Question:

Hello Dr. G. How old is too old to have a nose job? I`m Asian, my nose is ok (with Artefill to help with the bridge) but I`ve always hated the bulbous appearance of my nose. I went for a consultation with a Korean surgeon. He was horrible. He gave me a baleful glare that lasted a full minute and didn`t say a word during that whole time. His assistant was so uncomfortable. Finally, he said, You`re 57. Why bother? Amazing bedside skills. Regardless, I would like to know what are the risks, likely cost and recovery period? Is there more complication given that I have Artefill? If so, how long should I wait before considering surgery? Thank you!

Answer:

I will say that getting an Asian nose to look more refined is a complex issue that will require grafting and making the tip actually bigger because of that. The older you are the thicker the skin is on the tip and the less the amount of definition that can be achieved, so he might be just telling you that what you have tissue wise will not allow a significant change. JG 7.29.13

Question:

I am a 52yr old female and as I have gotten older I really don`t like the way the way my nose looks on the end. To me it looks like a light bulb. No one else seems to notice it, but when I look at a pic of myself it is the first thing I notice. Is there anything outside of surgery that can be done for this? If not, what do they do in surgery for the end to make it look better and how is it done? Also I have read many good articles on ultherapy for brow lifts and cheeklifts and necklifts. I do read for most people that it is very painful. I would like ur input on this procedure.

Answer:

You can try a Yag or VBeam laser to cut the redness on nose, as to the Ulthera, I am not a fan, painful expensive and does not last. JG 7.16.13

Question:

Is it hard to carve rib graft for a nose revision after rib graft was placed?

Answer:

Not too different than the first time. JG 5.29.13

Question:

Hi. I had a septoplasty 3 years ago. One year after surgery I had to have the medpor graph removed due to infection. Now two years after that I am still experiencing pain. I have a burning sensation in my left side nostrial. Also I get a tingling that runs down my face at times and into my top lip. It`s like pins and needles in my top lip. The pain increases sometimes when I yawn or chew. The pain also travels up to my left eye and forehead Sometimes I rub my eye and it hurts in the corner by my nose. What do you think it could be.

Answer:

Hard to say as a Medpor implant is usually not utilized in a septoplasty. Guesses as to what is causing the pain is nerve damage, a septal perforation, over resection of turbinates causing excessive dryness of the inhaled air. I think that this far form the surgery that the only thing that can be fixed, if it is the problem is the septal perforation. Wish I could tell you more. JG 5.28.13

Question:

Good morning, This is a follow up Q on rhinoplasty on Asians. I am curious why decreasing the bulbous nature of the nose is risky. Is it the risk of keloid scarring? I am not looking for a high bridge Caucasian nose, which would not fit the rest of my face, just lessening the bulbous look of the nose. Thank you.

Answer:

risky in the sense that scultping the cartilage or placing cartilage grafts will not lead to a refined tip due to skin thickness. That usually will require cartilage grafts or synthetic grafts like silicone, both of which can cause problems in the tip with erosion and or infection. The bridge augmentation is easier compared to tip definition. JG 5.16.13

Question:

If one does not have nose broken for rhinoplasty, can one wear sunglasses after surgery? Let`s just say a patient had tip work done with a little grafting in bridge.

Answer:

I would avoid it for at least a week because of the graft to the bridge ad not wanting it to shift, maybe use glasses with small feet on wire frames rather than the big bulky ones. JG 4.29.13

Question:

Hello, I had an open revision rhinoplasty three years ago. I am still taping my nose nightly. If I don`t tape it at night, it is noticeably swollen the next day? Isn`t this unusual so long after the surgery? What could be causing this? It`s not such a big deal to tape it at night, just thought this should be done by now!! Thanks.

Answer:

it is unusual this far out yes. Not sure what could be causing it as if the taping relives it, it would imply swelling that should not be happening this far out. I really cannot say why you are having it happen, sorry. JG 4.22.13

Question:

Dr. Garcia, Hello. I had a primary rhinoplasty in 2004; however, the result left me with two notched/retracted nostrils. I`ve read that a surgeon can lower the nostrils by placing ear cartilage grafts in the nostril rims. My question is: does placing the grafts over the nostrils widen the nasal tip? I have always wanted a small, refined nasal tip, and fear that the grafts could widen my nose. Why is it that some female models have very low, shapely nostrils while some men and women end up with a wide nose with unshapely nostrils? Thank you.

Answer:

The tip might widen a bit with the catilage grafts.As to why noses end up different is due to what they started with, what was done and also the thickness of the skin. JG 2.2.13

Question:

Dr. Garcia, After having two surgeries and taking thousands of dollars of sinus medication, going on a vegan diet... I am still experiencing pain in the ethmoid region of my nose. I am sentive to perfumes, hot and cold things bring about pain. My sinuses are actually clear. It seems that there is some nerve damage possibly. Would getting my nose cauterized in the ethmoid region stop and/or alleviate the pain that Im feeling. Your thoughts!!

Answer:

There is no guarantee that it would work, it could possibly make it worse, not sure you should do it. JG 2.1.13

Question:

Dr. Garcia, I recently noticed that meat (i.e. chicken and turkey) cause my sinuses to inflame very badly. As you know, I have had 2 surgeries. I recently went vegan and after two weeks I notice some improvement. I must admit that I do consume alot of chicken on a daily basis {5-6 chicken breast}. Have you had any clients with similiar stories.

Answer:

I personally have not to seen of it or heard about it, sorry. JG 1.24.13

Question:

If no ear or septum cartilage is left for nose revision surgery, is there anything new that is effective and can substitute a rib graft?

Answer:

you can use banked donated cartilage from a cartilage donor. JG 1.17.13

Question:

Dr. Garcia...... This is the Chicago Guy.... I had sinus surgery back in April of 2011. My ethmoid sphenoid & maxillary sinuses were blocked. At times I still feel pain and pressure in the ethmoid region between my eyes..but I can breathe. I feel pain in the ethmoid region after eating, taking vitamins and/or supplements as if there is a blockage of blood flow. I can breathe fine and my sinuses don`t feel blocked. Finally, I notice when I place pressure on the bridge of my nose, the pain subsides as I can feel the blood flow stop. Could this be a symptom of nerve damage or trapped nerves where the blood vessels are??? Your thoughts?

Answer:

Yes, it is possible but not much to do. JG 1.13.13

Question:

Hi Dr., in 2007 my daughter got her nose fixed. She had what the PS termed a difficult nose to fix . Incisions were made on either side close to the bridge, to fix what he called bull-horns . don`t know if this is a common term, but I`ve heard it is common in American-Indian features..although the ethnicity of that is very small on her granndmother`s side. That part of it actually was fixed quite well, and left virtually no scars. Other complications arose, and the PS was not able to refine the rest as much as he would`ve liked. Fast forward to 2012, and it appears that the very bottom (almost the tip) has widened, especially when she smiles. Why did this happen (scar tissue?) and how do you fix it, and who should we consult to fix it...a PS that only does rhinoplasty? I will admit her PS does not have rhinoplasty as part of his website. Any thoughts?

Answer:

Likely scar tissue causing the tip problem, I do think a rhinoplasty specialist is a good idea, either plastic surgeon or an ear, nose and throat specialist. I wish her the best. JG 11.28.12

Question:

Dr., is it true that your nose continues to grow the older you get.? Do older people often seek rhinoplasty because of this? I`m thinking I better start to save my money for nose surgery!

Answer:

the skin of the tip does get thicker and can make the nose look longer in some. I think it is few that seek a rhinoplasty in older years unless the have wanted one all their lives. JG 11.12.12

Question:

This may be a strange question. In my 30`s, I had 2 rhinoplasties, one to reduce the LLC`s, another to lower the septum. I was lucky and had a nice result. I`m now in my 40`s and have noticed that the skin on my nose is getting extremely loose. In animation (e.g., when I wrinkle my nose or smile), it looks like I have about twice the amount of skin I should have. Is this something that happens with age or is this a direct (if delayed) result of the surgery? It looks like I need a skin-only nose lift (which, I imagine, can`t be done without unsightly scarring). So, is this just going to get worse as I age? I bet you`re going to say yes ....just like everything else gets worse with age. Ugh. Thanks for your input.

Answer:

It is not due to the surgery, skin will thin with age but the progress of it should be slow. JG 9.12.12

Question:

Good evening, Dr. Garcia. I wrote to you in early July following a gortex implant to the tip of my nose to correct a deformity, and you were so helpful. Thank you! It`s now been six weeks and one nostril is still red/light purple. My surgeon doesn`t think it`s infected. (I was on 2 different antibiotics in succession for a few weeks post-op; I have no fever, it`s not hot to the touch and there is no visible pus.) He is speculating that the implant is just settling in and that this is a visible inflammatory process that will settle down in time. Does that sound right to you? I`m not sure how time will improve this. My nose perpetually looks like it`s festering a pimple that`s about to erupt and overtake the whole tip. Thank you for your opinion.

Answer:

well, we can hope. As long as there is no drainage and it is not getting worse, I would just go with the flow. Hang in there for a bit more. JG 8.16.12

Question:

Hi - I asked the question yesterday about continued swelling 2 years after revision rhinoplasty. Thank you - I will try the steri strips. How about gentle massage? I have been using 2 fingers from side of nose out to cheeks to try to promot lymph drainage. Is it ok to continue that or will that cause the skin to not readhere? Thanks!!

Answer:

I think at this time, gentle massage is counterproductive as it will tear the small attachments the skin is trying to make to the cartilage. If anything just firm pressure with no motion is all. JG 7.27.12

Question:

Hello, Dr. Garcia. I followed your (as ever) sound advice and found a surgeon to do a small cartilage graft to my retracted nostrils. It`s been about 4 weeks. Of course, I had some edema, and as a result, the skin over the graft peeled off a bit (almost like a sunburn). That skin is thin anyway, so that process made it even thinner. I can see the cartilage beneath the skin (though you really have to look to see it), and of course there`s a tiny step-off at both ends of the implants; but those are minor cosmetic concerns that don`t concern. I`m just glad that I`ve lost the pig snout look! My questions are:1) Because the skin over the implants thinned, is there a greater risk of extrusion than if it hadn`t? 2) Will that skin thicken up again or will the presence of the implants prevent that? That is, if the skin regrows, does it do so from the inside out and, if so, will the implants pose a physical barrier to that process? 3) How long before you think I can relax and assume that these implants have taken and no longer pose a risk of infection or extrusion? Finally, an unrelated question: I tried Zeltiqu last week. The technician said the final results are visible in about 8 weeks. Does that sound about right to you? Sorry for all the questions. You are amazing! We all love you, Dr. Garcia.

Answer:

although risk of extrusion exist sin think skin, as there is little motion in that area, the odds are good it will survive. The skin usually will thicken up over time, maybe a few months. I think 3 months and you are pretty safe. As to the Zeltiq or Cool Sculpting, final results are seen after 2-3 months, correct. I wish you the best. JG 7.29.12

Question:

Hi, I had an open revision rhinoplasty 2 yrs and 2 mos ago. My allergies are controlled (take Zyrtec and use fluticason nasal spray daily). I have been evaluated by a derm and do not have rocasea. I still have swelling in my nose. I know this is swelling because it changes shape and there are times when it is not swollen and looks quite refined. Heat, exercise, salt,and alcohol seem to make it swollen. What could be causing this and is there a way to make it stop? I have read that vascular congestion after rhinoplasty can cause this. What is the best treatment for that? Any advice would be greatly apprectiated. Thanks!!

Answer:

It is a thing that happens, the more times you have surgery, the greater the risk. Injections and pills have minimal results. You might try having the surgeon give you some steri strips and apply them every nigjt to get the skin to readhere so the swelling stays gone. JG 7.26.12

Question:

Hello Dr.Garcia,my little girl who is now 11 years old was born a preemie at only 24 1/2 weeks. While she was in the NICU (100 days) the skin which seperates the nostrals and attaches the nose to that area right above the lip are tore by the nasel cannula that gave her oxygen. I wanted to know what procedure she would need to fix it and the more of less cost of the surgery. She will be going into middle school next year and I am concern that kids will start to tease her. She has always been a tiny thing and her father and I were always scared about letting have surgery. Thanks in advance.

Answer:

if you can send some pictures to me at drgarcia@lvcosmeticsurgery.com, I would be better equipped to answer your questions, thanks. JG 7.27.12

Question:

My 20 year old daughter had rhinoplasty 6 months ago and her nostrils are severely retracted. Her surgeon acknowledges the problem but says, rightly, that the nose will continue to change for up to 12 months post-op. He acknowledges that the nostrils will likely need repair, but he says that the amount of retraction may improve a bit with time, since the post-op swelling could cause the retracted tissues to go up even more. Does this make sense to you? I would think that swelling could only make the tissue go down, not up, thus meaning that the retraction we see now at 6 months could get, if anything, not a bit better but worse over the coming 6 months. Thank you for your time and expertise.

Answer:

post op swelling above the level of the lower lateral cartilages can make the retraction appear worse, yes, and does get better in time. If the swelling was in front to the cartilages and only on the very tip, it then could pull the tip down. It all depends on where the swelling is on the nose. JG 7.22.12

Question:

Sp are you saying it will need to be removed? If so, how long before we can try it again? Thank you.

Answer:

Probably needs to be removed and I would wait at least 6 months before replacing it. JG 7.21.12

Question:

I wrote to you about an infected nasal implant earlier this week. The two sutures were removed this morning, and all looked good (I`m still on Cipro), but tonight one of the two suture sites opened and I can clearly see the white implant. It hasn`t exactly extruded; it just looks like the suture was removed too early (7 days) and the skin hadn`t healed over that spot. I will see the surgeon again on Monday. Can he just place a suture there to pull the skin together again over it, or because it has now been exposed, will he need to remove it? I`m so discouraged because the contour was great and fixed my problem beautifully. Thanks very much, Dr. Garcia, for helping me to prepare for what is to come on Monday.

Answer:

He can, but the chances of it healing long term are low, the implant is now technically infected and antibiotics alone will not fix it. Sorry. JG 7.20.12

Question:

I have a very small but highly noticeable retraction of my nostrils from rhinoplasty several years ago. My surgeon agrees that it needs correction, but it`s too small for cartilage grafts. He`s proposing a tiny injection of silicon. What do you think?

Answer:

Personally I do not think it will work as the silicone is liquid and you likely need something stronger. JG 7.2.12

Question:

What is your fee for small cartilage grafts from the ear to retracted nostrils from an aggressive rhinoplasty? Thank you.

Answer:

at the present time I am not performing revisionary surgeries on patients that had surgery performed elsewhere due to my operative schedule, sorry. JG 5.16.12

Question:

Hi - I am about 2 years post open revision rhinoplasty. I am still taping my nose at night. If I do not tape it, it is very swollen in the morning. This does subside throughout the day but still swollen compared to the days that I have taped the night before. Doesn`t this seem like a long time? Is there any harm in continuing the taping at night? Thanks.

Answer:

no harm, but using taping that far out is unusual, yes. If it works, no harm in continuing it though. JG 4.19.12

Question:

My nostrils retracted severely after rhinoplasty. I considered a composite graft but decided the deformity to the ear would be just as bad as the deformed nostrils, so I had my plastic surgeon inject hyaluronic acid into the alar walls, and to my delight, it pretty much solved the problem. He thought that because the filler has stretched the skin, it might actually have a permanent or semi-permanent effect and that I might not need any more injections -- or at most, just an occasional, tiny touch-up. This sounds too good to be true. Do you think he might be right or is he trying to offer me false hope, and relieving his own conscience, after making a mistake that he even admits to: an overly-aggressive rhinoplasty? I want him to be right, of course. I hope that the filler (and gravity) stretch my skin and permanently correct the problem, but I`m skeptical and think that this is going to cost me big money for the rest of my life. I`m only 30, so I`m looking at life-long outlay of cash here. I`ve already asked him if he would cover the cost of the filler, and he said no. (This may be another reason he`s trying to plant the suggestion that it will be a permanent fix after one injection -- to raise my hopes and perhaps alter my perception of the deformity down the road. I hate to be so suspicious. He`s a good guy, but I think he may be trying to protect his own wallet.) Thank you for your opinion, Dr. Garcia.

Answer:

I do not think the skin stretching will help permanently, but a cartilage graft below the skin could hold the position.I do not think a composite graft would be needed. No need to deform the ear. I wish you the best. JG 4.15.12

Question:

Hi Dr, I`m the one who posted the question below about the supratip area. I should have clarified, the doctor made the injections a few years ago. I was just wondering if you would be concerned about the softness in the supratip area after 6 years, although the shape is acceptable.

Answer:

no, I would not be concerned, it will not cause any problems. JG 3.28.12

Question:

Hi Dr Garcia I had a rhinoplasty almost 6 years ago. My supratip area is OK in shape (Would have preferred more definition but I would rather leave well enough alone). My question is, the supratip area of the bridge doesn`t feel firm or bony at all. It feels kind of soft when you feel it. It feels somewhat soft and almost like it`s not connected to bone, just a bit mushy. It`s been like this since the surgery and my surgeon retired a few months after my procedure and injected it once or twice with triamcinilone and told me to tape nightly for a year. If the shape is acceptable, would you worry about this?

Answer:

if the shape is good, don`t mess wit it with any shots. JG 3.28.12

Question:

Hi Dr. Garcia, I am currenty about 20 months after an open revision rhiniopasty. This was a complete re-do as I needed extensive correction. I am still experiencing swelling even though everyone says swelling is gone after one year. I know that the swelling is not gone. My nose will look nice and slim for weeks and then I will have a week or so where it becomes puffy again. During the puffy times, I can feel that my nose is squishy, it feels as if there is fluid under the skin and I also feel congested. Is this normal? Is there hope that it will ever end and stay looking like it does on the good days? It is so very frustrating. Thank you for any help or advice you could offer.

Answer:

It can take longer after a redo, as you are seeing days with good results, in time it will settle in . JG 2.25.12

Question:

Dr. Garcia, I had sinus surgery last April of 2011. I am still feeling pressure at times in the ethmoid region. Nothing constant. I recently came across some information pertaining to a herb called ganoderma mushroom (i.e. reishi) and its many healing properties to include allergies and sinus congestion. Have you heard and/or had any experience with this herb and its ability to help with the sinuses? How much longer can I anticipate the on and off pain?

Answer:

Impossible to tell how much longer the pain will continue, you might need the ethmoids opened again. i think taking the Reishi is worth it, some people do better using it. All the best. jG 2.21.12

Question:

What`s your opinion of facial acupunture and lumi microcurrent lifting treatments? Thanks

Answer:

waste of time and money for you. JG 2.20.12

Question:

Hi, I had a revision rhinoplasty approximately 19 months ago. Overall it looks good, but still seems to swell intermittently. This seems to be in conjunction with a stuffy feeling internally. Could inflammation in the lining of the nose from an allergy or cold cause the nose to appear swollen or thicker externally? Thanks.

Answer:

yes, internal swelling can cause that, so be sure to take whatever medications or sprays you use for that issue in order to control it. JG 2.16.12

Question:

Hi, Dr. Garcia: I received a Kenalog injection last week in the middle of my nose to reduce some of its thickness, following a rhinoplasty a few years ago, and as a result I have what looks like a red, very thin spider vein. I figured this was the result of the pressure applied when delivering the needle. Is there anything I can apply to my nose to make this mark go away, or do they tend to disappear on their own? Thank you, Sammy

Answer:

in many cases the small veins will go away in time, but not always. if it does not a session or two with a VBeam laser will eliminate it.All the best. JG 2.9.12

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

Is it normal to have anemia right after rhinoplasty surgery?

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

it should not cause a problem. JG 7.3.11

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

no reaction interplay with the blocked sinuses. 4.27.11

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

Hey Doc I,m 14 months post 3rd revision. I had my post year check up and have not laid down any scar tissue, which is a bit of a miracle as my nose was very damaged and needed a lot of work with grafts and I also developed an early doors infection. My result is great and like I say soft with no scar tissue thanks to various keen methods to control it.And they have paid off,thankfully. My question may sound a bit strange but I have been put on very high strength Collagen suppliments for my joints,also Hyleronic acid supps. I have noticed my lips look a lot fuller and skin also. would these at all cause me to lay down any scar tissue in the nose? I know all the initial Fibroblast stage will be long gone, but when does a wound/scar stop laying down collagen? And could high doses of this cause some scar response at this later date in the healing. I`d rather be hobbling along than get a big bulbous tip back after all I have been through!! All the very best to you and thanks

Answer:

no, if anything it might help a small amount. Glad all is better and I wish you the best. JG 4.18.11

Question:

I am in need of a revision and a doctor says he may need to use kwire.. Is this safe and does it get infected often over time...

Answer:

safe, they can stay in place for a permanent basis, all the best. JG 4.3.11

Question:

I don`t like the tip end of my nose or the lower part. It looks like it has gotten bigger over the years. If I had plastic surgery to correct just the nostril part or the tip end part of it, and not the part that had bone where it would have to be broken, would that be a painful surgery?

Answer:

it might have to be broken of there is some narrowing required to avoid it looking wide in the middle and it is not especially uncomfortable of a procedure to have done. JG 3.28.11

Question:

Hello I am about 10 months post op open revision rhinoplasty. My tip is quite soft and sometimes feels squishy. I thought this was swelling still; however, I have read that swelling/edema makes the tip feel hard. So is this likely scar tissue in my tip? will this shrink over time? It does seem to go up and down in size from day to day. My PS does not like to do kenalog injections. Is there any other way to help speed up the resolution of the swelling (if that is what it is). Thanks for all your help and advice.

Answer:

the swelling will only make it hard if there is a very large amount, If it is soft, I do not think the Kenalog injections will help much. You could ask the surgeon to give you some steri strip tapes to apply to the skin of the tip to see if you can speed it in its reattaching to the cartilage. Might help a little. All the best. JG 3.27.11

Question:

What do you think of turbinate surgery to make nose less runny? I think instead of the turbinate removed, it is resectioned.

Answer:

it might help, but the trade off is the nose might become too dry, especially if the turbinate is removed, allowing the nose to bleed form the crusts that will form inside your nose from not being adequately humidified, which is one of the functions of the turbinate, along with filtering of the air. JG 3.13.11

Question:

Hi, I am 9months post op open revision rhinoplasty (have had three total). My nose still swells intermittently. I am wondering if there is anything that can help this swelling? My gut feeling is that nothing will really help and that it will do what it wants to until it has settled down. 1). Is taping still beneficial at night this far out - I have read that it can control scar tissue formation; 2). Are compressions still helpful; 3). If the swelling is allowed to just sit there - will this cause increased scar tissue - or will the swelling resolve on its own without any long-term problems? Thanks so much for your help. It is so nice to have questions answered!!

Answer:

taping will not affect scar tissue but it might help getting the tissues to stick back into place. Compressions will also still help some. Swelling does not cause scarring unless it is blood, and yours is more likely serum. In time, it should all get better, just takes time in revision rhinoplasties. All the best. JG 3.8.11

Question:

Hi - I had an open revision rhinoplasty approximately 9 months ago. Since then my nose and skin on my nose have been slightly red and felt irritated at times. My PS assured me nothing was wrong. Well I just finished a course of amoxicillin (3xday for 10 days) and my nose looks/feels 100% better. What would be the symptoms of an infection from the rhinoplasty? Could I have had an infection this whole time or would that be unlikely? Thank you

Answer:

very doubtful this far out it it due to the rhinoplasty, but you might have a skin infection totally unrelated to it, or you might be developing a mild case of Rosacea too. All the best. JG 3.6.11

Question:

Dr...thanks so much for your answer to the revision rhinoplasty . I had no idea that fillers could fix the wavy profile view of an original rhinoplasty. How incredible, and probably less expensive....but like with all fillers is this only temporary? Also, I want to send her to you so you could see what I am talking about and counsel her as to the fillers....what is your charge for consulting with someone? Thanks so very, very much.

Answer:

the fillers that can be used in the nose last longer than fillers elsewhere. You can send the pictures to drgarcia@lvcosmeticsurgery.com There is no charge unless I see you in person. JG 2.20.11

Question:

Hi Dr...do only certain drs do revision rhinoplasty ? My daughter had her rhinoplasty done and truly, the results are less than favorable. Her nose looks fine from a front view, but the profile is quite strange...doesn`t look like a nose job, at all. The doc said he would try to smooth out some of the wavy look it has, but she is now freaked out about going to same doc and also we noticed on his web-site he does not have rhinoplasty in his repetoire...maybe we were his first real case! I would like her to see someone else, but have heard that many surgeons shy away from revisions and also that they are more expensive than the first one. Can you separate truth from fiction? I, too am a bit afraid to send her back to the original, but figure maybe the cost will only be for the OR, I believe he said that.

Answer:

although many surgeons do revision rhinoplasties on their patients, many surgeons will not take on a revision rhinoplasty from another surgeon due to the greater degree of difficulty involved. I will say that at times, there can be fillers injected to alleviate what you are describing and it might be enough so that she does not need another surgery. Might want to call around and rather than ask if they do revision rhinoplasty to ask whether they do fillers to the nose after a prior rhinoplasty. Best of luck. JG 2.20.11

Question:

Hi Dr...Im very concerned...I had a rhinoplasty last April 19...its healed well and I like it for the most part....earlier today my dog bumped my nose pretty hard...it hurt and it continues to hurt...it looks a little swollen and is throbbing. But my big concern is I had a graft put in the middle of my nose to make it longer and lower the tip....my profile was smooth, even when I touched it...now in the midddle of my nose where it hurts I feel a slight bump when I run my finger down my nose....It looks as if there is a bump now too when there was none before....do you think the graft has shifted possible??? Is this an emergency??? Its pretty painful.....I really dont want surgery I liked my nose :((( ....

Answer:

doubt the graft moved as by now there should be enough scar tissue to hold it in place, more likely is a small amount of blood causing the distortion and with time that will go away, ice and massage along with time I think will get you back to where you were. Best of luck. JG 2.19.11

Question:

Hi - I have been reading through the posts and see that flucuating swelling is normal after rhinoplasty. I am wondering how much swelling is normal 9 months after an open revision rhinoplasty? I have days where it looks very nice but then days when it is swollen. I don`t mean just a little puffy but HUGELY swollen and the whole shape of my nose is changed and I feel very congested. Could something be wrong? Thanks for any ideas.

Answer:

well, there is a little longer time for swelling to resolve after an open versus a closed rhinoplasty, and with a revision rhinoplasty, it is even slower as the scar tissue that formed from the first surgery does not absorb swelling as easily as non-scar tissue. I do not think there is anything wrong in your case, and although I tell my patients that after an initial rhinoplasty, there end results is seen after 12 months, in a revision surgery, it is likely closer to 18 months or more. If it is just swollen in the morning, you can use some tape applied to the nose and onto the cheeks to keep some mild pressure on the tissues while sleeping and then awaken with a little less swelling. Also, avoid allergens and red wine might help also. Best of luck. JG 2.13.11

Question:

Hi Dr. Garcia, I hope you don`t think this a stupid question, but I had a rhinoplasty not long ago, and ever since my operation I subconsciously touch the insides of my nostrils every night when I sleep, because I get dried discharge in there. I don`t want to do this, but I recall doing it the next morning after I get up. Will this actually widen my nostrils? They`re pretty narrow now, and I`m concerned that in time they may enlarge.

Answer:

should not have any long lasting effects, might want to see an allergy specialist, maybe there are some pills they can give you to stop the discharge. Could try a humidifier in your bedroom too. Best of luck. JG 2.9.11

Question:

Hi Dr. Garcia, I had an open revision rhinoplasty about 8 months ago. I am happy overall with the results; however, when I do the compressions my PS showed me, I noticed that the nasal skin still feels loose. Is this normal and is there anything that can to done to shrink or tighten the skin on the nose? Is the looseness of the skin what allows swelling to continue? Thank you.

Answer:

it is normal, can take a year or more for it to stick back down. It is just a matter of time, and the massage is to be done gently so as to not pull the skin from the underlying cartilage. Skin will be loose as long as there is swelling. Best of luck. JG 2.3.11

Question:

Hello, I am about 7mos post open revision rhinoplasty. My nose drips constantly! It is so annoying. I take a Claritin - D and use fluticasone nasal spray daily; however, this doesn`t seem to help much. i am constantly wiping my nose. Is this normal? Will it go away? Is there anything that will help in the meantime? Thanks!

Answer:

highly unusual for it to be related to the surgery, if there had been something that went awry with the surgery, like a septal irritation, it would more likely bleed than drip clear fluid. Clear fluid is more that of an allergy, might suggest seeing an allergist to be evaluated for allergies more fully. JG 1.20.11

Question:

Dr. Garcia, This is the Chicago Guy who had septoplasty back in 2008. I had a ct scan today which revealed that my ethmoid sinus is blocked. I had the procedure done at the Univ. of Chicago. Any suggestions other than surgery. I was advised that endoscopic surgery would be the procedure that needs to be conducted. After many years of speculation.....this is the problem. Your thought????

Answer:

possibly, but the ethmoid causes pain up higher in the nose, towards the bridge of nose, if that is where the pain is, it might help. All the best. JG 1.18.11

Question:

Dr. Garcia, Is it normal for the tip of the nose to be hard and swollen (a lot) after an open rhinoplasty, even if no tip work was done? Also, when does this type of swelling begin to go down? Thanks!

Answer:

yes, because the swelling form above settles in the tip, and some will say that an open rhinoplasty yields more swelling than a closed rhinoplasty. Swelling should begin to go down on the tip after 6 weeks, and then gradually continue for 12 months. Massage helps. Best of luck. JG 1.13.11

Question:

Dr. Garcia, This is the Chicago Guy who had septoplasty back in Aug of 2008 with numbing pain in the septal area. I have appointments scheduled with ENT`s at Univ of Chicago and Northwestern. If the surgery did in fact damage a nerve or if scar tissue is affecting a nerve, would an MR angiogram detect the findings. If not, what procedure (CT Scan or MRI??) could be used to identify scar tissue and/or damaged nerves trapped in scar tissue and can this be fixed under local anesthesia Please advise. Sorry for asking so many questions? I wish you were here in chicago!!

Answer:

likely not as the nerves will be almost impossible to see. There is really no procedure that will definitely detect it, unless there is a new mass that has grown, and that is doubtful. They might be able to try to inject a long acting local anesthetic into one area at a time, doing different spots in a series with a few days in-between, and see if the pain is relieved. If it is, then they could, in theory, kill the nerve with an injection of pure alcohol, but then the area that this particular nerve gives sensation to, will go numb on a permanent basis. Best of luck, you are in good hands with the guys there. JG 1.5.11

Question:

Hello Dr. Garcia, Hope you a nice holiday season. I have a rather strange situation and am wondering if I should be worried or if it could be in the normal course of healing...I had an open revision rhinoplasty in May 2010. I have been taping my nose at night. It always looks nice in the morning; however, it seems many times after lunch my breathing feels completely blocked/stuffy nose and when I look in the mirror my nose appears quite swollen and red. This resolves within a couple hours. Any thoughts or advice? Should I be worried or will this settle down? Thanks so much!!

