi dr garcia, i underwent an IPL on Thursday for rosacea. The doc treated me with triple filters 640, 590 and 560. After the treatment he mentioned i will be red and blotchy for 2-3 days. The redness after 2 days is going down however i am noticing slight black-purple areas near the junction of my beard where there was some hair during my treatment.What are theses? I hope these are not hyperpigmentation ? Any advice for this and for future treatments?thanks

  Answer:  those are areas where the heat of the light got more intense due to the hair follicles, might heal like a sunburn, too early to tell if there will be hyperpigmentation, that would take weeks to see. All that can be doen in the future is to turn the intensity down when treating the beard area as there is no Rosacea there. JG 10.28.06

• Had a rhino revision on tip to elevate right after surgery it looked nice but now 4 weeks later it almost looks the same. Ps gave an injection on tip, he said for swelling, or scar tissue. The incision was very small on the inside of left nostril, it was about 15 minutes under local. what is your opinion in order to lift the tip of the nose?

  Answer:  hard to say, at times that is all that is needed, but in most cases it requires much more, there is not much that can be done through a limited incision in 15 minutes, but it is possible in some cases. JG 10.27.06

• i`m in salt lake and my doctor`s on the east coast so if its okay i`m thinking about coming down and seeing you to have this done. Is there anything else that can be done instead of an injection? Is there a chance that it may do nothing since i am 6 months post op? Is there any chance that the kenalog could dissolve the tissue that many be holding my nasal bones together?

  Answer:  I do not think that the kenalog will dissolve all of that, I know some good plastic surgeons in SLC so there really is no need to come all the way here. JG 10.25.06

• Thanks for the quick response. I just wanted to go into a little more detail. I`m six months post op and it looks and feels like almost all my swelling has gone down, especially on my right side of my nose. On the left side of my nose there seems to be a little bit of swelling. When i massage this swelling i can feel a bunch of tiny bead like balls in this area, it feels kinda bumpy. Up until this point in the healing processes the swelling hasn`t felt like this. The beads are very hard. I had a slight bend in my nose which my Dr repaired by repositioning my nasal bones. OK here comes my slew of questions. Does this sound like scar tissue? Is 6 months ample time to wait to get a cortisone/kenalog injection? If i decide to wait to let my body heal more before i get an injection could this make the kenalog injection less effective? If i didn`t have any cartilage grafts is there a chance that the kenalog could dissolve any of the tissue that is currently hold my nasal bone together, essentially causing a collapse of my nasal bones? Sorry for all the questions, thank you for your help.

  Answer:  it does sound like scar tissue and you could not feel it initially due to the surrouding swelling, but now as that has gone down you can feel it more. Kenalog injections can still be done at this point. Kenalog works best when the tissues are fresher. Kenalog can dissolve all of the grafts and normal tissue too. JG 10.25.07

• May GOD bless you for taking the time to answer our questions. I am 4 weeks post op rhino and very swollen. How can people like Ashley Simpson look so great and normal right after surgery? Ashley`s picture was taken 2 weeks post op and she looked perfect. How is that possible?

  Answer:  well, it all depends on what is done, how aggressive of a nose surgery, what was done afterwards to control the swelling and then there is make up and PhotoShop on computers. JG 10.25.06

• What does scar tissue feel like? How safe and effective are cortisone shots? How much do they cost?

  Answer:  just a little firm, hard in severe cases. Cortisone can be injected but it can also cause loss of the surroundg normal tissue so it is not always a possiblity, fees vary from doctor to doctor and the amount needed to be injected. JG 10.25.06

• Dear Dr Garcia Im from the uk, 7 days ago i had septo rhinoplasty and had a cast which was removed ysterday, i feel like the tip is the same as what it was before and then nose is abnormal looking on one side , is this swelling and is there anything i can use ie frozen to put on it ,, will there be a change or could it be that they chopped of too much on top and left tip the same

  Answer:  all due to swelling, it will literally take months to see some of the changes so you need to give it time. JG 10.25.06

• Hi Doctor, Thank you for responding to my question Regarding the Black Eye Look 7 week post op (rhinoplasty). I will buy some arnica cream to use it. in the meanwhile will Hylexin work any faster? its a cream that is used primarily for severe black circles under the eyes area. OR is Skin staining different from dark circles due to lack of sleep.

  Answer:  I have never seen any good results form Hylexin for any cause of dark circles. JG 10.24.06

• hello Dr Garcia, i admire greatly what you do. i had revision surgery to straighten my nose two weeks ago and the swelling seems to be all gone, however it`s still not completly straight. one side is straight and the otherside curves inwards. is there a permanent filler i can get to even out my nose? and does it require surgery or is it a simple procedure? thank you for your consideration.

  Answer:  a filler like Radiesse might be an option there. I would wait at least 3-6 months to allow all the swelling to resolve so you can get it done with the least touch up risk. All the best and thanks for the kind words. JG 10.24.06

• I had a rhinoplasty 6 weeks ago (bump removal and some tip work) and rather to focus on my new nose im really concerened about the residue bruising underneath both of my eyes. I literally look as if i havent had any sleep in years. Sometimes they almost look like i have black eyes. and if i try to conceal them with makeup it just makes it look worse. I went online to research about this and nowwhere does it say that the brusing lasts for more then a month at the most. Did my surgeon damage my blood vessels.. is this normal? how much longer before my black eyes are gone.

  Answer:  probably some skin staining from the blood, avoid the sun and apply some Arnica gel available at the health food store and it should go away in time. JG 10.23.06

• hi dr garcia, I have another question for you. sorry. Can an IPL differentiate redness between rosacea and sebborheic dermatitis. I have both. I am undergoing IPL for my rosacea and now starting fluconazole for dermatitis? Would The IPL work even on the dermatitis redness? Thanks

  Answer:  it cannot differentiate but it will help both. JG 10.21.06

• Hi Dr. Garcia! I had a septoplasty done a few years ago because I had a very hard time breathing out of my left nostril. After a couple years passed, my breathing was a little bit better, but still difficult from my left nostril. I went to see a different doctor (my original doctor doesn`t do septoplasties anymore) and he said that insur. wouldn`t cover a second procedure since it`s already been covered. Is this true? Even if I have a different insurance carrier now?

  Answer:  well, they might, no way to tell without requestiong a pre-authorization from the insurance carrier. JG 10.20.06

• Hi Dr. I underwent revision rhinoplasty 4 months ago so my tip is still hard and swollen. I was just wondering if the steroid shots that my dermatologists administers on my face for pimples has the same effect as the kenalog or cortisone shots for nose swelling? I had a pimple on my nose one time and when I was given that shot, the swelling from surgery seemed to have gone down as well. Are they the same? I want to go back and ask her to administer more on my nose.

  Answer:  they might help but not as fast or as dramatic as the pimples. JG 10.20.06

• dear dr garcia, i read thru all the postings on your site concerning revision rhinoplasty. do you personally perform revision rhinoplasty? if so, how long have your been doing it? my problem is this: i had a rhinoplasty on aug 30 of this year. now my nostrils are very uneven and one is pulled up slightly higher than the other. i visited a revision rhinoplasty surgeon in cincinnati with a very good reputation (not my original rhino dr). i just wanted hope that he could fix my uneven nostrils. the dr in cincinnati told me, from my presurgical pictures, my left nostril was larger than my right and since the surgery (dr tilted my nose up) the changes became apparant. the dr in cincinnati told me that he could not change the shapes of my nostrils to match b/c it is the hardest procedure to perform in nose surgery. i was just wondering if any other specialists would have an different opinion of this problem. having a scar on my nose doesn`t bother me as much as having these awful uneven nostrils. if u could help me, i would find a way out to LV for your help. i just need a ray of hope. i believe that sent u some b/f and after pictures to examine. my email address is guffey@watchtv.net thank you so very much for consideirng my case. MIchelle Guffey

  Answer:  I do perform revision rhinoplasties and have been doing rhinoplasties for over 18 years. I think other surgeons may have different ideas as to what can be done but I will say that what you have been told is true, the nostril assymetry is one of the hardest things to repair. JG 10.18.06

• dr garcia, I had a nose job with you 8 months ago...my nose still looks like a nose. Not really any shape. Is this going to change? Hopefully? At night it looks thinner than day, however still no shape, is it too soon? help. thank you. your patient.

  Answer:  it can take as long as one year, if the size and shape change during the day it tells you that there is still alot of swelling, hang in there a litle longer. JG 10.18.06

• thank you kindly for answring question/and u mentioned a graft from skull...please do tell me more re that?--as I mentioned ear and rib had been used.I wish to find a doc whom has skills to help make the overoperated small nose to a larger more natural looking nose.Genuine and desperate for a normal looking nose.

  Answer:  teh bone is taken form the skull. Due to potential legal issues, and some doctors wanting to know why I referred a patient to someone else and not them, I think you are best to go to this website and look for a plastic surgeon in the area you desire. I wish you all the best. JG 10.18.06 www.surgery.org/public/findasurgeon.

• I have a deviated nose septum, is there one procedure better than the other to fix the problem. My brother in law is an oral surgeon, he lives in another state. He said that he will fix it by using a local anesthetic. But is their another type of surgery that is different.

  Answer:  well the surgery can be done under local but most people use general anesthesia. JG 10.18.06

• From a rhino 8 yrs ago I have cartilage poking out the tip of my nose. Would restlyane injections help? If not, what else? I notice this aspect in so many people who have had rhinos

  Answer:  the only thing that will help is to have the cartilage repositioned or cut off. JG 10.18.06

• I have had an over operated nose-and nose tip needs rebuilding and also bridge does.Twisted nostrils.Already rib graft/and ear has been used but nose is so small.Nasal projection i wish plus even nostrils.Help?I have had no surgeries for over 2 years but desperately unhappy..I would appreciate any advice.Thank you

  Answer:  may need another rib graft or bone from your skull, tough tough problem I am afraid. JG 10.17.06

• Good Evening, Dr. Garcia. My question concerns kenalog and silicone injections administered in the nose. I recently had two silicone injections in the upper part of my nose to fill in some irregular contours in the laying of skin. I also had Kenalog shots in the lower tip area. Now I`ve noticed that in two areas of my nose--both in the upper area where the bone meets my forehead, and in the middle of my nose--the skin has sunken in or atrophied, but just a little bit. Is it the silicone or the Kenalog that causes this, and is this irreversible? Could more silicone in these areas level the sunken-in skin? Thank you, Doctor Garcia. I enjoy your forum very much, and it`s very educational. Sincerely, Carl from NJ

  Answer:  I have not heard of silicone causing atrophy. As to being reversible, it all depends on what caused it and I am not sure why it has occured. Now if it had been kenalog to the nose, that could cause atrophy. JG 10.17.06

• hi dr garcia! i want to get a nose surgery done. i have a deviated septum so my nose turns towards the left of my face. it is not very obvious, but i have noticed this problem in my pictures. also it bends a little from the top. do you think i can get a surgery done to correct this and at the same time not look like i have gotten some procedure done (after recovery period). what will be the recovery period after such a procedure, and also the cost.

  Answer:  well many insurance companies cover surgery for a deviated septum if there are breathing difficulties, if all that is done is to straighten the septum, I think it will look better but not done, the recovery time before you are 100% is about 3-4 weeks. JG 10.16.06

• Dear Dr. Garcia, I had a rhinoplasty 6 wks ago to remove the hump and make my nose more narrow. The nose became more narrow, which i am happy with, but the hump is still there. my doctor wants to wait another 4 wks and evaluate it then. He said that he may have to go in and take some more off. what does this mean? do i have to go through all of that pain again? Should i look for another surgeon? are revisions common? how common? thank you for any feedback. i really appreciate it! s

  Answer:  revisions in the world`s best are still about 7% so I do not think they are uncommon, and it is always easier to remove more because it can be difficult to replace or rebuild later. I will say that the pain will be much less and I usually wait at least 6 months before a revision. JG 10.16.06

• Hi I just posted the previous massaging with hard tip question. Shall I continue? I am seeing my family in a week whom I haven`t seen since the surgery so Im worried they will notice my enlarged nostrils. What else can I do for now or even that day to bring it down a little?

