Ask Dr. Garcia - The Archives

• 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 defe