Answer:

might suggest keeping a diary of what you eat from mid morning until after lunch, might be an ingested allergen at this point. Even salt granules can cause that reaction. If that is the case, a nasal allergy spray may do the trick, don`t think it will be permanent though. I wish you the best for the New Year. JG 1.4.11

Question:

Dr. Garcia., I have sent you numerous questions regarding a pain that I have in my septal area since my septoplasty surgery two years ago. I thought the pain was allergy related & I have taken everything from antihistamines to decongestants & I had two food allergy test done which were negative. When I went to my ENT a year ago, she said that she did not know what was wrong. After researching, I think that I have a nasal adhesion scar tissue . When I exercise and eat I experiance a strong pain in my nose which is constant. Your thoughts? Are you familiar with any good minority ENT`s in the Chicagoland area. The Chicago Guy

Answer:

nor sure what else can be causing the pain besides nerves trapped in scar tissue. As to ENT`s in Chicago, I suggest the guys at U of I, very good program. Best of luck. JG 1.1.11

Question:

Hi Dr. Garcia: I noticed that (unfortunately) someone else asked a question about pain and swelling 14 months after a rib revision rhinoplasty. I am in the same position, 16 months after one. You mentioned scar tissue. Do you mean that as scar tissue is laid down it causes pain or is this something (gulp) permanent caused by the scar tissue? Thanks.

Answer:

in a small number of cases, it can be permanent, and in many cases like that, removing the rib graft can help. JG 1.1.11

Question:

I had a revision rhinoplasty with rib cartilage 14 months ago and my nose still swells up and I have chronic pain...is there something wrong

Answer:

not likely, just scar tissue and maybe a little too dry inside the nose, might want to see your surgeon to make sure, in the meantime you can use some saline nasal spray and use a room humidifier too. Best of luck. JG 12.26.10

Question:

Hi Dr. Garcia, I asked the above question. I just wanted to add that the cartilage just above the tip of my nose feels and appears thicker as well and was wondering if this might decrease over time as well. Again it`s been 1 year. Thank you

Answer:

probably not, sorry. JG 12.18.10

Question:

I hurt my nose a year ago after a fall. It was swollen. I got xrays and the doctor didn`t find any fracture but the xrays were taken a 2-3 weeks after the fall so it may have already began to heal. I`m not sure what happened to my nose but now it is fuller all down the bridge as if the bone is covered in scar tissue or it`s calcified or something. Will this ever soften up and shrink back to size? Do I have to get rhinoplasty to correct this?

Answer:

after a year, it is likely going to stay that way unless you have some type of surgery to correct things, nasal bone fractures are difficult to see on X rays. Best of luck. JG 12.18.10

Question:

Hi Doc> I had a septoplasty 10 months ago. I have a very hard lump inside my nose. It`s rough and raised but I can`t get rid of it... it`s too hard to pick out, it wont move. How can I get it out? thank you

Answer:

I suggest you see the surgeon for fear trying to remove it could start something to bleed and you might not be able to stop it at home. JG 12.9.10

Question:

Hi there. I had a rhinoplasty 2 yrs ago. The nose was great for the first year but since then it seems to keep growing. Could this be scar tissue? if so are there any tablets you can buy to help dissolve scar tissue? Thanks

Answer:

very unusual for it to look good for a year and then grow after that, not sure what is going on but there are no pills that will help that. Sorry. JG 12.7.10

Question:

Something that has bothered me after 2nd revision done to thin out cartliage was that it really felt thick on inside for at least 6 mths. My Dr. assured me he did not add any other cartialage to tip and prescribed steriod spray. Is this thickness just swelling.

Answer:

could be just scar tissue from the repeat surgery, not uncommon. JG 12.5.10

Question:

Hello Dr. Garcia, Thanks for this website - it is extremely helpfull and reassuring to get an unbiased opinion. I had an open revision rhinoplasty about six months ago. The supratip area looks quite swollen still and feels very soft and squishy. I can temporarily push the area down so I do not think it is cartilage that is causing the fullness there. Would a kenalog injection this far out still be beneficial? When will this swelling finally resolve? It gets so frustrating because it will look very nice and refined for a while and then swell back up and become distorted. AHHH! I guess patience is a virtue when it comes to rhinoplasty? Thank you for any advice!!

Answer:

I think it can be tried, as long as it is done not too often, it is safe, but improvements will come slowly, no mater what.It can take a year of more for all the swelling to go to its final stage. Hang in there for a little more. JG 11.30.10

Question:

Hi, Dr. Garcia. Thanks so very much for your answer earlier this week about my twitching nose. (I`m the post-scar-subcision-nerve-injury-nose-spasm person.) 5 days out and it`s still twitching multiple times each minute. I`m massaging it and have put some compresses on it a few times each day too, but no improvement yet. Would you think it should have settled down by now, or is this something that is likely to take many weeks or months to resolve? If it doesn`t stop, do you think a couple of units of botox might help? (Good grief! Isn`t this silly?)

Answer:

it can take weeks, and Botox should help, if you desire to use it.Silly, maybe, but just a pain in the butt more than anything else. JG 11.5.10

Question:

On Monday, I had a scar on the bridge of my nose subcised with a 25 gauge needle. A few hours after the procedure, I started having involuntary spasms on the sides of my nose (up to the bridge) several times each minute. It looks I`m sniffing or contracting my nose in an air of contempt multiple times each minute. I fear that this may be the beginning of a permanent facial tic. My doctor thinks he may have hit the infratrochlear nerve and that this reaction will probably settle down in time. I must say it`s very disconcerting, like a case of endless hiccoughs. Have you ever seen such a thing? Do agree that it`s probably transient? How probably ? If it`s likely more permanent than transient, any recommendations for how I should try to repair this? Incredibl, right?! Even the simplest of procedures seem so often to go awry. Thank you for your time and guidance, doctor.

Answer:

I do agree it is transient and will get better. Massage and time is about all you can do now. Must have been a really tiny scar to use a 25 gauge needle for subcision, the intent is to essentially cut the skin away form the underlying tissue to allow it to rise, not easily done with a 25 gauge needle, usualy something bigger is needed for it to be effective. All the best. JG 11.4.10

Question:

hi, after an unsuccessful revision rhinoplasty a plastic surgeon injected voluma inside my nose to try to straight it. It was crooked and slanted to one side. The voluma has pushed it over slightly and it seems much better, it is actually straighter right now due to the injection of voluma inside the nose. Do you think this will last ? Was this a risky thing to do ? thank you

Answer:

It might last as long as a year, maybe more. I will say that it is more of an optical illusion though as there is no way a filler will be strong enough to push structural cartilage over to truly straighten a nose out. I do not think it is risky though, because if desired, it can always be dissolved and removed. All the best. JG 11.3.10

Question:

Hello, I am about 5 months post op of an open revision rhinoplasty. My nose will look very nice for awhile, then it seems to become swollen again overnight. It is so weird. It`s like I have good nose days and bad nose days. When will this ever end? Thanks for any advise.

Answer:

It will lend, just more common in revisions than first time surgeries, give it time. JG 10.20.10

Question:

Dr. Garcia, I am the Chicago guy who has asked a million questions about my pain in my nose following my septoplasty surgery. First of all let me thank you for all of the advice that you have provided me over the course of the past two years. What you are doing with this website is outstanding and I thank you very much. As you know, I had septoplasty surgery in Aug of 2008 and as of a couple weeks ago, I was still experiencing pain dialy. It turns out that I have serious seasonal allergies that was causing pain/pressure in the nostril area. To date, I am taking claritin and nasonex and I feel 100% better. I was under the impression that the pain that I was experiencing was from the septoplasty surgery. Not!!! Well thanks again, I feel alot better!!!! You and this website rock!!!! Chicago GUY

Answer:

from one Chicago to another, glad all is better, and thank you for all the nice comments. JG 10.19.10

Question:

Hi Dr. Garcia: Apropos your earlier helpful answer about a possible hematoma on my nose, could a CT scan actually visualize the(comparatively) small hematoma itself or did you mean get one to view the bone? (Ow, this thing hurts!)

Answer:

CT scan for soft tissue might show it. JG 10.7.10

Question:

Hi Dr. Garcia: I may have a hemotoma on my nose post revision rhinoplasty, as you so helpfully pointed out. There is still discomfort there and swelling, though it has gone down slowly, but significantly in the past year. Is it possible that it will totally resolve on its own -- without surgery? My surgeon has not mentioned the term hematoma to me, only swelling. Should I seek a second opinion? Thanks so much.

Answer:

after a year I fear that it will likely not get better without something being done. Swelling also can be there, but as in the case of a hematoma, it should be long gone by now. The hematoma either caused scar tissue to form there and is not getting smaller or it pushed the bones that were manipulated. I think a second opinion and maybe even a CT Scan to evaluate the tissues and bones might help guide you to the correct course of action. All the best.JG 9.29.10

Question:

Dr. Garcia: I asked the above question about uneven swelling and I forgot to mention that this was an extensive revision rhino, if that matters. Tks.

Answer:

just more risk of a hematoma is all. JG 9.27.10

Question:

Ever since cast off one side of my nose has been much bigger than the other, say, twice the size. It has been coming down very, very slowly for the past 13 months, but I have my doubts if my nose will ever be even. Why would swelling be so much more pronounced on one side, so as to make my nose deformed? I also had a black eye on only that side. I did not have more work done on that side, so I just don`t get it. Do you think I should get a steroid shot, I mean, this is a ridiculous wait.

Answer:

it can be due to a hematoma on the one side, or if the nasal bones had shifted onto the cheek during the healing process, the latter is quite unusual. With the fact you had a bruise on only that side, makes me think it is the hematoma, and at 13 months I do not think a shot would make much difference. By this time you need to start thinking you might need a revision of the fractures, sorry. JG 9.27.10

Question:

Hello, I had an open revision rhinoplasty about 4 1/2 mos ago. I have been taping it at night. Sometimes the tape does not come off easily and I have to pull on it. Could this be disturbing the skin and actually be causing more swelling? Thank you for any advice.

Answer:

should not be causing any swelling this far out from the surgery, no. JG 9.23.10

Question:

Hi Doctor, How`ve you been?. I had a revision rhinoplasty 6 weeks ago, but there is something i don`t understand, at my 3rd week after the surgery i was very pleased with my nose, but from my 4th week until now my nose got bigger and it stays like that, it supposed to get smaller and smaller by time but my case is the other way, please advise. Thanks a lot.

Answer:

I have been well, thnak you. The evouton of swelling at the point after surgery you describe is not uncommon. There can be periods of time where the swelling increases, but that is a short term thing and with time, especially in cases of revisions, should go back to the way it loooked like at the 3 week time frame in the relatively near future. JG 9.23.10

Question:

Hello, I am wondering if after a rhinoplasty, does internal swelling cause stuffiness? Is this related to external visible swelling? I have noticed that at times my nose feels very stuffy and is also appears swollen when I look in the mirror. I hope this question makes sense - does the stuffiness indicate that the nose is looking swollen? And why does it come and go? I am about 4 1/2 mos post op. Thanks.

Answer:

absolutley, it does, for a period of time. It will get better in time, but it is due to the tissues going through the healing process. JG 9.21.10

Question:

Regarding restylane in the nose, I was referring to the Tyndall Effect, when it causes the nose to look blue. Is this a problem if the skin is very thin to begin with?

Answer:

the thinner the skin, the greater the chance, yes. JG 9.16.10

Question:

IF a filler is going to be used in the nose, which do you use and like best? (I have heard that restylane can cause discoloration. Is that true?)

Answer:

I normally use Restylane, have used Radiesse on occassion and any filler, injected too superficially, can cause discoloration. JG 9.16.10

Question:

How long to medpor batten graphs last for in your nose? Do you have to redo the surgery at a later date?

Answer:

should be a one time procedure. 9.15.10

Question:

HI DR G: I had a septoplasty 5 weeks ago with batten grafts lower lateral cartilage, no bone work. My nose looks bigger and uneven. It looks a lot wider on the nose just above the nostrils. Do you think it would be swelling? How long does it for all the swelling to go away. I was thinking of getting filler put in to make my nose look even. What do you think? How long should I wait before doing this? Thanks for your time.

Answer:

there will be lots of swelling after the type of surgery you had, but I will say that the grafts being placed there will always add bulk to that part of your nose. Post-operative swelling is essentially gone in one year. Small amounts of filler can be done to hide the uneven swelling in the meantime though. All the best. 9.15.10

Question:

Hi Doctor, i have a quick question, are you familiar with Scarprin for scar treatment?, I had an open rhinoplasty where i reduced my nostrils, I`m trying to use it on my nostrils and columella. Do you recomend this product? Thanks a lot.

Answer:

might help some, it is just old fashioned silicone, nothing new. JG 9.1310

Question:

Hi Dr. G: In revision rhinoplasty, could a DOUBLE layer of fascia be, um, fashioned (folded or sewn) to fill in a slight depression (2 mm), as I am all out of septal cartilage?

Answer:

yes, but it might not provide as much of a correction as cartilage. JG 9.1310

Question:

Hello, I have sort of a strange situation going on...I had an open rhinoplasty about 3mos. ago. I tape it at night and so it looks quite nice in the morning. However, after I eat lunch, my nose gets very swollen and red (my cheeks also feel red and warm, but not as red as my nose). Any thoughts on why this is happening? Is it related to the rhinoplasty or could it be rocesea? Thanks for your opinion.

Answer:

doubt it is from the rhinoplasty, almost sounds like an allergy, Rosacea should not fluctuate that fast, sorry, wish I had more insight to give you. JG 9.12.10

Question:

Hi Doctor, I had an open rhinoplasty 1 month ago, I`m concern about the scar of my columella and nostrils, which of these 3 medicines do you recommend the most, Kelo Cote, Mederma or Vitamin E oil?... Thanks

Answer:

Mederma. JG 9.3.10

Question:

Hello Dr. Garcia, I am confused about something. I am 3 mos post op from an open revision rhinoplasty. I had a follow-up appt. today and the PS commented that the tip was still a little full but then said that about 85% of the swelling is gone at three months? Is that really true- even with a revision? I really think my nose is still quite swollen as if flucuates- looking good some days and then quite swollon on other days. I was hoping the tip would still go down a little bit - volume wise. What is your opinion? Thanks for any advice.

Answer:

it all depends on how much work was done. I think about 50% is gone in the first two months and the other 50% takes another ten months, so it is just guesses for the most part. If it is going up and down in size I think it likely wil end up loooking like it does on the good days once it has all settled in. Best of luck. JG 9.3.10

Question:

Hi You mentioned earlier in a post that Predisone can do as much harm as good when prescribed for post Rhinoplasty. I thought Predisone was good for warding off scar tissue by preventing swelling. can you tell me what detrimental effects it can have. Is it the side effects it is associated with or an effect it has on the nose during healing. Thanks Doc

Answer:

it can cause thining of the skin and adrenal gland burn out if used for too long, it will avoid inflamation but has no effect on warding off scar tissue. Swelling does not necessarilly cause scar tissue, that is more blood, and Prednisone has no effect on bleeding. JG 8.30.10

Question:

Hi Doc I had a complicated 2nd open revision with grafts after a terrible 1st revision that caused a lot of damage to my nose. The result is good but I`m 6 months post op and find I will get periods of persistant swelling ,then it will refine for 4 days and I can feel the tip cartilages and it feels soft and pliable and I think this is it, the swelling is over and it looks fantastic. Only for it to come back again and last for a week or so. I tape on a night and massage gently which all helps. I know about the Lymphatic drainage in the nose and know scar tissue holds the Oadema for longer. My question is can the Lymphatic drainage system be damaged in the nose longterm, so intermitent swelling will be a permanent thing. I have very thin skin and never had this after my primary but after my last (sucsessful) revision my surgeon cut away huge amounts of scar tissue in my tip left over form the very poor 1st revision. It was after this 1st really poor job this problem started and never left really. Good news is though, I have a normal nice looking nose now, so like you... there are some good guys out there and I am greatful to my surgeon for giving me back my face. Great site you are a Gent.

Answer:

I think if the swelling is aided by the massage it is OK to continue, but do not peform it too strogly as you want the tissues to readhere, otherwise the swelling can perisist. Hang in there, revision rhinoplasties take time to settle down. All the best. JG 8.30.10

Question:

Hi Dr. Garcia, I had septoplasty two years ago and I sent several emails to you in reference to pain. I recently figured out that the pain is sinus pressure between my eyes that comes and goes. I did not have this pain prior to the septoplasty surgery. My doc gave me an antibiotic and nasonex that did`nt help. I use the neti pot and it helps only temporarily. Any suggestions???

Answer:

the openings inside your nose where the sinuses drain from might need to be enlarged surgically. JG 8.30.10

Question:

Hi Doctor, I have a revision rhinoplasty 3 weeks ago. I had my dorsal bones narrowed and also my tip done. My question is about my dorsal bones, they look pretty wide, I know is because of the swallen, how long does it takes to get narrow?, do I need to do something to help it to get narrower?, like pressing both sides or anything or can I just leave it and it will get narrower by itself? Thanks for your time.

Answer:

it migth take 6-12 months to get your final resutl. It is a matter of time, pressing will help only temporarily for swelling. JG 8.30.10

Question:

Dr. G: What is your opinion of k-wire inserted into rib in the nose? Safe or what?

Answer:

safe in experienced hands, yes.JG 8.27.10

Question:

Hello, I have a couple questions about rhinoplasty. I am 3mos post op - are the bones usually fused and reset by this point? Is it futile to continue to squeeze the bones together? Also, can having a rhinoplasty lead to headaches or make existing headaches worsen? Thanks for the help!!

Answer:

doubt you can move the bones this far out, headaches can occur from sinus not draining well after the rhinoplasty. JG 8.24.10

Question:

HI DOC: I am 11 days post op from a septoplasty, no bone work. My septum was deviated to the left and my nostrils where uneven. The left nostril was pulling in and the tip of my nose looked like it was going to the right. I had baton graphs put in my nostril area. I thought the op would fix the unevenness especially on the left side and although its still a little swollen, the over all shape looks the same. Do you think once the swelling goes down its just going to look like it did before

Answer:

the only thing visually that will be changed with a septoplasty is at times, the deviation of the nasal dorsum and the deviation of the tip, if that was addressed, which it is not always corrected. There are many, if not most, septoplasties that treat the offending deviation internally only to relieve breathing difficulties but do not go as far as needed to correct visual deviations. JG 8.23.10

Question:

Dr. Garcia: I recently asked you abt. implanting a fascia graft (vs. filler) in my supratip area via the closed approach, to which you responded it was not difficult and should work well. Now I am reading that the fascia can roll, is very slippery and VERY hard to place accurately. O.K., Dr. Garcia, is this really doable or are you just extraordinarily talented? ;) Thanks!

Answer:

if the fascia is measured well and the pocket dissected carfully and no extra room left for it to move, then it should not roll, it is slippery but that makes it easier to place through smaller incisions. It is doable by most plastic surgoens, I think you wil hear things like that just as a part of telling patients all potential issues is all. JG 8.20.10

Question:

Hi Dr. Garcia, I had Rhinoplasty 9 months ago. The surgeon implanted awhite silicone material to place over the bridge of my nose to make the bridge look straighter and broader. unfortunately over the next 3 monthst he implant sat tilted and croooked and created ridges along the side of my nose. The doctor decide to inject Juvoderm to smooth the ridges on the sides and he also injected the top portion of the tip. Suddenly my nose started to turn gray and dark, but he sent me homw anyway. the next day when I woke up The tip of my nose had turned black and the rest was bloody red(Necrosis). I called the doctor`s office and sent him pictures with my phone. He called in a prescription of nitroglycerin paste and told me to put it immediately on my nose. He said he must have closed some capillaries and the blood couldn`t circulate. after 3 months, my nose still looks beet red. the doctor keeps asuring me that this will reverse, but I have`t seen any improvements..Can this be reversed.

Answer:

I think it will improve but likely not reverse, I suggest letting it heal as well as possible and then seeing your surgeon about what can be done to improve what is left. Best of luck. JG 8.19.10

Question:

Hello, I had an open revision rhinoplasty about 3 mos ago. I have been doing some compressions that my PS showed me to do. After I complete them, my nose does look much better for about a 1/2 hr or so. However it always goes back to looking bigger and from the side it appears that there is a hump right above the tip. Is this likely still swelling since I can compress it or is it scar tissue? Thank you.

Answer:

it can take a year for all of the swelling to go down and the skin to reattach, keep doing as your surgeon suggested and hang in there. JG 8.16.10

Question:

Dr. Garcia, your response on my filler vs fascia question gives me hope. Thanks a lot.

Answer:

all the best. JG 8.11.10

Question:

Post-revision rhinoplasty, the two sides of my supratip area are not even, the left side is fuller-looking by about 1.5 mm. My doc has suggested either a filler or placing a fascia graft by means of a closed approach. How hard is it to place such a graft endonasally and what is the likihood of a good outcome? Is a filler a safer bet?

Answer:

it should not be difficult and it should work well. Filler is easier but might not last as long. JG 8.11.10

Question:

hi doc, i asked you before regarding my nose tip and the filler, you said if the filler didnt disolve with the hyalaise then it may be scar tissue. iam quite concerned now about it as my nose tip looks big. ive heard of steroid injections but iam hesitant to try it as ive heard it can cause indentations and i dont want to risk disfiguring it further. Now iam considering tip plasty surgery to make my tip reshaped and smaller, will this solve the problem? and if its scar tissue here will they be able to ament the tip and make it smaller? your advice is much appreciated.

Answer:

if it is swelling, the steoid might help, but not if it is scar tissue, it will soften the scar tissue but not remove it. I cannot say whether more surgery will make it smaller, if the same amount of scar tissue develops after the surgery, you might end up the same. JG 8.10.10

Question:

Hi Dr. Garcia, I am wondering how long after a rhinoplasty bromelain and arnica are effective for swelling? I took it for about one week after but now am having swelling issues (9 weeks post op)- would bromelain and arnica help now? Thanks!!

Answer:

usually their effect is diminshed after 2-3 weeks, sorry. JG 8.6.10

Question:

Dr. Garcia, I had septoplasty back in Aug 2008. I am still experiencing a numbing pain in the septal area periodically. Can heavy weight training cause this feeling. I can`t seem to figure this out. Any suggestions!!! I can`t seem to figure this out.

Answer:

there might be some nerves that were transected during the septoplasty that have caused that and the sensation might never be totally normal, the weight lifting should not affect it long term but straining can cause the mucosa to swell short term and aggravate the sensory nerves, hard to say 100%. JG 8.2.10

Question:

Hello Dr. Garcia, I am wondering how one can tell if they have thick or thin nasal skin? I am blonde with very fair skin; however, I do tend to have oily skin and have prominent pores on my nose. Is it more likely that I have thick nasal skin and would this interfere with a rhinoplasty? Thank you.

Answer:

the pores being large and oily skin point to thick skin. It will not interfere with the rhinoplasty but will limit how sculpted and small the tip can be made. JG 7.29.10

Question:

Hello, I had an open revision rhinoplasty about 8 weeks ago. It was quite swollen for a couple weeks then settled down and I really liked the way it looked. However, the last several weeks it seems much more swollen and distorted. Are flucuations like this normal? Are setbacks/increases in swelling part of the normal healing process? I can not think of any reason for the increase in swelling. Thank you for your help!!

Answer:

yes, fluctuations ae the normal way things go, especially after an open procedure. I would not call it a set back in terms of healing, it just teased you with what you are going to look like in about one year, but then it took it away for awhile is all.Hang in there. JG 7.22.10

Question:

Hi, I have a question about massaging the nose after rhinoplasty. I know this temporarily removes some fluid/swelling out to the tissues but can it create rebound swelling by disturbing the skin and tissues? Would simple compression exercises be best or is it ok to use a combination of compression and massage? How long post op should this be continued? Thank you!!

Answer:

if done too aggressivley or too often, it might, but once the tissues have healed and readhered it should not occur. The massage is essentially compression with motion upward as there is no stiff hard spot to massage against. We have our patients massage three times per day for 1-23 minutes for 6 weeks after surgery. JG 7.18.10

Question:

Hi, Sorry, I just posted the question about kenalog`s effects. I forgot to ask, is ice of any benefit in reducing swelling 8 wks after rhinoplasty?

Answer:

Ice at this point will likely not do much, sorry. JG 7.17.10

Question:

Hello Dr. Garcia, I am about 8 weeks from an open revision rhinoplasty. Overall, I am absolutely thrilled with the results. My nose is still changing and the swelling seems to come and go. Do kenalog injections actually work to remove the fluid/edema from the nose or does it only soften scar tissue? Would oral prednisone help relieve swelling? Thanks for your help and advice.

Answer:

just soften sacr tissue. Oral prednisone will have as many bad side effects as good so I would not suggest using it. JG 7.17.10

Question:

Hi Dr. Garcia! I had a Rhinoplasty done 2 years ago and I have had a clear runny nose ever since. I walk around with a tissue every day. My PS referred me to an ENT and he perscribed 3 different types of medications at 3 different times. None of them worked. Now I`m supposed to go and see another Dr. at USC. I haven`t done that yet. Have you ever come across this problem? I need help, my poor nose is rubbed raw..... Thanks in advance for any help

Answer:

a rhinoplasty should not cause a runny nose, assuming no complications. A runny nose might indicate a sinus problem or allergies, so I am nto sure what it is you will need. I doubt it is due to the surgical procedure, but I think checking to make sure there is no fluid coming from the sinus or other areas from the fracture needs to be ruled out. A very rare issue could be a cerebrospinal fluid leak from an ethmoid fracture. JG 7.7.10

Question:

July 7, 2010 Dear Dr. Garcia: Ten months ago, I had an open rhinoplasty to narrow the bridge of my nose and to raise the tip. Unfortunately, the operation was not successful and I was left with heavy scar tissue on the supra tip of my nose. My nose is bulbous now, and I think it looks bigger than my original nose. I received three kenalog 10 injections to reduce the scar tissue, but they did not work. I heard you mention 5-FU injections; do you know of any doctors in the New York, New Jersey or South Florida area who have given these injections? Also, it`s been three months since the kenalog injections, how soon after can 5-FU injections be given? I am desperate! Please help. Linda

Answer:

I persoanlly do not know the injection practices of doctors in that area I am afraid. The 5FU injections can be given as soon as you find someone to do them for you, all the best. JG 7.7.10

Question:

Hello, how long after an open rhinoplasty with osteotomies is it ok to wear sunglasses normally? Thank you.

Answer:

3-4 weeks. JG 6.29.10

Question:

Hello, I have a question about proper massaging techniques post rhinoplasty. My PS instructed me to do compression and massage but did not go into detail with the massage and now is gone for about 2 wks. I read conflicting things - one is to gently massage the swollen area and the other said to use two fingers and massage downward toward cheek area on tip and bridge to encourage the swelling to drain into the lymphatic system which makes sense to me. Which would you recommend as most effective? thank you.

Answer:

the two fingers to push the fluid onto the cheeks.JG 6.8.10

Question:

Hello Dr. Garcia, Thanks for answering my question regarding massaging the nose after rhinoplasty. How often should I massage my nose? A couple times a day or more than that? Is there any benefit to doing it more often or is that likely to cause irritation? Thanks again.

Answer:

twice per day for a couple of minutes is all you need to do. More than that will not help and can irritate the skin. JG 6.5.10

Question:

Hello, is it normal to have some throbbing/twinges in the nose after a rhinoplasty? Not really pain just some odd sensations. I am about 1 and 1/2 weeks post op. Thanks.

Answer:

yes, that is very normal, will slowly decrease but you can occasionally get them even months later. JG 6.3.10

Question:

Hello, when is it ok to begin massaging the nose to reduce swelling after a rhinoplasty? can one begin immediately after the splint is removed? thank you.

Answer:

gentle massage after 8-10 days and more aggressive as the tenderness goes down. JG 6.3.10

Question:

Hello, I posted yesterday about splint removal after an open rhinoplasty (splint was removed yesterday). It got quite swollen as the day went on (as expected); however, this morning it is hugely swollen (even into the inner corners of my eyes) and extremely tender. I am surprised that it is so sore as I had no pain while the splint was on. Is this normal? How much swelling is normal and when might it be cause for concern? Is pain/tenderness normal? I do not have a fever and there is no redness around or on my nose. Would ice be of any benefit? I can barely stand to do the compressions my PS showed me - brings me to tears just to touch my nose. Thanks for any advice.

Answer:

can happen and swelling does cause discomfort I am afraid. Ice and keeping your head elevated for now and you might want to drop by your surgeon`s office in a week or so for a quick check to make sure all is OK. Best of luck. JG 6.2.10

Question:

Hello again its me the one with the rhinoplasty on april 19 I just posted...im sorry one more thing...my nose at the tip is hard like a rock...and even though the bridge isnt as hard, is still pretty firm but when i press it gently it looks like fluid in there maybe, kinda under the skin....do you think that once those issues settle down, my nose will blend better with my nostrils??? the arc that dents in above the nostril on me is now pinched in looking but i was hoping it was because the tip was still swollen??? sorry to ask, I just dont see how my dr would have done that because he said he wouldnt touch the nostrils and if he did they would look dented in, so I was real suprised by this. Sorry thank you, hope you had a nice holiday :)

Answer:

the hardness is all normal from the swelling, that will also take a long time to resolve. I think you will be surprised at how much it will change over the next few months. Thanks for the kind words too. JG 6.2.10

Question:

Hello Dr, I posted a question about a month ago, I had a primary open rhinoplasty on Aprl 19...you suggested to wait til 6 weeks to see how i like my results and if some of the issues i was having would get better, well some of the issues have gotten better, but my main problem is that the dr made a graft with my own septum tissue and he said this would help bring my tip down a bit. But now my nose looks really long for my face, and when i smile, my nostrils flare and the tip seems to point down now, when I had an upturned nose before! I was very careful to say i still wanted to keep an upturned nose and he promised he would...im not sure why the bridge looks so long and when i smile downturned???? (the profile looks perfect by the way, I like how he brought the tip down there, but I guess i didnt understand that if he added the graft id get such a long bridge)....if he removes the graft, do you think my nose would look less long??? is that simple??? ...also, when i smile...it feels like my nose is pressing into my upper lip skin when it meets my nose, it feels really fake, i think its the graft pushing my nose down, am I right??? Thank you so much sorry to bug you but my dr is out of state and is hard to communicate with.

Answer:

it is not a simple thning and if the graft is removed it will likely go back to the way it was. I will say that swelling on the tip takes time to decrease and therefore a less than ideal appearance can take a long time to settle down, especially after a graft. I think that as long as the other things have gotten better I would suggest time and a little massage to help the swelling on the tip decrease, but it is a very slow process. Hang in there. JG 6.2.10

Question:

Hello, I just had my splint removed today after an open rhinoplasty. I know there is much swelling and it is not possible to evaluate the results right now. I am just wondering how long the acute initial swelling usually lasts? I understand there is residual swelling for a year or long but what about the acute surgical swelling and bruising? Also, I know the tip is turned up more at the beginning - how long before that goes down to a more natural angle? Thanks for your help.