  Answer:  not much besides the massage that you can do I am afraid. JG 10.16.06

• Hi doctor. I`ve been massaging the tip of my 3month swollen tip this past week as adviced but it seems my nostrils have become more flared. Also I can feel two hard bumps now at the very tip just above the columella. Why is this? I only had an implant placed at bridge so nothing done at tip. I know the suture was there though....

  Answer:  might be some swelling from the sutures that has to resolve. JG 10.16.06

• Hi docotr. I got a revision rhino 3 months ago and the primary one 3 weeks before that. Bridge implants were placed and each time the implant wasn`t as small as I want. I want to make it even smaller for the last time and this time some cartilage removed at tip and maybe alar trimming. Could you explain how the tip may have been damaged from prior implant placing only that revision will be difficult? (If it will?) Also, I`m shy with my doctor as it`s the third time and now thinking of going to another surgeon. Should I or better to stick with original?

  Answer:  might be best to change surgeons, as to making it more difficult, what is really the big determinant now is swelling, once it is swollen it is hard to determine how much cartilage to remove and it might be better to wait a number of months to start fresh. JG 10.14.06

• I had rhinoplasty and my nostrils were narrowed, I am almost 3 months post op. My question: Do the nostrils become even more narrow as the swelling subsides throughout the months?

  Answer:  no, they should not get any smaller. JG 10.13.06

• i really need a recommandation in here. im into my 2nd revision rhinoplasty and i really want a top dr. The problem is that i live in montreal, canada. Do u recommend any1 here dr or any top revision dr in the close states like New York, Chicago, Boston??? please help, my nose is a mess

  Answer:  Dr Dean Toriumi in Chicago. JG 10.10.06

• I am Filipina and had narrowing of my nose done 6 months ago but I am not happy because I want the tip to be smaller and a little lift if possible. Would you recommend sillicone or cartiledge. Please help.

  Answer:  a silicone implant nor cartilage will make the tip smaller nor lift it. There may be limitations on how small the tip cna be due to thickness of the skin. JG 10.10.06

• Good evening, Dr. Garcia. My question concerns the nose. In September 2004 I had a rhinoplasty. I was pleased with the overall result, but my nasal tip was still too bulbous to my dissatisfaction. In June 2006 a plastic surgeon began to administer Kenalog (25%) in my nose to reduce the ball effect at my tip. In September 2006 I had a tiplasty performed by another surgeon to straighten the columella. This doctor informed me that if he could change the angle of the columella, the ball effect would be minimized. It`s only been about 10 days since I had the tiplasty done, and the bottom of my nose does not appear swollen. Am I seeing the final result of the tiplasty when I look in the mirror, or does the healing process for a tiplasty (columellar reduction) also take up to one year before noticing the final result? Thank you, Dr. Garcia Carl

  Answer:  I think with everything you have had it will take months so it will get smaller as months go by, hang in there. JG 10.9.06

• I fractured my nose about a year ago, but I havent realy taken any action towards getting it fixed, because my mom doesnt want to be stuck with the bill. I was wondering if it would be covered by insurance, since i was hit in the nose, and I had a nose fracture. Even though its a year later?

  Answer:  if it was a fracture from an accident then insurance should cover it, the surgeon would need to ask the insurance company before doing the surgery. JG 10.8.06

• Hi Doctor Garcia! First of all thank you for your respond for my question 1 month ago. Sorry I`m bothering you again, but you might know how desperate a patient feels when you can`t see the results you were expecting. Today is going to be exactly 7 weeks after I had my nose surgery, almost 2 months, as I told you before, I broke my dorsal bones to narrow them and also my tip to make it smaller, my dorsal bones, I think, is begining to look better, but the tip of my nose is still too big, I asked my doctor how he did my surgery and he told me he did not take too much cartilage from the tip, he took just a little bit and put some cartilage from my ear, so my question is, if the tip of my nose was big and he only took just a little bit of cartilage and put another cartilage from my ear, is my tip gonna look smaller?, because he didn`t take enough cartilage, I mean that`s what i think, he said is gonna get smaller, but now is almost 2 months but I can`t see any changes, is still big. What you think Doctor? One more time thank you. Veronica

  Answer:  the amount of cartilage in the tip of the nose is not large so removing a little can make a substantial change in many patients. The tip of the nose is the last to get smaller and I think it will take a bit longer to really start seeing a difference, I think by 6 months things should look better and if at that time things do not look good I suggest speaking with the doctor and seeing what they think about a revision at one year. JG 10.8.06

• Dorsal bone braking to narrow tip of nose is this a painful surgery and how long is the healing time.

  Answer:  not very painful and back to 100% activity in 4-6 weeks. JG 10.8.06

• 2 questions for Dr. G. Will laser takes care of lower eyebags? I had a rhinoplasty 6 months ago narrowing of nosetril the effect is the tip looks wide is it possible to undergo the full noselift to make the tip narrow? How much you think will it cost? Sorry 3 questions/

  Answer:  lasers only tighten skin so they will not help the bags as they are fat pockets that are pooching out from weak tissiues below the skin. More surgery on the tip could be done and that might give you the desired results, fees may run about $4500. JG 10.8.06

• I had surgery about a year ago next month. I`m happy with everything. But, every time I bend over to do something or pick something up my nose aches and throbes and alomost feels like it is going to burst. Is this a problem? or is it normal?

  Answer:  not uncommon, should get better in time though. JG 10.6.06

• Dear Dr. Garcia, Thanks for taking time to read this. I had a rhinoplasty 3 months ago, but something has been worrying me. After my cast was removed, the doctor taped my nose and I was given instruction to tape my nose at bedtime to help control swelling. Well, the first few times I tried to take the tape off, it was very difficult (I did not really know how to get it off). I decided to quickly rip it off (gently, but briskly), and for some reason it got stuck on top of the bridge, and I felt like I pulled up the skin. I am a little paranoid that I may have pulled the skin off the cartilage as it was in the draping process. It didn`t hurt, it just felt sore as I did it (obviously, at only 6 days post op). I had a tip graft, and it was really hard to peel it off the tip of my nose and naturally the tape pulled at the tip as I was peeling it off (I did it really slowly around that area). Is it possible that I may have messed things up by doing that? Could scar tissue on my bridge now be very possible because of the tenting of my bridge from pulling off the tape like that and it getting stuck? I`ve read that the skin needs to drape and reconnect with the underlying structure. The area in the front half of my bridge (on top ) feels mushy at 3 months (the top half has a large callous and the skin is not mushy over the callous, but that`s another story). Is that probably just swelling? I don`t want scar tissue paradise! And I am really afraid I may have caused these problems because the tape really pulled up my skin from the top of the bridge when I was removing it like that at 6 days post op. I have taped every night since, though. A few days after peeling it off I realized that wetting it helps a little, and I eventually heard of and bought detachol solution. Thanks again for the time. I really think it`s great you take the time to answer questions like this.

  Answer:  I doubt you have done anything that will affect your end result in the long term. Most doctors do not have the patient put tape back on, it just takes time for all to settle down and shrink and re-attach. Just give it some time. JG 10.5.06

• Hi. I had a closed surgery operation for an implant 3 months ago. I am now considering alar trimming. Is this done without incisions at the same spot and just at the sides of the nose? Or will it require the trim plus the same incisions as the closed? I ask because Im still forever recovering from revision surgery where incision cuts are still hard. I want to get my tip improved this time with out making healing worse. What do you think doc?

  Answer:  well, there are a few different ways of performing an alar trimming so the incisions will depend on what and where the trimming is done. I think if it is something you desire, you may need to grin and bear it with the selling for a while. JG 10.4.06

• Hi doctor. I`m applying an exfoliant to my face (and nose) with tretinoin hydroquinone and am peeling. I wanted to know if this has any effect on swelling on my nose surgery. I am 3 months post revision op. My nose swelling seems to have gotten wider. Or just coincidence? Thanks!

  Answer:  well, I think it might effect it but not to any significant degree. JG 10.4.06

• I am a 26yr old male and I recently had rhinoplasty and septoplasty surgery back in Dec. 2005. I just wanted my nose to be re-straightened due to an injury to my nose. The dorsal hump on my nose was crooked and the nose hooked from right to left. The plastic surgeon suggested that I take the hump away and he would have to bring in the tip of my nose. I was not pleased with the results, my nose is now to small and upturned, it looks over-operated upon. I would like to resotre the length and height of my old nose and bring the tip down, instead of the tip pointing up in the the air, b/c my nostrils show more, and the tip is very tigh and upturned.It looks like a girls nose. What revision options would help my situation because I am searching for a correction to what I feel was a mistake. B/C my eyes look closer together, a piece of cartilidge was placed underneath on the bottom of my nose to hold the nose straight and that peice looks really weird. I really wish I would have never touch the tip of my nose. Could you please email me back with some advice on which doctor to see? I will travel anywhere?

  Answer:  I think you will need some grafting to the dorsum of your nose to give it more support and avoid the upturned part. Due to potential legal issues, and some doctors wanting to know why I referred a patient to someone else and not them, I think you are best to go to this website and look for a plastic surgeon in the area you desire. I wish you all the best. JG 10.4.06 www.surgery.org/public/findasurgeon.

• Hi, I had revision rhinoplasty one year ago. i am happy with the results other than the fact that my nose still looks bruised. when I am cold it is purple. My dr said to wait & it would get better. I tried cold laser therapy it has helped a little. I look like I am an alcoholic, i rarely drink. Would a different kind of laser help?

  Answer:  might try a YAG laser, it might be more effective for that discoloration. JG 10.2.06

• Hi Doctor G. I had revisional rhinoplasty 3 weeks ago. When they first removed the splint I liked my newly improved no-hump bridge although the bone felt irregular and a bit bumpy. Also, the tip was still too rounded but, I was told to be patient till the swelling came down. I noticed some kind of abrasion/scratch a bit under the bridge area (cartilage). The nurses said it happened during the surgery, although I didn`t get a full explanation. They said after it scabbed they would give me laser treatments and it would go away. Three weeks post-op there is an elevation of the skin that resembles a vein of some sort. My PS ordered some ultra-sound treatments. So far I have had 2 sessions and don`t see any improvement. It gives the nose a very weird appearance. What do you think caused this and how should it be treated? HELP!

  Answer:  might be a thinned area of skin form the surgery, at this point just best to hang in there and let time do its thing, still too soon to tell what if anything will be needed. JG 10.2.06

• Hi Dr. Garcia, I had lower eye bleph 3 weeks ago. My left eye seems to have healed nicely. However, my right eye is very teary and the mid-portion of the lid seems to droop when I lean over or look down. Is this any indication that it may permanently droop? or is there a chance that it may correct itself as well. When do you know you have permanent damage? and what can you do to prevent or correct it. Thank you in advance.

  Answer:  at this point it is most likely due to swelling and the muscles still being weak and should all get better in time. A little light massage pressing the skin out to the outer corner might help, a few times a days for a minute or so each time. JG 10.2.06

• Dr. Garcia, I had a nose surgery on 9/22 to remove the hump and reduce the width on the tip on my nose. The cast was removed on 9/28 and I absolutely LOVED the results. My doctor said it will actually get even better, because at that point it was still swollen. However, since then, the tip has gone back to what it used to look before surgery and I notice a hump coming back. More so when I run my fingers through on the right side of the bone, where my hump was more prominent to begin with before the surgery. What should I do??? Will taping it tightly help??? Can the hump go away??? I live in Florida, does climate matter??? Will the final results be better than the day the cast came off like the doctor said???

