NOTICE: Ask Dr. Garcia is intended for educational and discussion purposes only. It does not constitute a formal medical evaluation nor consultation. No doctor-patient relationship has been formalized by this communication. If you desire such, please feel free to call and schedule an appointment. Otherwise, please be advised that all information that has been given here should be cleared with your primary care physician before changing or instituting any therapy. Explanation of off-label use of substances may be discussed here in but does not reflect an endorsement nor promotion of such off-label use.

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• Hello Sir, I have had 3 rhinoplasties over the past 30 years, and the last on 7 years ago. The tip had a hole in it, that took forever to heal. The Dr. blamed the last Dr, said it was bad work, the worst he`d ever seen. Now, I am searching for a solution to fill in the dent, and small dent in bottom between nostrils. I can`t find a Dr. who will even tell me what to do. Can you advise? Would fat from my own body fill it in. He says my skin is thin, but I feel after 7 years, it is not. Thank you for any help, as I feel at a loss. Lin

  Answer:  Possibly a local skin rotation flap could repair the issue. JG 2.4.11

• hi dr garcia i had question i had rhinoplasty about 2 years ago then i had my nose broken by being hit then i had a septoplasty 4 mionths ago and i have this scar tissue formation @ the front of my nose inside the nostril thats obstructing my breathing how would i get rid of it? also since i had a rhinoplasty does it make my healing time longer?

  Answer:  the healing will take longer due to internal swelling and scar tissue from the rhinoplasty. As to improving the scar tissues, short of having it cut out, you might see your surgeon and see if they can inject some steroids into it to try to get it to soften up, but it is not possible in all cases. JG 1.26.12

• I had rhinoplasty >10years ago..and my surgeon had to graft cartilage from one of my ribs. Since then I`ve had pain in the area where the cartilage was taken. Its not painful all the time but when it is my pain on a scale from 1-10 is a 9 or 10. It seems to only occur in the morning for 5-10 seconds usually upon awakening (I always attributed the pain to laying on it the wrong way). Because of this I wear a bra to sleep in which is helpful in preventing it from happening but it still is happening just not as much. I told my surgeon years ago about it and he told me not to worry. Is this normal though? sometimes the pain is so unbearable that it hurts to take a breath. Any suggestions on what i can do to prevent it?

  Answer:  not normal, you might have to have a thoracic surgeon look at it, you might have a non-union rib fracture and it might require surgery or possibly see a pain specialist and they might have to inject something to kill the nerve in order to alleviate the pain, but then you will have an area of numb skin. Sorry to hear about the issues. JG 1.22.12

• Dr. Garcia, The Chicago Guy Happy New Year!! Hope all is well!! Question? I had sinus surgery back in April of 2011. My ethmoid, spenoid and maxillary sinuses were blocked. To date I do feel better than I did before the surgery, however at times I do have minor cases of sinus pressure/pain in the ethmoid region. My surgeon did state that the healing process would take time and I would experience small changes over the course of the next year. Is it typical to experience suttle pressure and/or pain 8months after surgery. Your thoughts?

  Answer:  Totally normal, might continue for a bit, glad its better though. Happy New Year. JG 1.3.12

• Hi, Dr. Garcia. I`ve been reading posts here recently from people with retracted nostrils post rhinoplasty. I have a particularly severe case of this myself but I didn`t have the courage to go through cartilage grafts. On the theory that I had nothing to lose, I asked my plastic surgeon if he could try to correct the situation a bit with hyaluronic acid. He was able to inject it between the cartilage and the skin, pushing the skin downward in the way that a cartilage graft might. He only needed to use .1 ml/alar wall and it made a huge difference. Since the nose moves so little, it lasted a full year. He has been reinjecting me for several years now with good success. My situation may not be like others, I know, and my surgeon may be a particularly skillful injector; but i thought I`d share this story with your readers who are hoping for a non-surgical solution to this common problem. If it doesn`t work, then they can always have it dissolved. I hope this helps. Happy holidays to you, Dr. Garcia! Thank you for everything you do so selflessly for others.