Answer:

the acute swelling will take about 6 weeks and the rest of it might take up to one year. The tip wil drop soem in 4-6 weeks. Best of luck. JG 6.1.10

Question:

For the past 3 years, my plastic surgeon has been injecting my nose with Juvederm to correct a collapsed nostril secondary to a kenalog injection following rhinoplasty. It works reasonably well but begins to visibly dissolve within 3 months. I can`t let it go longer than that because the whole left side of my nose begins to collapse and leaves my face looking twisted. My surgeon is now recommending small, incremental silicone injections to achieve an eventual permanent correction. I`m not eager to pursue a cartilage graft, as he`d need to harvest it from the septum, which might collapse the nose further. He already did an otoplasty on me, so there`s no spare cartilage in my ears, and digging into my ribs to fix this problem seems unnecessarily invasive to me. What are your thoughts about his silicone proposal? Safe? Would you suggest a cartilage graft instead? From the ribs? Thanks for your help.

Answer:

you can have a cartilage graft from a donor bank if you do not want the rib used. In most cases the size of the graft from the septum for this is small though. I think fillers have not done the job well for you and I would suggest the surgical option for you rather than silicone injections. Best of luck. JG 5.25.10

Question:

Hello, wondering what I can take post rhinoplasty for nasal congestion/runny nose? Is pseudoephedrine ok? When can I use Afrin nasal spray? I know you can`t use the spray for longer than three days at a time, just want something I can use once in a while before we go out to dinner or an event so that I am not costantly wiping my nose. Thanks for the help.

Answer:

allergy medicine is OK to take and I think after 10 days Afrin can be used. JG 5.23.10

Question:

Good Weekend Dr. Garcia! I am 7 weeks out from a minor revision and had Kenalog injections on either side of my nose to help with some swelling a couple days ago. My allergies have been acting up since then (they are seasonal and not caused by the Kenalog), and my nose has been a bit runny. I`m finding it necessary to blow my nose, but I am trying to be careful not to vigorously rub the sides where the injection were. Will the force of blowing my nose cause the Kenalog to move around?

Answer:

no, it will stay in place. JG 5.23.10

Question:

Hello, Just wondering how long to abstain from alcoholic beverages after a rhinoplasty? Not that I am a big drinker but do have several weddings in the near future. Thanks.

Answer:

just a couple of days. JG 5.22.10

Question:

Hello, I am having a rhinoplasty performed next Tues. I am wondering when to start the Arnica and do you recommend also beginning bromelain prior to surgery? I thought I had read somewhere that Bromelain can potentially thin the blood - or is that wrong? Thanks.

Answer:

2-3 days before. I have not seen bromelain thin the blood. JG 5.18.10

Question:

Hello, I would like to ask your opinion about my situation. I suffered an injury to my nose. The ER doc stated I did not break the bones but damaged/bent cartilage and had a septal hematoma. It looks visibly crooked and the left side sort of looks smashed. The middle third appears wider than previous. I was referred to a PS and he states he will need to perform an osteotomy to fix it and that there is some cartilage separation What does that mean and why is this so if the nasal bones were not broken? Thank you for your assistance

Answer:

the majority of the time what is broken in a nasal injury is cartilage and not bone, but when repairing the cartilage to straighten it out, the nasal dorsum part of the cartilage has to be pushed together and that usually requires the bones to be broken in order to push them together. Hope that explains it a bit more. JG 5.16.10

Question:

Hello, Just wondering how long after a rhinoplasty is it ok to use ibuprofen? Fluticasone nasal spray? Also, this may be a silly question - if a nose is made smaller during a rhinoplasty, is there extra skin? Thanks.

Answer:

I have them wait 10 days, same for the nasal spray, the skin usuallly shrinks quite well in most cases, especially the higher up on the nose it is. JG 5.11.10

Question:

Hello Dr. Im sorry to ask but Im noticing improvement in appearance (I had an open rhinoplasty 3 weeks today) the improvements are everywhere except the nostril and nasal fold area. Im hoping its still swelling but im not sure, my tip is still hard and swollen feeling, looks better at night, but my nostrils still appear too wide I feel (as my bridge was narrowed)...but it still feels like pressure on my cheeks when I touch them? Do you think the nostrils might be swollen still at 3 weeks??? They arent hard anymore like the tip though :(

Answer:

at three weeks there is still alot of swelling, the lower on your nose, the longer it takes for the swlling to go down. It wil take up to one year for the final result, so you need to be patient. JG 5.10.10

Question:

I had an open revision rhinoplasty & septoplasty in early May 2005. The tip of my nose still is a little hard and slightly swollen (noticeable only to me). In 2006, I went to a primary care doctor and he prescribed some Prelone syrup. Which helped temporarily. Later in 2006, I have tried lymphatic drainage by a physical therapist. That helped a little. 1. What might you recommend? 2. Which strength is more appropriate between Kenalog-10 or Kenalog-40 injections? 3. Isn`t there side effects with cortisone injections like: a. Tissue atrophy? b. Can it be difficult to control what the final result will be? c. Skin thinning & vascular proliferation (additional blood vessels)?

Answer:

I am afraid there is likely not much that will help as the problem is long standing, I think the degree of improvement with steroid injections at this point is minimal and if any will likely be temporary. The steroid injections can inded cause thinning of the tisseus and also the broken blood vessels. JG 5.9.10

Question:

Hello, I suffered an injury to my nose during a fall and am wondering if it is possible to damage the cartilage without actually breaking the bones? It looks and feels like the cartilage is bent in the middle part of my nose making my nose look crooked. Also there is now a dent on the left side of the tip. Can this be fixed without breaking the bridge of the nose? Thank you.

Answer:

yes, cartilage can be injured without a bone injury. I think most likely it can be repaired without breaking the nasal bones. JG 5.4.10

Question:

Hello Dr. I had a rhinoplasty 2weeks ago yesterday...I am so upset, I feel the dr narrowed the bones at the top too much and now my face looks weird! I dont look like myself, and my nasal folds appear really deep now, its werid but its like my upper face is sagging now or giving it a longer look cuz those bones are gone...has anyone else ever had this problem or am i just panicking??? Also, I told the dr I liked my rounded nostrils and id like them to stay that way...but I didnt realize he was gonna narrow the bones so much, so now it kinda looks like a parenthesis!!! Why didnt he consider this??? Im hoping my nostrils get a little less puffed out they still feel stiff do you think they might unswell and look less like a parenthesis??? He supposedly didnt do anything to my nostrils but they appear rounder instead of longer from basal view and VERY uneven, so maybe its just swelling????? Please help, This is soo frustrating, also my dr is from a different state or id just go see him and ask so I feel very helpless in my recovery :(

Answer:

I think it is too early to get worked up about things as you are still too close to the surgery date, I suggest giving it some time, at least 6 weeks before re-evaluating things. At this point there is lots of swelling that can cause distortions so I would not make any judgements at this time. Hang in there for a bit more. JG 5.4.10

Question:

Hi, Rather embarassingly, I tripped while on a treadmill, smashed my face on the panel and suffered a broken nose. The ER doc packed my nose because it would not stop bleeding but did not do anything else. He did refer me to an ENT specialist. My nose is hooked to the left and it looks like there is a dent - could that be cartilage damage? I am wondering if I should have an ENT do the surgery or consult an experience facial plastic surgeon? Thanks.

Answer:

an ENT should be able to perform that surgery, it is a common procedure for them. Best of luck. JG 4.24.10

Question:

Hi Doctor, one more question. I`m not interested in filling the area out as much as I am just reducing the supratip scar tissue which feels soft anyway. I have a tip cartilage graft. Could a series of kenalog injections help resolve the supratip fullness almost 4 years out? Also, does kenalog adversely affect cartilage grafts? I heard it can but wasn`t sure if it was a myth. Thanks again.

Answer:

kenalog might not work, surgery will be more effective. JG 4.23.10

Question:

Hi Doctor. I am 4 years out of a primary rhinoplasty. I am happy with my tip however my bridge from the profile does not look good. There is a dent and what must be some scar formation in my supratip from overresection and dead space. Do you think it is possible to correct these issues using a closed procedure without affecting the shape of the tip? From the front view the tip looks nice. It`s the profile view that looks irregular. Thanks for the time.

Answer:

should be able ot be done, or conversely you can use fillers to smooth the nasal dorsum out. Best of luck. JG 4.23.10

Question:

Hello Dr...I am very upset, i am 2 days post op from rhinoplasty and while i have a cast on and cant see most of my nose the tip i can see....the dr was just supposed to take a little off the knobs ...nothing to change the nostril hang or to minimize the columella. Now my columella looks flat and giving my nose a very upturned look...giving a really high nasolabial angle...it looks terrible....do you think this is gonna go away??? or after the swelling goes down my columella will look normal...also i had open rhinoplasty...im just so upset, i never thought my dr would change something we didnt discuss, espically i liked my nostril hang area. Thank you so much for help

Answer:

I think at this point ther is an enormous amount of swelling and I think it is very premature to even look at the nose to see how you like it, things will change for up to one year so you need to give it time. JG 4.21.10

Question:

Hi Dr. Garcia, I would like to ask your opinion about something. I had an open rhinoplasty in 2008 in which a graft was placed over the tip. I recently found out that there was zero reduction in size (spoke with my surgeon) as he only placed the graft to correct some asymetry. I feel my nose is still too large and somewhat bumpy. I saw another very experienced surgeon who explained the procedure about how he would reduce the overall size of the nose which is what I wanted in the first place. 1) Does this seem reasonable and safe two years after the first surgery (the PS stated my nasal skin was healthy) and 2)should I expect a lot of swelling? How long before surgery and how long after should I take arnica and bromelain? Thanks so much and sorry for the long question.

Answer:

it seems reasonable but I cannot say 100% without seeing you in person. As to the swelling, it will likely last longer than last time I am afraid. I would start the arnica nad bromelain 2 days before and continue for 2 weeks or so. Best of luck. JG 4.20.10

Question:

Good evening Dr. Garcia :) Is there a window of time that kenalog can be used for swelling after revision rhinoplasty? In other words, when is it too soon after surgery, and when is it too late for it to be effective? Thanks, and enjoy the rest of your weekend!

Answer:

the later the time, the less the effect, I suggest in the first 6 months, after that, the effects will be much less. I would not do it for at least 4 weeks after the surgery is performed. Best of luck. JG 4.18.10

Question:

JG 4.16.10I have a curved nose that slightly tilts downwards and I notice my upper lip is full, but does not appear that way because it slants on a downwards angle as well making it look a lot thinner than it is. I think I remember reading somewhere that the projection of the nose can also change the projection of the upper lip and lift it. I have considered rhinoplasty for years would this help the lip problem as well? Could fillers also change the angle of the upper lip? Thanks

Answer:

the rhinoplasty can, in a small percentage of patients, alter the appearance of the lip, but that is not common. Fillers are commonly used for the lips and that might be a more predictable intervention for you to consider.Best of luck. JG 4.16.10

Question:

Hello, I have a question about a very frustrating situation. I had an open revision rhinoplasty about 2 yrs ago - the first one was about 13 yrs ago. My nose still changes there are times when it seems larger and I am seriously considering another surgery, then it seems overnight it looks better - could this still be swelling? Why does is still change so much? Are there certain things that will increase or aggravate swelling -even 2 yrs later? Thank you.

Answer:

surgery will help change things that are static, but things that change, like your potential swelling, will not be improved with more surgery I am afriad. It is difficult to say why it is happening, thinsg normally heal and reattach, but some individuals, for some unknown reason, can have intermittent amounts of swelling. It could be allergies or other irritants that can trigger it, or even the position when sleeping, face down will cause more nasal swelling. Wish I had more to offer. JG 4.15.10

Question:

Hello, I am considering a second revision rhinoplasty (would make three total) to the tip are only for some refinement. This is to be a closed procedure with a bit of cartilage trimming. Doc is very reputable in my area and I have talked with several of his pts. He plans to use local anesthesia only and believes the procedure will be very breif -15 to 30 min. With this type of procedure, what is the healing time? I am reading 12 to 24 months? I can`t imagine going through more healing time as it seems I have been in the healing stage forever!! With this minor procedure, is it really true that results will not be seen for at least a year? Even if I ice afterwards and follow post-op directions to a T? Please advise. Thanks so much!

Answer:

final result will be 12 months, yes, as the swelling is slow to resolve on the tip, the swelling only goes down when you are flat on your back. Ice helps but will not shorten the time by much. JG 4.13.10

Question:

Dr. Garcia, Thank you for taking questions. I had revision rhinoplasty about 2 years ago. Last month I was hit on the side of the nose and it looks like the cartilage is higher than the bone now. I have a decent size bump right on top of my nose. I thought it was swelling at first, but I think I might have broken it. I made an appointment with my plastic surgeon, but I was curious if he could file down the bump that is there in his office or if I would possibly have to undergo another rhinoplasty. I would prefer not to undergo another surgery, but are there ways to even out the cartilage without going through major surgery. Thank you again.

Answer:

in a small percentage of cases a small procedure in the office can be done, all depends on what is causing the bump. JG 4.12.10

Question:

Hello, Sorry just posted the question regarding tip grafts with septum cartilage. Wanted to also ask if it could be displaced/damaged if I have been massaging my nose? Thanks.

Answer:

it can be, especially the first few months. Usually if I place a tip graft I do not have the patient massage for a couple of months to avoid the graft becoming displaced. JG 4.11.10

Question:

Hello, I have a question about rhinoplasty grafts. I am a little confused. I had an open rhinoplasty procedure with a tip graft. My PS stated my nose was very asymetrical and so he had to place a graft (from septum) over the entire tip. Does this mean he took a thin piece of cartilage and laid it over the tip like a blanket? I have been reading about grafts coming through the nasal skin. Could this be a possiblity in my case? thanks for your advice

Answer:

that is what he did and grafts poking through the skin are quite rare. JG 4.11.10

Question:

Hi - I asked the question recently regarding a minor revision to tip via closed rhinoplasty. Thank you for your advice. You indicated two weeks before treadmill or low impact aerobics - I forgot to ask, how long before it is safe to do light (5#) hand weights (lunges, squats etc), abd crunches or resistance bands? Is that 2 wks or 1 month? Thanks again

Answer:

less than 20 lbs at 2 weeks, no limitations after 4 weeks. JG 4.11.10

Question:

Hi Dr. Garcia, I am having a minor revision to my tip via a closed rhinoplasty with only a local anesthesia. There is going to be tip work only - a little trimming of cartilage, no manipulation of nasal bones. What is the general guidelines for how long to abstain from aerobic exercise? Are there any diet restrictions? There will not be a hard cast on my nose - do I need to be more careful to sleep on my back with head elevated? Thanks for your advice.

Answer:

I would refrain from any impact training where there is bouncing on a hard surface for one month, non-impact training such as walking on an treadmil or an elliptical trainer could be done after 2 weeks I feel. No special dietarty restrictions and I would avoid sleeping face down for at least one month. Best of luck. JG 4.11.10

Question:

Hello Dr. Garcia. I hope you are enjoying your weekend :) I had the outer splint (cast) removed from my nose last week and loved the slim and narrowed look of it. I`m aware that the nose swells after the splint comes off, and one side does look a little bit puffier than the other. However, when the swelling does finally resolve, will it even out and be slim and narrow like it was when the splint first came off? Thanks so much!

Answer:

should be like you saw it after the cast came off, yes. All the best. JG 4.11.10

Question:

Hi doc, Just wondering if scar tissue can swell and shrink? I am asking because I had an open nose job about a year and 1/2 ago. When I tape my nose at night it looks good in the morning but seems to swell by afternoon. How do I know if this is scar tissue or swelling? Thanks.

Answer:

not reallly, but it can slow the swelling`s resolution. Scar tissue is a stable material. Sounds like swelling in your case that comes and goes for some reason. JG 4.11.10

Question:

Hello, I had an open rhinoplasty about 18 mos ago. If I tape my nose at night, it looks great in the morning but then by afternoon begins to puff up and look swollen. Why is this happening? Thank you.

Answer:

it is swelling but I have no good solution to correct the problem I am afraid, sorry. JG 4.7.10

Question:

Dr. Garcia, Thanks for taking the time to answer my question. I had revision rhinoplasty about 2 years ago. Nose was a little crooked still, but started pushing on cartilage to hopefully straighten it. Not terribly hard, but applying some good pressure on it. I did this for about a month. Now I have a pretty good size bump on the other side of my nose. What is this from? Is it permanent? Will it go down? I know you would have to examine me to find out, but wanted to see if you could possibly take a guess and let me know. Thank you.

Answer:

most likely just swelling, do not think that pushing the cartilage around will do much good though. I suggest leaving the tip alone for now and letting the swelling go down on its own, if anything, just a little ice. All the best. JG 4.7.10

Question:

Hello Dr. Garcia. I hope you and yours had a lovely Easter! Does the cast/splint that`s put on the nose after a revision rhinoplasty determine the final shape? I don`t want the splint to cause dents, or a fabricated/molded look. I didn`t have any bones broken, just some fascia overay removed that had migrated on top of my bridge bone and slightly between my eyes, as well as some cartilage scoring on either side of my nose to narrow it a bit. Thank you! :)

Answer:

I had a wonderful time with family, thanks. As to the cast, and final shape, not really, it is more of a protection of displacing the bones right after surgery and an attmept to reduce swelling. I think the ultimate end results are not significantly influenced, although you might see the end result slightly sooner is all. All the best. JG 4.5.10

Question:

Hello, I have been reading about 5fU injections in the nose to help reduce scar tissue post rhinoplasty. What is the benefit of this vs. kenalog? What are the side effects. Which do you feel is more effective for scar tissue? Thanks.

Answer:

there is no risk of thinning skin and I feel it is as effective if not more than kenalog. JG 4.4.10

Question:

Hello, I had an open procedure nose job a couple years ago. the left side looks great, but on the right, there is a piece of cartilage near the top of the nose that is sticking out -I think it is cartilage because it feels springy when I push on it. it appears as hump from the profile view but looks perfect if I push it down. How can this be fixed? thanks

Answer:

need surgery to trim the cartilage down is all. JG 4.4.10

Question:

Hi Doc, I have had several nose surgeries the first was in `95 and the second in 07. The second was an open procedure to correct some assymetry. My nose is still not right with very little definition. My cast did not fit properly and actually fell off after the second surgery. I was also not given any post-op intstructions -only slept with head elevated for a week and began exercising after 2 and 1/2 weeks. I now have a polly-beak look and it still feels swollen. Is it possible that those early days caused the poor healing? Would it be worth trying a revision and allow proper healing? Thank you.

Answer:

Although those things happened, I do not think they have caused the polly beak deformity, that is usually due to the cartilage that has been altered. As much as I hate to say it, it might need more surgery to correct if it bothers you that much. The cast falling off will allow more swelling and possibly some widening of the bridge if the nasal bones were broken. The post operative activities are not too far different from what you would have likely been told, so that likely did not influece the issue.Sounds like you need more cartilage and septum work is all. Best of luck. JG 4.2.10

Question:

Hi Dr. thank you for your answer regarding a graft inside my nose to bring down my tip and project my nose out. :) I just had another quick question...i only want my tip brought down maybe 2 millimeters ( I know that sounds small, but i think anymore would make me look weird and change my profile too much) I also only want a slight projection...do u think that is reasonable with the type of graph I described to you that im getting??? Which was made from tissue inside my nose? Thank you so much for your time :)

Answer:

yes, it is reasonable. I think using your own intranasal cartilage would also be best. Good luck. JG 4.1.10

Question:

Hi Dr...i have a question about my upcoming surgery and i guess i didnt understand when my dr. explained it...he is using a graft from tissue inside my nose to make it a little bit longer and bring the tip down a little...my question is, where is the graft placed in the nose? In the bridge area? I am concerned about my tip remaining natural looking and he is supposed to be taking only a small amount off to make it more of a triangle on each side instead of boxy but other than that i like my tip. Do u think the graft will play a factor in the way my tip looks, other than bringing it down a bit??? Thank you so much for your help :)

Answer:

in that case it is likely secured to the front edge of the septum to push everthing down and out more, to gain projection. The graft should just place the tip more forward, not change its shape. Best of luck. JG 3.31.10

Question:

Hi jst telling ya thnk u for the advice bout needing co2 for the nose! due to rocacea! I was planning to have a damn nose job altogether. jst wana know if co2 treatment starts how does it work with the bulbous nose? is it a one go thing? or need few treatments? my nose isn`t so big like the ones i jst saw on google search like sticking up , jst has a long oval shape moving forward but can tell it got fat. and also while searching for co2 for this problem i keep getting erbium laser treatment (in my location) will erbium laser do the job? jst cant find co2.. or im finding co2 fraction laser is that good??.. i really can`t find anyplace that does traditional co2.

Answer:

it works by actually debulking the thickness of the Rosacea, like a sander. In most cases it is a one time thing, at least for a long time as the Rosacea does not grow quickly. Erbium can do it also but it is going to bleed lots more because it does not cauterize the tissues like a CO2 will. I think the Fractional is a waste of time, especially for this problem. The debulking can also be done with a loop hyfercator, an electrical cautery device. Best of luck. JG 3.30.10

Question:

Hello, Sorry for another question. I am the girl who posted yesterday re:several nose injuries/surgeries, still experiencing swelling (well, maybe not). I just want to be clear as my PS keeps recommending solutions - so far - kenalog (have had in the past and does not seem to help) and a debulking of scar tissue. I can accept the results I have now but just want to be sure of the options as I feel my PS may be biased as he has a stake in this situation. My question is, after two years, isn`t it most likely that the swelling is not swelling that will resolve but rather scar tissue? I have been reading that scar tissue begins hard and then softens over time. The tip of my nose is indeed soft and squishy - is this most likely mature scar tissue? After two years, would kenalog even be helpful? And wouldn`t additional scraping/surgery just cause more scar tissue formation? I am going to try the steroidal nose spray to improve breathing. I would really value your opinion - at this point, is it best to just leave well enough alone? Thanks so much for all your help and honest answers.

Answer:

correct, what you have after two years is scar tissue, not swelling. I think the kenalog will be of little help in most cases. Cutting the scar tissue out just allows new scar tissue to form, the only time that would not occur is if there had been an infection or excessive bleeding which could potentially be avoided the next go round, but if neither of those two things happened, more surgery will likely not help. Personally, I would leave it. All the best. JG 3.30.10

Question:

Hello, I posted the question yesterday RE: several nose surgeries/swelling/impaired breathing. Thank you for your honest, straightforward response. I can live with the tip swelling; however, I love to run and so the breathing issue is what is most frustrating for me. I am very hesitant to do any more surgery. Would a steroid nose spray be helpful to reduce the swelling in the nasal passages? Thanks again for all your advice.

Answer:

certainly worth a try or those breathing strips can be worn to see if they help. All the best. JG 3.30.10

Question:

Hello Dr. Garcia, I have posted several questions and truly appreciate your advice. Here is my situation. I had an injury to my nose in 1997 and had it fixed via closed septo/rhinoplasty. I reinjured it and had it fixed via open rhinoplasty with septal graft to left side of the tip in March of 2008. I then needed a minor revision (straight local lasted about 15 minutes closed method) in Jan 2009. Right now, I am so frustrated with the whole deal - my nose still seems to swell - the inside feels very stuffy and it looks visibly swollen on the outside as well with no definition or contour at the tip at times. Is there anything at all I can do to reduce the swelling - would surgery to reduce the size help at all or only increase the problem. Thank you for your help.

Answer:

from what you are describing, with the repeated surgeries, there is likely a significant amount of scar tissue on the tip that is limiting the defintion there. I think more surgery will likely not do much to reduce the thicker appearance and sensation you have there as any scar tissue that would be remvoed would be replaced with new scar tissue I am afraid. I hate to say it but, you might be stuck with things as they are. JG 3.29.10

Question:

oh yea and with nose job, nomrally does it make a difference with the cost if surgery done to correct the bridge or the tip?

Answer:

the cost will depend greatly on what is done in total. JG 3.28.10

Question:

hi doc c the tip of my nose is like its growing after 30 yrs of age, female. I have like pores on it too. the tip is moving like forward and looks like a oval shape, c the nostrils from each side it looks like the oval shape is more noticable rather then flowing with each nostril. like i never had a problem with it before... does nose tip really grow? and the skin is looking thick... can i do surgery to fix the tip? whats the surgery called? and will the skin kinda be more smoother if surgery is done? and if surgery is performed will it grow again in the future? it look like eggplant.... bloody on a female face... and ye its got reddy look to i think its rosacea who knows.. can this even be fixed without surgery??... i know 2 many ques`s.. but thank ya

Answer:

if it is a skin problem, surgery will not help. If it is Rosacea it can be controlled with topical creams and antibiotics and in severe cases the skin can be lasered to reduce the thickness, unfortunately, it will regrow slowly over time. It will likely be a continued treatment series. JG 3.28.10

Question:

hi doc I have a bulbous nose tip im worried bout the tip only. with surgery to remove this problem will it be easier and lesser surgery time to fix this problem then doing a whole nose job? and will it take lesser time to recover? the tip is just looking like a mans nose , you know like fat sticking outforward from the boney part...

Answer:

smaller, yes,but it will still take a full year to see the final results. JG 3.25.10

Question:

Dr. Garcia - Thanks for your time. Can anything be done about overgrown oil ducts in the very tip of the nose. It looks bulbous to me and this is the place I have trouble with oil.

Answer:

might try some IPL treatments, sounds like a little mild Rosacea and the IPL along with some topical antibiotic Clindamycin should help. Best of luck. JG 3.24.10

Question:

Hello, I am about 2 years post op a second rhinoplasty (first one was in `97). Overall it looks good but the tip still feels very squishy and sometimes looks smaller while at times it still looks quite swollen. Is this still normal? Will it ever settle down and quit changing?!!! Many thanks for your opinion.

Answer:

it can be normal ,yes, but it might be like that from now on too.JG 3.23.10

Question:

Hello, I had an open rhinoplasty in March 2008 with a very minor revision in Jan 09. I am still experiencing swelling in the tip. I have been told and have read on my own that massage is no longer recommended and may be prolonging the swelling - what is your opinion on this? I also read that compression may be helpful but am unsure what compression means in that case - should I tape it at night? Do you know of any type of splint or dressing that would provide adequate compression to reduce the swelling? Thank you so much for advice in this matter.

Answer:

I agree that at this point the massage will not do much, but I also do not think it will hurt much.I do not think compression will help at this point either. I am afraid you are likely at the final result, sorry. JG 3.20.10

Question:

I had revision rhinoplasty about 2 years ago. I have been pressing on the side of my nose hoping to make it a little straighter. Can and will I do damage to my nose by pressing on where it is crooked or can I actually manipulate the cartilage and make it straighter. What do you advise? Thank you.

Answer:

do not think it will damage it but it likely will not make it any straighter this far out from the surgery, unless you broke the bones again, which I doubt you could do just by applying pressure. It will likely need more surgery to make it more straight. JG 3.3.10

Question:

Hi Dr Garcia,sorry I forgot to ask with the previous question,could the infection I have in my nose predispose me to more scar tissue formation then average,could it spoil my final result as I am happy with my result so far with little swelling.

Answer:

hard to say, it might dissolve some of it. JG 2.28.10

Question:

Hi Dr D I had an open Revision Rhinoplasty 17 days ago,I had extensive graftinga to the tip collumella strut,,spreader grafts ,crushed cartilage for facia grafts,some of this was harvested from my own septum and irradiated cartilage was also used.I have develop an infection in my tip and also what feels like my collumella inside and down in my septum on my lefthand side,I have had two lots of antibiotics and have just started my third.Could there be a reason why when I`m off the antibiotics this infection starts to rear it`s ugly head or should I just carry on taking them to be on the safe side and it should settle in time,Could this take a while to settle? Thanks

Answer:

it might just have not been a long enough period of time for the antibiotics to irradicate the infection, not all infections can be cleared with the anitbiotics. The grafts, in some cases, can be infected and might need to be removed, but that is rare. All the best. JG 2.27.10

Question:

Thanks for your help Doc. Is it strange that at 2 months post op I havent seen ANY changes to my profile? How long does it take usually for the bridge of the nose to go down and become less convex after a first rhinoplasty? My nose is still pretty tender on the top but its still very convex. May it never go down? I know it was rasped a little in surgery. Thanks!

Answer:

it can take up to 6 months at times, give it a little more time. JG 2.13.10

Question:

Hi Dr. It has been exactly 2 months since my rhinoplasty procedure. It was my first procedure. I had my nose broken and straigthened and slightly narrowed. I also had my nose rasped just slightly on the bridge. I have a two questions. 1. I have not seen any change in my bridge; it has not gone down at all, if anything its actually more convex than before. When do you most patients see the change on the bridge for their first procedure? Second, I had closed rhinoplasty and even at 2 months am having a lot of swelling. When i get a little hot my nose grows so big, sleeping and excercise is the same. I knew my nose would swell but i was not expecting this fluctuation. I have read from some patients in never goes away, will the fluctuating swelling go away and when? Many thanks Doc!

Answer:

well, it varies, the greater the swelling immediately after the surgery, the longer it takes, most patients should see changes starting at 6 weeks and they progressively see more for up to one year. Once the incisions on the inside have healed, it tends to fluctuate less and less, have to give it some more time. Hang in there. JG 2.12.10

Question:

I was wondering what it would cost to have my nose reset. I broke it in a car accident and never had it reset. I have breathing problems and some blockage. I was wondering if it is possible to just have it broken and reset. If you could help with this, that would be great. Thank you.

Answer:

most times that is covered by insurance and is done mostly by an ear, nose and throat specialist. JG 2.12.10

Question:

Hello dr...i was wondering how accurate you think the 3D Visual Imaging is for noses??? I really, really liked my after nose (it wasnt a hump removed but narrowing the tip and bridge )...do u think the results are likely to be pretty close to the pictures??? Im just wondering. Thank you so much!

Answer:

I do not think it is accurate as the human tissues of the nose cannot be predicted as to how they will shrink and heal. JG 2.11.10

Question:

I was in a car accident two summers ago. I was hit by a drunk driver and I broke my nose, bruised my cheekbones, and broke my jaw. I never had my nose reset and I obviously feel where the bone splits off on the bridge. I sometimes have breathing problems through my left nostril and it really bothers me. I had a great nose before and after my accident, I was playing football and my chinstrap came up and I felt my nose pop. My nose was swollen up just like when I broke it. I was wondering what I should do about it. I play baseball and very active in other sports. Every time I get hit in the nose just a little bit, it swells up and I have trouble breathing and find it difficult to sleep. Please help. Thanks

Answer:

I suggest you see an e,ar nose and thoat specialist to see if any surgery could help your condition, all the best. JG 2.9.10

Question:

Nearly 8 months postop from rhino/septo/turbinate work and while nose looks o.k., it still feels very odd-wooden, as if full of drying glue. Sometimes when I press it (as blowing nose) I feel a small shift/click and I have to press the opposite direction to right it--very odd. Approaching 8 months p.o., my breathing feels congested most of the time (was fine before and I only did septo/turbinate work as the doc is widely regarded as nose expert and I put faith that he knew best). It looks o.k., on the bright side. Sorry such a long question and THANK YOU.