  Answer:  just give it time, the splint controls some swelling and when that comes off the swelling increases but it will all go back down as time goes by. JG 10.2.06

• Hi Dr. Garcia. I don`t know how unusual a revision rhinoplasty is with regard to reducing the columella, but I recently had such a revision. I felt it was necessary because my tip was somewhat bulbous. When I got home the day of surgery, however, I noticed that the surgeon slightly cut a piece of the columella in my left nostril, and now my left nostril appears pointier than my right nostril. Is this cut intentional, or is it cause for alarm? Are there hidden stitches inside my nose that will take care of this problem in time? Also, how long does it take for a swollen tip and columella to subside?

  Answer:  hard for me to say without seeing you but sounds like it was intentional. There should be internal stitches too that you might not be able to see also. The tip and columella swelling can take months to resolve though. JG 9.26.06

• Hi Dr. Garcia, Thank you so much for answering these questions... I think you must provide more reassurance and guidance to more people than any other nose doctor in the country! I have two questions related to rhinoplasty. The first is about post-operative nausea. I have wanted a nose job for years but am afraid of the recovery-- not so worried about the pain, which I can deal with, but am petrified of the nausea/vomiting associated with anesthesia. I had a bad experience as a teenager and have been afraid of general anesthesia ever since (I`m 35). Can rhinoplasty be done with local? Will that reduce the chance of nausea? How often do patients experience nausea? Can I be given anti-nausea drugs? My second question relates more to the procedure. I am female and would like the width of my nose reduced and a little more definition in the tip-- nothing dramatic; I`d just like a somewhat thinner, slightly smaller version of the nose I have now. I think the bridge of my nose is fine-- I just have a kind of round/bulbous tip that I`ve always hated. (My husband calls my nose a line with a ball i.e., normal, strong bridge and round end. I am 1/4 black.) Can I have rhinoplasty on the end of my nose without having to get any bones broken? In other words, can my nose be made smaller and thinner without messing around with the bridge? I think I`m looking more for refinement than anything else-- and a little reduction in size. Thank you for your thoughts!

  Answer:  It can be done under local but most of the nausea is related to one of two things, swollowed blood, which can be avoided, and then how much narcotic is used during and after as narcotics cause nausea, so keeping them to a minimium helps quite a bit. I think nausea happens in rhinoplasty about 5% of the time. There are many good anti-nausea drugs out there now so that should not be a big concern for you. As to the tip, you can certainly have the tip done without touching anything else. All the best. JG 9.26.06

• Hi, Doc i was told that there is some other procedure other than having nose surgery... do you have andy idea? My nose is to wide. i would love to have nose surgery but cant` afford it.. any other options for me?

  Answer:  I do not think any of the other little tricks can make your nose less wide I am afraid. JG 9.26.06

• I am a 26 year old female seriously considering rhinoplasty to narrow the bridge of my nose. Is this generally done with an open or closed technique? Also, I have heard that one of the possible risks is that the eyes may appear sunken in or hollow after the surgery, a side-effect which can be permanent. On average, how often does this occur? I already have a little bit of excess skin under my eyes so would that put me at a higher risk of this happening? I am not happy with the shape of my nose, but I don`t want to have it fixed only to have something else to happen to my face that would make me unhappy.

  Answer:  if it is just the nasal bones it is usually done closed and if the bones are reduced a large amount it can give the appearance of deeper set eyes in certain individuals but not all. I think that risk is rare. I do not think the excess skin on the lower lids will impact it greatly. JG 9.25.06

• Hi I had revision closed rhinoplasty two months ago and had an implant put in but at the bridge only. I want to know what it is about the columella and tip that stays extremely hard. The incisions are there yes.. But is it because the skin was seperated from the tissue there and is now regenerating or something? Or maybe that`s where the implant went through the muscle? I question because I`m afraid that when I massage it often I might be interupting the healing process or more scar tissue might form.... Could you explain that a bit to us laymen please doctor? =P Thanks so much

  Answer:  the firmness is due to swelling that stays there a long time as it settles there and goes away very slowly. Since it is the lowest or dependent are, that is where all of the swelling from above goes and since there are scars there it is hard for the swelling to get across the scar and therefore takes time to resolve. Massage will help not hurt all of that, but mostly it is a matter of time. JG 9.24.06

• I`m 5 months post op, my swelling seems to have taken forever time to subside. Well it has for the most part but the area around my nasal bones that used to be hard, graining and swollen is now soft and i guess you could say kinda swollen. I can`t tell if the skins just loose or there`s fluid behind the area. Has this happened to anyone, is this normal? Reply To This Message

  Answer:  normal and probably just still a little swollen, should get better in time. JG 9.23.06

• Hello Dr Garcia. When a rhinoplasty is conducted under local anaesthesia, can the sedative be given oraly (pill)? I really can`t stand intravenous intake. Thank you

  Answer:  It could, but it is something I would not do. I feel an IV should be started even if you are not planning on giving any medications in case of an emergency. JG 9.21.06

• Wow, it must have been a long time since i last asked a question, because everythings different. Anyways, i have figured out what was wrong with me. i injured my nose a year ago, and didnt really know that i had fractured it, because i was told by my doctor that there was nothing more than just swelling. after about 4 months or so, i started to notice a different nose. bigger, crooked, and now i have a hump on my dorsum, and a wider bridge. i guess the fracture has healed, but i`m left with the horrible outcome. what can i do about this, and at what cost? does my story qualify for insurance coverage (should it atleast?)

  Answer:  it certainly sounds like your insurance should cover it, I am presentluy not on any insurnace carrier list so I cannot tell you what it would cost you. It is not uncommon for no fracture to be seen on an X-Ray as most nasal fractures are of cartilage and do not show up on an X-ray. An open reduction of the nasal fracture should help what ails you. JG 9.20.06

• Dr. Garcia, My son had nose surgery 3 weeks ago. He had a cartilage taken from his ear and placed across the inside of his nose, to help him breath better. He also had his septum removed, straightened and put back and had his tip straightened, and a bump on his bridge smoothed very slightly. We were told that there would be no significant change to his nose, but it seems shorter and much wider, and his left nostril seems pushed up. He also feels a round lump inside his right nostril. What could this be, and is this a concern? We are emotionally stressed over all this as we were told his nose size and shape would really not change much. He doesn`t want to return to college, because he is so upset. Any advice you can give us on all this is greatly appreciated.

  Answer:  the lump coudl be the start of some scar tissue or some edge of the cartilage graft that was placed, it is still way too early to tell how it will change but as the swelling does improve the size should normally decrease quite a bit. Try to hang in there for a little more time. JG 9.20.06

• Hello Dr. Garcia. First of all I want to congratulate you for the prompt response to all those questions and worries of people who had a plastic surgery. I have some questions about what I believe worries most of people who had a rhinoplasty. Are bones swollen too, after fractures have been made? And I don`t mean temporary swelling that goes away after 2 weeks, I mean consistent swelling. What can someone expect during the second semester post op about this type of swelling? Is MOST of this swelling gone by then? With respect.

  Answer:  usually all swelling on the bones is gone in 6-12 moths. The more swelling at the begging, the longer it takes. JG 9.17.06

• Hi Dr! I had rhinoplasty about 1 and a half months ago and had an implant put where my bridge is. However, I find the implant a bit too low cuz it made me look like I have a protruding button nose with little bridge. It would be perfect if it were placed a bit higher up so that I have more bridge and less height by the tip. Sometimes I gently push the implant up out of frustration. Will this help and settle that way if i continue doing that? Or will sliding the implant up dislocate the implant and make the pockets loose? Thanks Dr for your help! - kim 09/17/06

  Answer:  I think sliding it will make the pocket stay open, if it stays too low you may need repeat surgery to position it better and then have sutures placed to hold it there. JG 9.17.06

• hi dr garcia. my question is ive had my 2nd nose job recently due to problems with first one done 10 yrs ago. i had to quit cigerettes 4 weeks before surgery which i did sucessfully, now after 5 weeks ive started back on them, prob average about 5 a day. scared this will jepordise my chances of needing 3rd procedure due to possible graft rejection (30% chance i was told by my surgeon). am i playing with fire? many thanks CD 7/05/06

  Answer:  I think you can smoke, although it would be best for your heart and lungs if you did not. JG 5.7.06

• ps Dear Dr Garcia I had rhinoplasty done about a year and five months ago and i am not satisfied with the results. i feel as though i threw my money away. i did no research on my doctor and was naive. i later found out that he is not a plastic surgeon but an ent. my question is are ent's qualified to do rhinoplasty in your opinion? also is it odd that since my operation i had only one check up consultation which was after the six months? thank you for your time and much needed help.

  Answer:  I feel most ENT's are trained and can do rhinoplasties but not it can vary from surgeon to surgeon. Having one check up after 6 months is very unusual. I suggest seeing some other surgeon and maybe there is more that can be done. Best of luck. JG 5.6.06

• Hellow Dr. Garcia, Is it possible to have cartalidge added to the inside of my nose, I feel like to much has been scraped away and have a much larger whole inside my nose on one side. Or can something esle be used to build that up? Is this a very difficult procedure, can it be done without complications. Please advise, Aleshia

  Answer:  how complicated it is is difficult to say without examining you but in general, cartilage can be transplanted to the nose, donor site can be the septum or ear. JG 5.4.06

• I have had work done on my nose 2 months ago. I was left with bruising around and below both eyes. It has been 2 months and I still have some discoloration below both eyes in the crease area. Will this ever go away? I'm getting worried. Thanks

  Answer:  it should but it might take a few more months. JG 5.3.06

• Hi Dr.Garcia, I had a nose job 15 years ago and was pleased with the results, except my right nostrol was smaller and uneven on the inside wall. The cartalidge was sticking out more. I went back last week to see if he could stitch the cartalidge back against the wall to even it out, but it seems like he shaved away to much on the inside above the protruding area and after my stitches disolved the nostril on the inside is still uneven and the cartalidge is still protruding. Can this be fixed and how can it be sown into place if he removed to much from the inside wall of my nostril. I only want my cartalidge to lay flatter against the inside wall so my nostrils look the same. Any sudgestions, I like my doctor alot but not sure he will want to try it again, It seems like a pretty straight forward and simple procedure.

  Answer:  actually it can be difficult and may require a full opening up of the nose to make sure the cartilage lays properly and you may need some stitches into the cartilage. JG 5.3.06

• I was hit in the nose about 8 months ago and it swelled up. now it looks broken, like my bridge is uneven and the left side is a little wider than the right, but they both look bigger than ever. And I also have a dorsal hump now. The doctor told me there is nothing broken after getting an xray, but theres no way it could be normal, I can see how big and deformed it is now compared to 10 months ago. Could this be cartilage, or scar tissue? Also, how can I fix it (all options please), and how much? Does insurance cover the procedures if my nose was injured, rather than my own personal reasons to fix it. My father told me that cartilage, after awhile repairs itself (I dont believe him because its been over 8 months and it seems to only get worse).