  Answer:  thank you for you story, I am sure it gives many other a degree of hope. I wish you a Happy holiday season and the best for the New Year. JG 12.22.11

• Hello Dr. Garcia: There are so many great questions here about rhinoplasty-- and so many great answers--that I feel that buried among them all lies my answer; but I will ask anyway: are 4 kenalog injections at 10%--that are each 2 months apart--the equivalent of a single 40% kenalog injection? Also, what is the non-surgical way to lower one`s nostrils if they are retracted? Does Juvederm have limited benefit? I know some doctors use Silikon 1000, but what if the outcome is undesirable? Silikon is permanent, right, and so would surgery be able to remove the silicone? I have a very tiny tip, but there`s a lot of nostril show on both sides. I don`t know what my alternatives are to shaping and lowering the nostrils. I am a male, and I notice that womens nostrils tend to be diamond-shaped; is this also for men? Thanks so much, Dr. Garcia

  Answer:  the multiple shots of a weaker kenalog do not equal a higher single dose. Although there are doctors out there that claim fillers can lower retracted nostrils, I do not believe it to be effective or predictable.Surgical removal of Silikon can be quite difficult as it will spread into a large area over time.It is not indicated for anything except injections into the eye after a retinal detachment, not for anything like you have heard about. The best option for your retracted nostrils is repeat surgery with cartilage grafts to de-rotate the lower lateral cartilages. Shape of the nostrils is not sex dependent, men can have that shape to a nostril too. Best of luck. JG 12.18.11

• Hi Dr. Garcia: I had a rhinoplasty done about 5 years ago, and the result left me with a very bulbous tip. My surgeon has been using Kenalog 10 on six different occasions, spaced 8 weeks apart. I`ve been having these shots for the past year, and I am wondering: wouldn`t it be better for him to administer Kenalog 40 instead of the 10% strenght? I`m thinking I`d see faster results, no? Thank you,

  Answer:  well,it might help a small amount, but it also might thin the skin and cause broken blood vessels, so it is best to use dilute amount I think. JG 12.16.11

• I am 7 weeks post op revision rhinoplasy. 40 year old male, thick skin. My first surgery left me with pinched tip/collapsed alars, I had scar tissue in supra tip but it was straight. Now my piched tip is gone although one of the grafts is still noticable, however the supratip and tip are hard or swollen and causing a bump or ramp from profile view, my Dr has prescribed Triamcinolone .1% cream to be applied twice a day to the graft area and brdge. Ever heard of this as treatment? Thanks Scott

  Answer:  Honestly, no, not sure it will have much effect as it is likely edema causing the problem. I do think it will get better on its own in time though. JG 11.3.11

• Hello, Dr. Garcia. I`ve been following some of the recent posts here on composite grafts for nostril rims. My daughter`s rhinoplasty healed in such a way that her nostrils are very retracted. She`s concerned that an attempt to repair the nostrils (which may or may not go well, we know) will further disfigure her by causing noticeable damage to her ears. She has thin hair that doesn`t grow well, so covering that deformity with hair isn`t a good option. Can the composite grafts be harvested in a way that is largely invisible (e.g., from the posterior of the conchal bowl rather than the anterior)? Thank you.

  Answer:  composite grafts from the ear can be taken from the back or front, and in general heal quite well with very good scars that are hard to see. I wish her the best. JG 11.2.11

• Hello, First of all I will like to say sorry for my English. I am Japanese so my English is not too correct. I have couple question. I have retracted Alar Rim from may be Rhinoplasty I had or may be even from before, but I hate my look from frontal view. My nostril looks like V line. My husband does not want me to do any surgery and I am considering to put Juvederm to improve. (I want to be secret....). I heard if it is not too sever It can be temporary treat this with Hyaluranic Acid like Juvederm. May be all I want is 2mm of the skin to go down. Is it possible? But I am little scared of complication that can be happen to the nose. Is it safe enough to use such as this on the Alar of the nose? Some Doctor said they do not recommend any filler on the lower part of the nose. I do not mind Thank you.