Answer:

might suggest using some nasal decongestant sprays until it heals a bit more. Best of luck. JG 2.5.10

Question:

One more question Dr. Garcia. This is the guy from chicago who is still experiencing periodic pain that had septoplasty 16 months ago. What`s the longest time frame that you have seen it take to heal. I need to mentally prepare myself, because I had no clue septoplasty/somnoplasty would take this long to heal.

Answer:

if there is no exposed cartilage and no septal perforation, I have not seen it last longer than two years to get better. JG 2.5.10

Question:

Thank u for youre answer, but i did not understand, u say as u get older the skin gets thicker, and if it develops i would loose some detail in the tip. What do you mean by if it develops? Does the skin to all people get thicker by age? And when u say i would then loose some detail in the tip, what does that mean? Like the tip will come more down, or get bigger? Will it anyway be a significant change? Thank you very much, sincerely.

Answer:

what I mean is that the speed and degree of the thickening of the skin on the tip of your nose is variable and conrolled by genetics, so there is no way to predict how fast and to what degree it will happen. As to losing the detail, imagine placing a thin cotton sheet over a chair versus a goose down comforter, the sheet would allow most people to see that it is a chair where the comforter would only reveal a lump, that is how the thichkenss hides the detail of the tip. It is impossible to say how much of a change a person will see without feeling the tissues, and even then, it is an approximation. JG 2.3.10

Question:

Dr. Garcia, I had septoplasty 16 months ago. I periodically experience pain/numbing feeling in the septal area when I go outside and when I eat. I live in chicago and the temperature is cold. I went to my surgeon recently and she stated that she does not know why the pain is still there. I have talked to numerous people who have had septoplasty and I have been told that it takes a long time especially in cold climates. Your thoughts!!! I am miserable !!!

Answer:

not uncommon due to scar tissue and poor circulation on the mucosa covering the cartilage, warm normal saline sprays help, and using a humifier in your home too, it will get better, but very slowly, nothing to worry about though.JG 2.2.10

Question:

Thanks for answering my question, but I`m still a little bit confused. So the glucosamine and chrondoiton sulfates are the supplements that aid in rebuilding cartilage. I remember taking MSM with probably had one of these in it. So if I did take one of these supplements would it have an effect on how my nose looks?

Answer:

it can also help, it is more of an anti-inflammatory though. None of the three will affect your nose, they are for joint cartilage. JG 1.29.10

Question:

Would supplements that people take to supposedly rebuild cartilage in their knees etc, make the cartilage in my nose regrow after I`ve already had surgery?

Answer:

reported aid is with glucosamine sulfate and chondroiton sulfate supplements. JG 1.28.10

Question:

Hello dr. Garcia, I had open rhinoplasty 8 months ago,after having 2 previous closed rhinoplstys 3 years before. The surgeon shortened my tip and rounded it, when cast came off the nose was lovely, then later i got 2 dents at the side,i had juvederm put in only 3 months after the surgery. a tiny amount was put at the side of my tip, and ever since then, my whole turned hard and bigger and more drooped differnt from the shorter shape i had before. at first i thought it was the filler that spread over my tip, but another doctor i went to told me that becouse the filler was injected in the side of the tip, it may have shifted the cartilage over into the tip making it bigger, as the filler was a very tiny amount he said it couldnt have been that. Is this possible that cartlidge can shift from filler being ingected near the tip? and will it ever go back to normal? now iam confused as another doctor i went to told me it may be scar tissue and that i might need steroid injections, i really dont know what to do, can i get nose tip surgery again to correct this if its cartllage? Please do advice me as iam really in a dilema here. many thanks, sam.

Answer:

I think it would be difficult for the filler to shift a piece of cartilage. I think I would give it time for the filler to absorb and then re-evaluate things. I would wait a full year to let things heal and soften before contemplating another surgery. Best of luck. JG 1.19.10

Question:

Hi dr! Thank you so much for your answer! I had the question earlier about the nasal cartilidge graft. Yikes! I definately dont need a larger tip! I will have to speak with my dr because he wants to make my tip less bulbous he said and more of a triangle from the basal view as its boxy he said....also, he did say he felt my tip was projected he correct amount away from my face...just that it was upturned a bit too much ...so i am really thinking i am not in need of a cartilidge graft....hmmmm...thank you for your help though!!! :)

Answer:

that likely will need a graft from what you have told me, hopefully a small one. Best of luck. JG 1.15.10

Question:

hi again dr...its me again, the cartilidge graft girl...i just wondered if getting a graft in the nose increases the chance of necrosis and what is the risk of necrosis with any nose surgery??? is it big?? Thank you :)

Answer:

that would be an extremely rare problem, only if too large a graft were placed under very thin skin. JG 1.15.10

Question:

Hello Dr....my Dr. suggested a cartilidge graft made with tissues from inside my nose. He didnt say exactly what they would be for though. Ive consulted with other drs and they didn`t suggest this method. What sort of things would this be used for ??? Im confused, mostly cuz his plan is to narrow the bony base...make the bridge which he thinks is too wide at the top and skinnier in the middle more balanced ...and make it less boxy and more of a triangle from the basal view. Do you think he means he would use the graft to make the middle of the nose wider a little to match the bigger top bridge? Because i dont think i want the middle of my nose bigger, i would like the top skinnier then. I know i need to ask him these questions, im so sorry to ask all this, but i was mainly wondering if you think a graft is appropriate if i just want my nose slimmer and less bulbous tip????? thank you so much!

Answer:

a graft at times is placed in order to get better projection and give the tip more definition by stretching the skin, but by doing that, the tip will be larger. JG 1.15.10

Question:

I had a septoplasty performed on me two years ago to correct breathing problems in my nose. It seems that I am able to breathe better, but noticed a decreased amount of tip support. It looks like there is more of a droop. I have heard from a few bloggers that they experienced something similar. Is this a common effect of septoplasty surgery. If so, what is usually done to correct this?

Answer:

it should not be, usually an l-shaped caudal septum remnant can be left to avoid the tip from plunging, it can likely be repaired by adding some cartilage support to the tip. If the septal cartilage was removed, then ear cartilage can be used for the grafting procedure. JG 1.14.10

Question:

I had a fifth revision rhinoplasty with rib cartilage 11 weeks ago. to raise the bridge and open my airway..Batten grafts made of rib were used too.. The grafts are feel like bumps on the side of my nose.. and my airway is very sore...almost like I am getting too much air.. Is this normal and will the tissues adjust to the extra air in time? Thanks a lot.

Answer:

it can be normal, yes. The palapable edges should get better and as to the air feeling dry or too much, you can use saline nasal spray until it settles down some. JG 1.13.10

Question:

Hi Dr. Garcia. I had a rhinoplasty about 4 years ago. While I like the slightly-elevated angle of the tip of my nose, my nostrils are a bit larger than I had hoped for. Is it possible that a tiplasty could lower the tip`s angle and reduce the nostril size overall? Thank you, Bill

Answer:

you would need cartilage grafts placed in order to possibly achieve that and it would remove the elevation of th tip, the nostril got bigger likely because of the degree of tip elevation. JG 1.2.10

Question:

Hi Dr Garcia Thank you for answering my previous question regarding swelling post-rhinoplasty. My open procedure was done in March 08 with a very minor revision Jan09. You indicated that the swelling comes and goes due to the tissues being disturbed. My question is, should I continue with the lymphatic massage or will this disturb the tissue and lead to more swelling? Would compression (with fingertips) be more helpful? Thanks again!

Answer:

using tape at night is helpful in some cases, massage can help right after surgery, but massaging too hard can keep the skin mobile and that allows swelling to persist, so massage at this point, if done, has to be very mild and not aggressive. JG 12.29.09

Question:

hey dr garcia, i m african american male and had a nose surgery to drastically narrow my wide nose... it has been 2 months now and i haven`t seen great change... how long will it take for my nose to shrink or should i be anticipating a revivision

Answer:

I think you need to give it a good 10-12 months I am afraid. Best of luck. JG 12.28.09

Question:

Happy Holidays Doctor!! 5 revision rhinoplasty, lots of scar tissue, my doctor is iffy about using kenalog injections, but he won`t explain why. I feel I may benefit from it to help shrink the scar tissue to allow better breathing. I also have partial collasped nostril on one side. Do you know why he would be against using Kenalog? Should I go to another doctor? Thank you.

Answer:

liklyl because of the collapsed nasal valve potentially getting worse with the kenalog. JG 12.28.09

Question:

Hello, I had an open rhinoplasty in March 08 and a very minor revision in Jan 09. Well here it is almost one year later from the touch up and my nose is still quite swollen. Some days is looks perfect but then seems to balloon up over night. Is this normal and will it ever end? Is there anything that will help the swelling at this point? Why does it come and go? Thank you so much for your help. Have a wonderful Christmas.

Answer:

it is normal and there really is not much you can do, it is a matter of the tissues healing, some doctors try kenalog but it helps only for short periods of time. It will end eventually though. It comes and gose because the tissues have not totally reattached so when there is motion on the tip, new swelling appears, just like when you sprain an ankle and then start moving too soon. Hang in there. Merry Christmas and a Properous New Year. JG 12.24.09

Question:

Hey, Dr. Garcia, I have a odd problem with my nose. I`ve had two surgeries and although going into details would demand a long story, I`ll go ahead and say that my main problem is that my nasal roof and tip looks like a V going down from the front. If you look at Adam Lambert`s nose, mine looks like his, and I do not like that. With my revision surgery, I was wanting my tip to be spread out in the roof area and tip points to create a symmetrical nose, but I did not want sidewall grafts or anything what would make my nose look round or fat. My revision surgeon instead added huge grafts near my alar creases (the sidewalls) and did nothing to widen my tip points and roof, which still looks like a pinched turtle head poking through the center of my nose (from a front view). It seems like such a complex nose to get fixed again, but it just looks so odd! Do you think a another revision surgery would be a success?

Answer:

might be, I suggest using an open rhinoplasty technique so all the cartilage components can be seen and made sure to make the correction you desire. All the best. Merry Christmas, Happy Channukah and Prosperous New Year. JG 12.18.09

Question:

Hi Dr! I know you are not supposed to reccomend one dr over another, and i resepct that. However, I was told my a surgeon to see a nose specialist and I am trying to find a good one. Have you ever heard of Dr. Jack Gunter in Texas? I looked at his work online and it does look amazing. He does just noses and chins too. I would appreciate any info you can pass along :)

Answer:

excellent surgeon, and I have known him a very long time. You are in good hands. Please give him my regards when you go. JG 12.9.09

Question:

What causes an inverted v on the nose? Will retin-a help thicken the skin there? Or does it mean the nose is about to collapse?

Answer:

most of the time it is due from changes from a previous rhinoplasty where cartilage was reduced and the deformity then shows up. I do not think Retin-A will correct a V deformity of the nose as it is not a skin problem. It is a partial collapse of the internal nasal structures but it does not mean it will all collapse. JG 12.1.09

Question:

Hello, I am 9 weeks post closed rhinoplasy and septoplasty. I also has a tipplasty about 10 yrs ago but did not get results I wanted. I also have thick skin. My issue is I have a noticeable bump on the side of my tip that feels like cartilage. I can press it and it springs back. The other side is fine. I am going today to get a kenalog injection to the bump. My question is, will kenalog help dissolve cartilage or does it only bring down swelling? Any other suggestions?

Answer:

it only helps swelling, it does nothing to the cartilage. If it does not help you might need a revision that occurs with closed rhinoplasties as the visualization is less than an open procedure. JG 11.30.09

Question:

What is an inverted V on the nose? Is it hard to fix?

Answer:

usually where there is thin skin between the middle and lower third of the nose, what it would take to fix varies, it could be merely injections of a filler and it could also involve a revision rhinoplasty, impossible to tell without seeing you in person. JG 11.29.09

Question:

Hello, Just wondering if bromelain tablets and arnica would still be beneficial for swelling 10 months after a rhinoplasty? Thank you.

Answer:

only for recent swelling, sorry. 11.30.09

Question:

Hello Dr. Garcia, could Rhinoplasty help better improve my breathing (through my nose)? I suffer from rhinitis on occasion and sinus trouble regards Monica

Answer:

it is more of a septoplasty and turbinate modification that you need, rather than arhinoplasty, which generally refers to a cosmetic enhancement of the nose. JG 11.25.09

Question:

Hi Dr Garcia, I am an Asian who desperately needs a bridge on the nose; I am totally flat. I got a Teosyal injection on 4 Nov 2009. However it has not made any difference to my bridge at all; its still flat. I have decided to go ahead and get augmentation rhinoplasty done; the only time I am able to have it done is on 24 January 2010. There are some opinions that I should not do this as the PS is not able to assess my `actual` nose; however, I have photographed myself from the front, right and left view; the difference is hardly significant. Am I able to proceed with the augmentation? What is your expert advice? Will proceeding cause any problems in my augmentation? I really would like to have it done in January 2010.

Answer:

I really think that an in person consultation is best, pictures give the surgeon an idea but for implants, measurements usually are done best in person, all the best. JG 11.24.09

Question:

Hello Dr. Garcia. I had a rhinoplasty a few years ago. Now, I would like to do finesse rhinoplasty to bring more refinement to the tip area. A surgeon I went to see said that a revision would be unnecessary, as he could easily administer Kenalog in the supratip area to achieve the kind of refinement I want. Is Kenalog an alternative to secondary rhinoplasty if I want refinement to the tip area? Thanks so much for your help--Steven.

Answer:

It might, and I repeat, might help soften scar tissue but if a secondary rhinoplasty is needed, the Kenalog will not replace the surgery. Having said that, there are limitations to the tip refinement possible due to thicker skin and scar tissue, so one`s desires cannot always be met I am afraid. JG 11.23.09

Question:

Hello, I have had an open rhinoplasty and a closed very minor revision. (20 months and 10 months post op respectively). I have had several injections of kenalog after which the swelling goes down nicely for about 3-4 weeks but then seems to swell back up overnight. My PS is suggesting another kenalog injection and I am hesitant as I had some skin discoloration from previous ones that has finally resolved. I am also wondering if kenalog can cause rebound swelling and if it is best to just let the swelling resolve on its own? I would very much appreciate your opinion. Thanks!!

Answer:

no rebound swelling but if injected too large in amount and too close to the skin, it can cause skin atrophy and color changes, might be best to just leave it alone and let it get better on its own. JG 11.22.09

Question:

Hello, I am about 20 months post op from an open rhinoplasty and 10 months post op from a minor revision. I have a cold right now and my nose appears larger. Could a cold cause the nose to look swollen on the outside? Also, some times it looks very nice and then over night it seems to swell up again. Is this normal? Thanks!

Answer:

yes, very common, normal, and goes down slowly once the cold goes away. JG 11.21.09

Question:

Hello Dr. Garcia, I hope you can answer my question soon. I`m asian, and as a typical asian, I`ve flat nose bridge. I don`t wanna do the rhinoplasty at this point because of the recovery time, and also the price. Therefore, I was thinking about Radiesse injection. I heard and saw videos on Youtube, and it seems like this procedure is sort of safe, cheap and has an immedieta result. Only downside is that it lasts only 1-2 years. My question is that is this procedure is safe? What are the dangers? If it lasts 1-2 years, does that mean it start to disappear after year or it will be completely gone after 1 year? I also read that after injecting this filler many times, it induces the formation of new tissue from our body which can result to a permanent nose bridge from my own body. Is this true? Could you please, please, please tell me all about this procedure? Thank you and sincerely, Kay.

Answer:

In general it is safe, I do not think it will last that long but is quick and few side effects. Worth a try. JG 11.21.09

Question:

Dr. Garcia, I had Rhinoplasty surgery done 8 years ago. An artifical implant was placed on the top area of my nose to even out the indention that I had. Several years ago I noticed that the implant began shifting to one side and now I am left with a noticable gap on my nose. I really do not want to undergo another surgery unless it is completely necessary. My PS has injected some collagen to that area to make it less visable, however that only lasts a few days. Any suggestions?

Answer:

could try Radiesse or Artefill injections, they should last longer. JG 11.19.09

Question:

I will be having surgery in January to correct a devated septum. In 1991 was was in a boating accident and crushed the left side of my face. One year later they had to go back and do some corrective surgery on my nose. My question is this. Since I will have to go into surgery for the deveated septum and my insurance will cover this procedure, I would like to have the bump on the bridge of my nose reduced again (it is back from the second corrective surgery in 1992). Is this something that can be done at the same time as the deveated septum surgery?

Answer:

yes, it could be done. JG 11.18.09

Question:

I am a 75 yr. old woman with thick skin and I had an open rhinoplasty about 3 months ago. The Dr. narrowed the bridge of my nose and lifted the tip slightly. Four to six weeks post-op my bridge looked good and the tip of my nose looked smaller even though the tip was still swollen. The Dr. told me to rub Vit E on my nnse, which I did for approximately 3 weeks. This only caused my nose to swell up more. I am very unhappy with the way my nose has turned out. The Dr. has recommended Kenalog 10 injections. My question for you Dr. Garcia is how soon post-op should the injections be given to get the best results, and how soon after these injections will I see any improvement? Thank you for taking the time to answer my questions.

Answer:

the injections typically have to be doen a few times to make a difference and it might take up to one year in a thick skinned individual for the final resutls to be seen. The fact that it looked good right at the begining is a good sign for the eventual end result though, just need to give it some time. JG 11.17.09

Question:

Thank you!!Is Dr. F, Palmer in Beverley Hills an excellent surgeon for rhinoplasty revision and cheek implant surgery? I have what I see as white areas and skin colored swelling on sides of cullmella. It makes it wider and is painful when I apply light pressure. It was not there after surgery and became evident about 10 days ago. My surgery was Oct. 19th. Is this cartilage trying to poke through?

Answer:

it might be thin tissue over the cartilage, yes, but at this time I suggest waiting as it likely will get better with time, I am not familiar with Dr Palmer though. JG 11.17.09

Question:

hello dr.Garcia. i am a 22 year old lupus patient of african american heritage. i am going to be getting a septoplasty/turbinate reduction, along with a dorsal augmentation. i was reading some of the questions and i was wondering if i would develop un wanted lumps in bumps due to the septorhinoplasty? will i develop scar tissue that would be noticeable. and what can be done to prevent this. i am currently on corticosteroids by the way (a very low doseage) and i already got the consent of my rhemutalogist and PCP. thanks in advance for responding.

Answer:

I do not think you are at any higher risk than other patients and in general the risks are small JG 11.8.09

Question:

Hello, I had an open rhinoplasty 3/08 and a minor revision 1/09 (to left side only). Well it is still puffy on the left side. It looked very nice for about 2 weeks and then became swollen again. Is this normal and will the swelling ever be gone for good? Thanks.

Answer:

all normal and can take up to one year to totally resolve I am afraid. JG 11.7.09

Question:

Hello, Doctor. I have a bump on my nose and deviated septum. Also, when i push up the tip of my nose it makes some noise. Can this be corrected at the same time, and do you perform that kind of surgery? If you do, will be recovery be longer? Thank you.

Answer:

it should be able to be fixed but I do not perform septoplasties any longer, just purely cosmetic rhinoplasties, sorry. JG 11.6.09

Question:

Thank you for your quick respond. One more question. I don`t live in Las Vegas, so what`s the best way to find a great plastic surgeon. I know i should check his credentials and before and after, how many surgeries he has done...but it still very hard to choose. Any suggestions, and do you know great plastic surgeons in Denver area. Good bless you for being so helpful and patient. Thank you.

Answer:

go see Stacy Folk MD and tell her I sent you. JG 11.7.09

Question:

Hi Doctor, how`ve you been?, hope you are doing fine. Doctor, i have a scar on the tip of my nose, it happened after i did my second rhinoplasty, i really don`t understand how it happened, all scars supposed to be from the inside of my nose but he left me a scar from the outside. Doctor, which of these 2 gel do you recomend, SCARPRIN or Kelo Cote?, Thanks again.

Answer:

between those I suggest Kelocote, best of luck. JG 11.2.09

Question:

Hello I have been getting kenalog injections in the tip of my nose for over 5 years now for scar tissue from a revision nose surgery. The tip shrinks so nice for about 3 weeks, and then I need another injection. My doctor says eventually the scar tissue will stop. I want another surgery. What do you think?

Answer:

I would not do another surgery and I think after 5 years I would stop the kenalog injections too for fear of long term side efects. JG 11.1.09

Question:

hi dr. garcia I wanted to ask you of my skin and what type it can be. Each person says something else Im getting confused. I`ve got some capillaries on my cheeks and nose with redness but initially I`m light olive skin therefore my skin doesn`t turn red but the caps show in red and I`ve got 2 spots (on upper cheeks) with tiny snake like appearance in red ( bout 1-2 mm in length) I have large pores with often dryness and if i moisturise my skin just shines without hiding the dryness or the tiny lines. I also have tiny light brown spots (can see it on olive skin in spots up&close) if i wax It tends to leave red patches with some more capillierirs also with tiny blueish lines. I do have fine lines however when i use retina it makes my skin red and too dr

Answer:

sounds like sun exposure hyperpigmentation with fragile broken capillaries of the face that appear with age, and maybe a light case of Rosacea, unfortunately, all normal. I suggest no irritants on your skin like retinols and you need IPL or microdermabrasions for the pores and the spots and sunblock, not sunscreen, from now on. JG 10.30.09

Question:

Hi Dr. Garcia, I had a septoplasty and a closed rhinoplasty to narrow the bridge of my nose. I am about 2 1/2 weeks out and my Dr. took the cast off after 1 week. At first my nose looked more narrow but since has widened and almost looks the same as before the surgery. At my 2 wk follow up, my Dr. told me that happens sometimes and to squeeze my nose 4 times a day for 20 seconds. It hurts pretty bad but seems to temporarily work. Then I wake up the next morning and it is wide again. My question is- is this a normal post procedure technique and will it be affective or is there anything else I can do to help keep my nose from spreading back out? Thanks you greatly!

Answer:

all normal, it is just swelling that while the cast was on was controlled, that will take up to one year to totally go down, have to be patient. Continue the massage though, we do for 3-6 months. Best of luck. JG 10.28.09

Question:

Hello, I had an open rhinoplasty in March 08 and a very minor revision in Jan 09. It has been looking very good with no swelling. A couple days ago my nose became very swollen, red, and tender. My PS said that an infection at this point would be very unlikely. Last night what looks like a pimple appeared on my nose(my face does get the occassional pimple so this would not be unusual for me). Could a pimple cause the entire nose to become swollen? Also, I have still be massaging the nose - could this cause rebound swelling and redness? Should I stop massaging? Thanks for your help.

Answer:

yes, a pimple there can certainly cause that, I would stop the massaging at this point. JG 10.3.09

Question:

Hi Doctor, hope you are doing fine. I had a revision rhinoplasty 7 months ago and my nose is still big, but there are some days that my nose looks a little bit smaller and when i think finally this is getting better suddenly it looks big again and i get so frustrated, but after a few days it looks smaller again so i get happy but again after a few days it gets big, what`s going on?, is this normal?, it seems like my nose is playing with my mood. Thank you for your time.

Answer:

if ther are fluctuatiosn on the size, that is due to swelling and with more time, it will settle to the smaller size, revision rhinoplasties always take longer to heal than the first go round. All normal in revision rhinos, got to hang in there for a full year at least. All the best. JG 9.22.09

Question:

I had rhinoplasty with septoplasty and turbinectomy in July. My nose still feel like it is healing, the best way I can describe is it feels immobile, as if full of glue. There is the slightest, fleeting bad odor at times. Is this typical or normal at 9 weeks? Thank you for answering our questions here.

Answer:

all normal, it takes up to one year for all to soften up, got to hang in there. JG 9.09.09

Question:

Dr. Garcia, I had septoplasty a year ago. Still feeling sporadic pain where my septum is. The pain comes and goes. Have you ever given patients kenelog injections for pain.

Answer:

no, I have not and I am not sure if it would help, sorry. JG 9.8.09

Question:

Hello, I had a kenalog injection on Friday. I know sometimes kenalog can cause bluish discoloration of the skin. Does this happen immediately or over time? I had an area of bluish color immediately after the injection - is this just a bruise? Thank you.

Answer:

if it is going to happen it usually takes a few weeks for that to show up. If it happens right after it is a bruise. JG 8.9.09

Question:

Hello, I had an open rhinoplasty in March 2008 and very minor touch up in Jan 09. The skin on my nose feels very bumpy and loose (almost wrinkled in some spots). Why is this and is there anything that will help. Would lasers help tighten the skin? Thank you.

Answer:

not much to do except wait, secondary revisons will take more time to heeal then the first, migth take a year or more to tighten up, and laser will not do the trick, sorry. JG 8.7.09

Question:

Good Evening Dr. Garcia! I know that Kenalog injections can cause soft tissue atrophy at times, but does it have any effect on fascia? The bridge of my nose was built up using a piece of fascia from behind my ear. Overall, I`m pleased, except for one portion above my bridge bone. I was wondering if an injection of Kenalog there would dissolve it and take it down some. Thanks! :)

Answer:

the amount of dissolving it will do is unpredictable I am afraid. JG 8.3.09

Question:

Hello, I have been reading more about hyaluranidase injections and have found info that about 25% of people experience an allergic reaction? What is your experience with hyaluranidase? What are the possible side effects? Thank you for your help.

Answer:

I have never seen an allergic reaction nor any negative side effects from hyaluronidase injections in my practice. JG 8.3.09

Question:

Hello, I would like to get an injection of hyaluranidase to dissolve some restylane that I am not happy with; however, I do not want to go back to my current PS. I am wondering how someone else would know how much hyaluranidase to inject without knowing how much restylane was injected into the area? If too much was injected, would it dissolve the natural tissue in the area? Thank you.

Answer:

it is a satandard dose per area and it will dissolve some of the natural hyaluronic acid but yoru body remakes that part very quickly. JG 8.1.09

Question:

Hello, I posted the question several days ago regarding having restylane placed to the left side of the nose in May and then having a kenalog injection to the left side of the tip this last Monday. You indicated that this should not react with each other. Now it is Friday and the left side of my nose (especially tip) is still mishapen and quite swollen looking. Is this still normal? I have had kenalogy injections before and usually it looks back to normal after about 2-3 days. Is it because it is in the tip which does not get great circulation? Thank you for your help.

Answer:

it all depends on how much kenalog was injected and if they hit a small vein, both can cause prolonged swelling. The tip can show swelling longer as it takes longer for it to decrease there due to its anatomical position. JG 7.31.09

Question:

Hello, I received a kenalog injection several days ago and my nose is quite swollen. Is this a normal side effect of kenalog and when will this resolve? Thank you.

Answer:

yes, usually it is just the fluid of the kenalog, that should go down in a few more days. JG 7.29.09

Question:

Hello, At the end of May, I had some restylane injected into the left side of my nose to even out some bumpiness. This Monday, I had a small amount of kenalog 10 inujected into the tip area on the left side. It is feels and looks swollen. Could the kenalog hav reacted with the restylane and be causing the swelling? How long might this last? Thank you for your help.

Answer:

do not think there would be an interaction between the two. It is likely due to the Kenalog and might last a couple of weeks or so. JG 7.29.09

Question:

I fyou do not have any nose or ear catilage left for revision rhinoplasty, what can be used?

Answer:

rib cartilage. JG 7.25.09

Question:

Dr. Garcia, I have 2 questions for you? I had septoplasty 11 months ago and my nose is still healing. I notice that when I am hungry or when I have not eaten that my nose throbs at the tip. Once I eat about 20 to 30 minutes later the pain subsides and it comes and goes. In your experience, what`s the longest amount of time a septoplasty surgery has taken to heal. I was recently told by a lady that it took two years.

Answer:

usually 12 months but some people take as long as 18 months at times. JG 7.25.09

Question:

Dr. Garcia I submitted the question below in reference to feeling some discomfort at the tip of my nose. I had septoplasty/somnoplasty August 28, 2008. Will nasonex help with the pain i am experiancing from the nerves at the tip of my nose. Advice??

Answer:

nope, just time, sorry. JG 7.13.09

Question:

Dr. Garcia, I had septoplasty/somnoplasty August 28, 2008. I live in Chicago and the weather has indeed delayed the healing process. I do feel better than I did months ago, but I do still feel pain/discomfort at the tip of my nose at times. The sensation comes and goes. Is the tip of the nose the final location of where the nerves might be healing. I have been told by several doctors that nerves cut during septoplasty can take 1 year to 1 year and a half to heal depending on the person. Your advice????

Answer:

the tip is definitely the last place to feel better, yes, it can take up to one year. Best of luck. JG 7.13.09

Question:

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

Answer:

I would only do 2-4 sessions. JG 7.1.09

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

should be OK to do so. JG 6.10.09

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

silicone struts or Gortex. JG 5.17.09

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

all normal at this time, yes. JG 5.12.09

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

no. JG 3.5.09

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

all the best. JG 2.23.09

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

no, it should not. JG 2.9.09

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

certainly. Please send them to drgarcia@lvcosmeticsurgery.com

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

yes, 24-48 hours. JG 1.14.09

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

no, the MTV and biotin are OK. JG 1.3.09

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Answer:

not necessarilly. JG 8.14.08

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Answer:

all the best. JG 7.18.08

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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.

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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.

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

Hello dr Garcia. Are columella grafts safe?

Answer:

in most cases, yes. JG 5.16.08

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

Is there any medication to reduce swelling after nose surgery?

Answer:

Medrol pack can help. JG 5.4.08

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Answer:

OK.

Question:

Thank you.

Answer:

you are very welcome. JG 4.25.08

Question:

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

Question:

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

Question:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

Shifting of the cartilage too?

Answer:

possibly. JG 4.5.08

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

sorry but I have not, sorry. JG 1.28.08

Question:

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

Answer:

yes, that is allowed. JG 1.24.08

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

no effect on the naolabial folds, sorry. JG 1.15.08

Question:

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

Answer:

sorry but nothing safe. JG 1.14.08

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

yes, it returns without scar tissue. JG 12.9.07

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

sorry, but no. JG 12.5.07

Question:

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

Answer:

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

Question:

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

Answer:

at least one year. JG 12.4.07

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

just surgery I am afraid. JG 11.22.07

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

one year for a final appearance. JG 11.8.07

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

will not do much, sorry. JG 11.4.07

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

best of luck. JG 10.30.07

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

low risk if injected deeply as he says. JG 10.15.07

Question:

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

Answer:

I think it is probably safe. JG 10.14.07

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

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

Question:

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

Answer:

everything will be OK. JG 10.2.07

Question:

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

Answer:

can try ScarGuard or Mederma. JG 10.2.07

Question:

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

Answer:

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

Question:

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

Answer:

have to cut them somehow. JG 10.1.07

Question:

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

Answer:

not a problem. JG 10.1.07

Question:

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

Answer:

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

Question:

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

Answer:

no I do not think they should cause that. Stress can though, or a nervous tick. JG 10.1.07

Question:

I am 6 months post surgery and I just bumped my nose at the bridge and now there is a big bump there. Could I have rebroken it?