  Answer:  most nasal fractures are broken cartilage so they do not show up on xray, cartilage will heal frequently bigger than it was before the injury, insurance will commonly cover the procedure. JG 4.30.06

• I had rhinoplasty on March 1 of this year and am happy with the results. However, within 2 weeks of the splint being removed I developed what seemed to be under the skin boils on the tip of my nose (both sides) I have finished a course of Cipro and Tetracycline but these nodules are still there. The swelling associated with them seems to have reduced but the hard, round areas are still present. My plastic surgeon is at a loss. I guess my next course is a dermatologist but the good ones are scheduling months from now for a first appointment. I am very discouraged as these hard round areas are significantly impacting my new look Thanks for any guidance you can give. SBS 4/29/06

  Answer:  may need a low dose for along time of tetracycline, or minocycline. JG 4.30.06

• dear Dr. Garcia I wrote you a couple of weeks ago but cant find the question and answer since. I had rhinoplasty 3 months ago and since then i am having trouble breathing . I;m tired of using saline spray. My nostrils sometimes feel like they are sticking together on the inside. I am driving myself and my family nuts by sniffing trying to breathe and nothing happens. I'm beginning to get awful panicky what should I do Help

  Answer:  well first go back and see your surgeon to see what is going on, it can be many different things. May want to also try some antihistamines too. JG 4.30.06

• Hi Dr. Garcia! I had septoplasty done about 2 years ago. Since than, my breathing has improved, but it's still not great. Sometimes, I wake up in the middle of the night because I can't breathe properly. My nose currently bends to the left a little bit and it causes the inside of my left nostril to be very narrow. If I use rhinoplasty to straighten out my nose, will it also open up the airways? Thank you! MJ 04/29/06

  Answer:  I think you need a repeat septoplasty from what you describe. JG 4.30.06

• Hi Dr Garcia....I was wanting to have my nose smaller,I live in Australia,and my sister lives in Ohio usa...I was wanting to come over there and get you to preform the procedure for me....is that possible?????? Fay email address fbrats@yahoo.com

  Answer:  we do perform surgery on patients form all over the world, I would need you in Las Vegas for about one week though. JG 4.30.06

• dear dr garzia. april 23,2006 jd it has been a little over a year that i have had rhinoplasty. during the initial few months i was pleased with the results. however it seems that my nose looks less and less refined and more and more like my old nose. six months after the surgery, i began picking my nose. funny but true. can picking your nose after the six month period affect the size etc of your nose. it seems as though ever since i have been picking my nose the nostrils and overall size has gotten bigger. can this be so? please give me your honest opinion. thank you

  Answer:  no, picking your nose will not affect it. It may be due to scar tissue developing which does not happen immediately after the surgery. JG 4.24.06

• dr. garcia, i'm going into surgery for polyp removal. i also have a deviated septum and a fracture in my nose. is it possible to get it all done at once? my surgeon said that i can't and that i need to get rid of the polyps first. after 1 to 2 months i have to go into surgery again. i was heart broken when i heard that i had to have 2 different surgeries. i'm all readynervous about the first one. thank you. m.h. april 22, 2006 @1 pm

  Answer:  from what I have seen, all of that is usually done all together. JG 4.22.06

• Dear Dr Garcia, I've recently had reconstructive surgery done (7 months ago) due to internal valve collapse from my first unsuccessful op. My surgeon used some of my own cartilage from my septum, but it was not enough and donor rib cartilage had to be used. Although he assures me that the donor grafts rarely are rejected, I am psychologically still trying to accept it. You might laugh at these questions, but they drive me insane!!!!!The thought of having some dead persons rib in my nose!!!!Please put my mind at ease, assure me that everything will be okay, and I don't need to undergo any further ops.What keeps these donor grafts from not rotting in my system, if they are initially kept in a freezer or donor bank to remain fresh? Also, my face and eyes have been puffy for the past two months, is there a chance that my system can develop an allergy to this donor cartilage? My ENT assures me that donor cartilage does not get rejected because it receive no blood supply, is this correct? What about alloderm? Does this work on the same principle? He also made use of alloderm, is there a chance that anything can go wrong now, as my surgeon has assured me that the critical stage is over. What is the difference between these donor grafts and a donor organ transplant where immonosuppresents need to be taken to prevent rejection? Please explain in detail, as I need to know exactly how these things work, to be able to sleep at night. I know you might think I'm neurotic, but PLEASE put my mind at ease.These constant questions in my mind are giving me grey hairs!and quite honestly, I think my surgeon is tired of me and my technical questions.Also what are compression exercises and are they necessary? What exercises can I use for the scar tissue at the tip of my nose? Regards A. Tsiteros Date:20/4/2006

  Answer:  the grafts are irradiated and essentially are dead and are just the structure, so very safe. There has not been any cases of anything bad being transmitted form them with the saftey mecahnisms in place now. Rejection is almost unheard of as are allergies, the swelling is common form the extensive amount of surgery you had and may take a whole year to get better. The alloderm will eventually dissolve but it is quite safe and I have used it many times. No real exercies, just light masage to the tip and bridge and time is what is needed. Hang in there. JG 4.21.06

• Hello, I had skin cancer on my nose several years ago and now it is becoming really red. What could I use to take the reddness out? Also my arms look like alligator skin from too much sun which I now avoid. Any suggestions for that? Thanks so much for your time.

  Answer:  Moisturizers and sunblock for the arms. As to the nose, I think you should see your doctor to make sure you do not have a cancer coming back. Best of luck. JG 4.19.06

• Your websight is awsome!! I had a revision rhinoplasty a week ago and would love for you to answer a few questions if you have time. My PS is on a long vacation so the nurse took my stiches out. ( I don't think he likes it when you ask him many questions anyway ) He told my husband he had to take out alot of scar tissue from the previous surgery. Is there anything I can do, to keep it from forming again? I have been putting tape back on it at night, hoping to keep it's shape. Is this good or am I wasting my time? Should I tape the hard plastic cast back on at night? Also, the tip of my nose had fallen, so he said he would place something plastic in there to help keep it up. I'm so afraid it will fall again. Do you have much luck with doing that procedure? Can I massage it without hurting something? Any advice you can give me would be MUCH appriciated!! Thanks so much for your time. I'm not sure how you do it.

  Answer:  thank you for the kind words. The scar tissue forms from the way you heal and also the amount of bleeding and swelling, so not much you can do right now. Taping is not a bad idea, but I cannot say how much of an effect it will have. The hard cast should only be applied to avoid getting hit on the nose, will not make much difference now. There are plastic struts you can put into the tip to assist in projection although you can also use your own cartilage if availbale. Hang in there and best of luck. JG 4.16.06

• Dr. Garcia, On average, what percentage of your rhinoplasty patients are happy enough with the results that they don't have to see you again? On average, how many have post op problems like scar tissue, bumps, indentation? Thanks!

  Answer:  even in the best of hands about 5% or slightly more of rhinoplasties need to be touched up, the more that is done, then the higher the chance. JG 4.16.06

• Dr. Garcia, Would being on antidepressants affect rhinoplasty candidacy? Thanks for your time.

  Answer:  no it should not affect it in any way. JG 4.16.06

• dear Dr. Garcia I had nose surgery to make my nose shorter about 11 weeks ago but since then I have had trouble breathing like my nose is very dry. I took antibiotics for 10 days and had a prescription for nascort. Now I use saline spray and ointment. It seemed to get better for about a week and now its acting up again. what should I do. april 16/06

  Answer:  It might get better in time, hard for me to say anyting more without knowing what they did exactly during the surgery. If the cauterized the turbiantes which normally moisturize and humidify the air breathed in, as they normalize it should get better. JG 4.16.06

• This is not exactly a cosmetic surgery but along the same lines as a nose job, Three weeks ago I had a surgery called DCR for a blocked tear duct, a week latter my doctor took the stiches out and I was still really swollen and bruised, he did not seem really concerned but he never does. I am still swollen on the side the incision was made and my nose is very sore, there is still some buising and I could not possibly wear makeup because any rubbing or touching is very painfull. I am worried because he talked like it would be a quick recovery, aside from the tube in my eye and nose driving me crazy the swollen nose and eyelid are still painful to touch or make certain facial expressions. Is them normal? I am supposed to get the tube out in about 4 more weeks, should I wait and see or go back? It was really swollen and is a lot better but very slow.

  Answer:  all of that is normal and the swelling can take some time to go down. Ice may help, the tube needs to stay in place until the wound heals and the swelling goes down. JG 4.16.06

• What a fantastic website - you are a kind man Dr Garcia! One side of my nose looks wider and there is a gap / ridge at the side of the bridge of my nose - could this be where the bone is un-attached to the septum / un-alined one side making the bone look wider? Its stings in the dented area? The other side is perfect much narrower and smooth all the way to the septum. Thanks in advance :-) Answer: Thanks for the kind words. You are correct in your assessment and it may hurt because small little nerves can be trapped in that space. May need to have it broken and pushed together. All the best. JG 3.26.06 *** Thanks for the reply - I am seeing my surgeon this Friday to get the problem sorted - Just wanted to know what might have caused this to happen - Thanks in advance and Happy Easter ***

  Answer:  thanks for the kind words. I think your assessment is correct. May take more surgery to correct or improve it I am afraid. JG 4.15.06

• Hi Dr. Garcia , i was wondering what is the appropriate age to get a nose surgery ?. My daughter that is 16 years old is uncomfortable with her nose because it's wide . Do you think she is too young ?. Thank you .

  Answer:  I think 16 is OK to proceed, you just need to wait until they are almost fully grown so that you do not stop the nose form its normal growth. JG 4.15.06

• Dear Dr. G., I am a healthy 37-yo woman who had a rhinoplasty 5 months ago. The profile looks excellent, but the tip is undeniably wider than it was before surgery. I am also experiencing significant variations in swelling during the day - sometimes my nose looks 30-40% wider and puffier than it did just an hour earlier. I've noticed that taking a bath definitely makes it swell, but I'm not sure what other factors would do it (salt in my diet? fluid intake? allergies? amount of sleep?). My questions are: why would the tip and sides of my nose end up wider than they were before surgery (it's been 5 months and they haven't shrunk), and why would I have so much variation in swelling throughout the day? Will this eventually stop? Thanks very much for your help. Sincerely, DK 4/14/06

  Answer:  The size change you describe is due to the normal swelling and healing of the skin. All the things you mention, like heat, allergies, salt can affect the swelling. It might take a year for it to all settle down, a little massage may help. JG 4.15.06

• Last summer, i was elbowed in the nose and it swelled up. I've never had a swollen nose before that, so I thought it was broken, but all i could do was ice it. the doctor told me that it was not swollen, based on her opinion (didnt even get an xray). Well, the swelling went down, but I was left with a hump on my nose, and the bridge of my nose was wider than it ever was. I HATE the way it looks, and i recently got an xray, and it came back not broken, so why is it so damn big. I feel like Marsha (bradybunch), by the way, how did she fix her nose. plastic surgery would be a burden on my pockets

  Answer:  it will require surgery, and you probably did have a broken nose, but what broke was cartilage and that does not show up on X-ray, you would need surgery to fix what you have, sorry. JG 4.13.06

• I had my nose done about 5 weeks ago and now the tip of my nose is hard,is this normal and how long will it be like this. Also the inside of my nostrils are smaller. Is my possible that my doctor moved my Cartilage around in there to reshape my nose. I though he would just cut some cartilage out to make the tip smaller. I don't think my doctor explained everything to me upfront.

  Answer:  all normal and make take a few months to soften up. The nostril may appear smaller due to the selling too. Hang in there and give it some time. JG 4.12.06

• I have had 4 surgery's to correct my nose. The last one, he put something plastic in to hold the tip up. I should have asked more questions, but was so thrilled when he told me this should keep it from drooping. my question is, have you had good results from using this? and is it possible for it to break or shift? He also said he removed a good amount of scar tissue this time. Is there anything I can do to prevent it from forming? Your websight is very helpfull. Thank you. RM 4-10-06

  Answer:  they can break, shift and also poke through the skin in time. Removing scar tissue can be good, but some or all of it might come back. I wish you the best with the last surgery. JG 4.11.06

• i had a revision rhinoplasty. My ps added carlidge to my bridge and made my nostrils alittle smaller. right now i have packing in and i look like i have a pignose. Is this common? Is it due to packing and swelling also MMR

  Answer:  yes, all normal and the packing makes it look worse, all should get better soon. JG 4.9.06

• Hi Dr Garcia, In responce to your answer (I posted the question regarding a rhinoplasty done 18 months ago and still suffering swelling), I had the base of my nose narrowed as it was sitting a little high and also a minor bump removed. It was a closed procedure and although it looked great for the first month after the cast came off, the swelling has gone up and down ever since aswell as the tip still being numb. You mentioned recovery could take up to 2 years, so should I just wait it out or is this unusual for the surgery I had done?? Thanks for your help!