  Answer:  I do not think the hyaluronic acid will work well but it is certainly worth a try to avoid the surgery. It is not a permanent filler and it can be dissolved if you do not like it. Best of luck. JG 10.30.11

• Thank you for your answer about the cartilage grafts. I think you`re right about my surgeon`s reluctance. If this were my first consultation with him, that would make the most sense, but I`ve been a patient of his for six years now, and we`ve always had a fantastic relationship. He removed and replaced some cheek implants for me (in which I did develop a serious complication but I never presented to him as dissatisfied and never hassled him in any way). He has been injecting me regularly for all those years too. We just hadn`t yet gotten around to my nose until this week. I think the problem may be that he inadvertently transected the buccal branch of my facial nerve when he was replacing the cheek implants, and it`s the first time in his 35 year career that he`s inflicted nerve damage. These kinds of things happen, I know. Whenever he sees me, I suspect that I remind him of that mistake, which is, I think, as devastating to his ego as it is to my ability to smile (though I`ve never told him that because he already feels badly enough about this and I don`t want him to feel worse). I`ll try another conversation with him, since you think it`s more a matter of his reluctance to have another complication than the actual nature of the surgery itself. I really appreciate your advice. I`ll let you know if he changes his mind! So grateful to you, Dr. Garcia.

  Answer:  best of luck, I think the plan is a good one. JG 10.30.11

• Hi, Dr. Garcia. I wrote to you recently about my retracted nostrils post-rhinoplasty many years ago. I am now fortunate to have an extremely competent (in fact, genuinely world-renowned) plastic surgeon whom I saw today to discuss the possibility of cartilage grafts. His assessment was that the retraction is quite severe and would require conchal rather than septal cartilage as well as skin. He feels it`s too complicated for him to undertake. This is an unusually brave surgeon who takes cases from all over the world that few others can or would. He specializes in rebuilding facial skeletons and complex revisional cosmetic surgery. I appreciate that this is not a simple procedure but I was surprised and frightened by his response. Is this indeed as risky and delicate a surgery as he suggests? (I do realize that all surgeries carry inherent risks.) This guy thrives on difficult challenges, so I was really taken aback by his reluctance to touch this. Even if I can find someone else who specializes exclusively in revisional rhinoplasty (which he suggested I could consider), I`m now scared to pursue it. What do you think? Thank you for being a sounding board for so many of us who are chopped up and disfigured and dismayed and confused, Dr. Garcia! May you and your family never have even one of the woes we all bring to your cyber-doorstep. God bless you.

  Answer:  well, I think it is maybe something of a not wanting to get saddled with a patient who has surgery and does not get better or has new complications. Sometimes the dissatisfied patient post operatively will shy some surgeons away. Maybe talking wit him and being frank with him, in terms of giving him some type of reassurance that you understand the potential pitfalls might make him take your case on. Just a thought. Thank you for the kind words and keep me posted. JG 10.29.11

• Dr., how common is it for a nose job to go well after the first time? I see so many 2nd, 3rd and even 4 time questions on your site. My daughter had her nose done and there was some bleeding complication. Needless to say, she has been left with a nose that is better (being that she had two very prominent bony structures at the top of the nose, along with other issues), but it is definitely not pretty. Her Dr agreed that due to the bleeding he was not able to refine it as he wanted, and that he will fix it. The problem is that she thinks he just doesn`t specialize in noses, and that she`s afraid to go from bad to worse. Don`t all PS do rhinoplasties? Are there some that just don`t take this task on? I will admit that he was just establishing his practice at the time. I want to convince her to go back and get it fixed, but am at a crossroads with her. What is your opinion? Go back, or save up a few more thousands and go elsewhere?

  Answer:  about 5% of rhinoplasties need a touch up. When one gets into unexpected bleeding, which can happen to even experienced surgeons, then things might have to be cut short and the full extent of what was desired to be completed might not be able to be done. I will say that not all plastic surgeons do rhinoplasties, some do none whereas some that is all they do, it varies. I think having confidence in your surgeon is a very important thing though, and although I am sure he would do a fine job, if she does not want to go back to the same surgeon, it might be best to at least have a consultation with another surgeon for an opinion. All the best. JG 10.17.11

• After a rib graft in my bridge, tip and columella, I get a indented crease on my upper lip that is as wide as my nose when I show my teeth as I smile. Do you know if the ib graft could somehow cause this. Maybe a harder or longer columella pressing on something?

  Answer:  I think it is more likely scar tissue or muscle activity of the muscles around the lips from the skin being stretched by the rib graft, not sure if much can be done I am afraid, you should see your surgeon and see if the scar tissue can be released.JG 10.12.11

• Thank you for the answer about GoreTex v. cartilage for rhinoplasty correction. Is there any other synthetic material that could be used, something less flimsy than GoreTex, that would prevent the need for a cartilage graft? Thank yoU!