Answer:

possible but doubtful unless it was quite a strong blow. JG 9.30.07

Question:

Hi Dr. Garcia, Is it normal to have twitching under the eye and corner of the nose and mouth 9 months after rhinoplasty? My nose feels tight underneath the nostrils. Thanks so much.

Answer:

it can be, but twitching comes form either irritated nerves or also a nervous twitch form stress, so it might not be related. JG 9.29.07

Question:

i have wrote to you regarding my nose job that i done 7 weeks ago and now is swellen and red is that sinus infection or the bone is infected as all my nose is so red and swellon i am now in antibiotic is this dangerous

Answer:

should not be dangerous, no. I doubt there is a bone or sinus infection but you should see your surgeon for some antibiotics to help it heal better and faster. JG 9.29.07

Question:

i had a nose job 7 weeks ago i had swelling all my face now suddenly all gone and just sudenly my nose only swellen is it normal or an infection in my nose is the reason i am very worried

Answer:

doubtful it is an infection, could have come from something as innocent as blowing your nose, it should all go back down in time. JG 9.27.07

Question:

hi dr i am the lady that had a nose surgery with botox inject to my fore head the same time, as i told you my eye lids dropped after botox, which now 85% better however i have noticed that all my swelling in face gone and suddenly my nose is swollen very much is that normal?? now is 7 weeks gone from my operation. i am now worried. i had also on my left side of my nose from start like bump swelling that does not look reduced aswell. thanks for listening

Answer:

all normal, nothing to worry about, nose swelling is a long term issue but does get better, final results will not be there for 10-12 months though. Glad the droop is getting better. JG 9.27.07

Question:

Thankyou Dr Garcia for your quick response regarding the big lump that has formed right down my nose. Could this alredy be scar tissue forming? Towards the tip it is fairly hard but the rest i can squeeze it and push it around, although it does also feel hard to. The lump that is on the bridge of my nose definelty moves away when pressed so i know it`s not bone. A year hey, wow, what a long time, very depressing but guess there`s no other choice. I can`t understand how my surgeon didnt tell me to wait longer before redoing yet another one, he said it waS A walk in the park. He is a top surgeon in australia here to we did our research extremely well. If I had read this site before hand i would not of had that third revision, it was only the one ninor thing and all else was perfect, should of just lived with it! Anyway dr, do you think that i should continue on with steroid shots or something other than that to help along, i just dont want to use it to much and it have the other effect. I massage my nose everyday hoping that will do something little along the way. If you know of any way to minimise swelling quickly please let me know. Anyway thankyou so much for your time, the answers are really greatly appreciated.. AMANDA (australia)

Answer:

scar tissue is difficult to compress so that area is likely swelling, the scar tissue should feel firm. Well the surgery might have been a walk in the park for the surgeon, but the end result is you have to cut the grass and heal and that takes time. I think steroid shot should help though. Just not too big of a dose to avoid tissue atrophy, your surgoen will be aware of that, best of luck. JG 9.26.07

Question:

Hi Dr Garcia,Thankyou for your site, it helps reading and knowing that there are other people going through the same thing! Okay i first had open rhinoplasty done in Thailand in february this year, he removed the lump on the bridge of my nose and also took cartilage from my ear and did something with the tip, which i didn`t know about, it didn`t actually seem to make any difference though. Anyway after the splint was removed and i had come back to Australia i developed a lump on the side of my nose. I went and saw another surgeon here in Australia and he said that it wouldn`t go away without a revision done. Had closed revision done in April this year as my surgeon said there was no swelling visible still from previous one. Nose was perfect for about two months but then developed i think it was cartilage (it was really white) right on the tip which was very noticeable. So have just had another closed revision done, coming upto 7 post op now. My nose now has a big lump that has formed right on top of my nose, from the bridge til just before the tip and there is a lump on the bridge once again. I have had two steroid injection shots but it seems to have done nothing. I can pinch the lump, it feels squishy and soft. Just wondering what it is and if it will eventually go away? My surgeon showed me the photo he took just after he put the splint on after the operation and my nose looks perfect, will it go back to that ever? I realise now i should of waited longer before having the third operation done, if i knew it would make it heaps worse i wouldn`t of done it! Thankyou for your time, greatly appreciated! Amanda (Brisbane Australia)

Answer:

it likely will, sounds like just a lot of swelling due to frequent surgeries close together, but to get to the look you had in the photo may take a year or more, just give it some time, best of luck. JG 9.25.07

Question:

Hi Dr Garcia, I wrote to you last week about restylane in the dent in my nose following a rhinoplasty. Is this a kind of procedure most rhinoplasty surgeons can and will do? Is it something you would be willing to perform? Or is it a specialist kind of thing?

Answer:

I think it is a straightforward thing for any surgoen to do. I would certainly be willing to do it for people that would benefit from it. JG 9.24.07

Question:

Hello, I am 3 months post op after a tip revision rhinoplasty. My tip is still very swollen. I have been wearing sunblock and a hat but it is hot outside and hot in the car and in the house. Does summer months increase the swelling in a rhinoplasty. Is this permanent swelling or can it cause scar tissue ? How do people manage staying out of the heat for one full year in warm countries. I am not lying in the sun but I do have to go outside to pick up the kids from school and do errands ? What is the risk and is it permanent swelling ? thanks

Answer:

heat can increase swelling a tiny amount but nothing excessive. It cannot cause anything permanent nor cause scar tissue.JG 9.23.07

Question:

I send you an e-mail attached a picture of mine. I am interested in having a non surgical nose job. I need a little bridge. Please educate me on the different typse of filler and how long they will last and your price too. Thank youvery much for your time Doctor.

Answer:

let me look at the picture and then we can see, but the fillers are all about the $650 range or so if we use Perlane or Radiesse, they woudl last about one year, maybe a little more. JG 9.23.07

Question:

I had a tip plasty and narrowing of my nose almost 2 months ago. I did not have my nose bridge touched. If you perform non surgical rhino plasty on my bridge what is your initial charge or how my do you charge?

Answer:

well we charge in accordance with the filler used so it is by syringe, approximate cost would be $650 or so. JG 9.22.07

Question:

sorry I just post about the non surgical plasty. How much do you charge for a non surgical nose jobe I need a little bridge I had a tip plasty and narrowing of my nose almost 2 years ago.

Answer:

depends on filler chosen. JG 9.22.07

Question:

Hi Dr Garcia, I have two questions. I had a rhino a little over a year ago and for whatever reason (another doctor told me over resection). I was told that Restylane injections will help but that they are temporary. My doctor told me that sometimes it turns into scar tissue and becomes permanent. Is this true? Also is there such thing as a permanent filler and if so, would you recommend this instead? Thank you

Answer:

I do not think Restylane will become permanent with scar tissue. There are permanent fillers that can be used off-label like Artefil, but Restylane is a good place to start to see if what needs to be corrected can be done with fillers. JG 9.21.07

Question:

Oops i made a typo in that last message! What I meant to say was, for whatever reason, I ended up with a dent in my bridge, probably due to the overresection Sorry!

Answer:

got it. JG 9.21.07

Question:

IN RESPONSE TO THE QUESTION ABOUT NOSE LUMP, POSSIBLE CYST. WILL A CYST EVENTUALLY GO AWAY OR IS IT PERMANENT. DOES IT HAVE TO BE SURGICALLY REMOVED? OR IF THIS LUMP ON BRIDGE OF NOSE IS SCAR TISSUE, CAN MEDERMA OR ANYTHING LIKE THAT HELP SINCE IT KIND OF RAISED UP?

Answer:

it might need to be cut out. Topical therapy will not help a cyst. JG 9.19.07

Question:

REGARDING THE NOSE PICKING/SCAR TISSUE QUESTION. I HAVE PICKED WITH A TWEEZER, SOMETIMES UNTIL IT BLEEDS. IF I DID CAUSE SCAR TISSUE, WILL THIS EFFECT THE SHAPE OF MY NOSE? WILL IT BE THICKER LOOKING,ETC?

Answer:

should not if you have not had a chronic problem with it. It will not affect the thickness. JG 9.19.07

Question:

is there skin inside nose or is it something else. for some time now i have been having dry nose inside and i peel off dry flaky white see thru skin or at least that;s what i think it is. but it always grows back in a couple of days time. should i just leave it alone? this wouldn`t be scar tissue that i`m pulling off? also is this skin supposed to hold up the nose because sometimes it looks as if the tip is a little droopy after this but when skin grows back the tip lifts back up. is this possible or just coincidence? nose

Answer:

it is called mucosa and is not as strong as skin. Just leave it alone. I think the lifting is coincidence. JG 9.19.07

Question:

Hi Dr. Garcia. Is it true that the surgeon can see if there is cocaine use during rhinoplasty by a certain type of scar tissue that forms in the nose? Thank you.

Answer:

the most common cause for a septal perforation is either cocaine abuse or a traumatic septal hematoma that was large and went undrained, so they can at times tell, yes. JG 9.17.07

Question:

if a person overpicks their nose inside, can this cause scar tissue?

Answer:

potentially yes, especially if it bleeds. JG 9.17.07

Question:

in the middle of the bridge of my nose, i have a lump which is soft, so it`s not a hump. at times my nose will look almost straight and then it swells back up.when i touch it, it presses down. over a year ago, in that same area i had picked at some dry skin/pimple, maybe the new skin grew back with scar tissue????

Answer:

could be, hard for me to tell mroe without feeling it, could be a cyst also. JG 9.17.07

Question:

What does it mean that scar tissue retracts or subsides? Does that mean that some scar tissue will form after surgery and some of it sometimes slowly goes away?

Answer:

in time it usually flattens and softens in the healing phase, it never totally goes away though. JG 9.17.07

Question:

I have an nose operation and botox was injecyed to my fore head the same time when i was under annestetics(uncounsios)on 08/08/07, afetr 3 day i had a dropping eye lids in my right eye and also my mouth in my right side is dropped. now 6 weeks is gone i am 30% better i am worried that am i get fully recoverd from this.why this happened?? is the nose operation make my nerve like this or botox or the swelling make all of this. thank you for listening

Answer:

it can happen form the Botox migrating, it can happen if you lie on your side after the injections, should all wear off and not be permanent. JG 9.17.07

Question:

Hi Dr. Garica. For patients with very thick scar prone nasal skin: when does scar tissue peak and then subside follwing revision rhinoplasty? Thanks

Answer:

final softening and shrinking will be 12-18 months. JG 9.16.07

Question:

THIS IS A GENERAL QUESTION ABOUT NOSES, NOT RHINOPLASTY. IS THIS TRUE? SUNLIGHT ENCOURAGES THE NOSE AND/OR CARTILAGE TO GROW OR GET THICK? IS THAT WHY ELDERY PEOPLE HAVE THICK NOSES?

Answer:

no, sunlight does not affect it, it just happens with age as the oil glands tend to enlarge and thicken the skin with time. JG 9.16.07

Question:

Hi Dr. Garcia, I am very frightened and need your professional opionon. I had my first Rhinoplasty procedure done 8 weeks ago. I was noticing pain inside my nose and stiches sticking out. I went to a ENT specialist and they took out a quarter inch of prolene sutures from the skin side my nose. They said they could not get it all out because the doctor had threated it into the tip of my nose. Is this common to use this type of permanent suture? I went back to him several times and he just said it was dissolvable sutures that did not dissolve yet. Now I know he is not telling the truth. What do you suggest?? Thank you for your help! Sandi

Answer:

well some doctors do use prolene in the tip, I think you should ask the surgeon who did it and try to get the answers from him as they are the best to know what is in there. JG 9.16.07

Question:

Hello Doctor Garcia I had septo/Rhino 6 months ago. One of my concerns was my bridge was too wide and I had breathing problems. I had to have ear cartlidge placed as graphs and now the bridge looks even wider which does not fit with my face. Ny nose still feels somewhat numb. Will this possibly narrow in time and if not what type of revision surgery would you recommend? Thank you

Answer:

it might narrow some in time but not a large amount, the narrower bridge can cause difficulty in breathing though. JG 9.16.07

Question:

how do people get uneven nostrils after rhinoplasty? is this noticed right after surgery or several months/years?

Answer:

it can come from treatment of the cartilage, it is usually noticed after the swelling starts to go down. JG 9.16.07

Question:

Hi Dr Garcia, I wanted to let you know how much I appreciate your taking the time to answer questions. It`s a very generous thing you have here. I am appx. 1 year post op from an extensive rhinoplasty with extensive tip work done (including a tip graft). In the morning, my supratip area is slightly swollen. It goes down through the day, however, if I apply very gentle pressure (not much at all is needed) to the supratip area for maybe 10 seconds or so, the swelling goes away. I can almost make a miniature dent in the swelling. Could that area still be healing and improve in time? The swelling in that area was a lot worse a few months ago and two kenalog injections helped significantly. Thanks for the time.

Answer:

yes, very likley due to the extensive nature that there is still swelling, might take up to 18 months after surgery to slow down. Hang in there. JG 9.6.07

Question:

I had a rhinoplasy/septoplasty in Dec 2006. Seven months later I developed a bump on the bridge of my nose. My PS gave me a kenolog injection that helped but didn`t fix it completely. A month later (a week ago) he gave me another one and now it is actually worse. It`s like a big soft pimple on the bridge of my nose and feels sore. My PS thought this one would work but now I`m super upset. It there a chance it will eventually work or can I get a revision? Thank you!

Answer:

I would give it a few months and I think the bump from the shot will go away, but what was there before the shot might not. JG 9.5.07

Question:

Hi Dr. Garcia. I`m 1 month post-op open rhino and septoplasy and 3 month post-op bullhorn lip lift. So you can imagine the area is very stiff and feels like cement. Should I do smile exercises to loosen tightness and break up scar contracture? I heard tension is the worst for keloids.

Answer:

I think just giving it some time and light massage is all I would suggest. JG 9.4.07

Question:

Hi Dr Garcia, How long after rhinoplasty can kenalog injections be considered effective (for scar tissue/edema?) Is 1 to 1.5 years too long to have any effect?

Answer:

I think the longer one waits the less effective they will be. JG 9.3.07

Question:

Hi Dr Garcia, A quick follow up question, how long does it take for the skin to properly drape over the frame? It wasn`t so much the tape I was worried about, but the tape pulling the skin off the cartilage framework a week after surgery. You`re saying that that should not have caused any damage longterm?

Answer:

it takes months for the swelling to go down so the skin will not really re-attach to the cartilage for a long time, you are safe. JG 9.2.07

Question:

Hi Dr. Garcia. Does answering questions also help you get an idea of what works for patients and what`s problematic? Also, I asked last week about a dent in the tip after cortisone injection during surgery (3 weeks post-op) and it`s filling in a little already (I think). Thanks for putting my mind at ease.

Answer:

I always learn from all of the questions. Glad your issue is improving and best of luck. JG 8.31.07

Question:

Is it possible to have a revision surgery after having depression filled with Radiance? Will it create complications or is it OK once it reabsorbs?

Answer:

well it is probably best to see if it dissolves, but it will not cause any problems. JG 8.27.07

Question:

Hi Dr. Garcia. I`ve had a few rhinos. and had a revision 3 weeks ago. I always form a thick band of scar tissue above the tip. The surgeon removed the scar tissue and gave me a shot of cortisone at surgery time. Now I have a slight dent at 3 weeks. Every other time i had cortisone, it shrunk initially and sprang back up a little. Since I form a lot of scar tissue in general, do you think the dent will fill in...especially because I`m only 3 weeks postop and scar tissue peaks at 6 months (right)? Nervous here. Thank you so much!

Answer:

yes, it should fill in over time. Give it some time. JG 8.26.07

Question:

question about humps on nose. i know humps are genetic but can they come from trauma, hitting? is this permanent or resides over time? if hit on the top boney part? i have a tiny raised lump where a tweezer hit the upper boney portion of my nose, is this possibly just swelling or permanent since bone?

Answer:

trauma can cause humps too. If it is hard most likely it is permanent and would need to be surgical reduced. JG 8.24.07

Question:

Hi Dr. Garcia. I was reccomended to Dr. Guyuron for a rhinoplasty revision. Do you know much about his techniques? Thanks so much. You really help to ease peoples nerves. Invaluable service you provide.

Answer:

I think you are in great and talented hands. Best of luck. JG 8.23.07

Question:

how about radiesse or artecol to fill in nose indentation? Or is restylane still better and safer? Thanks!!!

Answer:

I would try the Restylane first and then switch to the other once the Restylane has absorbed, just to make sure it can be filled in to your liking. JG 8.21.07

Question:

Hi Dr. Garcia. I had the bullhorn lip lift (which I love) and a rhino revision 8 weeks later with a top revisionist. The doc who did my lip lift put in dermal fat grafts in the philtrum columns. The left side healed out of place. Can these be easily corrected through an internal incision (mucosa) ? I don`t want to cut under the nose again. Thanks much!

Answer:

I think it is better to do it from the outside so the muscle does not have to be cut through. JG 8.20.07

Question:

Hi Dr., I just had a question about the dressings (steri-strips) on my nose from my tiplasty...What are they for? and will my nose change if they came off and i put them back on?

Answer:

no probelm if they came off, they just help minimize the swelling. JG 8.17.07

Question:

Hi Doctor, I am a year post op from a complex rhino, and thick skinned. I still notice that sometimes my nose is a bit more swollen than othertimes. Is this normal and how long can swelling persist for?

Answer:

that can happen in some people for up to 18 months I am afraid. JG 8.13.07

Question:

thanks for answering about Iam 17 yrs old.. can I just send you some pictures so you can asses? Ive been looking for a celebrity look near me and Adriana Lima got my eye, maybe its because of her wide Alar but her bridge is really pronounced that made her look better.. so where can I send my pic? Thanks a lot!!

Answer:

please send them to drgarcia@lvcosmeticsurgery.com

Question:

Iam still 17 years old and asian with an oval face, big almond eyes and full lips. the only problem is that I dont have a prominent nose bridge and both my alar hang low, I also believe I have thick oily skin on my nose, so what can be done with it, I am thinking about alar trimming only, or will a bridge also be necessary? my nose is my only problem please help! thanks

Answer:

might need both I fear but hard to say witout seeing pictures. JG 8.11.07

Question:

How many Kenalog shots can a person safely get in their nose? I`ve had two with minimal results. It`s been 11 months since my rhinoplasty and the tip and cartilages are still hard. Granted, they have reduced some, but not as much as I would like. I am contimplating another Kenalog shot but am worried of the consequences.

Answer:

it all depends on the dose given each time. JG 8.11.07

Question:

Hi Dr.Garcia! I wrote recently regarding a facial tic. I had the upper bleph, rhinoplasty, septoplasty and turbinate reduction. The tic is still bothering me, but I have found if I hold my nose shut and breathe through my mouth, it goes away. What are your thoughts on this? Thanks so much.

Answer:

I am sorry but i really cannot say awhy that is happening, a puzzle for me too. JG 8.11.07

Question:

Dr. garcia, Can a ski lift type nose be straightened out?

Answer:

in most cases it can. JG 8.10.07

Question:

I have had a previous septoplasty and rhinoplasty in early 2006. I have noticed that my deviated septom has returned and my nose started to regain a swinging door apparence. Should I have a sense of urgency or can i wait another year before getting this taken care of? Also, can a septom be straightened?As well as, what can be done to round of rough edges around the tip of the nose and raise the bridge of the nose, i have heard about grafts and implants but which would be best for gaining a natural loose looking nose?. Thank you for your time.

Answer:

I think waiting is OK and in many cases the septum can be straightened but not in all. Cartilage grafts are commonly used to raise the bridge of the nose. JG 8.10.07

Question:

I had a rhino revision 2 weeks ago, where ear cartilage was slipped into a pocket in my bridge. The cartilage is warping a little creating a bump. It is springy when I push down. Will taping my bridge help and how long before scar tissue forms around cartilage?

Answer:

taping will only help a smal amount, I think you should return to the surgeon and be examined. JG 8.10.07

Question:

Hi Dr. Garcia, I just had rhinoplasty and septoplasty yesterday. It was my second operation. I was promised not a piggish nose, but in my cast that is exactly what it looks like. While before i had 2 tips at the end of my nose, i know have one which is what i wanted, but my nostrils are much more exposed than before. Is this just the cast and swelling or will this be a problem? Im very worried about this and thank you!!

Answer:

I think at this point it is likely due to the selling and the cast and should settle down quite abit, just hang in there. JG 8.9.07

Question:

Hi, I asked the question about the tip rhinoplasty a few post ago. Are there any questions I should ask? People say I shouldn`t mess with a problem that is not that bad. People have actually said I have a cute not. But it is Pug . I`m not messing with making it longer. Just want to thin the tip. I assume no nose breaking is necessary? Any thoughts or warnings? Wish you practiced in my town! :)

Answer:

well the only thing to remember is if your skin is thick it might not show the detail of the cartilag2e cahnges so your skin will limit the end result as much as the surgery. JG 8.7.07

Question:

What is the range in price for Rhinoplasty?

Answer:

in our office it can range from $4000 to $6300, depending on what is done. JG 8.6.07

Question:

Hi How long after a septoplasty can I start going back to the gym? My operation was three weeks and three days ago. Thanks

Answer:

2-4 weeks. JG 8.6.07

Question:

I`m a 50 YO male in very good shape. I`ve decided after all these years I really do want a nose, chin aug, lipo and possibly pec implant. Crazy at my age? I mean physiologically do difficulties arise because of my age? I do not foresee any complications such as deviated seps, etc. Probably the only problem might be that I only need less than 4 lbs lipo`d from the belt line.

Answer:

well I think the issues might be loose skin after the liposuction and at times a pec implant can have an unnatural appearance when your own pec muscle flexes. JG 8.3.07

Question:

i heard about using epsom salt on pimples so i tried it on my nose because of blackheads, well it made my nose swollen. i hope this swelling goes away. i hope it didn`t do anything to the cartilage? i have a graft in tip.

Answer:

all temporary, will all go away, you did not do anything to the tissue below the skin. JG 8.3.07

Question:

is it possible for a person to get a collapsed looking nostril from hitting. i used to see both of my nostrils when looking into mirror, now one side is half noticeable. i have a cartilage graft in tip and i hit it hard, when i hit it my hand hit the tip down and then back up. ever since, i noticed my nostril looked different, never noticed before. probably from hitting.

Answer:

could be from the cartilage or boens caving in, yes. JG 8.3.07

Question:

hi me again, i had asked about ice on nose. i dont think i have frostbite, but if i did what would be the symptoms? would the swelling be permanent?

Answer:

constant pain and the skin would look very white. JG 8.3.07

Question:

P.S. on my epic revision rhinoplasty question (blister-like cartilage showing through skin, strut bowing): Is there any possibility that, if a graft was placed too superfically in the nasal tip, it could resolve on its own? Doesn`t sound promising from other poster`s experience. Again, thanks.

Answer:

all depends on how thick you skin is, the thicker the better. JG 8.2.07

Question:

I had revision rhinoplasty 5 weeks ago (open with ear cartilage grafts) to repair 20+ year old rhino gone bad (tip too turned-up, right side collapse so no breathing, notching of nostrils so inside of columella visible on one side). Originally thrilled, could breathe for first time in years, very straight, swollen of course, but I was glad to see some volume back. Now, swelling going down very fast and, while breathing still great, two things have me fearful that things are going very wrong. First, a round red spot has appeared on one side of the tip (maybe half-dime sized). I see that you discussed with another poster that this could be the result of a graft placed too superficially. Second, the PS placed what he referred to as a floating strut in the columella below the septum. While he assures me that he inserted a straight piece of cartilage, it is bowing BADLY to one side and, I think, pulling the whole tip out of line. Worse, I can actually feel the tip of the thing kind of poking out (not through the skin . . yet?) on the end closest to my face. Of lesser but cosmetic concern, I don`t think the tip got rotated down very much, though its better. My PS has poo-pooed my concerns on these fronts so I have lost trust and made appointment with out-of-state top revision specialist (who was on my original list and who I probably should have gone to in the first place, but was convinced by this doc`s credentials). Long wait, however, and I am very concerned about the possibility of irreversible damage (tissue loss?) if these things are left alone for several months. Thank you for your kind and informed responses. You cannot imagine how helpful and calming it is to have an honest, straight forward and impartial opinion and to read that others have similar fears/problems.

Answer:

I think the potential of skin damage is small so I think you are safe in waiting a bit, but I understand your concerns, hopefully with time they will settle in without further surgery. The skin will tend to thicken up in time and some of what you are seeing now will look better but I am unsure as to the deviation getting better, hang in there. JG 8.2.07

Question:

thank-you for you website. I had revision rhinoplasty done 4 weeks ago to remove a ball of cartilidge on the tip that had formed. The doctor said it was cartilidge the nurse told me it was scar tissue. Now 4 weeks post-op there is still a ball at the tip not at the exact same location but still too much cartilidge. Is this swelling or am I doomed again ? What can be done ? thanks so much

Answer:

sounds like swelling, need to give it a number of months for all of that top go down. JG 8.1.07

Question:

Hi again I forgot to ask you the following. I had revision rhinoplasty done 4 weeks again (closed) and I have a bump or maybe it is a scar on the outside of the nose on the side near the nostril. The doctor just told me to put vitamin E on it. He said it formed because he had to come so close to the skin and bone to remove the ball of cartilidge that I had (it was all closed rhino). Do you suggest something else I am 4 weeks post op and it really shows alot ? thanks alot

Answer:

I think just a good moisturizer and stay out of the sun is the best. JG 8.1.07

Question:

sorry Dr., forgot one question...if possible to correct the current positioning of the cartilage, would it be better if done through open surgery?. 1st was closed, perhaps that is why the result was so poor & uneven. Is the healing of open much longer than a closed one?. Thank you again.

Answer:

placing the alloderm can be done closed too. I do not think the closed technique caused the cartilage to show though. An open technique has longer swelling time on the tip. JG 7.30.07

Question:

I had a septoplasty on 13 July 2007 and it is uncomfortable to wear my glasses. I want to check is it ok to wear my contact lenses (day and night ones) please?

Answer:

yes, OK on the contact lenses. JG 7.15.07

Question:

I had a septoplasty on 13 July 2007 and it is uncomfortable to wear my glasses. I want to check is it ok to wear my contact lenses (day and night ones) please?

Answer:

OK on the contact lenses. JG 7.15.07

Question:

HI. CAN I HAVE A NOSE JOB AS I AM 18 YEARS-OLD?IT REALLY BOTHERS ME PSYCHOLOGICALLY!!

Answer:

at 18 you can have it but we must determine that your are psychologically stable in order to do it for you. JG 7.13.07

Question:

If you have a bullnose lip lift, can you (at the same time) straighten crooked nostrils? The nostrils are not cemetrical and the nose is slightly slanted.

Answer:

it could be done at the same time,yes. JG 7.12.07

Question:

i was recently hit in the nose so i applied ice to ice, but then i found out that ice should not be applied directly to skin of nose and that`s what i did. i just placed an ice cube on nose. did i just further damage my nose. it seems more swollen?

Answer:

no damage in most cases, you just should not leave it in direct contact for long periods of time to avoid frostbite. JG 7.12.07

Question:

Hi Dr. Garcia, Thank you very much for this site. I had a nose job 9 weeks ago. My nose was long, had a large bump, very long nostrils (I could put three finger in it.) The doctor left some of the bump which is okay, but pulled it up so that I now have the columella pointing up and the tip of my nose is high. My nose now looks short and you look at my nostils. It is a nice nose but too short so I now have to walk with my head down to make it appear that my nose looks lower. Can my nose be lengthened and the columella be brought down so that it is pointed at a normal angle/level. This has also effected my speach as my upper lip now curles around the nose when I smile. Thanking you in advance for your experience and time.

Answer:

it can, it is more involved, it might require some cartilage grafts to maintian it too. All the best. JG 7.11.07

Question:

Hi Dr, Puffy tip guy. You said it could possibly stay this way. Could kenalog or anything at all help? You mentioned stitching it down possibly. Would kenalog do anything?

Answer:

If it gets better with tape then it is not scar tissue causing the appearance so I do not feel Kenalog will help. I think the issue is your ksin is thick and will not re-attach and adhere to show the underlying definition you desire. JG 7.9.07

Question:

HiDoc, I see. Do you still think that stitching the skin down might help,or notreally?

Answer:

it might, if you can get the skin to readhere and create a thin layer of scar tissue that will hold it there. Need to see your surgeon to see if it is possible. JG 7.9.07

Question:

Hi Dr Garcia, I posted previously about a puffy supratip area. Well, my doctor has given me a couple of kenalog injections. I had a big injection about a week and a half ago. I haven`t really seen any improvement yet. Basically, when taped, the area looks nice. but when I go to sleep and wake up, it`s swollen like a balloon. Throughout the day, the swelling *feels* softer and less firm. It`s been 1 year and I`m tired of this. Will it always be this way? Should I give the kenalog more time? Could the kenalog even work?

Answer:

I am afraid it might be, yes. JG 7.9.07

Question:

I have another questions, I had Septoplasty and shaving of hump 4 weeks ago. The tip of my nose has started to droop meaning there is a lump appearing where I believe my septum was re-aligned. Is it too long after surgery to start taping up the tip to supprt it? How many hours a day would be sufficient to wear the tape?

Answer:

I think taping it at night might help some. JG 7.6.07

Question:

Good Evening, Dr. Garcia. I am a 39-year-old male who had a rhinoplasty in Sep.`04 and a tiplasty in Sep.`06. I still am not crazy about my side profile; the nasal skin on both sides appears thick, and my nasal tip still appears bulbous. Also, I wish I could refine my nostrils a little more; they`re kind of pear-shaped. Would full-strength Kenalog-40 do anything to reduce the size of the tip, thick skin, and the size of the nostrils? If not, would a second revision be needed to achieve thinner skin, a more refined tip, and more refined nostrils? Thank you.

Answer:

I do not think the kenalog will do much to reduce skin thickness and I feel that is the limiting factor in your end result. The desired end resualt you have pictured in your mind might not be possible due to the thickness of the skin and more surgey may not be abe to achieve it as more surgery can only reshape the underlying structures but cannot thin the skin. JG 7.7.07

Question:

I had a Septoplasty and shaving of hump on 06/06/07. I did have an infection in the septum following surgery and was on antibiotics. After the tape splint came off my nose looked very straight and smooth, now I have devloped a raised hard lump on the left side of the bridge of my nose where the hump was. My nose look worse than it did before surgery. I have tried putting ice on it regularly but nothing seems to be working. Is this swelling or overgrowth of bone? Or could the infection have caused it. Is there anything I can do to get rid of it? I have read you tell people to massage-how is this done, how often and how much pressure should you use. I don`t seem my surgeon for another 3 weeks

Answer:

it is mostly swelling as it will take one year for all of that to go down and the reaction on the cartilage to soften andd flatten. Light pressure massage is OK, daily, and tincture of time. JG 7.6.07

Question:

Hello Dr.Garcia, Okay i was wondering.. My sister and I both have a consultation with you on the 30th and we`re both getting a Rhinoplasty,the lady we spoke to told us it`ll cost around $6200 something..the only thing is that with my nose im not really worried about any hump on it,im mostly only concerned about my nostrils and tip done,(unlike my sister)...How much would you say that would cost??For me i mean.