  Answer:  I would wait it out, if you can, because if it gets better on its own its better and easier than surgery. You can always have more surgery later. JG 4.7.06

• I got my nose broken around 3 years ago and I didn't know it. I let it heal on its own, but it never felt the same. There is an uncomfortable dull pain on the bridge of my nose, where there is a dorsal hump caused by the injury. I feel like something must be done for my nose to go back to normal, because three years have gone by and the pain is constant. My hypothesis was for a surgeon to re-break my nose where the dorsal hump is, and bring it down to where it was before. Then afterwards do the nasal exercises for full therapy. I have talked to a few nose doctors and are clueless. If you were my surgeon, what do you think of the procedure I said?

  Answer:  the pain you have in the hump which is basically a callus, may get better with surgery but no one can guarantee it. If the pain is that bad, it might be worth it, I doubt it would get any worse. JG 4.6.06

• A little over three years ago I was in a car accident and my nose was broken. I could not breath through my nose. On right side of my nose there was a bump in the bone that was making it very difficult to wear my glasses. The doctor and I talked about fixing the bump in addition to repairing a deviation in my nose so I could breath again. Everything seemed to go well until the packing and stitches were removed. To my shock the doctor had done a rhynoplasty and had reshaped my nose taking the hawk like bridge out of my nose and made a straight nose leaving the bump still there. When I complained about it he shrugged and told me that most people want a straight nose . Things got much worse, part of my nose under the bump on the upper part of my right side below eye level sank inward and down. I felt it happen, it seemed like my nose slid down my face for a second or two. A tickle in my nose started and has resulted in constant tickling and pain in my nose and upper palate in my mouth right above my front teeth. The doctor diagnosed it as a sinus infection, we did a CT, and I took some very expensive antibiotics. Then some more antibiotics, then he diagnosed it as allergies and REFUSED TO CONTINUE SEEING ME. I saw my family doctor, he looked at the CT, called the surgeon up and had a talk with him. The surgeon saw me again, ordered another CT, diagnosed me with atypical facial pain told me it had nothing to do with the surgery and subscribed Neurontin (costs $100 dollars a month) and told me that I would probably be on it the rest of my life or until I got tired of taking it. The Neurontin helps some, we have increased the doseage three time, but not a lot. I went back to my family doctor and he sent me to a neurologist. This doctor checked me out and basically told me that nothing could be done, I have nerve damage. If part of my nose, before it became completely solid again pushed down on a nerve does it not make sense that another rhynoplasty could reverse the pressure on the nerve? Or at least possibly give some level of relief? My nose is partially curved in and to the touch you can feel right side being slightly lower, the whole nasal bone seems to be a little lower on my face than the left side. Is a procedure I should talk to a doctor about? The nerve pain is terrible, it is taking a very heavy toll on me.

  Answer:  well, attempting to re-fracture the nasal bones and trying to support them may help, but it also may not do anything. If your pain has gotten that bad, it might be worth the risk to try it, wishing you the best. JG 4.6.06

• Dr. Garcia I had a rhinoplasty 2 years ago and when I smile my nose seems to flare out at the nostris (on the sides). It also looks, or reminds me of, a beak shape. What causes this and can it be fixed? I especially HATE the way it looks when I smile. I looked at old pictures and it didn't do that.

  Answer:  the widening is due to the muscles of the nose pulling to the sides, they can be cut but they like to heal right back up. In terms of the beak, it is called a Polly Beak deformity, it sometimes requires more surgery to sculpt what is called the distal septum and supratip break area to avoid that problem. The widening is a litle more common after a hump is removed. JG 4.6.06

• I am a dark skinned african american female 47 years old. If it weren't for my nose, I would be considered attractive. My nose is large, bellshaped, and flat across the top. It takes over my whole face. I went to see a PS about rhinoplasty. He said you want to to have this done so you can have a nose like a white person. Don't you? I was completely taken aback but then it got worse. He said you people have thick skin and I don't know if it would even show if I stuck a finger bone into the bridge of your nose. He started to examine my nose, then drew back as if he were repulsed. He kept saying UUU your skin is so thick! I want my nose fixed so that it won't be large, bellshaped, flat. and so it won't take up most of my face. I've been teased and tortured about this since I was a small child. Every photograph thats ever been taken of me looks like a weird caracature of me. Is dark skin a problem when it comes to rhinoplasty? Or should I just forget about surgery and live with the heckling and bad jokes.

  Answer:  That was extremely rude of the physican. African Americam skin is thicker and there are limitations on what we can achieve but many people of color have rhinoplasties done with very nice results. I am sure that there can be some things done to make it look a little more proportional. Don't be deterred. JG 4.6.06

• Hi Dr. Garcia, I had a rhinoplasty 18 months ago, but I am still experiencing swelling. The tip and sides of my nose still flare up and I am worried that it will constantly be like this. Will my nose ever go back to the size when the cast first came off?? Thank you!

  Answer:  yes, but it all depends on what was done, I have had cases where it takes almost two years to stabilize. Hang in there. JG 4.6.06

• How long after a rhynoplasty operation can I start wearing sunglasses?

  Answer:  4-6 weeks. JG 4.6.06

• Dear Doctor- I am looking to have septoplasty here in London. Could you please tell me who the best surgeon would be. I would be so grateful if you could please help me. Mr YJ

  Answer:  I am sorry but there are many good surgeons there and I am not familiar with all of them.Due to potential legal issues, and some doctors wanting to know why I referred a patient to someone else and not them, I think you are best to go to this website and look for a plastic surgeon in the area you desire. I wish you all the best. JG 4.6.06 www.surgery.org/public/findasurgeon

• I had a nose job 2 yrs ago, I'm still very unhappy with the results even with several steroid shots in attempt to make the swelling go down. The graft he put in my septum has slipped out of place and make my nostrils look two different sizes and whenever I smile it pops in and out of place and is very apparent. I think the tip of my nose still has a bolus and have request that he go back and shave it down some. He declines to do that but agrees to trim my graph down by cutting me on the inside of my nose, which will be an in office procedure with just a local shot in my nose to numb the area. Does this sound right, for an in office procedure, and will it even correct the oversized graph?

  Answer:  That can be done for a graft revison, yes. JG 4.4.06

• since rhinoplasty two months ago my left nostril is stuffed up and dry which is very uncomfortable what do you think is happening and what should I do? april 2/06 suffering in Canada

  Answer:  most likely some old dried blood around some sutures, use some saline nasal spray and it should get better. JG 4.3.06

• Hi, Doctor I am 26 years old and about 4 years ago one my left under eye has become very puffy and dark and will not go away, no matter what i use. I finally found a cream that lessened the darkness but nothing seems to work for the puffiness. I have spent so much money, and I am searching for a surgeon now for surgery. Is it ok to only do one under eye for the puffiness? what is the average price for one under eye? And will it look normal like the right eye? And what do you think this is with just this one eye issue all of a sudden? Thank you very much for your valuable time and patience. Christina/3-29-06

  Answer:  it is OK to do just one eye, prices vary from surgeon to surgeon though, so find the one you are going to go to and then get the price from them. It is difficult for me to say what has caused it without examining you. JG 3.3.0.06

• Hi Dr. Garcia, 7 months ago I had a revision rhinoplasty. I had excessive growth of scar tissue on the bridge, causing a large red bump, so a month ago, the surgeon operated and removed the scar tissue. At first, it felt great, but after a month, I have some red spots cropping up again, soreness on the bridge, and some bumpiness. The next time, he says he will make an incision on the outside of my nose to get rid of it. Am I doomed to continue this cycle? Do some people just naturally produce more scar tissue than others? I don't want a scar on my nose if I can avoid it.

  Answer:  I think you need to give it time as many times the bump softens and goes away. JG 3.28.06

• Nasal Flaring/ I guess what I mean is what do you do for such a problem? Botox? or what muscles would cause this in me and not others?DD Boston

  Answer:  Botulimum toxin A is an option but it mght be difficult to weaken the muscles that cause the flaring and not others. Which muscles need to be injected varies form person to person, depending on each nose. JG 3.26.06

• Nasal Flaring! Help When I smile ar speak my nose flares alot! I have been made fun of for this for many years! When my nose is at rest it is not unattractive! BUT when I talk or smile OH my my face becomes very unattractive and distorted alot with that is the nasal flaring! what can be done .. I have inspected alot of faces smiling and not one do I see this distortion of the face!!! Where do I begin to find a plastic surgeon to help me!? I live in Boston.. Thanks for your help.. Deborah D boston. ps. I am 40 years old... doegirlsr6@hotmail.com

  Answer:  I think you can find a surgeon at www.plasticsurgery.com. best of luck. JG 3.26.06

• What a fantastic website - you are a kind man Dr Garcia! One side of my nose looks wider and there is a gap / ridge at the side of the bridge of my nose - could this be where the bone is un-attached to the septum / un-alined one side making the bone look wider? Its stings in the dented area? The other side is perfect much narrower and smooth all the way to the septum. Thanks in advance :-)

  Answer:  Thanks for the kind words. You are correct in your assessment and it may hurt because small little nerves can be trapped in that space. May need to have it broken and pushed together. All the best. JG 3.26.06

• I had a nose job 6 days ago and my nose is clogged up with all kinds of junk, I thought it was dried up blood, so I tried to pick it out, but a stich came out so I left it alone. When I went to my doctor he said to leave it alone and use some saline nose spray. But it hurts too bad to just be dried up blood, and why would there be stiches in the inside of my nose. Besides that I'm not very happy with the results even though its only been six days, is it ok to ask for a partcial refund?? EH from Louisville, KY

  Answer:  there are usually sutures inside the nose to close the incisions, they will dissolve in time and the saline spray does help quite abit. 6 days is very soon after surgery and there is still an enormous amount of swelling so just give it some time. I would wait at least 6 months before deciding if anything needs to be done and then you can discuss it with the surgeon again. JG 3.25.06

• Hello, Dr. Garcia, I had septo-rhinoplasty nearly three weeks ago. Three days ago my plastic surgeon said that my swelling was pronounced and gave me several cortico-steriod injections in my nose and cheek area. The results were stunning within one day, with greatly reduced swelling. Now, it appears that the swelling (and numbness) is returning and feels like it is moving down into my chin, which was reduced five weeks ago during a neck and facelift with upper and lower blepharoplasties. My question is this? Can I get an additional round of steriod injections or is this a one-time fix? Thank you so much. DCR March 23

  Answer:  it might help but you may need oral steroids to keep it safer.JG 3.25.06

• Dr. Garcia, I am considering rhinoplasty. I have a smallish bump on the bridge and a bulbous tip. Here are my questions: How much does a consultation cost and what does it consist of? My biggest worry is recovery time: I just started a new job and time off is a big factor, as well, I really don't want to go back to wirk with it totally obvious that I just had surgery. What is the average aftermath like? And last: I see that average rhinoplasty hovers around 6-10 Grand, does your office finance? Thanks for your TIME, ---

  Answer:  Consult fees vary from surgeon to surgeon, our fee for that is $50.Depending on what needs to be done, there will be dressings and bruising and that may take about a week to get well enough to hide in public with make up. We do offer financing but our fees range from about $4000-$7000. All the best.JG 3.25.06

• I am unhappy with the shape of my nose. There is a bump and i would like to get it removed. What sort of procedure would you recommend for this at the lowest price and best results? Would there be any swelling after? If so, how long would the swelling take to go away? Is it a bad idea to get a nose job when you are younger?