  Answer:  Not really, the gold standard is septal cartilage, and after that is ear cartilage, easy to harvest and should not leave a deformity. JG 10.9.11

• Dear Dr. Garcia, My surgeon will soon be repairing my retracted nostrils from over-resection of my lower lateral cartilage in a previous rhinoplasty. He intends to use Goretex strips, since he believes it`s less complicated than harvesting and transplanting cartilage. (I don`t have enough septal cartilage for a transplant anyway, and getting it from my ears or ribs seems too invasive to him and to me.) What are your thoughts on this -- pros and cons? More chance of infection with the Goretex? Just as viable as cartilage? Thank you.

  Answer:  I think the GoreTex is easier, and is well tolerated but it is pretty flimsy, much more flimsy than cartilage so I am not sure it will be strong enough to hold the retracted cartilage in its desired place. JG 10.9.11

• Hello, I received a kenalog injection into my nose about 4 weeks ago (16 months post open revision rhinoplasty). The results are great - I am curious, if it were going to casue indentations - would these have occurred by now or might they still appear? Thank you.

  Answer:  it can take up to 2-3 months to see an indentation form and can progress for up to 6 months, all depends on the area and the dose injected. All the best. JG 10.7.11

• Does an incision in the tip need to be made for the following nose corrections??? I am hoping not to disturb or change shape of my tip. I have uneven nostrils. I wanted to fix this with dermis ear graft. I do not know if if an incision can be placed inside nostril right above nostril hole that needs graft instead of making incision in tip? I had open rhinoplasty revision. The incision scar on columella is wide and indented so I wanted it revised to make it more narrow and take out the indentation. Can an incision just be made at surface of columella or does the incision have to do deeper? Besides the incision scar, the columella profile is also indented in the middle needing more cartilage graft to soften the look. Will it be easy to add cartilage there? Also, the bottom of the columella sticks out a little too straight so I was thinking of having it shaved down to curve it a little. A rib graft was placed in columella with rib strut= will that complicate things by adding a little ear cartilage to middle of columella or shaving bottom of columella?

  Answer:  I am sorry to say that most likely the things you need done will require more than small minimal incisions. JG 9.22.11

• Hi Dr. Garcia, I am approximately 16 months post open revision rhinoplasty. I was still experiencing some intermittent swelling in the tip. Last week, my surgeon injected some kenalog into the tip. It now loods quite refiend and exactly how I wanted it. Is this likely to last? Will it go back to being swollen after the kenalog wears off? Since the injection worked - does that mean it truly was swelling and will eventually look like this on its own? Thanks for anwereing all these questions.

  Answer:  After 16 months it is more likely due to scar rather than swelling,the analog cam soften scar tissue and once soft, it should stay that way. iI would expect that it should stay looking the way it does now. All the best. JG 9.15.11

• Hello, I am about 15 months post open revision rhinoplasty. My nose has been looking good; however, I had a wedding on Sat. and had a little too much drink. I did not tape my nose that night as I usually do. My nose is quite swollen now. Is this due to the alcohol? How long is it likely to stay swollen? Thank you.

  Answer:  Might take a few days, start the tape again. JG 9.5.11

• Thanks for the answer about HA fillers to the nostrils. If it`s too flimsy, what about something Radiesse, which I know is routinely used on the nasal dorsum to fill in depressions to simulate rhinoplasty. Do you think that be safe in the nostril rims?

  Answer:  I don`t think the longer term fillers like Radiesse will be any better, they are still soft and pliable, that is why they can be injected through small needles. JG 9.4.11

• I`ve written to you recently about severely retracted nostrils post rhinoplasty. Before I proceed with cartilage grafts, my ps has recommended that we test drive the appearance of a surgical improvement by simulating its effect with HA filler to the nostril rims. Does this sound reasonable/workable to you? Will it really mimic the appearance of the grafts? If so, it might be a less risky, though temporary, improvement. Since the nose doesn`t move much, the HA may last longer than it would in the lips, so perhaps I`d only need to do it every 6-8 months. Thank you for your help, Dr. Garcia. Have a great holiday weekend!