Answer:

It would likely be less but I would need to see you to give you an accurate quote. Sorry. JG 7.2.07

Question:

Hi Doctor, I had a second set of kenalog injections in my supratip area yesterday. The area injected got pretty swollen! Is this normal, and does that mean it`s working?

Answer:

normal, it is from the marterial injected, it does not mean it is working though. JG 6.28.07

Question:

Hi Dr. Garcia: have you ever used skin from the scalp for a rhinoplasty surgery (tiplasty)?. Thank you very much.

Answer:

well, no, I have never used it nor heard of it being used and really see no reason to use scalp for something like that, I think the potential negatives are too high, like anbormal hair growth if it survives. JG 6.25.07

Question:

Hello Doctor, I was wondering is revision Rhinoplasty surgery more difficult for you to perform? And also, how much do you charge for this? Thank you.

Answer:

it is more difficult because there is scar tissue and much of what was done at the first surgery might not be able to be reversed. I do peform it but I would need to see you in person to determine a fee. JG 6.15.07

Question:

I am 10 months post op from a rhinoplasty and septoplasty. My tip is now quite bulbous and still hard - especially the columella. I have had one Kenalog injection into the tip. Will the Kenalog injection complicate revision rhinoplasty? How much massage should be done after a Kenalog injection? It`s been 5 wks since the injection with little results. Also, I had quite a bit of swelling after the surgery that took at least 7 months to dissipate. Do you think the swelling will be as severe with a revision rhinoplasty?

Answer:

the shot should not complicate the revison. As to massage, a little maybe three times per day for a few days is all. I think the swelling unfortunately will be at least as bad for the revision. JG 6.15.07

Question:

I HAVE ADVANCED ROSESEA WITH BUMPS ETC. CAN THIS BE CORRECTED?

Answer:

IPL and topical antibiotics will help. JG 6.15.07

Question:

I had a rhinoplasty surgury conducted of an interm of three years ago to buff it down to attain a slightly straighter visualised result incorporated with a slight lift on the tip inreduction of the natural dropiness that was primitivally there to commense with however i was still extreamly satisfied and optimistically assured thateverything resulted as expected because the ssurgant mentioned that it does actually take up to two years for the shape of the bone to result in a finanl outcome now it is the third year and it looks almost as big as it was before the surgury and the slight lift that was there has gone back to its previous form. Finally my quierie to yourself is this common, reasons as to why it might have possiably resulted as such and is it also true that scientifically that the nose is the actual one aspect of the human body that continuosly grows other than the ears? i would very much appriciate a response pertaing to my issue of concern, thankyou very much in this respect.

Answer:

well, not common, but not uncommon, there are limitations and at times those are not surmountable, such as thick skin. It might require more surgery at this point. As to the nose growing, what does grow is the thickness of the skin of the tip and that can give the appearance of a larger tip that droops with time. JG 6.15.07

Question:

I had some cartilage/bone bumps shaved off on one side of my nose. The Dr. put a thin piece of Alloderm over the area to supposively help to achieve the look that the two previous bumps had produced as white coming out of the side of the bridge of my nose. They are still there. That is not the issue. The issue is that where the tissue had been lifted on the 45% angle of the bridge is out farther than before and is hard dense sponge like and i can`t distinguish if it is the Alloderm or still swollen. They can tell me what I want to here and cringe possibly if this has done more damage that help (I don`t want to call them). I look like an ex-boxer. Not me. The surgery was done on may 1st. Today is June 13th. Some say swelling can take many months. I am upset at this point and feel like it is going to stay like this. Does this sound like still being swollen or Alloderm gone wrong? I can feel on the other side of my nose my usual thin skin and bone. The alloderm side I feel less through to the bone if more like numbed nothing. I want to feel the ridge edge of my bone again (!) Thank oyu, Judy

Answer:

most likley it is the Alloderm and in most cases in a year or so it dissolves, otherwise they would need to go in and remove it. JG 6.13.07

Question:

Hi Dr. Garcia, My husband has a deviated septum, and has unknowingly lived with it for years. Because he was experiencing a lot of problems(coughing, gagging), especially after eating certain types of foods, he went to an ENT. They suggested a surgery that was fairly invasive and after being through 2 recent knee surgeries, he was not up for it. Now, about a year later, the knee surgeries are behind him, but he still does not want to have surgery. Mainly because he is worried about the potential for brain injury, the uncomfortable recovery period and the possibilty that it will not work(his dad`s surgery did not take). He was told that there was a procedure involving balloons that has not yet been put into practice, and I was wondering if you can elaborate on the most minimally invasive, safe and effective procedures available today for deviated septums? Thank you

Answer:

I have not been impressed with the amount if improvement with the balloon surgery. As to the septum, you are correct, it does not always stay straight, and the septum is not causing the gagging and coughing, tough call, but as long as he is willing to live with it he can continue to do so. JG 3.7.07

Question:

QUESTION ABOUT THE OUTER NASAL BONES WHERE THE NOSE AND UPPER PART OF CHEEK MEET. CAN THAT PART GET SWOLLEN IF HIT? LIKE A HUMP, SINCE IT`S BONEY OR JUST SWELLING. KIND OF JABBED IT WITH A Q-TIP BY ACCIDENT. WHAT ABOUT CLEANING THE NOSE OUT WITH WARM WATER /QTIP? I HIT THE INSIDE OF MY NOSE AS WELL IN THE UPPER OUTER BONEY PART. COULD THIS CAUSE DAMAGE TO THAT BONE

Answer:

Q-tip will not create much swelling I feel. A large blow to the outside could though. JG 6.12.07

Question:

Dr. Garcia, One side of my columella hangs down a little lower than the other. I have a cartilage graft to hold up one side of my nose and it`s just natural on the other side. It looked great coming out of surgery, but over time, the side of my columella with no cartilage graft began to droop and now it is noticeable. Is there anything, outside of surgery, that can be done to shrink it up, or make it even with the other side. Will a steroid shot do, or what are your suggestions? Thanks for taking questions.

Answer:

hard to say without seeing you, doubtful a steroid shot will help though. JG 2.2.8.07

Question:

Kenalog follow up: What do you think is the smarter move. To have surgery to fix or to take the kenalog injection? Its been 1.5 years is that going to affect the injection? Is the exess scar tissue fixable?

Answer:

I think at this point the surgery might be better. JG 2.25.07

Question:

My follow up to the Kenalog injections after a rhinoplasty. If injected does the kenolog specifically target scar tissue or does it target all tissue? Secondly the physician who did the surgery said he could cut out the scar tissue, is that a smart move being that tissue will just form again? Is it cut with lasers or other tools of the trade.

Answer:

it will affect all the tissues in the area. Cutting scar tissue out will heal with new but possibly less scar tissue. It is cut out with a scalpel or scissors. JG 2.25.07

Question:

I had rhinoplasty about 1.5 years ago. Bad move. I have soft scar tissue on the left side of my bridge. What that does is makes my nose look crooked and larger. What are my options to fix. Kenalog i heard could help, but how much and does it only target the scar tissue and what is the radius it covers? Also what would be the best dose to use 5mg 10mg or even less. It looks horrible and I feel like I`m getting desperate again. From my second and third consults with 2 of the top 5 surgeons in the country they say it was caused by the physician not lifting the tissue from the bone when rasping. Is this also true?

Answer:

the radius that kenalog will cover depends entirely on the amount or volume injected. I think one or two shots migth be a good idea though, as otherwise it might need more surgery. I usually use 5 the first time and ten the second. As to the skin not being lifted for the rasping, that is not entirely correct, the rasp will not fit if the skin is not lifted, it can from from blood pooling there and creating scar tissue or from the production of callus which is how the cartilage heals when rasped. JG 2.22.07

Question:

Good Afternoon, Dr. Garcia. Can you tell me whether Fougera steroid cream has the same properties as Kenalog? I was wondering whether Fougera can be used to reduce nasl swelling following a rhinoplasty. Thank you.

Answer:

sorry but no, topical creams will not help the swelling below the skin. It needs to be injected. JG 2.21.07

Question:

Hello Dr. Garcia, I am 7 weeks post rhinoplasty and 2 weeks ago I noticed a bump on my left side of the nose. I saw my doctor and he told me that I was feeling the edge of bone (something like that) and the bone will eventually mold itself. I haven`t really seen an improvement since I last saw him. I am worried because the bump is quite noticeable.

Answer:

it would normally take months for that to smooth out. JG 2.19.07

Question:

Hi Dr. Garcia, I will try to keep this as short as possible- bear with me! My left nostril has been bleeding for close to a month. Sometimes it`s like a real nose bleed and other times, it`s when I blow my nose, there`s blood (not old blood either). If I go too long without blowing my nose, I get all stuffed up on the left side. I am having a very hard time breathing out of this side whether or not I blow my nose. It`s happened very suddenly. It`s even getting painful when I breathe b/c the inside is so raw. My regular M.D. said I have a popped blood vessel and to treat it with saline spray and bacitracin. She also asked me if I ever broke my nose b/c I have a deviated septum. I never broke it, but it was once banged pretty hard and then swollen thereafter for about a week. Can breathing problems due to deviated septums have such a sudden onset? Is rhinoplasty the ultimate cure for such a thing? Please give me your advice! I`m desperate to breahe! Lauren N.Y.

Answer:

sounds likes one type of surgery will be needed, it might be a place on the turbinates that has a non-healing area that scabs and bleeds. I think you need to see an ENT and have them examine you after they have numbed you up, posssibly they can cauterize it at that time. Best of luck. JG 2.15.07

Question:

Good Evening, Dr. Garcia. I had a rhinoplasty done 2 years ago, but this past fall I had a tiplasty to reduce a bulbous tip. Before the tiplasty, the bridge of my nose was quite thin, but the doctor performing the tiplasty said my nose would look more uniform if he injected silicone to the bridge and mid-area. Since he injected silicone, my nose appears wider at the top and middle. Is there any way to make my nose look narrower, after having the silicone injections to the bridge and mid-area? I heard that the effects of silicone can be temporary sometimes. Thank you.

Answer:

silicone is permanent and most likely the only thing that can be doen is to surgically remove the silicone. JG 2.14.07

Question:

It`s me the shifted cartilage girl again. Your answer has helped me tremendously, thanks so much. May I ask another shifted cartilage question, please. Can removing this cartllage cause any denting or misshaping?

Answer:

if too much cartilage is removed, yes. JG 2.13.07

Question:

Thank you for your help, I really appreciate it. I am 1 yr out from my rhinoplasty and 2 months ago discovered a small red pimple like bump on the right side, at the tip of my nose. My doctor says the cartilage has shifted and he needs to do an in office procedure under a local to remove some of the cartilage. In your opinion, is this the best solution and could it cause scar tissue that will create difficulty in breathing? Also, could this cause a dent in my nose or a mishappen appearance? Can cartilage shift at anytime and could this happen again? Once again thank you for your time.

Answer:

shoudl be straight forward and should not affect your breathing. Cartilage can shift due to scarring for years after the surgery. Best of luck. JG 2.13.07

Question:

It`s me with the shifted cartilage. I forgot a question. What if I do nothing about this shift? Will it get increasingly worse. Thanks again

Answer:

it might get worse for a while, yes. JG 2.13.07

Question:

Hi! I have a quick question regarding my nose. I had a septoplasty done about 2 years ago. Since than, my breathing has improved a little, but I still have extreme difficulty breathing through my left nostril. If I look at my septum in the mirror, I can see that it bends towards the left side of my face, than hooks back towards midline. I thought the septoplasty I had done would`ve solved that, but it didn`t. So, I`m not sure what the surgeon did, but I have a feeling he didn`t actually straighten my septum...he just took pieces out to open it up. My question is this: If I have another septoplasty done, would straightening out the septum be the best option? I really hate to get repeat procedures because of the risk of losing too much cartilage. If the septum is straightened from the inside, is it usually straightened from the outside as well? And one last question: If it`s straightened on the outside as well, does that count as cosmetic and not covered by insurance? Thank you! - Mike

Answer:

the septum is made out of cartilage so commonly it will spring back to the old shape, might need some more cartilage taken out. If it is a septal procedure and the outside straightens because of the septum it is not considered cosmetic. JG 2.11.07

Question:

Thank you for your time, it is generous of you. I have had a primary rhinoplasty surgery, due to a nasal fracture. I used to have a Roman nose with a dorsal hump. Since, the surgery my nose appears to be shorter, flatter, wider, the tip has become more upturned, as well as, flarred nostrils. I was wondering your opinon on non-surgical rhinoplasty with injection fillers? to raise the bridge of the nose and to make the tip fuller. Ultimately,I would like to regain the appearence of a Roman nose, now that my nose is straight. Thank you again for your time.

Answer:

I think that is a very reasosnable approach, just go slow with the injections, you can always put in a little more, that is easier than taking too much out. JG 2.10.07

Question:

My sister-in-law had basal cancer on her nose. She had surgery for this 2 days after Christmas 2006. She has been severely depressed ever since and we are extremely worried about her. Is there anything you can suggest to help her appearance? She has a small bump on her nose and also an indentation.

Answer:

hard to say without seeing here, I think in most cases with time the surface does even out. JG 2.8.07

Question:

Hi Doctor, How`ve you been, i hope you doing fine.I just posted my question but i think it did not go through. Doctor, remember I did my nose surgery 6 months ago, but my tip is still big, I already had 2 shots, kenalog shots, one 3 months ago and the other one 1 week ago, if it still doesn`t go down, how many more shots can i get?, is there any limits of shots?, and also is there any danger in getting these shots? I mean can my tip get disfigure or something like that?. and also shouldn`t i get the shot in the middle of my tip, to get it smaller? Thank you

Answer:

I think once every 4-6 weeks for 4-6 times is OK, all depends on how much they inject. The biggest fear is to thin the skin. Hang in there. JG 2.8.07

Question:

why do we have to enter our email address everytime we ask a question? Also, i was wondering what qualifies a person to get insurance coverage for a rhinoplasty. I have a disfigured nose from a past fracture, but my ENT told me that insurance more than likely wouldnt pay for it. I was also watching the news the other day about a teeneage girl who died getting a rhinoplasty. that alone gets me thinking, but they said that she had gotten in a car accident a year ago, but her family still had to pay to get her nose fixed. Maybe she didnt have insurance, i really dont know, but what would qualify a person for coverage. everytime i touch my nose, i hear a crack, and one of my nostrils is smaller than the other now.

Answer:

I will speak with my webmaster and see if we can set it up to give repeat visitors a passwaord to make it easy, but in short we had to start the email issue because the site was getting spammed by unsavory sites. As to insurance coverage for a rhinoplasty, if the nose has suffered a fracture AND there is a breathing problem, then at times the insurnace will cover the correction of that and only that. If the fracture has not limited the breathing and only the appearance it will not be covered. Hope that explains it. JG 11.29.06

Question:

DR.GARCIA. HI, I AM A 51 YEAR OLD FEMALE. WHEN I WAS 17 I HAD RHINOPLASTY. I NOW LOOK AT MY NOSE AND I SEE THAT THE BUMP THAT WAS SHAVED DOWN SEEMS MORE PROMINENT AND MY NOSE SEEMS CROOKED. IS THAT NORMAL SINCE IT HAS BEEN SO LONG SINCE I HAD THE PROCEDURE AND I ALSO HAD A BREAST AUGMENTATION WITH SILICONE BREAST IMPLANTS AND THEY HAVE STRETCHED AND I HAVE NOT HAD THE MONEY TO CORRECT THIS PROBLEM CAN THIS BE DANGEROUS. I HAVE CLOSTROPHOBIA CAN ANYTHING BE DONE WHEN YOU ARE IN THE RECOVERY ROOM TO RELEIVE THIS PROBLEM. EVERYTIME I HAVE SURGERY I HAVE TROUBLE LYING DOWN FLAT IN THE RECOVERY ROOM .

Answer:

stretching of the breast skin is not dangerous and at times with passing years some cartilage warping can occur after a rhinoplasty. I think you can certainly be sat upright on the gurney in the recovery room. JG 11.28.06

Question:

Hello Dr. Garcia, sorry to ask again about bsaically the same thing but I want a little more information. how is it possible to deproject a tip, add definition to it, and at the same time make the upper lip stay the same and not drop over the teeth? I didn`t know thi was possiblem are there new and safe techniques that have been developed recently for this? and are there new techniques that make alar base escisions safe in the long term? with a fairly forseeable outcome? thank you dr.

Answer:

yes, that is possible, by refining the lower lateral cartilages and by trimming the caudal septum. JG 11.28.06

Question:

Hello Dr. Garcia, thank you for your site, it`s a blessing. can the tip of a nose be fairly deprojected while maintaining the upper lip position and shape and maintaining tip definition and maybe making it more defined? I know this is very hard, but is it impossible? maybe reducing the alar base? because I have thick skin. is this possible? maybe for Dr. Toriumi? or is it really far out? (of course the bridge may be built more projected, do you think this will stretch the skin of the tip to make the tip more defined?)

Answer:

firstly, thank you for the kind words. As to the tip of the nose, yes, those issues should be able to be achieved. Not far out and certainly within the realm of Dr Toriumi`s talents. I think in certain cases the tip needs some skin stretching to have more definition. JG 11.27.06

Question:

Hello Dr. Garcia another Q about rhinoplasty. can a slightly convex dorsum be achieved with rib grafting?.

Answer:

yes, it all depends on how you carve it. JG 11.27.06

Question:

Good Evening. I had nose surgery in February 2004 to correct a deviated septum, and to also contour the nose for a more appealing look. I was very pleased with the look I received after the surgery, however after several months I couldn`t breath from the left side of my nose. I went in for surgery again just a couple of weeks ago...after my doctor began the surgery (it was explained to me later!) he found that the left side of my nose was shattered. He had to completely rebuild that side of my nose, and ended up using some synthetic materials to help build it up. I`ve felt pretty good since the surgery - lots more pain than last time, but nothing unbearable -- I`m HORRIBLY bruised (my nose) and it`s extremely swollen. Correct me if I`m wrong - I assume this is because of what all he had to do. Over the past couple of days I`ve noticed that I have a spot inside my left nostril-fairly far up inside that feels very, very tender - almost raw. I`ve also noticed that my nose is slightly curved to one side. Is this just because of the swelling going down unevenly, or is it something that should be checked sooner rather than later? Thanks for your help,

Answer:

all normal and should all settle down in time, best of luck. JG 11.27.06

Question:

Hello Dr. Garcia, I was reading about rib grafting by dr. Toriumi and read that rib grafting can cause the lung to collapse... is that a high risk? and also, how much time could it take to happen? or does it happen immediatly?.

Answer:

that risk is very low with the techniques used now, but still a very small possiblity. If it is going to happen it happens in the operating room and is usually recognized there and treated. JG 11.26.06

Question:

is it possible for hanging columella to show up after 1 year since rhinoplasty? at first it looked like my nostrils were looking quite larger than usual and now i noticed what appears to be hanging columella.

Answer:

at times when the swelling goes down it can make it appear more visible. JG 11.23.06

Question:

I`m quite puzzled with my nose. I have been taking pictures of it to track it`s improvement. However I noticed my nose is so much larger now (4 months) as compared to my nose a few weeks after surgery. That was when it was at best shape. Shouldn`t it be the other way around? My tip has been getting larger although I only had bridge work done and closed rhino. Am I developing scar tissue? How do I get it back to the 3 weeks post-op look?

Answer:

I am afraid it is just a matter of time and a little masage might help. JG 11.20.06

Question:

Its me again, i asked about the scar on my nose, and i was telling you about my self esteem problems, and one reason i have self esteem problems is because 1.5 years ago, i was happy with muy image, very happy. and out of nowhere i break my nose, fracture but i was told to leave it alone because they told me it wasnt fractured (even though i didnt get xrays and it wasnt even a specialist, it was just my normal doctor who told me it was fine). i really should have got it taken care of, but my doctor did tell me to leave it alone. then it got bigger and asymmetric. i hate it, especially the hump i got now. on top of that, i end up getting a scar on the Tip of my nose, which is already broken. Way too many bad things hapening all at once really shot me down. I`m trying to work everything out one at a time. my ENT is trying to tell me that my nose was always like this, so I would have to pay for my own nose surgery, even though it was never like this before, and i was never a patient of his before so he would never know. can you give me some advice on how i would go about getting my old appearance back, the cheapest way. Its really not fair that i would have to pay forr nose surgery, even though i just want my old nose back. when it first happened, i had constant headaches everyday i woke up. im telling you as much as possible because i want the best advice i can get, please. my nose isnt even, straight or as narrow as it used to be, and it looks WAY different than it used to be. my parents are even lying to the ENT, just so they wouldnt have to pay, they are telling him that they havent noticed a difference in my nose`s appearance, but why would i make this up, i cant even make this up i wasnt born with a crooked nose. this has just got me all riled up, because i know that if i got my nose fixed and my scar taken care of, I would be back to the way i was before all this. Sorry for the long query, but I NEED HELP!!

Answer:

I am afraid that as there is no medical probelm with the nose in terms of breathing that you will need to pay for it I am afraid. JG 11.24.06

Question:

that 1.5 years below is really 1 and a half years, just to make sure

Answer:

correct. JG 11.18.06

Question:

Dr. Garcia, hello. I had a rhinoplasty about 4 months ago and yesterday I walked into a glass door as if it wasn`t there,and all the impact was received by the tip of my nose... it hurt a lot and I bleed a little, but it wasn`t the kind of dark blood that comes out when a nose bleeds...it was a lighter colour blood...and now what hurts is my upper lip and he upper bony part a litte too... but what I hit was the tip structure...you know, that pyramid like thing... now it looks like it didi before, only a little more swollen , but it`s imperceptible... as I have a strut/graft to raise my droppy tip... I am worried about getting skin necrosis now out of this trauma that my nose received yesterday. how long does skin necrosis take to manifest? and after which time should I stop worrying and discard the possibility of SN occurring?. also...will this make my revision attempt harder? (I have had just one primary and plan to have a revision by Toriumi wich will hopefully be my last). thank you Dr.

Answer:

I do not think that type of injury would cause tip necrosis, the worst case scenario is that the tip graft might have shifted. Should have no efect on future surgeries. JG 11.17.06

Question:

I had a nasal bump removed along with some tip work done (from pointy tip i now have a round tip), I`m 2 months post up and noticed a piece of suture erupting on the top of my nose the middle area of my nose. Should I be concerned at all? I just used a nail clipper to clip it so it doenst show and its not red and shows no signs of infection but why did it erupt and will this effect the outcome of my new nose

Answer:

I think you need to see your surgeon, maybe they can just trim it off. Should not pose a big problem. JG 11.16.06

Question:

Hi Dr. Garcia. I had a rhinoplasty a year and two months ago. He fixed a slightly deviated septum, narrowed the nose, got rid of the hump, shaved off cartilage from the tip to get rid of bulginess and I think gave me an implant at the tip. Bottom line is that I am really happy with the results. It looks really natural to the point that people cant tell. Problem: My breathing isn`t as clear as before and I almost always have a runny nose. Somedays its very light and on some I feel clogged up. Also on occasion, I take out really stringy/rubbery clear mucous which gives me temporary relief(though I cringe when I do so). Ive used ocean spray but I did not feel a difference. Its not as severe as some of the other posts but do you think there is something wrong? or do you think it will it go away in time? What do you suggest?

Answer:

might be allergies, I would suggest seeing your ear nose and throat specialist. JG 11.16.06

Question:

Hi doctor. I had rhinoplasty 5 months ago and it`s revision 4 months ago. Most of the swelling has gone down considerably and I only had an implant inserted at the bridge. I now want some improvement on my tip and nostrils though and I only have this month left for a procedure as my family is out of the country. I know about a years waiting time is advised but after much deliberation I`ve decided I really want the tip work. Given my surgery record, what are the risks involved in getting a third rhinoplasty this early?

Answer:

I think the biggest risk is that since the tissues are swollen they may not be able to be accurate in what they do and it might end up not different enough or too dramatic of a change. JG 11.16.06

Question:

My nose has been nothing but an embarrassment for me my whole life. I avoid many situations in life because of my large nose, I do not like to sit in a way that provides anyone a glimpse of my profile, kissing my own husband of 12yrs is humiliating to me... my nose gets in the way. I am in the beauty industry and I am always self conscious around people, I feel they are starring at my nose it is large with an over pronounced hump and it is very bulbous at the end. I hope to one day have surgery but at this point I cannot afford it. I have delt with it my whole life but for some reason it is really bothering me at this stage in my life. I was wondering is there ever an instance that insurance will provide coverage for rhynoplasty and are there any programs such as medical schools teaching plastic surgery, which may provide surgical procedures at a discount and if so can you trust to go to a place like that?

Answer:

I am sorry but not that I am aware of. JG 11.15.06

Question:

How are you Doc? Last year I had revison work done on a botched rhinoplasty/deviated septum procedure from 10 yrs previously. My NY doctor did a BEAUTIFUL job straightening the septum and refining the nasal tip. The only thing bothering me is some collapsed cartilage on the left side from the first rhinoplasty that breaks up the line of the bridge and gives the impression that my tip `leans` to the side. My doc suggested Restylane injections and even demonstrated the result by shooting this `dent` full of saline. I loved it! I asked about grafts so it would be permanent but he seemed hesitant because he said it`s not such a big dent anyway and the graft could be incorrectly sized, it could shift, be absorbed, show through or create more scar tissue that could potentially block out the nostril (the septum wall needed extensive repair on the left side and the collapsed cartilage apparently already leaves me little room for breathing properly) Do you believe that grafts are so risky and injectibles are better options in such a case? I`d like the effect to last as long as possible, obviously. All my thanks

Answer:

I agree wholeheartedly with your doctor, best of luck. JG 11.13.06

Question:

hello....I has a nose revision 6 months ago. In that time I have noticed the tip of my nose feels like I have 2-3 uneven bumps. The bumps are not visible but I can feel them. What could they be? Also, is it possible to make my nose wider...I feel that it looks to narrow and doesnt fit my Lebonese look. I am uspet that i ever even touched it. PLEASE ADVISE.Thank you for your time.

Answer:

the hard lumps may be swelling or scar tiisue and it can take a long time to soften. It is possible to widen the tip at times by placing cartilage grafts onto it. JG 11.13.06

Question:

Hello again Dr. Garcia, is it true that Dr. Toriumi tends to make noses very large? and also... do you think he can give me a veruy natural result and fashion a hump with cartillage without much risk of warping?. thank you! also, how much time do you advise for me to wait before having my second surgery and hopefully my last with Dr. Toriumi?

Answer:

well, I think that is a matter of likes and dislikes, at times, to correct a previous problem one needs to add cartilage support and that can make the nose look a bit longer. As to the risks, he wil need to tell you what he can do after he examines you. Best of luck. JG 11.12.06

Question:

Hi Dr. Garcia!! I had rhinoplasty done 2 ears ago and the DR. shaved down the tip of my nose to make it less bulbous. About 3 months ago I developed a cyst on the tip of my nose with mucous. I got a biopsy and it turned out to be benign. The dermatoligist said it was most likely from fragmented cartilidge from the rhinoplasty procedure. I still have the cst and wonder what can be done to minimize scaring. Thanks, Chris

Answer:

might need a wider cut to remove the cyst, let it heal and then maybe 6 months later a light laser to fade and smooth the scar. I seriously doubt the cyst is due to the prior rhinoplasty though. Cartilage shaving do not cause cysts in the skin. JG 11.9.06

Question:

Hi Doc.: Blood staining (under eyes) continues 6 weeks post op. Besides use of arnica montana, would applying hot compress help? Do I need to prepare myself that this might turn out to be permenant? With my thanks.

Answer:

should not be permanent, warm packs might help, and also avoid sun exposure. JG 11.9.06

Question:

Hello Dr. the bony part of my nose looks flat from the front, and lower than the cartillage part, so it looks like I lach something in the upper part of my dorsum... can this be fixed by a revision? or all rhinoplasty procedures tend to leave this result?. also, if I request a hump in a revision, what is the most likely material to be used and will it appear natural?. thank you.

Answer:

I think you will need something added there, either a cartilage graft or a small short implant, either silicone or gortex can be used. Another alternative would be an injectable filler like Radiesse to build the area up and that could also be injected to give you a hump. JG 11.7.06

Question:

Thank you for your previous answer Dr. Garcia, you are the best!!! I have another question about rhinoplasty, I am 4 moths post op and the outcome is horrible, I prefer my other nose. I will wait a year and try to get a revision with Dr. Toriumi in Chicago though. do you think he can give me a totally natural outcome and maybe a natural well defined hump? or it`s only possible to augment the bridge in a straight way?. am I at a high risk of skin necrosis with an open aproach for a revision having already had a primary rhinoplasty, and a stitched strut to raise the tip? I am 20 years old, in a relative good health and don`t smoke. thank you again Dr. Garcia, I admire you!=) all the best.

Answer:

humps can be replaced, it does not always have to be a straight dorsum. I do not think the open approach is any riskier than the closed approach. Best of luck and keep me posted. JG 11.5.06

Question:

Hello Dr. Garcia, I have had a rhinoplasty 4 months ago and had a cartillage graft placed at the tip to lift it. the skin of the lower part of my nose is darker than the rest of my face now now and I am worried about skin necrosis. what signs should I look for to see it it is? and how can the dammage be stopped and/or reversed if it is indeed skin necrosis?. thank you.

Answer:

necrosis if it is going to happen would have happened a long time ago, it is not uncommon for the swelling in the tip to make it look darker and should get better in time. JG 11.5.06

Question:

Hi Dr. thanks for your response on 10/6/06 re: rhino. I am wondering if I can e-mail picture and tell me if grafting or lift is possible? I had narrowing of nasal but tip seem round and bigger than before. Surgery was done on 3-15-06

Answer:

please send the photos to drgarcia@lvcosmeticsurgery.com JG 11.4.06

Question:

Hello Dr. Garcia My question is about perception. Is how we appear in a mirror how others see us?

Answer:

yes, I think that is pretty accurate. JG 11.4.06

Question:

i injured my nose a year ago and i was told by my doctor that it was fine. He told me not to worry about it, so I didnt. Then about 3 months later, I noticed that my nose was crooked, wider, and bigger, and I had a hump. Then, about 2 or 3 months ago, I went to an ENT, who told me that I had a nasal fracture that has since closed up, and caused my nose to set crooked. He told me that if I had come to him when it happened, they couldve avoided this whole thing, but I was told to not worry about it. Now I`m worried about the cost of surgery, and the surgery itself, and especially the recovery time. How much would it cost, and should insurance cover it. How long would the recovery time for a straightforward nosejob be, no tricks, just back to normal.

Answer:

insurance should cover it and you should be back to normal in 4 weeks or so. JG 11.3.06

Question:

I had rhinoplasty done one week ago. a break was fixed as well as some refinement of the tip. a piece was placed to turn t6he tip up slightly. about 3 days after sugery i took the tape off as i had an event to go to. i was not bruised at all. I noticed the tip was not any different. It did not appear that the tip was raised whatsoever. I DID NOT put the tape back on. today i visited with my doc who says i was at fault for removing tape and it could cause problems with the tip. he re taped it, said to keep it on there for a week. Has this potentially caused a problem with the tip raising?