  Answer:  hard to say without examing you, it might be a straightfoward rhinoplasty or something more involved, it can vary in price from $4000-$6800. JG 3.23.06

• Hello Dr. Garcia, I had a revision rhinoplasty done 6 1/2 month's ago. My nose looks nice but on the left side of my nosetip there is a thick spot (bump) and it feels very hard and looks swollen. It also makes my nose look crooked. I'm pretty sure it's scar tissue. My PS gave me at least 3 shots over a period of three months. Do you think it will completely go away. Also, is there anything I can do to make the bump and the hardness go away...i.e. any creams? Thank you for your time.

  Answer:  It might, hard to say at this point. No creams out there that will help, may need more shots I am afraid. JG 3.23.06

• doctor garcia, when one does have rhinoplasty are there cases wherein he has to repeat the procedure because the stuff that was put inside the nose went out of the place ..dislocated.. protruded.. or whatever term one can possibly imagine...what can cause these things to happen, i mean the implants get dislocated..

  Answer:  it can happen, cetain implants cause that problem more than others. Any motion in the implant or trauma to the nose can cause the implant to move and possibly protrude. JG 3.23.06

• Hi Dr. Garcia, I have a hump on my nose and I'm interested in rhinoplasty. Approximately how much do you charge?

  Answer:  fee is about $3800 if it is only the hump. JG 3.23.06

• Dr.Garcia what is the working condition for a plastic surgeon

  Answer:  all depends on where they practice and what type of practice they have and their desire to work. JG 3.22.06

• Dear Dr.Garcia, I live in London and had a nose job 6 weeks ago in Iran. I think I have developed scar tissues on the bridge of my nose. It is not very visible but if you look close you can see that the bridge is not 100% even. Unfortunately I have no access to my doctor at this point, but is this something i need to be concerned about? will the scar tissue disappear with time? and also what causes these scar tissues? Many many thanks

  Answer:  it might get smaller and it might not, it comes from the normal healing process of the nose surgery. JG 3.18.06

• Hello Dr. Garcia. I looked through some of your before an after rhinoplasty photos and they are wonderful. I've been through hell with my nose. I've had three rhinoplasties for functional (deviated septum and turbinate reduction)and cosmetic reasons. I had a rib graft placed on the dorsum to build up the bridge. Later, the graft shifted and was poking out. Five months ago, I had the graft removed and the surgeon cut the graft up and used it to build up my tip. The problem is I believe the grafts became infected. My nose was abnormally swollen (so much so that it didn't look like a nose) and at one point started to drain yellow fluid from the incision site. I wasn't able to see my surgeon because he was out of town. He first prescribed Cephalaxin and then Cipro. It's remained extremely swollen (goofy looking) and is still somewhat sensitive even though it's been almost half a year. I've had kenalog injected twice to reduce the swelling, but that's so temporary and risky to keep injecting. The surgeon said just give it time, but there really hasn't been much change over the months. I'm worried that the infection could have altered the healing and/or is possibly still infected. I was hoping you could give me some direction on how to approach this and to find out what's going on. Also, is there an antibiotic that you've known to work in situations like this? I'm extremely grateful for any input.

  Answer:  I think Cipro or others like it is what I would use. I am afriad that in the removing and morseliizing the graft and putting it back in has caused the infection and inflammation you describe. This happens much more so in rib grafts that are not the patient's own, like from a tissue bank. I am afraid the only thing that will be able to be done to help is to go in and remove the graft and leave it out, let it all heal and see what you will need at that time. Wish I had more to offer. JG 3.18.06

• Hi Dr. Garcia, This question doesn't specifically relate to nose surgery or any kind of plastic surgery, but about 7 months ago I noticed a small bump under my left nostril around the bone area. It was quite sensitive and I later had a root canal done the the #9 tooth directly below. I figured it was caused by the infection in the tooth. It's been about 2 months since the root canal and the bony mass has harden and progressed kind of into my check area. No one can explain what this is to me. Its quite hard and it makes my face look swollen on that side, especially near the nose. Is this something that a plastic surgeon would need to treat or an ENT? Any info. would be so great appreciated. Thank you, Steven C. Covina, CA., March 17, 2006

  Answer:  I would see an ENT and get a CT sacn to see what has settled in there. JG 3.17.06

• Hi Dr. Garcia!... I was reading the numerous Q & A's and noticed a lebanese girl had been looking for a surgeon on the east coast who can cater to non-caucasian patients looking to keep their ethnicity in their features. I have just had rhinoplasty with Dr. Michael Evan Sachs in NY and he has done countless surgeries in which he contours the nose, but keeping the person's character in their face. He has assisted many people I know and I would highly recommend him for the east coast. My question is, the stiff upper lip does eventually go away in time correct? I look like i had more than my nose done when i smile, i'm not worried, since I am sure it's very common, it just helps to hear it from a second doctor skilled in this area, since everyone heals differently. Thanks so much for your time.

  Answer:  yes, but it takes time as the muscles get very swollen and that makes them not functional as well for quite awhile. Thanks also for the info to the people on the board. JG 3.16.06

• DearDr. Garcia i wrote this question yesterday but didnt receive an answer yet i had my nose broken 20 years ago and just decided to get something done 6 weeks ago as my nose was always long and looked longer so thought i would get it shortened. 4 weeks after having it done i had a couple of nose bleeds and a blood clot 4 or 5 inches long came out of my left nostril. since then i am having trouble breathing in my left nostril a stuffy smothering feeling and nothing will come out of it. I went to my plastic surgeon a couple of days ago and he said everything looked fine and it should be okay when all the swelling comes down which is almost down now. what do you think and what should i do. Leona

  Answer:  I would use some salt water nasal spray instead of rolling anything in there as that may cause more irritation nad bleeding. It should all settle down in time. JG 3.15.06

• Dr., If a person has a slight bump on the bone on one side of the nose, can it be shaved down without breaking the bone of the nose? How much risk is involved, side effects? Can you tell me a little about the procedure that would be needed? How much downtime? Costs - estimate? SHA

  Answer:  it can be rasped which is not a fracture but a scraping. Risks are that either too much or too little is removeed. Downtime is about 7-10 days before light actvity. Costs will vary from surgeon to surgeon so you would need to pick someone and see them. Best of luck. JG 3.15.06

• Dear Dr Garcia, First, hats off to you. How do you find the time? Love your website. I had tiplasty 10 months ago. the tip of my nose is not symetrical and it looks as if one side of my nose is bullbous. On that same side in addition I have noticeable redness, chapping and a constant drip. I have seen an ENT who says I have a heavy staph infection and an infectious disease doctor who thinks that the one permanent stich which happens to be on the same side as the redness and swelling nostril could possible be infected. I have been on five rounds of different antibiotics which help the nostil some but does not cure the problem completely and the redness and drip returns within a few weeks. My question is, when is the best time to have the surgery again? Also, what are the chances of fixing the asymetry and thining out the nose at the same time? It looks like I also may have some scar tissue build up. What would you recommend? Thank you for your time. E

  Answer:  thanks for the kind words. I think if you have had that many courses of antibiotics it is time to get the suture out to alleviate the problem.In terms of fixing anything I would be hard pressed to say without seeing you as it would be nice to try to avoid sutures being placed in order to avoid the same problem again and they may be needed to get the desired improvement you want. Scar tissue can be removed but some of it may come back. All the best. JG 3.15.06

• i had my nose broken 20 years ago. my nose was long and 6 weeks ago i had it shortened. about 2 weeks ago i had a couple of nose bleeds and a blood clot came out of my left nostril about 5 inches long. since then i have difficulty breathing out of that nostril. sort of dry smothering feeling. i went to my plastic surgeon and he said everything looked fine to him it should get better when all the swelling goes down. i feel better when i roll a bit of tissue up there. what do you think. thanks leona

  Answer:  I would use some salt water nasal spray instead of rolling anything in there as that may cause more irritation nad bleeding. It should all settle down in time. JG 3.15.06

• Is there a nose implant instead of using Breath right (R) nosal strips (US Patent No. 5333499 5533503 6318362) Thank You in advance. K.S., Bulgaria

  Answer:  I am not familiar with that product, sorry. JG 3.15.06

• Dr. Garcia- My nose is very thin at the bridge and also somewhat thin all the way down. Additionally, the projection is a little much for me and makes my already deep set eyes seem lost . What is the price range of a rhinoplasty and with that, a lip lift (incision at base of nose)? Can I send you a picture via email and then travel for surgery? Thanks!

  Answer:  photos would help me to see what can or needs to be done. As to the pricing, I can tell you more after I see the photos. Please send them to drgarcia@lvcosmeticsurgery.com. All the best. JG 3.17.06

• Hi Firstly would like to say what a great website and thanking Dr Garcia for all the information. I had a hooked nose (sometimes called Roman/Jewish nose). My brother hit me with a magnifying glass when i was 11 years old after which the shape of my nose changed drastically. I have had three operations to correct the problem and remove the hump at the bridge of the nose. My question is related to one thing that I have always wondered. Can an injury at childhood alter the shape of ones nose that it becomes totally large and takes on a different shape or is it genetics (if one parent has a particular nose, the child inherits) Up till a certain age, my nose was normal and I had no problems. After which, no one failed to miss an opportunity to point out how big and long my nose was.

  Answer:  It is a matter of both, one is not more important than the other in your case. JG 3.17.06

• I have a wide nose. Is it possible to use a non-surgical method to correct or coverup this problem? (airbrushing?)

  Answer:  place a thin line of a white concealer over the width of your nose to cause what looks like a light reflection and then your powder over it. JG 3.16.06

• Hello Dr Garcia! im 3 months post-rhinoplasty that left me with terrible deviation and a thin asymetric nose! Cartilage was taken off from the nostrils leaving me now with collapsed nosetrils on the side! another PS suggested to wait 3 extra months than to perform a revision rhinoplasty! he suggested using implants (sponge??) to fill in the spaces but said that those implants might get infected! He said that he cant also do anything to the nostrils! Isnt it a better solution to use cartilage graft? he said he doesnt use cartilage cause it shows under the skin and doesnt give a smooth and natural effect? is this true? Can cartilage be grafted again to the nosetrils in order to give it volume again or its true that nothing can be done in there? i would appreciate ur opinion! Any referal over Montreal, Canada would be much appreciated!

  Answer:  I think the cartilage grafts are the best way to go. Maybe reasearch a little and find a different surgeon who does the cartilage grafts. Due to potential legal issues, and some doctors wanting to know why I referred a patient to someone else and not them, I think you are best to go to this website and look for a plastic surgeon in the area you desire. I wish you all the best. JG 3.36.06www.surgery.org/public/findasurgeon.

• hi i am 2 weeks post rhinoplasty and i was doing graet all my swelling and bruising was gone .i have now picked up a very heavy cold and my nose has gone puffy and swollen again like it was after cast removal. will this go down or have i damaged it by sneezing . i have been really careful not to blow my nose .its very frustrating!

  Answer:  All will go away in time. JG 3.7.06

• Dear Dr Garcia, I had rhinoplasty two weeks ago and one side seems wider and the other narrow - could this be swelling? It makes my nose look asymmetric. On the wider side there is a very noticeable dent by the top of the bridge ? I have discomfort on this side aswell, especially by the dent -stings and have sharp pains now and again. There is also a dent on the other side, but that is half way down the bridge - will the dents go away? Does this sound common? and will I have to have further treatment? Kind regards

  Answer:  yes, still due to swelling, give it some time. All common things. JG 3.6.06

• I had nose surgery when I was 17, now I am 28 and my nostrils/wholes are bigger than after the surgery...Can I get surgery again to make the nostrils look smaller like before? 3/3/06

  Answer:  it depends greatly on how you look and the tissue, hard to say without examining you, but possibly. JG 3.3.06

• Hi Dr Garcia, I had a rhinoplasty about 15 years ago, a few days after I had the cast off I noticed a lump on the left side nasal flap. The doctor said some cartilage had snapped and bunched up. Can this cartilage be repositioned and sutured back into place or will it need a graft?