  Answer:  Less risky, yes, but the filler is not rigid so it cannot replicate what a stiff cartilage graft can All the best. JG 9.3.11

• Are most stitches inside nose after rhinoplasty the dissolvable type? I do not know the name of cartilage border between nasal passages that is right behind the columella. If you have a clear colored dissolvable stitch starting at one end of passage and ending through the border to other passage, will the line of stitch dissolve on its own? t has been a month since my surgery, and the stitches still have not dissolved. There is a tight knot that is too small and tight to cut, but when I tug at it with tweezers I feel burning pain going across the nasa border so I know the stitch goes all the way through to other side. Just worried if the stitch will be able to dissolve inside my nose or how long it will take to dissolve. Since I had my surgery out of town, I can`t see the doctor who performed the surgery to remove remaining stitches.

  Answer:  all of the sutures used inside the nose will dissolve, albeit slowly, over time, not uncommon to still feel and see one at this time. You can take peroxide in equal amounts with warm water, soak a q-tip in it and rub it on the knot, it will then help break it and help dissolve it. Best of luck. JG 8.31.11

• If a rhinoplasty surgery has resulted in uneven nostrils (one nostril cut noticeably larger than other), would you try to enlarge the shorter nostril or try to shorten the larger nostril with ear dermis? If you used ear dermis, would you make incision from inside nostril or would you have to make incision inside tip area? Is it an in-office procedure with just local anesthesia? Also, how much would you charge for this surgery? Thank you.

  Answer:  Difficult to say what would be best without seeing you in person, but I no longer perform revision surgery on patients that have had surgery elsewhere, sorry. JG 8.26.11

• Is it normal to have anemia right after rhinoplasty surgery?

  Answer:  unusual unless your blood count was a little low to begin with. JG 8.26.11

• Dr. Garcia, Can blocked sinuses impact and/or cause heart palpatations. I experienced the abovementioned symptoms prior to my surgery. I had heart ultrasound and everything was fine. I spoke with a young lady who advised that her ENT said bad sinus issues can cause heart palpatations. I have not had this issue since having endoscopic sinus surgery?

  Answer:  The pressure build up can cause pain and any painful source can cause heart palpitations. JG 8.18.11

• Dr. Garcia, I had endoscopic sinus surgery April 20, 2011. It has been four months to date. I feel better, however at times I do feel facial pain at the surgical site when I am eating. How long does the total healing process take. My ethmoid, sphenoid and maxillary sinuses were all blocked. Your thoughts?

  Answer:  Might take another few months, hang in there. JG 8.18.11

• Quick follow up question about the cartilage grafts in the nasal tip: You imply that rib cartilage is an especially risky choice. Would ear cartilage be preferable? Why? Any other viable donor sites? And would all of them potentially put me in Michael Jackson`s Nasal Never Never Land? YIKES! Thanks again for your guidance. If you couldn`t catch any fish, I`m glad you were at least able to enjoy a conference and learn a bunch of new (and old) stuff!

  Answer:  Not risky but very rigid, no more or less risky than cartilage, both react about the same. Usually cartilage from the septum is used, then ear cartilage, then rib. Hope that helps. JG 8.18.11

• Hi, Dr. Garcia. Welcome back! I hope you were on vacation and got some well deserved rest. Fishing perhaps? I am having cartilage grafts (rib) placed in my nostril rims to correct over resection of the LLC in a rhinoplasty some years ago, which left my nostrils significantly retracted. I`m writing to ask how common it is (in terms of percentages) for the grafts not to take due to poor vascularization or for them to become infected. I am pretty worried about developing a necrotic tip a la Michael Jackson! And how long of a recovery process am I looking at? Thanks so much. So grateful to for all you do for us.