Answer:

all it does is reduce the swelling but long term it has no effect. JG 11.2.06

Question:

I had rhinoplasty done a year and half ago because my nose was wide, very minor change. Two weeks after surgery I felt a bump on the left side of my bridge my surgeon said to wait to see if it disappears but it never did. The doctor wants to do a revision he said he needs to file down the bump but I`m scared. Will filing down the bump work?

Answer:

it is the the best way to remove it. JG 11.2.06

Question:

i had rhinoplasty when i was 16 years old to remove the hump; however 2 years later i wanted it to be closer to my face so i had a 2nd surgery. this time the doctor used a graft from my ear. the outcome was that my nose was longer, still not close to my face and now the tip is sharp, pointy looking and droopy. so, i am now 26 years old and i had my 3rd operation done last august 2005. it was supposed to be shorter,lower(closer to my face, lifted up and hump removed again. 2 weeks after surgery my nose still looked long, with hump, the only difference was that it was piggish looking. i asked why it was still so long and protruding,he said that if it was small right now that would be a problem because in a year it would be too small. i think that even though the nose was extremely swollen it still should have been shorter. anyway, it`s been a year now and my nose looks almost exactly the same as before. it looks as if nothing was fixed. i originally wanted the ear graft cartilage removed because i think that is what`s making it long and pointy sharp, but doctor said he didn`t want the tip to get infected or rotate out of shape. it seems like i`ll never get the nose that i want. i just wanted to have a shorter nose that`s close to my face and not a pinnochio nose. my nose is now longer than my original birth nose. it seems that my nose just looked different because of the tape that was on it after surgery and once the tape came off it slowly started to go back to the way it was before. is it possible to remove ear graft cartilage from nose or at least round it off so it wont be so sharp,harsh looking? thanks tricia

Answer:

cartilage grafts can be removed and it might or might not affect the tip, all depends on what it was placed for and where it was placed. With all the surgeries you have had I will be honest and tell you that some of your desires may not be possible due to the scar tissue that has developed below the skin and there is nothing safe that can be done to remove it. On whether anything can be done to make it look better, I am afraid I cannot say without physically examining you. JG 11.1.06

Question:

hi, i have another question. how is it that when i use a facial cleansing mask on my face,when i put it on my nose after the mask dries my nose looks completely different. it is extremely short and upturned looking rather than my usual long nose. it looks how i wish it would have looked after surgery. is it because of the oils in the skin shrinking,because when i put the same facial mask on someone else their nose doesn`t change at all. it is very weird. also, do you think that after 3 surgeries and my nose still isn`t close to my face is because i have thick oily skin in the nose area. if it try a skincare products to reduce oil production would my nose be smaller? thanks

Answer:

a facial mask can very often dehydrate the tissues and that can make it look smaller until the swelling returns. Thick nasal skin, especially on the tip cannot be changed with topical treatments, the oil can but not the thickness and that will limit the eventual look of the tip of the nose. JG 11.1.06

Question:

Dr. Garcia, my daughter wants to get her nose fixed. We don`t know anyone who has had this done, so don`t know who would be a good doctor. We can`t afford the fees they charge for consultations for numerous doctors. How do we find a doctor who does great nose jobs in Tennessee?

Answer:

Due to potential legal issues, and some doctors wanting to know why I referred a patient to someone else and not them, I think you are best to go to this website and look for a plastic surgeon in the area you desire. I wish you all the best. JG 10.31.06 www.surgery.org/public/findasurgeon.

Question:

Dr. Garcia, I recently had a silicone injection at the bridge of my nose because my doctor thought the skin surrounding the bridge on both sides was not straight. He said the silicone would fill in any contours. Now, when the light hits the bridge of my nose, it looks like the silicone can be seen under the skin as a horizontal rubberband across the bridge. Is this a permanent effect of the silicone injection, and is there anything that can be done to get rid of, or minimize, that effect? Would a dermabrasion get rid of that effect, or perhaps a laser? Thank you for your help.

Answer:

if it is silicone it is permanent unless you have it cut out. No way a laser or an abrasion will help. JG 10.29.06

Question:

hi dr garcia, i underwent an IPL on Thursday for rosacea. The doc treated me with triple filters 640, 590 and 560. After the treatment he mentioned i will be red and blotchy for 2-3 days. The redness after 2 days is going down however i am noticing slight black-purple areas near the junction of my beard where there was some hair during my treatment.What are theses? I hope these are not hyperpigmentation ? Any advice for this and for future treatments?thanks

Answer:

those are areas where the heat of the light got more intense due to the hair follicles, might heal like a sunburn, too early to tell if there will be hyperpigmentation, that would take weeks to see. All that can be doen in the future is to turn the intensity down when treating the beard area as there is no Rosacea there. JG 10.28.06

Question:

Had a rhino revision on tip to elevate right after surgery it looked nice but now 4 weeks later it almost looks the same. Ps gave an injection on tip, he said for swelling, or scar tissue. The incision was very small on the inside of left nostril, it was about 15 minutes under local. what is your opinion in order to lift the tip of the nose?

Answer:

hard to say, at times that is all that is needed, but in most cases it requires much more, there is not much that can be done through a limited incision in 15 minutes, but it is possible in some cases. JG 10.27.06

Question:

i`m in salt lake and my doctor`s on the east coast so if its okay i`m thinking about coming down and seeing you to have this done. Is there anything else that can be done instead of an injection? Is there a chance that it may do nothing since i am 6 months post op? Is there any chance that the kenalog could dissolve the tissue that many be holding my nasal bones together?

Answer:

I do not think that the kenalog will dissolve all of that, I know some good plastic surgeons in SLC so there really is no need to come all the way here. JG 10.25.06

Question:

Thanks for the quick response. I just wanted to go into a little more detail. I`m six months post op and it looks and feels like almost all my swelling has gone down, especially on my right side of my nose. On the left side of my nose there seems to be a little bit of swelling. When i massage this swelling i can feel a bunch of tiny bead like balls in this area, it feels kinda bumpy. Up until this point in the healing processes the swelling hasn`t felt like this. The beads are very hard. I had a slight bend in my nose which my Dr repaired by repositioning my nasal bones. OK here comes my slew of questions. Does this sound like scar tissue? Is 6 months ample time to wait to get a cortisone/kenalog injection? If i decide to wait to let my body heal more before i get an injection could this make the kenalog injection less effective? If i didn`t have any cartilage grafts is there a chance that the kenalog could dissolve any of the tissue that is currently hold my nasal bone together, essentially causing a collapse of my nasal bones? Sorry for all the questions, thank you for your help.

Answer:

it does sound like scar tissue and you could not feel it initially due to the surrouding swelling, but now as that has gone down you can feel it more. Kenalog injections can still be done at this point. Kenalog works best when the tissues are fresher. Kenalog can dissolve all of the grafts and normal tissue too. JG 10.25.07

Question:

May GOD bless you for taking the time to answer our questions. I am 4 weeks post op rhino and very swollen. How can people like Ashley Simpson look so great and normal right after surgery? Ashley`s picture was taken 2 weeks post op and she looked perfect. How is that possible?

Answer:

well, it all depends on what is done, how aggressive of a nose surgery, what was done afterwards to control the swelling and then there is make up and PhotoShop on computers. JG 10.25.06

Question:

What does scar tissue feel like? How safe and effective are cortisone shots? How much do they cost?

Answer:

just a little firm, hard in severe cases. Cortisone can be injected but it can also cause loss of the surroundg normal tissue so it is not always a possiblity, fees vary from doctor to doctor and the amount needed to be injected. JG 10.25.06

Question:

Hi Doctor, Thank you for responding to my question Regarding the Black Eye Look 7 week post op (rhinoplasty). I will buy some arnica cream to use it. in the meanwhile will Hylexin work any faster? its a cream that is used primarily for severe black circles under the eyes area. OR is Skin staining different from dark circles due to lack of sleep.

Answer:

I have never seen any good results form Hylexin for any cause of dark circles. JG 10.24.06

Question:

hello Dr Garcia, i admire greatly what you do. i had revision surgery to straighten my nose two weeks ago and the swelling seems to be all gone, however it`s still not completly straight. one side is straight and the otherside curves inwards. is there a permanent filler i can get to even out my nose? and does it require surgery or is it a simple procedure? thank you for your consideration.

Answer:

a filler like Radiesse might be an option there. I would wait at least 3-6 months to allow all the swelling to resolve so you can get it done with the least touch up risk. All the best and thanks for the kind words. JG 10.24.06

Question:

I had a rhinoplasty 6 weeks ago (bump removal and some tip work) and rather to focus on my new nose im really concerened about the residue bruising underneath both of my eyes. I literally look as if i havent had any sleep in years. Sometimes they almost look like i have black eyes. and if i try to conceal them with makeup it just makes it look worse. I went online to research about this and nowwhere does it say that the brusing lasts for more then a month at the most. Did my surgeon damage my blood vessels.. is this normal? how much longer before my black eyes are gone.

Answer:

probably some skin staining from the blood, avoid the sun and apply some Arnica gel available at the health food store and it should go away in time. JG 10.23.06

Question:

hi dr garcia, I have another question for you. sorry. Can an IPL differentiate redness between rosacea and sebborheic dermatitis. I have both. I am undergoing IPL for my rosacea and now starting fluconazole for dermatitis? Would The IPL work even on the dermatitis redness? Thanks

Answer:

it cannot differentiate but it will help both. JG 10.21.06

Question:

Hi Dr. Garcia! I had a septoplasty done a few years ago because I had a very hard time breathing out of my left nostril. After a couple years passed, my breathing was a little bit better, but still difficult from my left nostril. I went to see a different doctor (my original doctor doesn`t do septoplasties anymore) and he said that insur. wouldn`t cover a second procedure since it`s already been covered. Is this true? Even if I have a different insurance carrier now?

Answer:

well, they might, no way to tell without requestiong a pre-authorization from the insurance carrier. JG 10.20.06

Question:

Hi Dr. I underwent revision rhinoplasty 4 months ago so my tip is still hard and swollen. I was just wondering if the steroid shots that my dermatologists administers on my face for pimples has the same effect as the kenalog or cortisone shots for nose swelling? I had a pimple on my nose one time and when I was given that shot, the swelling from surgery seemed to have gone down as well. Are they the same? I want to go back and ask her to administer more on my nose.

Answer:

they might help but not as fast or as dramatic as the pimples. JG 10.20.06

Question:

I have a deviated nose septum, is there one procedure better than the other to fix the problem. My brother in law is an oral surgeon, he lives in another state. He said that he will fix it by using a local anesthetic. But is their another type of surgery that is different.

Answer:

well the surgery can be done under local but most people use general anesthesia. JG 10.18.06

Question:

thank you kindly for answring question/and u mentioned a graft from skull...please do tell me more re that?--as I mentioned ear and rib had been used.I wish to find a doc whom has skills to help make the overoperated small nose to a larger more natural looking nose.Genuine and desperate for a normal looking nose.

Answer:

teh bone is taken form the skull. Due to potential legal issues, and some doctors wanting to know why I referred a patient to someone else and not them, I think you are best to go to this website and look for a plastic surgeon in the area you desire. I wish you all the best. JG 10.18.06 www.surgery.org/public/findasurgeon.

Question:

From a rhino 8 yrs ago I have cartilage poking out the tip of my nose. Would restlyane injections help? If not, what else? I notice this aspect in so many people who have had rhinos

Answer:

the only thing that will help is to have the cartilage repositioned or cut off. JG 10.18.06

Question:

I have had an over operated nose-and nose tip needs rebuilding and also bridge does.Twisted nostrils.Already rib graft/and ear has been used but nose is so small.Nasal projection i wish plus even nostrils.Help?I have had no surgeries for over 2 years but desperately unhappy..I would appreciate any advice.Thank you

Answer:

may need another rib graft or bone from your skull, tough tough problem I am afraid. JG 10.17.06

Question:

Good Evening, Dr. Garcia. My question concerns kenalog and silicone injections administered in the nose. I recently had two silicone injections in the upper part of my nose to fill in some irregular contours in the laying of skin. I also had Kenalog shots in the lower tip area. Now I`ve noticed that in two areas of my nose--both in the upper area where the bone meets my forehead, and in the middle of my nose--the skin has sunken in or atrophied, but just a little bit. Is it the silicone or the Kenalog that causes this, and is this irreversible? Could more silicone in these areas level the sunken-in skin? Thank you, Doctor Garcia. I enjoy your forum very much, and it`s very educational. Sincerely, Carl from NJ

Answer:

I have not heard of silicone causing atrophy. As to being reversible, it all depends on what caused it and I am not sure why it has occured. Now if it had been kenalog to the nose, that could cause atrophy. JG 10.17.06

Question:

hi dr garcia! i want to get a nose surgery done. i have a deviated septum so my nose turns towards the left of my face. it is not very obvious, but i have noticed this problem in my pictures. also it bends a little from the top. do you think i can get a surgery done to correct this and at the same time not look like i have gotten some procedure done (after recovery period). what will be the recovery period after such a procedure, and also the cost.

Answer:

well many insurance companies cover surgery for a deviated septum if there are breathing difficulties, if all that is done is to straighten the septum, I think it will look better but not done, the recovery time before you are 100% is about 3-4 weeks. JG 10.16.06

Question:

Hi doctor. I`ve been massaging the tip of my 3month swollen tip this past week as adviced but it seems my nostrils have become more flared. Also I can feel two hard bumps now at the very tip just above the columella. Why is this? I only had an implant placed at bridge so nothing done at tip. I know the suture was there though....

Answer:

might be some swelling from the sutures that has to resolve. JG 10.16.06

Question:

Hi I just posted the previous massaging with hard tip question. Shall I continue? I am seeing my family in a week whom I haven`t seen since the surgery so Im worried they will notice my enlarged nostrils. What else can I do for now or even that day to bring it down a little?

Answer:

not much besides the massage that you can do I am afraid. JG 10.16.06

Question:

Hi docotr. I got a revision rhino 3 months ago and the primary one 3 weeks before that. Bridge implants were placed and each time the implant wasn`t as small as I want. I want to make it even smaller for the last time and this time some cartilage removed at tip and maybe alar trimming. Could you explain how the tip may have been damaged from prior implant placing only that revision will be difficult? (If it will?) Also, I`m shy with my doctor as it`s the third time and now thinking of going to another surgeon. Should I or better to stick with original?

Answer:

might be best to change surgeons, as to making it more difficult, what is really the big determinant now is swelling, once it is swollen it is hard to determine how much cartilage to remove and it might be better to wait a number of months to start fresh. JG 10.14.06

Question:

I had rhinoplasty and my nostrils were narrowed, I am almost 3 months post op. My question: Do the nostrils become even more narrow as the swelling subsides throughout the months?

Answer:

no, they should not get any smaller. JG 10.13.06

Question:

i really need a recommandation in here. im into my 2nd revision rhinoplasty and i really want a top dr. The problem is that i live in montreal, canada. Do u recommend any1 here dr or any top revision dr in the close states like New York, Chicago, Boston??? please help, my nose is a mess

Answer:

Dr Dean Toriumi in Chicago. JG 10.10.06

Question:

I am Filipina and had narrowing of my nose done 6 months ago but I am not happy because I want the tip to be smaller and a little lift if possible. Would you recommend sillicone or cartiledge. Please help.

Answer:

a silicone implant nor cartilage will make the tip smaller nor lift it. There may be limitations on how small the tip cna be due to thickness of the skin. JG 10.10.06

Question:

Good evening, Dr. Garcia. My question concerns the nose. In September 2004 I had a rhinoplasty. I was pleased with the overall result, but my nasal tip was still too bulbous to my dissatisfaction. In June 2006 a plastic surgeon began to administer Kenalog (25%) in my nose to reduce the ball effect at my tip. In September 2006 I had a tiplasty performed by another surgeon to straighten the columella. This doctor informed me that if he could change the angle of the columella, the ball effect would be minimized. It`s only been about 10 days since I had the tiplasty done, and the bottom of my nose does not appear swollen. Am I seeing the final result of the tiplasty when I look in the mirror, or does the healing process for a tiplasty (columellar reduction) also take up to one year before noticing the final result? Thank you, Dr. Garcia Carl

Answer:

I think with everything you have had it will take months so it will get smaller as months go by, hang in there. JG 10.9.06

Question:

I fractured my nose about a year ago, but I havent realy taken any action towards getting it fixed, because my mom doesnt want to be stuck with the bill. I was wondering if it would be covered by insurance, since i was hit in the nose, and I had a nose fracture. Even though its a year later?

Answer:

if it was a fracture from an accident then insurance should cover it, the surgeon would need to ask the insurance company before doing the surgery. JG 10.8.06

Question:

Hi Doctor Garcia! First of all thank you for your respond for my question 1 month ago. Sorry I`m bothering you again, but you might know how desperate a patient feels when you can`t see the results you were expecting. Today is going to be exactly 7 weeks after I had my nose surgery, almost 2 months, as I told you before, I broke my dorsal bones to narrow them and also my tip to make it smaller, my dorsal bones, I think, is begining to look better, but the tip of my nose is still too big, I asked my doctor how he did my surgery and he told me he did not take too much cartilage from the tip, he took just a little bit and put some cartilage from my ear, so my question is, if the tip of my nose was big and he only took just a little bit of cartilage and put another cartilage from my ear, is my tip gonna look smaller?, because he didn`t take enough cartilage, I mean that`s what i think, he said is gonna get smaller, but now is almost 2 months but I can`t see any changes, is still big. What you think Doctor? One more time thank you. Veronica

Answer:

the amount of cartilage in the tip of the nose is not large so removing a little can make a substantial change in many patients. The tip of the nose is the last to get smaller and I think it will take a bit longer to really start seeing a difference, I think by 6 months things should look better and if at that time things do not look good I suggest speaking with the doctor and seeing what they think about a revision at one year. JG 10.8.06

Question:

I had surgery about a year ago next month. I`m happy with everything. But, every time I bend over to do something or pick something up my nose aches and throbes and alomost feels like it is going to burst. Is this a problem? or is it normal?

Answer:

not uncommon, should get better in time though. JG 10.6.06

Question:

Hi doctor. I`m applying an exfoliant to my face (and nose) with tretinoin hydroquinone and am peeling. I wanted to know if this has any effect on swelling on my nose surgery. I am 3 months post revision op. My nose swelling seems to have gotten wider. Or just coincidence? Thanks!

Answer:

well, I think it might effect it but not to any significant degree. JG 10.4.06

Question:

Hi. I had a closed surgery operation for an implant 3 months ago. I am now considering alar trimming. Is this done without incisions at the same spot and just at the sides of the nose? Or will it require the trim plus the same incisions as the closed? I ask because Im still forever recovering from revision surgery where incision cuts are still hard. I want to get my tip improved this time with out making healing worse. What do you think doc?

Answer:

well, there are a few different ways of performing an alar trimming so the incisions will depend on what and where the trimming is done. I think if it is something you desire, you may need to grin and bear it with the selling for a while. JG 10.4.06

Question:

I am a 26yr old male and I recently had rhinoplasty and septoplasty surgery back in Dec. 2005. I just wanted my nose to be re-straightened due to an injury to my nose. The dorsal hump on my nose was crooked and the nose hooked from right to left. The plastic surgeon suggested that I take the hump away and he would have to bring in the tip of my nose. I was not pleased with the results, my nose is now to small and upturned, it looks over-operated upon. I would like to resotre the length and height of my old nose and bring the tip down, instead of the tip pointing up in the the air, b/c my nostrils show more, and the tip is very tigh and upturned.It looks like a girls nose. What revision options would help my situation because I am searching for a correction to what I feel was a mistake. B/C my eyes look closer together, a piece of cartilidge was placed underneath on the bottom of my nose to hold the nose straight and that peice looks really weird. I really wish I would have never touch the tip of my nose. Could you please email me back with some advice on which doctor to see? I will travel anywhere?

Answer:

I think you will need some grafting to the dorsum of your nose to give it more support and avoid the upturned part. Due to potential legal issues, and some doctors wanting to know why I referred a patient to someone else and not them, I think you are best to go to this website and look for a plastic surgeon in the area you desire. I wish you all the best. JG 10.4.06 www.surgery.org/public/findasurgeon.

Question:

Hi Dr. Garcia, I had lower eye bleph 3 weeks ago. My left eye seems to have healed nicely. However, my right eye is very teary and the mid-portion of the lid seems to droop when I lean over or look down. Is this any indication that it may permanently droop? or is there a chance that it may correct itself as well. When do you know you have permanent damage? and what can you do to prevent or correct it. Thank you in advance.

Answer:

at this point it is most likely due to swelling and the muscles still being weak and should all get better in time. A little light massage pressing the skin out to the outer corner might help, a few times a days for a minute or so each time. JG 10.2.06

Question:

Hi Doctor G. I had revisional rhinoplasty 3 weeks ago. When they first removed the splint I liked my newly improved no-hump bridge although the bone felt irregular and a bit bumpy. Also, the tip was still too rounded but, I was told to be patient till the swelling came down. I noticed some kind of abrasion/scratch a bit under the bridge area (cartilage). The nurses said it happened during the surgery, although I didn`t get a full explanation. They said after it scabbed they would give me laser treatments and it would go away. Three weeks post-op there is an elevation of the skin that resembles a vein of some sort. My PS ordered some ultra-sound treatments. So far I have had 2 sessions and don`t see any improvement. It gives the nose a very weird appearance. What do you think caused this and how should it be treated? HELP!

Answer:

might be a thinned area of skin form the surgery, at this point just best to hang in there and let time do its thing, still too soon to tell what if anything will be needed. JG 10.2.06

Question:

Hi, I had revision rhinoplasty one year ago. i am happy with the results other than the fact that my nose still looks bruised. when I am cold it is purple. My dr said to wait & it would get better. I tried cold laser therapy it has helped a little. I look like I am an alcoholic, i rarely drink. Would a different kind of laser help?

Answer:

might try a YAG laser, it might be more effective for that discoloration. JG 10.2.06

Question:

Dr. Garcia, I had a nose surgery on 9/22 to remove the hump and reduce the width on the tip on my nose. The cast was removed on 9/28 and I absolutely LOVED the results. My doctor said it will actually get even better, because at that point it was still swollen. However, since then, the tip has gone back to what it used to look before surgery and I notice a hump coming back. More so when I run my fingers through on the right side of the bone, where my hump was more prominent to begin with before the surgery. What should I do??? Will taping it tightly help??? Can the hump go away??? I live in Florida, does climate matter??? Will the final results be better than the day the cast came off like the doctor said???

Answer:

just give it time, the splint controls some swelling and when that comes off the swelling increases but it will all go back down as time goes by. JG 10.2.06

Question:

Hi Dr. Garcia. I don`t know how unusual a revision rhinoplasty is with regard to reducing the columella, but I recently had such a revision. I felt it was necessary because my tip was somewhat bulbous. When I got home the day of surgery, however, I noticed that the surgeon slightly cut a piece of the columella in my left nostril, and now my left nostril appears pointier than my right nostril. Is this cut intentional, or is it cause for alarm? Are there hidden stitches inside my nose that will take care of this problem in time? Also, how long does it take for a swollen tip and columella to subside?

Answer:

hard for me to say without seeing you but sounds like it was intentional. There should be internal stitches too that you might not be able to see also. The tip and columella swelling can take months to resolve though. JG 9.26.06

Question:

Hi Dr. Garcia, Thank you so much for answering these questions... I think you must provide more reassurance and guidance to more people than any other nose doctor in the country! I have two questions related to rhinoplasty. The first is about post-operative nausea. I have wanted a nose job for years but am afraid of the recovery-- not so worried about the pain, which I can deal with, but am petrified of the nausea/vomiting associated with anesthesia. I had a bad experience as a teenager and have been afraid of general anesthesia ever since (I`m 35). Can rhinoplasty be done with local? Will that reduce the chance of nausea? How often do patients experience nausea? Can I be given anti-nausea drugs? My second question relates more to the procedure. I am female and would like the width of my nose reduced and a little more definition in the tip-- nothing dramatic; I`d just like a somewhat thinner, slightly smaller version of the nose I have now. I think the bridge of my nose is fine-- I just have a kind of round/bulbous tip that I`ve always hated. (My husband calls my nose a line with a ball i.e., normal, strong bridge and round end. I am 1/4 black.) Can I have rhinoplasty on the end of my nose without having to get any bones broken? In other words, can my nose be made smaller and thinner without messing around with the bridge? I think I`m looking more for refinement than anything else-- and a little reduction in size. Thank you for your thoughts!

Answer:

It can be done under local but most of the nausea is related to one of two things, swollowed blood, which can be avoided, and then how much narcotic is used during and after as narcotics cause nausea, so keeping them to a minimium helps quite a bit. I think nausea happens in rhinoplasty about 5% of the time. There are many good anti-nausea drugs out there now so that should not be a big concern for you. As to the tip, you can certainly have the tip done without touching anything else. All the best. JG 9.26.06

Question:

Hi, Doc i was told that there is some other procedure other than having nose surgery... do you have andy idea? My nose is to wide. i would love to have nose surgery but cant` afford it.. any other options for me?

Answer:

I do not think any of the other little tricks can make your nose less wide I am afraid. JG 9.26.06

Question:

I am a 26 year old female seriously considering rhinoplasty to narrow the bridge of my nose. Is this generally done with an open or closed technique? Also, I have heard that one of the possible risks is that the eyes may appear sunken in or hollow after the surgery, a side-effect which can be permanent. On average, how often does this occur? I already have a little bit of excess skin under my eyes so would that put me at a higher risk of this happening? I am not happy with the shape of my nose, but I don`t want to have it fixed only to have something else to happen to my face that would make me unhappy.

Answer:

if it is just the nasal bones it is usually done closed and if the bones are reduced a large amount it can give the appearance of deeper set eyes in certain individuals but not all. I think that risk is rare. I do not think the excess skin on the lower lids will impact it greatly. JG 9.25.06

Question:

Hi I had revision closed rhinoplasty two months ago and had an implant put in but at the bridge only. I want to know what it is about the columella and tip that stays extremely hard. The incisions are there yes.. But is it because the skin was seperated from the tissue there and is now regenerating or something? Or maybe that`s where the implant went through the muscle? I question because I`m afraid that when I massage it often I might be interupting the healing process or more scar tissue might form.... Could you explain that a bit to us laymen please doctor? =P Thanks so much

Answer:

the firmness is due to swelling that stays there a long time as it settles there and goes away very slowly. Since it is the lowest or dependent are, that is where all of the swelling from above goes and since there are scars there it is hard for the swelling to get across the scar and therefore takes time to resolve. Massage will help not hurt all of that, but mostly it is a matter of time. JG 9.24.06

Question:

I`m 5 months post op, my swelling seems to have taken forever time to subside. Well it has for the most part but the area around my nasal bones that used to be hard, graining and swollen is now soft and i guess you could say kinda swollen. I can`t tell if the skins just loose or there`s fluid behind the area. Has this happened to anyone, is this normal? Reply To This Message

Answer:

normal and probably just still a little swollen, should get better in time. JG 9.23.06

Question:

Hello Dr Garcia. When a rhinoplasty is conducted under local anaesthesia, can the sedative be given oraly (pill)? I really can`t stand intravenous intake. Thank you

Answer:

It could, but it is something I would not do. I feel an IV should be started even if you are not planning on giving any medications in case of an emergency. JG 9.21.06

Question:

Wow, it must have been a long time since i last asked a question, because everythings different. Anyways, i have figured out what was wrong with me. i injured my nose a year ago, and didnt really know that i had fractured it, because i was told by my doctor that there was nothing more than just swelling. after about 4 months or so, i started to notice a different nose. bigger, crooked, and now i have a hump on my dorsum, and a wider bridge. i guess the fracture has healed, but i`m left with the horrible outcome. what can i do about this, and at what cost? does my story qualify for insurance coverage (should it atleast?)

Answer:

it certainly sounds like your insurance should cover it, I am presentluy not on any insurnace carrier list so I cannot tell you what it would cost you. It is not uncommon for no fracture to be seen on an X-Ray as most nasal fractures are of cartilage and do not show up on an X-ray. An open reduction of the nasal fracture should help what ails you. JG 9.20.06

Question:

Dr. Garcia, My son had nose surgery 3 weeks ago. He had a cartilage taken from his ear and placed across the inside of his nose, to help him breath better. He also had his septum removed, straightened and put back and had his tip straightened, and a bump on his bridge smoothed very slightly. We were told that there would be no significant change to his nose, but it seems shorter and much wider, and his left nostril seems pushed up. He also feels a round lump inside his right nostril. What could this be, and is this a concern? We are emotionally stressed over all this as we were told his nose size and shape would really not change much. He doesn`t want to return to college, because he is so upset. Any advice you can give us on all this is greatly appreciated.

Answer:

the lump coudl be the start of some scar tissue or some edge of the cartilage graft that was placed, it is still way too early to tell how it will change but as the swelling does improve the size should normally decrease quite a bit. Try to hang in there for a little more time. JG 9.20.06

Question:

Hello Dr. Garcia. First of all I want to congratulate you for the prompt response to all those questions and worries of people who had a plastic surgery. I have some questions about what I believe worries most of people who had a rhinoplasty. Are bones swollen too, after fractures have been made? And I don`t mean temporary swelling that goes away after 2 weeks, I mean consistent swelling. What can someone expect during the second semester post op about this type of swelling? Is MOST of this swelling gone by then? With respect.

Answer:

usually all swelling on the bones is gone in 6-12 moths. The more swelling at the begging, the longer it takes. JG 9.17.06

Question:

Hi Dr! I had rhinoplasty about 1 and a half months ago and had an implant put where my bridge is. However, I find the implant a bit too low cuz it made me look like I have a protruding button nose with little bridge. It would be perfect if it were placed a bit higher up so that I have more bridge and less height by the tip. Sometimes I gently push the implant up out of frustration. Will this help and settle that way if i continue doing that? Or will sliding the implant up dislocate the implant and make the pockets loose? Thanks Dr for your help! - kim 09/17/06

Answer:

I think sliding it will make the pocket stay open, if it stays too low you may need repeat surgery to position it better and then have sutures placed to hold it there. JG 9.17.06

Question:

hi dr garcia. my question is ive had my 2nd nose job recently due to problems with first one done 10 yrs ago. i had to quit cigerettes 4 weeks before surgery which i did sucessfully, now after 5 weeks ive started back on them, prob average about 5 a day. scared this will jepordise my chances of needing 3rd procedure due to possible graft rejection (30% chance i was told by my surgeon). am i playing with fire? many thanks CD 7/05/06

Answer:

I think you can smoke, although it would be best for your heart and lungs if you did not. JG 5.7.06

Question:

ps Dear Dr Garcia I had rhinoplasty done about a year and five months ago and i am not satisfied with the results. i feel as though i threw my money away. i did no research on my doctor and was naive. i later found out that he is not a plastic surgeon but an ent. my question is are ent's qualified to do rhinoplasty in your opinion? also is it odd that since my operation i had only one check up consultation which was after the six months? thank you for your time and much needed help.