  Answer:  It might need to be repositioned or just smoothed out with a rasp. JG 3.3.06

• Hi Dr. Garcia, I had a revision rhinoplasty 3 years ago and the doctor used an open rhinoplasy where the columella area was cut and a scar is visible. One side of the columella area is fine but the other side of the columella area looks like he accidentally cut a part of my cartilage. It looks the same as it did 3 years ago after my stiches came off. I was wondering if I can do anything about this like a scar revision. Also, have you heard anything like this. Thank-you! S.P. 3/3/06

  Answer:  yes, not uncommon and can be improved with a scar revision. JG 3.3.06

• Dr Garcia- I am having a biocornal brow lift and rhinoplasty. The surgeon wants to approach the nose from the top in the insicion in the scalp.....does that sound ok to you?

  Answer:  if it is just for a dorsal hump it should be OK. JG 3.2.06

• Dr. I have a depressed scar on the crease of my nose, next to my right nostril. It was caused by a blister from an aggressive YAG laser treatment in order to get rid of my littler red veins around my nose. I am trying peels and microdermabrassion but because it is an indented scar I have seen little results….It looks like a little whole. What would you recommend? Would minor surgery take care of that? And what type of surgery would I ask for? Would laser surgery work..? I have fair skin, but I am Hispanic. Please be specific. Thank you very much! Desiree 3/2/06

  Answer:  very hard for me to tell you what the best option would be without seeing you in person.A more aggressive laser may help but there will be a longer down time for healing and some small risk of hyperpigmentation. JG 3.2.06.

• Dr Garcia, Thank you for your reply to my problem of lumpiness with regards to Artecoll. You mentioned that I may need surgery to remove the lumps. Can you be more specific as to what this will entail and will I be left with scars at the site of surgery. Also, will I not be left with depressions and unevenness where the lumps are removed. Im sorry for all the questions, but I need to know everything before I decide on any procedure rather than going in naive as I did before. Thanks, Brigitte.

  Answer:  yes, there will be scars where the incision is made to remove it and it will be swollen for some time after the removal. As to the depressions, it all depends on how large the lumps are and if they have caused any damage to the tissue that would leave you with a depression. JG 3.2.06

• Hi doctor. i posted a question on feb 27th. thanks for prompt response. i have done the CT scan and the doctors say that the sinus is all right.they told me that i have a hypotropy in my right nose, and something on the back of my nose is a bit enlarged. they told me that it usually goes off during 10-12 years,but in my case it is still a bit there.actually they could not find out the exact reson for my headache.it is not sinusproblem.it is confirmed.they are suggesting a surgery to burn the tissue,but they say that there is no permanent cure for hypotropy.please suggest the necessary steps ... jeevan,march 1st.

  Answer:  I think the surgery they are recommending is probabaly warranted and may need to be done again in the future. JG 3.1.06

• hello.. i am 36 yrs old and i had rhinoplasty when i was 18. everything has been fine all these years and recently out of the blue.. my nose began to appear broken within just a few days. i did not bump it on anything and there is no pain.. however over the last few weeks it has been slowly evolving.... it almost feels like some sort of subtle, yet very bony growth is happening on top of and around my nasal bone. have you ever heard of anything like this? i have no headaches or pain... however, it occurred at a time when i was recovering from severe brochitis and was experiencing some intense coughing and sneezing... could a sneeze cause that?? could i have bursted a blood vessel under my bone? please help!! thanks & love.

  Answer:  could be a burst blood vessels or a cyst developing, I would suggest you see a plastic surgeon or an ENT to evaluate it for you. JG 3.1.06

• Dr. Garcia, I am 12 days post op my ps used a cartilage graph at the tip to resolve a indentation. After my splint was removed He put some tape on and told me to come back in a week. Over the course of 4 days it became very dirty so I removed it with intentions to put clean tape on in the manner he did. Do you think carefully removing that tape could have torn that graph? Just curious how fragile that is. Thank you so much K.M.

  Answer:  no, it would not tear the graft. The tape is there to minimize swelling to keep the graft in place. JG 2.28.06

• Will an intense pulsed light procedure have an adverse effect on a nose that previously underwent rhinoplasty?

  Answer:  should not adversely affect it. JG 2.28.06

• Concerning my question about having a rhinoplasty 8 years ago, that was fine until a couple of years ago. Bump at tip of nose appeared. You mentioned it may be warped cartlidge. What can be done about it and would it be a simple procedure?

  Answer:  it wil require surgey and the skin over that area will need to be lifted, the cartilage refashioned and then all closed and it will be swollen for months, up to one year. JG 2.27.06

• Hi Dr. Garcia - I appreciate your feedback. I had a revision rhinoplasy six months ago. My tip is still very bulbous. My doctor says that this will go down. What do you think?

  Answer:  hard to say without examining you and knowing what was done but the tip can at times take one year to get to where it is going to be, just hang in there. JG 2.27.06

• HI doctor.i had undergone 'SEPTORHINOPLASTY' 6 MONTHS BEFORE(ON AUGUST 1st 2005).The shape and all is fine.But there is blockage in both the noses(breathing difficulty) and had sinus attacks 3-4 times after surgery, with headache and sneezing etc... I consulted my doctor,he said it was all fine and gave me some anti allergic stuffs to prevent sinusitis.But even when i thake the medicine the headache,sneezing and sinusitis is coming.i am really tensed about the situation.please answer to my difficult situation? posted by: jeevan, 27th feb 2006

  Answer:  I think a CT Scan to evaluate the sinus and septum are needed, may need more surgery. JG 2.27.06

• Hello dr garcia- I am from calli. I am intrested in getting a nose job. I am 25 yrs old and My nose does not fit my face. I hate it. but I am very scared to get the surgury. I have heard alot of good and bad things. also I dont know were to go.what is the price range for this type of surgury?? thank you, a.l 2-25-06

  Answer:  price ranges vary from surgeon to surgeon and also depend on what is done I suggest geting at least a couple of evaluations by a couple of surgeons to get some opinions. JG 2.26.06

• I had a rhinoplasty about 8 years ago. Everything was fine until a couple of years ago. I have noticed a bump on the tip of my nose. It seems something strange is happening to the cartlidge. What is causing this and is it normal to appear so long after surgery? Will it get worse and what can be done about it?

  Answer:  unusual but it could be warping if a cartilage graft was used. It might get worse slowy in time if that is what it is. JG 2.26.06

• This may sound like a strange question, but.........can a nose that has already had rhinoplaty surgery that resulted in 'too small' of a nose benefit from another surgery to somehow be made LARGER? If yes, what are your reccomendations? (ear or rib grafts?)

  Answer:  yes it might be better with more surgery and whether to use ear cartilage or rib depends on how much of an enlargemnt is needed, the more you need, the more likely the rib will be required. JG 2.26.06

• I had a rhinoplasty one week ago, i had an over all reduction, when the cast was removed my nose was really great but after a few day i have developed another hump on the bridge, do you think that it will go away? i have very little swelling... thanks.

  Answer:  yes, it will take time but should go away in time. JG 2.24.06

• Hi, I posted about having scar tissue on the bridge of my nose after 7 weeks of surgery, but i have noticed now that my nose seems to be getting bigger and changing shape for the worst rather than for the better, its now been 3 months to the day since surgery. I am feeling very low at the moment as I have already had 2 rhinoplastys. Am I being impatient and will it settle down? All my previous operations, my nose looks great for the first couple of weeks and then starts to get bigger and out of shape! Can I still have swelling on the bridge and tip of my nose after 3 months? I hope you can help. Kind regards, J

  Answer:  yes there can be swelling still at this point but it should not be increasing, either more callus/scar tissue is forming or the swelling is going down and then the irregularities below the skin are becoming more visible. Some doctors will inject kenalog into the developing scar tissue to get it to soften and shrink but it has to be done very conservatively as it can also cause problems. I think you need to go back to see the surgeon and see what can be done. Best of luck. JG 2.25.06

• I had rhinoplasty two years ago, and the day after the procedure i noticed a piece of cartilage visible in my nose, i asked my mom about it(bad move), she said it was nothign so i never brought it up to the surgeon post op. but as it turns out after surgery, once the swelling resolved, that there was an indentation on one side of my nose, making my profile look awkward. I have two noses. anyway i was wondering if its possible to just reposition that piece right back into place without the need for surgery, as by touching it it seems to feel like it would fit perfectly, if i do require surgery, would this run the cost of normal revisions?

  Answer:  after this much time it can be repositioned but it will require surgery to do so. As to the cost, it will all depend on your surgeon, couldn't tell you exactly. JG 2.24.06

• I am seriously considering getting rhinosplasty, and I was wondering how long visible swelling lasts? I want to be able to get the nose job but still go to school. Approximately how long does the swelling last, and does the swelling itself look really bad, to the point where people would wonder what happened? Thanks for your time!

  Answer:  maybe a 4-6 week period for most of it, but final results will take up to one year. Most people look pretty normal in about 10 days, enough to look fairly normal and not draw attention. JG 2.24.06

• I have a slightly turned up nose and although I don't mind the shape, it's the end I don't like. In my opinion, there is too much skin on the end of it and if just a sliver of it was taken off it would look alot thinner and alot better. Is there anyway I could have this done at all? Or if/if not, is there anyway to have a nose procedure where you're not unconscious during the procedure? Just wondering. Thanks

  Answer:  yes but it hurts to have the local anesthesia injected into the tip of your nose. JG 2.24.06

• Hi Dr. Garcia, I had Rhinoplasy when I was 14 and not I'm 28. Lately I've noticed that the tip has been swelling and it looks like a tiny bump of cartilage is more prominent on the right side of my nose. So the other day I began picking deep inside my nose hoping to eliminate some scar tissue and swelling myself. My nose swelled a little and today it seems like it's a little smaller. Is it possible to reduce swelling by picking out the scar tissue?

  Answer:  never. Please stop doing that, it will only potentially cause more scar tissue. JG 2.23.06

• Hey Dr. Garcia... wow you're quick..thanks for getting back to me so fast... the suture -- that lifted the tip of my nose... you said it could break... but.. what could cause it to break... -- JD [original post] Hello Dr. Garcia... I am 9 days post op from my second nose surgery. This surgery I really only had tip refinement done (no breaking of bones) I wanted the tip raised & shortened because my nose was long & pointy. My Dr. said he stiched the tip to the septum... I didn't have a cast, just tape to help with the swelling... I got the tape off last week, and I know there is still swelling, it's obvious, but my nose is not raised at all..looks the same. Is there an instance that the stich didn't hold, or did I maybe do something wrong (i changed the tape once mid, but was very very careful with taking it off) or.. is this just swelling..and I should chill out :-) I cant imagine that the stitching he did inside, could be that fragile… Please help ease my mind… JD

  Answer:  it breaks because all sutures can break or crack in time, but usually not right away. Also the knots can unravel loosening the suture. JG 2.23.06

• Hello Dr. Garcia... I am 9 days post op from my second nose surgery. This surgery I really only had tip refinement done (no breaking of bones) I wanted the tip raised & shortened because my nose was long & pointy. My Dr. said he stiched the tip to the septum... I didn't have a cast, just tape to help with the swelling... I got the tape off last week, and I know there is still swelling, it's obvious, but my nose is not raised at all..looks the same. Is there an instance that the stich didn't hold, or did I maybe do something wrong (i changed the tape once mid, but was very very careful with taking it off) or.. is this just swelling..and I should chill out :-) I cant imagine that the stitching he did inside, could be that fragile… Please help ease my mind… JD

  Answer:  the suture can break but more likely it will look that way until the swelling goes down and alleviates the pulling down caused by the swelling. I think you just need to do as you said, chill. JG 2.23.06

• hi, I am in the UK and I had a open nose job 5 years ago. I had a long narrow nose and I feel it is now long with a bulbous tip and I am very unhappy as it dominates my face, which is otherwise very small and elfin. My original surgeon has since died and I have spoken to 3 other surgeons about a revision. 2 of them said they would not do it and the surgeon who said he would is the most inexperienced out of the 3 of them. I really hate my nose and feel other peoples results look so much better than mine. Do you think I should look into coming to the USA for the op and if so can you offer any advice. Thanks a lot. Amanda.