  Answer:  thanks, wish I had been fishing but but I was actually at a plastic surgery conference, getting to hear all the newest stuff from guys around the world, it was great. I think the grafts never re-establish good blood supply but do offer a long term support, the blood vessels cannot grow into the bone, but I do not think you are at risk of the Michael Jackson problem due to the use of rib grafts. I think total recovery from rib grafts will take at least a year, but you will look and feel better much much sooner. All the best, and thanks for the kind words. JG 8.18.11

• Hi Dr. Garcia, I have had three rhinoplasties - the first was 14 yrs ago, the second was three years ago and the last was 15 months ago. The first was closed the other two were open. I am still experiencing swelling. My nose looks very nice and thin for several weeks at a time but then will swell again. It also swells in heat, with alcohol (even 1 drink), and after exercise. Is it likely to always be this way? It is frustrating because at times it will look very nice and I love it but it never seems to last!! Would a steroid injection be helpful? Will this flucuating swelling stop with more time?

  Answer:  It might take another few months in your case to get to the final point but whatever you have at 2 years I feel will be permanent. Steroids would be short lived and have negative side effects. Might want to consider some antihistamines that are not sedating and see if it helps though. Best of luck. JG 8.11.11

• Dr. Garcia: I`ve read a lot of info. about silikon being used to lower retracted nostrils. I`ve got retracted nostrils that also happen to be very crooked--there`s really no arch to them at all. Can silicone change the shape of them and lower them at the same time, or is silicone just for lowering?

  Answer:  I personally cannot see how it would work, and I do not use a filler of any kind for retracted nostrils, I thin it requires surgery to repair, sorry. JG 7.28.11

• Dr. G: I had an 8.5-hr. third nose surgery with rib. Do you think my nose might refine some more 2-3 yrs. post op?

  Answer:  I think in your case, 18 months after surgery, you will be where you are going to be. JG 7.27.11

• Dr. Garcia, This is the Chicago Guy ..who had sinus surgery on my ethmoid, maxillary and sphenoid sinus on April 20, 2010. To date, I feel better but I started feeling sinus pressure weeks after the surgery. After documenting everything that I ate and everything that I put on my body...I realized that scented fragrances to include lotions, deoderants, rubbing alchohol/aftershave caused sinus pressure. I also figured out that the seasoning (lawry`s) that I put on my food caused me to have sinus pressure as well. In your experience, have you seen this occur? Once again thanks for your time......you are indeed the best. I wish you were here in Chicago!!! The Chicago Guy

  Answer:  actually what you are describing is very common, most people do not work hard enough to figure it out, but once you know and can avoid the triggers, it is much better than medications. There are surgicenters and hospitals that do not allow patients or people that work there to wear cologne or perfume for allergic reasons. Glad you are doing better and also that you figured out the triggers. As to the Lawry`s it is probably one of the ingredients, you can try to isolate it out if you want. All the best and thank you for the kind words. JG 7.11.11

• So sorry to ask one more question. After Rhinoplasty (dorsal bump) removal could there be blockage that would cause undereye fluid/swelling - not getting better even 1 year after rhinoplasty. If there is blockage can something be done to fix the problem

  Answer:  I have never seen that be the cause and really cannot see how the surgery would cause that. Unless the location of the blockage can be determined, it will not be able to be corrected surgically. JG 7.3.11

• I`ve been following the recent exchanges here on retracted nostrils post-rhinoplasty. I have a severe case of this, along with weakness in one side of my face following nerve damage from a facelift done at the same time (great luck, right?). On front and side views, the interior of my nostrils is fully visible. I look like I`m snarling all the time, which is only made worse by the fact that when my mouth is animated, only one side of it moves, making me look like I`m REALLY snarling! Lovely. It sounds like you don`t think this kind of problem can be repaired. The few plastic surgeons I`ve consulted say that the problem is too complicated for them to take on. One said he would need to rotate the nostrils, but didn`t explain how and claimed he`s never done that procedure before, so obviously, I wouldn`t go to him. . I must say that, on the face of it, the notion of injecting silicone into the top and sides of the alar walls, makes sense as a way to hide the septal show; but it sounds like you don`t think this is a viable option. Is that so? I read a review of Richard Ellenbogen`s caritlage graft technique which claimed that it has a high rate of implant extrusion, which would only make the problem worse.. Any other options? I know you have a wise policy of not recommending particular colleagues, but could you name a few you know who are wizards at this kind of secondary rhinoplasty repair> Thank you very much for your time and help!