  Answer:  I think you can find good surgeons too in Spain and in Belgium that will be much closer. JG 2.21.06

• Hello dr. Garcia, I had a revision rhinoplasty done 3 month's ago, My nose looks nice but on the left side of my nosetip there is a thick spot (bump) and it feels very hard, i think it is scar tissue. My PS told me to massage it 3 times a day but it seems not to help (he also gave me an injection). Will it go away and if it doesn't goes away can it be removed with surgery? Thanks already for an answer!

  Answer:  may take more shots, I doubt that more surgery will be needed but it might take months to soften and go away as there is a lot of scar tissue most likley due to the number of surgeries. Hang in there. JG 2.21.06

• Dr Garcia-I am having a brow lift and 3rd rhinoplasty....do you think that it sound like a good idea to work on my nose from the top going in through the brow lift area...peeling the face foward to approach it?

  Answer:  all depends on what they need to do, if possible to do the revision from there it is OK to do. JG 2.20.06

• Hi Dr García: I had a rhinoplasty more tha a year ago and dthe surgeon cut me the alar walls to make the nose more narrow, I have been extremely careful when i clean it but sometimes of course I have to clean it well and a little inside the nostrils my question is, could the cartilagues modify if I do it and became wider or can I I clean it and do it like before the surgery, of course carefully.

  Answer:  not a problem, all should be stable, go ahead and clean it. JG 2.20.06

• PLEASE HELP! I had a rhinoplasty about 6 months ago to thin and lift up the tip of my nose. How long do you have to wait to have a second one done if (1) there is now a bump on the bone (top right) that was never there before, (2) the area between my nostrils at the end of my nose now protrudes, and (3) after all that, the tip never even achieved that upturned button-nose quality I was hoping for?? Thank you SO much for your input - I trust your feedback. KS 2-19-06

  Answer:  I usually wait one year. Things will change for that amount of time, especially the tip, hang in there. JG 2.19.06

• second rhinoplasty where cartlidge from the rib was used. The strip going up to the bridge has wraped and is pushing outward on one side of the nose. This is after 8 weeks. I am told I can wait 6-9 months to see if the cartlidge will pull back from the force of healing or put incession on both sides of nose and screw it down, now. The other option is to desinegrate the cartlidge with a needle but this has not worked for my doctor with good success. namely, I have a bump from carlidge from my rib 8 weeks out and can i get it down without surgery or scars ? The tip of the cartlidge is sticking up and does not seem to be going down at all. My e-mail is eshields95@comcast.net Thank you Earl Shields

  Answer:  I think it will need surgery, either the external scars or removing it and then carving it and immediately replacing it. I don't think there is any reason to wait. JG 2.18.06

• hi,i just wana know that r there any alternate ways to change the shape of nose,i dont wana pass through nose surgery,bcoz i dont hv such a bad shape.the all i want is just a bit change in nose shape.hopw,i can get my answer in details.thx a lot

  Answer:  I do not think there are any reliable ways to do it without surgery, sorry. JG 2.17.06

• What do you think of the lip lift where you cut the outline of the upper lip, remove excess skin and resew the outline?

  Answer:  I think the scars are not good and it flattens the vermillion border, I prefer to do it with an excision at the base of the nose. JG 2.16.06

• I have what I believe is called bifidity of the nasal tip, basically my nose looks good otherwise but there is a dent between the two lower cartillages of my nasal tip. I have considered rhinoplasty but I am wondering if a filler could be used to fix the dent and make the tip look more refined as opposed to surgery. Thank you for your time amy 2/13/06

  Answer:  Filler can be used but the tip will look bigger. JG 2,13,06

• LD12. Dear Dr.Grcia, You are a very kind and helpfull man. I had a septorhinoplasty about 5 months. at first i was very pleased with the result but a month or two down the line, the bridge of my nose began to look bent again it doesnt look like it was pre surgery because the tip of my nose is now in the center of my face so instead of a slant / my nose is more like a bow(. is it possable that the bridge will straighten over time as i heard it could take up to a year to see the final result. or is another surgery my only hope. Thank you for your consideration.

  Answer:  it can take a year for all to settle down but I don't think the septum will straighten out much more. I think another surgery most likely will be needed, sorry. JG 2.13.06

• I had revision rhinoplasty 18 months ago. Only the tip was touched. The tip was raised because I had a hanging tip. Now I seem to have a small round ball at the end of the tip (more on one side). I am not sure if it is swelling, cartilidge that must be removed or scar tissue. Could it be still swollen ? I am afraid to have another operation because it may not heal properly. HOw long does swelling last in tip revision rhinoplasty ? Thanks

  Answer:  After 18 months I doubt it is swelling, more likely a fold or knuckle of cartilage. It could be scar tissue also. I do not think removal of the scar tissue will work as it could recur. Usually the swelling takes about a year to resolve. JG 2.7.06

• Hello Dr.Garcia, I need more input on a situation I ran into early this month. Its been a year since my rhinoplasty and happy with the look of my nose. Though I developed inside of my nose a hard round tiny bump the size of a pimple a few months ago. It had turned out to be cartilage he put in and he sniped it off the same day. My concern is this problem normal amongst most patients? Lori

  Answer:  It can happen but it is unusual, should not present any permanent problems. JG 2.6.06

• Hi I came across your website and was trying to find a feew answers. I was born with a deviated septum. I had surgery when I was 16 because not only could i not breathe right but my nose was totally shifted over to one side. About a month after the surgery I could breathe right and eat again as I had swallowing difficulties. Not sure if that is related, but you know how they say nose, ear, and throat all connected. My question is this, I am now 31 and since I was in my 20's I am having problems swallowing again, same thing as before, my voice always sounds kind of tinny, i get the same sneezing attacks as before, and I have trouble breathing out of my nose again. I had heard that since I was so young that a second surgery may be needed. Is that correct? Thanks,

  Answer:  Septal deviations can fold back to the way they were and it might require repeat surgery. It also may be a different nasal problem like polyps or other issues so I think it would be best to see another ENT surgeon for a consultation. JG 2.4.06

• Dr. Garcia, I am considering having rhinoplasty to slighty reduce the prominence of the bridge. My nose is proportionate to my face, but I would like to improve my profile. Other than the risks associated w/aneshesia, what are the risks w/rhinoplasty when there is no breaking of the nasal bone? Thanks

  Answer:  just that there may not be enough taken out, that the surface may not be perfectly smooth, and that the dorsum of your nose may look a little more broad. JG 2.3.06

• I had revision open rhinoplasty a year ago and my PS said that it takes longer for the swelling to go down on the second rhinoplasty. My question is usually PS's say it takes up to a year sometimes 18 months before you will see your final results. If it took me about a year on the original rhinoplasty how long will it take for all the swelling on the revision surgery? Like I said it has been a year and there is still quit a bit of swelling still in the tip. Thank you for all your advice!

  Answer:  that is true about the prolonged time for swelling to resolve after a secondary rhinoplasty. This time around it might take two years to get back to normal. JG 2.2.06

• I interested in a nose job but an scared of having a surgeon give me a cookie cutter nose. I'm half Lebanese and know that I need a Lebanese nose to balance out my face, I just need a smaller one. How do i go about finding a surgery who can perform a ethnic nose job on the east coast? Will going to a eyes, nose, and throat Dr. improve my chances?

  Answer:  I do not think an ENT surgeon has any benefit over a plastic surgeon, just ask them to look at their befores and afters before you decide who to go with. JG 2.2.06

• Dear Dr. Garcia, I had a revision rhinoplasty done 4 1/2 months ago. I have developed what seems to be a large cyst right below the bridge of my nose. It is red and about the size of a pea and really detracts from my profile.My surgeon feels that surgery is in order to remove it, and has ordered a CT scan for me (but in Canada, the queue for these things is often up to 2 months). All this waiting is driving me nuts! Have you ever experienced this? What is the cause? My surgeon seems hesitant to guess until he sees the CT scan. I have done some reading and some theories point to the combination of packing and petroeum-based antibiotics. Any thoughts? Thanks, P.

  Answer:  cause may be hard to determine, could consider asking him to see if they can aspitrate it and see if it is fluid or oil though. Best of luck. JG 1.30.06

• hi dr garcia i had open rhinoplasty revision about 27 days ago. i dont understand why one day my nose looks and feels small then a couple of days later the tip and columella blow up like a beach ball. i understand that it takes time for the swelling to go down but is it normal to change from big to small on a daily basis? i feel like it will never stay at one size.it looked small when the splint came off. this is my second open rhinoplasy revision. thank you.

  Answer:  Very normal after a revision, just swelling that comes and goes with activity and sleeping face down too. Should all go to the not swollen size in time. JG 1.30.06

• I HAD 2 SURGERIES ON MY NOSE I HAVE I GUESS THEIR POLYPS OR HUGE BUMPS UNDER MY SKIN CLOSE TO MY EYE, AND ON THE TOP OF MY NOSE BY MY EYES BOTH SIDES HAVE IT . WHAT IS THIS? WILL THEY GROW?CAN YOU HELP ME WITHOUT MY NOSE FALLING OFF? THIS IS A PAINFULL SURGERY! WHAT CAN I DO? DID THE DOCTOR DO THIS ON PURPOSE? MY EMAIL IS ELLIEALLIE1016@AOL.COM CAN YOU HELP ME?

  Answer:  There can be polyps inside of your nose that look like bumps but they do not occur under the skin. Polyps will almost always grow back after they are removed and the surgery can be uncomfortable. You may want to see a different ear nose and throat specialist to get a second opinion in person. All my best. JG 1.28.06

• Sorry, the PS said 'your nose is less than attractive'.

  Answer:  gottcha

• Dear Dr Garcia, recently I consulted a PS about soft tissue augmentation. He began to 'analyse' my face, and said 'Hmm well lets face it, you're not is less than attractive'. I was a bit taken aback (not that I didnt know, just that it doesnt bother me). So I said, well if you were to do some work on it, what would you do? And he replied that I am too old for a rhinoplasty. I'm 45. He said something along the lines that it would be difficult to 'drape' the skin. As I said earlier I'm not hung up about my nose, I actually think it has character, but there have been times I've thought about having the tip refined. Is 45 plus 'too old'? for nose work?

  Answer:  no, certainly not, but I think you need to find someone a little more compassionate, the nose surgery is still OK at your age, even older. JG 1.25.06

• Dr Garcia, I had a 2nd Rhinoplasty about 5 months ago. At some point I developed indentations/lowered skin on either side of the nose and I find this incredibally distressing/embarrassing. These may have been caused by nose pads but I only wore glasses a couple of times and not until after 10 weeks post op. Also they are not the same size. Regardless, can they be filled in with an injectable? Is it safe since it`s fairly close proximity to the eyes? Would Fat be a good choice since it`s natural? 1/24/06 PE

  Answer:  A filler is OK to use there and can be done whenever you like. Fat is a good choice but may not last any longer than the other ones off the shelf. JG 1.24.06

• I posted the question about Maxillofacial surgery effects on the nose. I had the surgery on the upper maxilla 5 months ago. My nose now has that Boxer's nose feel and look to it. If feels like it is unattached, not the thin pointy nose I had before. That is something the surgeon did not mentioned as a potencial risk before the surgery. Isn't it required to mention ALL the most likely risks before such a procedures? Is there anything I could do? Would it get better? worse? What are the options? I just want my normal nose and face back.

  Answer:  I am unsure why they may not have mentioned it to you,possibly because the amount of movement they were planning was not that much and they did not think it would affect the nose to any significant amount. As to what can be don