  Answer:  I do tto think injections help, but I do think that in many cases, placing cartilage grafts back into the lateral part of the tip, where potentially cartilage was removed that allowed the retraction to happen, will prove successful. As to names, jack Gunter in Dallas, Rollin Daniel in southern California, Ron Gruber in northern California. Best of luck. JG 7.3.11

• Dr. Garcia, 8 mos. after I had dorsal bump removed (nose surgery) I unfortunately got a DUI. I had interlock device put in car and was wondering if blowing into the interlock device would cause fluid/puffiness under eyes. I know it takes up to 1 year for nose to heal - is it possible the blowing device would cause this problem. Thank you

  Answer:  it should not cause a problem. JG 7.3.11

• Also, is there any proof hgh thickens skin and in your experience do patients skin look better when they are given prescriptions to use it?

  Answer:  I think the visual improvements seen with HGH are very small, and are usually due to other hormones being supplemented. JG 7.3.11

• Good Evening, Dr. Garcia: Why is it that some people will have a rhinoplasty and end up with a very thin nose that looks like a model`s nose, but other people will end up with a thicker nose? I`m one of those people who had a rhinoplasty and ended up with a thicker, wider tip than what I had before. I don`t understand what happened. Is it genetics, or what the plastic surgeon did that limits the result? I also have retracted nostrils, and a second surgeon said he could do a tip revision or use Silicone to lower the nostrils. If I were to have the silicone injection (because it`s much cheaper for me), but I don`t like the end result (say my tip looks too thick after the silicone injection), would a second rhinoplasty get rid of the silicone the surgeon injects? I guess what I`m asking is: what happens to the silicone once it is injected, and will a subsequent rhinoplasty thin out the area injected, or is the silicone permanently embedded in the tip?

  Answer:  it can be due to thicker skin on the tip before surgery, and also from scar tissue developing on the tip, something unpredictable. I think the effect of injections to correct retracted nostrils is minimal to none and will make the nose look bigger and thicker.The silicone cannot be guaranteed to be removed with further surgery, sometimes it will create more scar and make it hard to remove. JG 7.3.11

• Hi Dr. Garcia, I was going to ask you a question, but I see that it may have already been asked in the thread above me. Like the person who is thinking of using Silicone for the nostrils, I also have very wide nostrils, but instead of silicon, my dr. wants to inject cartilage from my ear and inject it above my nostrils. In my case, will the injection of cartilage make my nose look larger and thicker? I read that your feeling is that no matter what is injected (cartilage or silicone), it still will make the nose thicker/wider?

  Answer:  yes, it will look thicker and possibly wider. It is only logical that adding something make sit bigger. The only time it might not appear like that, and it is only an optical illusion, is when someone has a bump on the bridge and then filler is placed above and below to make the bump go down, but in reality the nose is now higher and larger in order to make it look straight. JG 7.1.11

• Hi Dr. Garcia, I am the person who emailed you earlier about whether silikon 1000 injected above the nostrils will lower retracted nostrils. Are you saying that if a minimal amount of silikon 1000 is injected, it will not make the nose appear thicker and wider, and that only a significant amount will make it appear thicker and wider? Thank you

  Answer:  I think any amount will make it look thicker and large, just the more you inject, the larger it will look. I see no reason to try it for your issue. You cannot add material to something without making it larger. JG 6.30.11

• Hi Dr. Garcia: About 4 years ago I had a primary rhinoplasty that left me with very retracted, wide nostrils. Literally you can see inside my nose on my side profile and frontal views. I read an article online that said plastic surgeons may inject--as an alternative to surgery--Silikon 1000 above the nostrils and this would lower the nostrils significantly. What is your overall feeling about the effectiveness of Silikon 1000 to lower the nostrils? Also, as my second question, would injection directly above the nostrils make the nose wider or thicker, especially the nostrils wider or thicker? Thank you, Dr. Garcia

  Answer:  I do not think a filler will help much unless it is a minimal amount, ti will likely take surgery with cartilage grafts being placed to correct the issue. Any filler injected will increase the dimensions of the nose, so it will look thicker and likely wider in most cases if injected above the nostrils. JG 6.30.11

• With the overuse of antibiotics, do you think it is necessary to take antibiotics after rhinoplasty surgery?

  Answer:  I use it for three days to avoid a sinus infection. JG 5.23.11

• Hi Dr. Garcia, I am almost exactly one year post an open revision rhinoplasty. I am seeking your opinion if compressions, massage, and taping at night are still effective or futile? Also, I do have some intermittent swelling although not to the extremes that I used to. I recently finished a very short course (2 days) of oral prednisone for an allergic reaction to a bee sting. It appeared that my nose stopped swelling - is it due to the prednisone or coincidence? Also, if it is an effect of the prednisone, will it likely last or will the improvement be short-term? Thanks so much for any advice.

  Answer:  The prednisone likely helped, but should not be used long term, taping is OK but at this point so far from surgery, it is more of a matter of time and letting it all readere I would avoid the massage so as not to pull the skin away from the cartilage . Best of luck. JG 5.19.11

• Hello, Just wondering what you think about ultrasound facial massage to help rhinoplasty swelling? Is it helpful in improving the lymphatic circulation? Can the device be used directely on the nose or just along the cheeks/neck to encourage lymph flow? Do you think this would be at all helpful or a waste of time? Thank you for your opinion.

  Answer:  Likely not a help, small probes could used, I have not personally though. JG 5.15.11

• Hello, I had an open revision rhinoplasty one year ago. I have noticed that in heat and when I exercise, my nose still swells somewhat (although not to the extent it use to) Will this end or will it always swell this way due to the surgery? Is there anything that can be done for this intermittent swelling? Thank you.

  Answer:  yes, it will take time, but will eventually stop. No much you can do I am afraid. JG 5.15.11

• Dr. Garcia, This is the Chicago Guy who had sinus surgery approximately 2 weeks and 2 days ago. I am still having pain in the ethmoid region. I started using ponaris emollient and I coughed up black mucus from my sinuses.(3 questions) How long does it take for the pain to subside? How long can I expect dark colored mucus to come out? Does ponaris emollient help with draining sinuses.

  Answer:  might take 4- 6 weeks for the pain to get better. The dark mucus might take 3-4 weeks,especially if the air is very dry. The ponaris merely helps with the moisture, it will not help the sinus to drain. All the best and hang in there. JG 5.6.11

• Hello, I am about a year out from an open revision rhinoplasty - will be 1 year May 25. I was hoping by now my nose would have settled down but I still get quite swollen some days and this will last for a week or so then the swelling subsides again. Is this normal? My PS said the flucuation is a sign that it is still healing - what is your opinion? When it is not swollen it looks great. Thank you

  Answer:  it can be normal in some individuals.Hang in there, it will get better.JG 5.1.11

• Dr. Garcia, This is the Chicago Guy with another question. Prior to my recent surgery to clear my ethmoid sphenoid and maxillary sinuses, I had three instances where I went into anaphalactic shock after being exposed to nuts and benedryl. Can blocked sinuses cause an allergic reaction to be worse off being that the sinus cavities are blocked.

  Answer:  no reaction interplay with the blocked sinuses. 4.27.11

• Dr. Garcia, This is the Chicago Guy and I have an update. The facial pain that I have been experiencing turned out to be a blockage in my ethmoid, maxillary and sphenoid sinus (CT scan revaled this). I had endoscopic sinus surgery at Northwestern Hospital Wed. Besides rest and saline spray what advice would you have so that I fully recover. One final question? The pain that I had when I ate prior to surgery is gone now. Can a blockage in the various sphenoid ethmoid and maxillary sinuses cause facial pain when you eat.

  Answer:  I think those suggestions are essential, along with avoiding anything that can cause you nasal swelling, so avoiding any allergens, decreasing salt intake, and maybe a humidifier in your bedroom are also good ideas. Blockage of those sinuses can certainly cause the pain as the pressure builds and eating causes the opening of the sinuses to shut closed. I wish you the best. JG 4.23.11

• I had my sixth rhinoplasty 18 months ago and my nose still hurts..I had rib grafts put in to improve my breathing... I also have dry nose...no buggers.. and mucous only in the cold weather which drips ... Is this normal? Could the scar tissue be pressing on a nerve (I had batten grafts placed on the sidewalls).. Thanks.

  Answer:  in cases where rhinoplasties have been so numerous and to the degree of intervention you describe, it is not uncommon for that all to occur and I have to say it is likely permanent. The pain could be due to scar tissue but there is likely nothing that will fix that, removing it will likely just cause new scar tissue, sorry. JG 4.20.11

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