Answer:

I feel most ENT's are trained and can do rhinoplasties but not it can vary from surgeon to surgeon. Having one check up after 6 months is very unusual. I suggest seeing some other surgeon and maybe there is more that can be done. Best of luck. JG 5.6.06

Question:

Hellow Dr. Garcia, Is it possible to have cartalidge added to the inside of my nose, I feel like to much has been scraped away and have a much larger whole inside my nose on one side. Or can something esle be used to build that up? Is this a very difficult procedure, can it be done without complications. Please advise, Aleshia

Answer:

how complicated it is is difficult to say without examining you but in general, cartilage can be transplanted to the nose, donor site can be the septum or ear. JG 5.4.06

Question:

I have had work done on my nose 2 months ago. I was left with bruising around and below both eyes. It has been 2 months and I still have some discoloration below both eyes in the crease area. Will this ever go away? I'm getting worried. Thanks

Answer:

it should but it might take a few more months. JG 5.3.06

Question:

Hi Dr.Garcia, I had a nose job 15 years ago and was pleased with the results, except my right nostrol was smaller and uneven on the inside wall. The cartalidge was sticking out more. I went back last week to see if he could stitch the cartalidge back against the wall to even it out, but it seems like he shaved away to much on the inside above the protruding area and after my stitches disolved the nostril on the inside is still uneven and the cartalidge is still protruding. Can this be fixed and how can it be sown into place if he removed to much from the inside wall of my nostril. I only want my cartalidge to lay flatter against the inside wall so my nostrils look the same. Any sudgestions, I like my doctor alot but not sure he will want to try it again, It seems like a pretty straight forward and simple procedure.

Answer:

actually it can be difficult and may require a full opening up of the nose to make sure the cartilage lays properly and you may need some stitches into the cartilage. JG 5.3.06

Question:

I was hit in the nose about 8 months ago and it swelled up. now it looks broken, like my bridge is uneven and the left side is a little wider than the right, but they both look bigger than ever. And I also have a dorsal hump now. The doctor told me there is nothing broken after getting an xray, but theres no way it could be normal, I can see how big and deformed it is now compared to 10 months ago. Could this be cartilage, or scar tissue? Also, how can I fix it (all options please), and how much? Does insurance cover the procedures if my nose was injured, rather than my own personal reasons to fix it. My father told me that cartilage, after awhile repairs itself (I dont believe him because its been over 8 months and it seems to only get worse).

Answer:

most nasal fractures are broken cartilage so they do not show up on xray, cartilage will heal frequently bigger than it was before the injury, insurance will commonly cover the procedure. JG 4.30.06

Question:

I had rhinoplasty on March 1 of this year and am happy with the results. However, within 2 weeks of the splint being removed I developed what seemed to be under the skin boils on the tip of my nose (both sides) I have finished a course of Cipro and Tetracycline but these nodules are still there. The swelling associated with them seems to have reduced but the hard, round areas are still present. My plastic surgeon is at a loss. I guess my next course is a dermatologist but the good ones are scheduling months from now for a first appointment. I am very discouraged as these hard round areas are significantly impacting my new look Thanks for any guidance you can give. SBS 4/29/06

Answer:

may need a low dose for along time of tetracycline, or minocycline. JG 4.30.06

Question:

Hi Dr. Garcia! I had septoplasty done about 2 years ago. Since than, my breathing has improved, but it's still not great. Sometimes, I wake up in the middle of the night because I can't breathe properly. My nose currently bends to the left a little bit and it causes the inside of my left nostril to be very narrow. If I use rhinoplasty to straighten out my nose, will it also open up the airways? Thank you! MJ 04/29/06

Answer:

I think you need a repeat septoplasty from what you describe. JG 4.30.06

Question:

Hi Dr Garcia....I was wanting to have my nose smaller,I live in Australia,and my sister lives in Ohio usa...I was wanting to come over there and get you to preform the procedure for me....is that possible?????? Fay email address fbrats@yahoo.com

Answer:

we do perform surgery on patients form all over the world, I would need you in Las Vegas for about one week though. JG 4.30.06

Question:

dr. garcia, i'm going into surgery for polyp removal. i also have a deviated septum and a fracture in my nose. is it possible to get it all done at once? my surgeon said that i can't and that i need to get rid of the polyps first. after 1 to 2 months i have to go into surgery again. i was heart broken when i heard that i had to have 2 different surgeries. i'm all readynervous about the first one. thank you. m.h. april 22, 2006 @1 pm

Answer:

from what I have seen, all of that is usually done all together. JG 4.22.06

Question:

Hello, I had skin cancer on my nose several years ago and now it is becoming really red. What could I use to take the reddness out? Also my arms look like alligator skin from too much sun which I now avoid. Any suggestions for that? Thanks so much for your time.

Answer:

Moisturizers and sunblock for the arms. As to the nose, I think you should see your doctor to make sure you do not have a cancer coming back. Best of luck. JG 4.19.06

Question:

Your websight is awsome!! I had a revision rhinoplasty a week ago and would love for you to answer a few questions if you have time. My PS is on a long vacation so the nurse took my stiches out. ( I don't think he likes it when you ask him many questions anyway ) He told my husband he had to take out alot of scar tissue from the previous surgery. Is there anything I can do, to keep it from forming again? I have been putting tape back on it at night, hoping to keep it's shape. Is this good or am I wasting my time? Should I tape the hard plastic cast back on at night? Also, the tip of my nose had fallen, so he said he would place something plastic in there to help keep it up. I'm so afraid it will fall again. Do you have much luck with doing that procedure? Can I massage it without hurting something? Any advice you can give me would be MUCH appriciated!! Thanks so much for your time. I'm not sure how you do it.

Answer:

thank you for the kind words. The scar tissue forms from the way you heal and also the amount of bleeding and swelling, so not much you can do right now. Taping is not a bad idea, but I cannot say how much of an effect it will have. The hard cast should only be applied to avoid getting hit on the nose, will not make much difference now. There are plastic struts you can put into the tip to assist in projection although you can also use your own cartilage if availbale. Hang in there and best of luck. JG 4.16.06

Question:

Dr. Garcia, On average, what percentage of your rhinoplasty patients are happy enough with the results that they don't have to see you again? On average, how many have post op problems like scar tissue, bumps, indentation? Thanks!

Answer:

even in the best of hands about 5% or slightly more of rhinoplasties need to be touched up, the more that is done, then the higher the chance. JG 4.16.06

Question:

Dr. Garcia, Would being on antidepressants affect rhinoplasty candidacy? Thanks for your time.

Answer:

no it should not affect it in any way. JG 4.16.06

Question:

This is not exactly a cosmetic surgery but along the same lines as a nose job, Three weeks ago I had a surgery called DCR for a blocked tear duct, a week latter my doctor took the stiches out and I was still really swollen and bruised, he did not seem really concerned but he never does. I am still swollen on the side the incision was made and my nose is very sore, there is still some buising and I could not possibly wear makeup because any rubbing or touching is very painfull. I am worried because he talked like it would be a quick recovery, aside from the tube in my eye and nose driving me crazy the swollen nose and eyelid are still painful to touch or make certain facial expressions. Is them normal? I am supposed to get the tube out in about 4 more weeks, should I wait and see or go back? It was really swollen and is a lot better but very slow.

Answer:

all of that is normal and the swelling can take some time to go down. Ice may help, the tube needs to stay in place until the wound heals and the swelling goes down. JG 4.16.06

Question:

What a fantastic website - you are a kind man Dr Garcia! One side of my nose looks wider and there is a gap / ridge at the side of the bridge of my nose - could this be where the bone is un-attached to the septum / un-alined one side making the bone look wider? Its stings in the dented area? The other side is perfect much narrower and smooth all the way to the septum. Thanks in advance :-) Answer: Thanks for the kind words. You are correct in your assessment and it may hurt because small little nerves can be trapped in that space. May need to have it broken and pushed together. All the best. JG 3.26.06 *** Thanks for the reply - I am seeing my surgeon this Friday to get the problem sorted - Just wanted to know what might have caused this to happen - Thanks in advance and Happy Easter ***

Answer:

thanks for the kind words. I think your assessment is correct. May take more surgery to correct or improve it I am afraid. JG 4.15.06

Question:

Hi Dr. Garcia , i was wondering what is the appropriate age to get a nose surgery ?. My daughter that is 16 years old is uncomfortable with her nose because it's wide . Do you think she is too young ?. Thank you .

Answer:

I think 16 is OK to proceed, you just need to wait until they are almost fully grown so that you do not stop the nose form its normal growth. JG 4.15.06

Question:

Last summer, i was elbowed in the nose and it swelled up. I've never had a swollen nose before that, so I thought it was broken, but all i could do was ice it. the doctor told me that it was not swollen, based on her opinion (didnt even get an xray). Well, the swelling went down, but I was left with a hump on my nose, and the bridge of my nose was wider than it ever was. I HATE the way it looks, and i recently got an xray, and it came back not broken, so why is it so damn big. I feel like Marsha (bradybunch), by the way, how did she fix her nose. plastic surgery would be a burden on my pockets

Answer:

it will require surgery, and you probably did have a broken nose, but what broke was cartilage and that does not show up on X-ray, you would need surgery to fix what you have, sorry. JG 4.13.06

Question:

I had my nose done about 5 weeks ago and now the tip of my nose is hard,is this normal and how long will it be like this. Also the inside of my nostrils are smaller. Is my possible that my doctor moved my Cartilage around in there to reshape my nose. I though he would just cut some cartilage out to make the tip smaller. I don't think my doctor explained everything to me upfront.

Answer:

all normal and make take a few months to soften up. The nostril may appear smaller due to the selling too. Hang in there and give it some time. JG 4.12.06

Question:

I have had 4 surgery's to correct my nose. The last one, he put something plastic in to hold the tip up. I should have asked more questions, but was so thrilled when he told me this should keep it from drooping. my question is, have you had good results from using this? and is it possible for it to break or shift? He also said he removed a good amount of scar tissue this time. Is there anything I can do to prevent it from forming? Your websight is very helpfull. Thank you. RM 4-10-06

Answer:

they can break, shift and also poke through the skin in time. Removing scar tissue can be good, but some or all of it might come back. I wish you the best with the last surgery. JG 4.11.06

Question:

i had a revision rhinoplasty. My ps added carlidge to my bridge and made my nostrils alittle smaller. right now i have packing in and i look like i have a pignose. Is this common? Is it due to packing and swelling also MMR

Answer:

yes, all normal and the packing makes it look worse, all should get better soon. JG 4.9.06

Question:

Hi Dr Garcia, In responce to your answer (I posted the question regarding a rhinoplasty done 18 months ago and still suffering swelling), I had the base of my nose narrowed as it was sitting a little high and also a minor bump removed. It was a closed procedure and although it looked great for the first month after the cast came off, the swelling has gone up and down ever since aswell as the tip still being numb. You mentioned recovery could take up to 2 years, so should I just wait it out or is this unusual for the surgery I had done?? Thanks for your help!

Answer:

I would wait it out, if you can, because if it gets better on its own its better and easier than surgery. You can always have more surgery later. JG 4.7.06

Question:

I got my nose broken around 3 years ago and I didn't know it. I let it heal on its own, but it never felt the same. There is an uncomfortable dull pain on the bridge of my nose, where there is a dorsal hump caused by the injury. I feel like something must be done for my nose to go back to normal, because three years have gone by and the pain is constant. My hypothesis was for a surgeon to re-break my nose where the dorsal hump is, and bring it down to where it was before. Then afterwards do the nasal exercises for full therapy. I have talked to a few nose doctors and are clueless. If you were my surgeon, what do you think of the procedure I said?

Answer:

the pain you have in the hump which is basically a callus, may get better with surgery but no one can guarantee it. If the pain is that bad, it might be worth it, I doubt it would get any worse. JG 4.6.06

Question:

A little over three years ago I was in a car accident and my nose was broken. I could not breath through my nose. On right side of my nose there was a bump in the bone that was making it very difficult to wear my glasses. The doctor and I talked about fixing the bump in addition to repairing a deviation in my nose so I could breath again. Everything seemed to go well until the packing and stitches were removed. To my shock the doctor had done a rhynoplasty and had reshaped my nose taking the hawk like bridge out of my nose and made a straight nose leaving the bump still there. When I complained about it he shrugged and told me that most people want a straight nose . Things got much worse, part of my nose under the bump on the upper part of my right side below eye level sank inward and down. I felt it happen, it seemed like my nose slid down my face for a second or two. A tickle in my nose started and has resulted in constant tickling and pain in my nose and upper palate in my mouth right above my front teeth. The doctor diagnosed it as a sinus infection, we did a CT, and I took some very expensive antibiotics. Then some more antibiotics, then he diagnosed it as allergies and REFUSED TO CONTINUE SEEING ME. I saw my family doctor, he looked at the CT, called the surgeon up and had a talk with him. The surgeon saw me again, ordered another CT, diagnosed me with atypical facial pain told me it had nothing to do with the surgery and subscribed Neurontin (costs $100 dollars a month) and told me that I would probably be on it the rest of my life or until I got tired of taking it. The Neurontin helps some, we have increased the doseage three time, but not a lot. I went back to my family doctor and he sent me to a neurologist. This doctor checked me out and basically told me that nothing could be done, I have nerve damage. If part of my nose, before it became completely solid again pushed down on a nerve does it not make sense that another rhynoplasty could reverse the pressure on the nerve? Or at least possibly give some level of relief? My nose is partially curved in and to the touch you can feel right side being slightly lower, the whole nasal bone seems to be a little lower on my face than the left side. Is a procedure I should talk to a doctor about? The nerve pain is terrible, it is taking a very heavy toll on me.

Answer:

well, attempting to re-fracture the nasal bones and trying to support them may help, but it also may not do anything. If your pain has gotten that bad, it might be worth the risk to try it, wishing you the best. JG 4.6.06

Question:

Dr. Garcia I had a rhinoplasty 2 years ago and when I smile my nose seems to flare out at the nostris (on the sides). It also looks, or reminds me of, a beak shape. What causes this and can it be fixed? I especially HATE the way it looks when I smile. I looked at old pictures and it didn't do that.

Answer:

the widening is due to the muscles of the nose pulling to the sides, they can be cut but they like to heal right back up. In terms of the beak, it is called a Polly Beak deformity, it sometimes requires more surgery to sculpt what is called the distal septum and supratip break area to avoid that problem. The widening is a litle more common after a hump is removed. JG 4.6.06

Question:

I am a dark skinned african american female 47 years old. If it weren't for my nose, I would be considered attractive. My nose is large, bellshaped, and flat across the top. It takes over my whole face. I went to see a PS about rhinoplasty. He said you want to to have this done so you can have a nose like a white person. Don't you? I was completely taken aback but then it got worse. He said you people have thick skin and I don't know if it would even show if I stuck a finger bone into the bridge of your nose. He started to examine my nose, then drew back as if he were repulsed. He kept saying UUU your skin is so thick! I want my nose fixed so that it won't be large, bellshaped, flat. and so it won't take up most of my face. I've been teased and tortured about this since I was a small child. Every photograph thats ever been taken of me looks like a weird caracature of me. Is dark skin a problem when it comes to rhinoplasty? Or should I just forget about surgery and live with the heckling and bad jokes.

Answer:

That was extremely rude of the physican. African Americam skin is thicker and there are limitations on what we can achieve but many people of color have rhinoplasties done with very nice results. I am sure that there can be some things done to make it look a little more proportional. Don't be deterred. JG 4.6.06

Question:

Hi Dr. Garcia, I had a rhinoplasty 18 months ago, but I am still experiencing swelling. The tip and sides of my nose still flare up and I am worried that it will constantly be like this. Will my nose ever go back to the size when the cast first came off?? Thank you!

Answer:

yes, but it all depends on what was done, I have had cases where it takes almost two years to stabilize. Hang in there. JG 4.6.06

Question:

Dear Doctor- I am looking to have septoplasty here in London. Could you please tell me who the best surgeon would be. I would be so grateful if you could please help me. Mr YJ

Answer:

I am sorry but there are many good surgeons there and I am not familiar with all of them.Due to potential legal issues, and some doctors wanting to know why I referred a patient to someone else and not them, I think you are best to go to this website and look for a plastic surgeon in the area you desire. I wish you all the best. JG 4.6.06 www.surgery.org/public/findasurgeon

Question:

How long after a rhynoplasty operation can I start wearing sunglasses?

Answer:

4-6 weeks. JG 4.6.06

Question:

I had a nose job 2 yrs ago, I'm still very unhappy with the results even with several steroid shots in attempt to make the swelling go down. The graft he put in my septum has slipped out of place and make my nostrils look two different sizes and whenever I smile it pops in and out of place and is very apparent. I think the tip of my nose still has a bolus and have request that he go back and shave it down some. He declines to do that but agrees to trim my graph down by cutting me on the inside of my nose, which will be an in office procedure with just a local shot in my nose to numb the area. Does this sound right, for an in office procedure, and will it even correct the oversized graph?

Answer:

That can be done for a graft revison, yes. JG 4.4.06

Question:

since rhinoplasty two months ago my left nostril is stuffed up and dry which is very uncomfortable what do you think is happening and what should I do? april 2/06 suffering in Canada

Answer:

most likely some old dried blood around some sutures, use some saline nasal spray and it should get better. JG 4.3.06

Question:

Hi, Doctor I am 26 years old and about 4 years ago one my left under eye has become very puffy and dark and will not go away, no matter what i use. I finally found a cream that lessened the darkness but nothing seems to work for the puffiness. I have spent so much money, and I am searching for a surgeon now for surgery. Is it ok to only do one under eye for the puffiness? what is the average price for one under eye? And will it look normal like the right eye? And what do you think this is with just this one eye issue all of a sudden? Thank you very much for your valuable time and patience. Christina/3-29-06

Answer:

it is OK to do just one eye, prices vary from surgeon to surgeon though, so find the one you are going to go to and then get the price from them. It is difficult for me to say what has caused it without examining you. JG 3.3.0.06

Question:

Hi Dr. Garcia, 7 months ago I had a revision rhinoplasty. I had excessive growth of scar tissue on the bridge, causing a large red bump, so a month ago, the surgeon operated and removed the scar tissue. At first, it felt great, but after a month, I have some red spots cropping up again, soreness on the bridge, and some bumpiness. The next time, he says he will make an incision on the outside of my nose to get rid of it. Am I doomed to continue this cycle? Do some people just naturally produce more scar tissue than others? I don't want a scar on my nose if I can avoid it.

Answer:

I think you need to give it time as many times the bump softens and goes away. JG 3.28.06

Question:

Nasal Flaring/ I guess what I mean is what do you do for such a problem? Botox? or what muscles would cause this in me and not others?DD Boston

Answer:

Botulimum toxin A is an option but it mght be difficult to weaken the muscles that cause the flaring and not others. Which muscles need to be injected varies form person to person, depending on each nose. JG 3.26.06

Question:

Nasal Flaring! Help When I smile ar speak my nose flares alot! I have been made fun of for this for many years! When my nose is at rest it is not unattractive! BUT when I talk or smile OH my my face becomes very unattractive and distorted alot with that is the nasal flaring! what can be done .. I have inspected alot of faces smiling and not one do I see this distortion of the face!!! Where do I begin to find a plastic surgeon to help me!? I live in Boston.. Thanks for your help.. Deborah D boston. ps. I am 40 years old... doegirlsr6@hotmail.com

Answer:

I think you can find a surgeon at www.plasticsurgery.com. best of luck. JG 3.26.06

Question:

What a fantastic website - you are a kind man Dr Garcia! One side of my nose looks wider and there is a gap / ridge at the side of the bridge of my nose - could this be where the bone is un-attached to the septum / un-alined one side making the bone look wider? Its stings in the dented area? The other side is perfect much narrower and smooth all the way to the septum. Thanks in advance :-)

Answer:

Thanks for the kind words. You are correct in your assessment and it may hurt because small little nerves can be trapped in that space. May need to have it broken and pushed together. All the best. JG 3.26.06

Question:

I had a nose job 6 days ago and my nose is clogged up with all kinds of junk, I thought it was dried up blood, so I tried to pick it out, but a stich came out so I left it alone. When I went to my doctor he said to leave it alone and use some saline nose spray. But it hurts too bad to just be dried up blood, and why would there be stiches in the inside of my nose. Besides that I'm not very happy with the results even though its only been six days, is it ok to ask for a partcial refund?? EH from Louisville, KY

Answer:

there are usually sutures inside the nose to close the incisions, they will dissolve in time and the saline spray does help quite abit. 6 days is very soon after surgery and there is still an enormous amount of swelling so just give it some time. I would wait at least 6 months before deciding if anything needs to be done and then you can discuss it with the surgeon again. JG 3.25.06

Question:

Hello, Dr. Garcia, I had septo-rhinoplasty nearly three weeks ago. Three days ago my plastic surgeon said that my swelling was pronounced and gave me several cortico-steriod injections in my nose and cheek area. The results were stunning within one day, with greatly reduced swelling. Now, it appears that the swelling (and numbness) is returning and feels like it is moving down into my chin, which was reduced five weeks ago during a neck and facelift with upper and lower blepharoplasties. My question is this? Can I get an additional round of steriod injections or is this a one-time fix? Thank you so much. DCR March 23

Answer:

it might help but you may need oral steroids to keep it safer.JG 3.25.06

Question:

Dr. Garcia, I am considering rhinoplasty. I have a smallish bump on the bridge and a bulbous tip. Here are my questions: How much does a consultation cost and what does it consist of? My biggest worry is recovery time: I just started a new job and time off is a big factor, as well, I really don't want to go back to wirk with it totally obvious that I just had surgery. What is the average aftermath like? And last: I see that average rhinoplasty hovers around 6-10 Grand, does your office finance? Thanks for your TIME, ---

Answer:

Consult fees vary from surgeon to surgeon, our fee for that is $50.Depending on what needs to be done, there will be dressings and bruising and that may take about a week to get well enough to hide in public with make up. We do offer financing but our fees range from about $4000-$7000. All the best.JG 3.25.06

Question:

I am unhappy with the shape of my nose. There is a bump and i would like to get it removed. What sort of procedure would you recommend for this at the lowest price and best results? Would there be any swelling after? If so, how long would the swelling take to go away? Is it a bad idea to get a nose job when you are younger?

Answer:

hard to say without examing you, it might be a straightfoward rhinoplasty or something more involved, it can vary in price from $4000-$6800. JG 3.23.06

Question:

Hello Dr. Garcia, I had a revision rhinoplasty done 6 1/2 month's ago. My nose looks nice but on the left side of my nosetip there is a thick spot (bump) and it feels very hard and looks swollen. It also makes my nose look crooked. I'm pretty sure it's scar tissue. My PS gave me at least 3 shots over a period of three months. Do you think it will completely go away. Also, is there anything I can do to make the bump and the hardness go away...i.e. any creams? Thank you for your time.

Answer:

It might, hard to say at this point. No creams out there that will help, may need more shots I am afraid. JG 3.23.06

Question:

Hi Dr. Garcia, I have a hump on my nose and I'm interested in rhinoplasty. Approximately how much do you charge?

Answer:

fee is about $3800 if it is only the hump. JG 3.23.06

Question:

doctor garcia, when one does have rhinoplasty are there cases wherein he has to repeat the procedure because the stuff that was put inside the nose went out of the place ..dislocated.. protruded.. or whatever term one can possibly imagine...what can cause these things to happen, i mean the implants get dislocated..

Answer:

it can happen, cetain implants cause that problem more than others. Any motion in the implant or trauma to the nose can cause the implant to move and possibly protrude. JG 3.23.06

Question:

Dr.Garcia what is the working condition for a plastic surgeon

Answer:

all depends on where they practice and what type of practice they have and their desire to work. JG 3.22.06

Question:

Dear Dr.Garcia, I live in London and had a nose job 6 weeks ago in Iran. I think I have developed scar tissues on the bridge of my nose. It is not very visible but if you look close you can see that the bridge is not 100% even. Unfortunately I have no access to my doctor at this point, but is this something i need to be concerned about? will the scar tissue disappear with time? and also what causes these scar tissues? Many many thanks

Answer:

it might get smaller and it might not, it comes from the normal healing process of the nose surgery. JG 3.18.06

Question:

Hello Dr. Garcia. I looked through some of your before an after rhinoplasty photos and they are wonderful. I've been through hell with my nose. I've had three rhinoplasties for functional (deviated septum and turbinate reduction)and cosmetic reasons. I had a rib graft placed on the dorsum to build up the bridge. Later, the graft shifted and was poking out. Five months ago, I had the graft removed and the surgeon cut the graft up and used it to build up my tip. The problem is I believe the grafts became infected. My nose was abnormally swollen (so much so that it didn't look like a nose) and at one point started to drain yellow fluid from the incision site. I wasn't able to see my surgeon because he was out of town. He first prescribed Cephalaxin and then Cipro. It's remained extremely swollen (goofy looking) and is still somewhat sensitive even though it's been almost half a year. I've had kenalog injected twice to reduce the swelling, but that's so temporary and risky to keep injecting. The surgeon said just give it time, but there really hasn't been much change over the months. I'm worried that the infection could have altered the healing and/or is possibly still infected. I was hoping you could give me some direction on how to approach this and to find out what's going on. Also, is there an antibiotic that you've known to work in situations like this? I'm extremely grateful for any input.

Answer:

I think Cipro or others like it is what I would use. I am afriad that in the removing and morseliizing the graft and putting it back in has caused the infection and inflammation you describe. This happens much more so in rib grafts that are not the patient's own, like from a tissue bank. I am afraid the only thing that will be able to be done to help is to go in and remove the graft and leave it out, let it all heal and see what you will need at that time. Wish I had more to offer. JG 3.18.06

Question:

Hi Dr. Garcia, This question doesn't specifically relate to nose surgery or any kind of plastic surgery, but about 7 months ago I noticed a small bump under my left nostril around the bone area. It was quite sensitive and I later had a root canal done the the #9 tooth directly below. I figured it was caused by the infection in the tooth. It's been about 2 months since the root canal and the bony mass has harden and progressed kind of into my check area. No one can explain what this is to me. Its quite hard and it makes my face look swollen on that side, especially near the nose. Is this something that a plastic surgeon would need to treat or an ENT? Any info. would be so great appreciated. Thank you, Steven C. Covina, CA., March 17, 2006

Answer:

I would see an ENT and get a CT sacn to see what has settled in there. JG 3.17.06

Question:

Hi Dr. Garcia!... I was reading the numerous Q & A's and noticed a lebanese girl had been looking for a surgeon on the east coast who can cater to non-caucasian patients looking to keep their ethnicity in their features. I have just had rhinoplasty with Dr. Michael Evan Sachs in NY and he has done countless surgeries in which he contours the nose, but keeping the person's character in their face. He has assisted many people I know and I would highly recommend him for the east coast. My question is, the stiff upper lip does eventually go away in time correct? I look like i had more than my nose done when i smile, i'm not worried, since I am sure it's very common, it just helps to hear it from a second doctor skilled in this area, since everyone heals differently. Thanks so much for your time.

Answer:

yes, but it takes time as the muscles get very swollen and that makes them not functional as well for quite awhile. Thanks also for the info to the people on the board. JG 3.16.06

Question:

DearDr. Garcia i wrote this question yesterday but didnt receive an answer yet i had my nose broken 20 years ago and just decided to get something done 6 weeks ago as my nose was always long and looked longer so thought i would get it shortened. 4 weeks after having it done i had a couple of nose bleeds and a blood clot 4 or 5 inches long came out of my left nostril. since then i am having trouble breathing in my left nostril a stuffy smothering feeling and nothing will come out of it. I went to my plastic surgeon a couple of days ago and he said everything looked fine and it should be okay when all the swelling comes down which is almost down now. what do you think and what should i do. Leona

Answer:

I would use some salt water nasal spray instead of rolling anything in there as that may cause more irritation nad bleeding. It should all settle down in time. JG 3.15.06

Question:

Dr., If a person has a slight bump on the bone on one side of the nose, can it be shaved down without breaking the bone of the nose? How much risk is involved, side effects? Can you tell me a little about the procedure that would be needed? How much downtime? Costs - estimate? SHA

Answer:

it can be rasped which is not a fracture but a scraping. Risks are that either too much or too little is removeed. Downtime is about 7-10 days before light actvity. Costs will vary from surgeon to surgeon so you would need to pick someone and see them. Best of luck. JG 3.15.06

Question:

Dear Dr Garcia, First, hats off to you. How do you find the time? Love your website. I had tiplasty 10 months ago. the tip of my nose is not symetrical and it looks as if one side of my nose is bullbous. On that same side in addition I have noticeable redness, chapping and a constant drip. I have seen an ENT who says I have a heavy staph infection and an infectious disease doctor who thinks that the one permanent stich which happens to be on the same side as the redness and swelling nostril could possible be infected. I have been on five rounds of different antibiotics which help the nostil some but does not cure the problem completely and the redness and drip returns within a few weeks. My question is, when is the best time to have the surgery again? Also, what are the chances of fixing the asymetry and thining out the nose at the same time? It looks like I also may have some scar tissue build up. What would you recommend? Thank you for your time. E

Answer:

thanks for the kind words. I think if you have had that many courses of antibiotics it is time to get the suture out to alleviate the problem.In terms of fixing anything I would be hard pressed to say without seeing you as it would be nice to try to avoid sutures being placed in order to avoid the same problem again and they may be needed to get the desired improvement you want. Scar tissue can be removed but some of it may come back. All the best. JG 3.15.06

Question:

i had my nose broken 20 years ago. my nose was long and 6 weeks ago i had it shortened. about 2 weeks ago i had a couple of nose bleeds and a blood clot came out of my left nostril about 5 inches long. since then i have difficulty breathing out of that nostril. sort of dry smothering feeling. i went to my plastic surgeon and he said everything looked fine to him it should get better when all the swelling goes down. i feel better when i roll a bit of tissue up there. what do you think. thanks leona

Answer:

I would use some salt water nasal spray instead of rolling anything in there as that may cause more irritation nad bleeding. It should all settle down in time. JG 3.15.06

Question:

Is there a nose implant instead of using Breath right (R) nosal strips (US Patent No. 5333499 5533503 6318362) Thank You in advance. K.S., Bulgaria

Answer:

I am not familiar with that product, sorry. JG 3.15.06

Question:

Dr. Garcia- My nose is very thin at the bridge and also somewhat thin all the way down. Additionally, the projection is a little much for me and makes my already deep set eyes seem lost . What is the price range of a rhinoplasty and with that, a lip lift (incision at base of nose)? Can I send you a picture via email and then travel for surgery? Thanks!

Answer:

photos would help me to see what can or needs to be done. As to the pricing, I can tell you more after I see the photos. Please send them to drgarcia@lvcosmeticsurgery.com. All the best. JG 3.17.06

Question:

Hi Firstly would like to say what a great website and thanking Dr Garcia for all the information. I had a hooked nose (sometimes called Roman/Jewish nose). My brother hit me with a magnifying glass when i was 11 years old after which the shape of my nose changed drastically. I have had three operations to correct the problem and remove the hump at the bridge of the nose. My question is related to one thing that I have always wondered. Can an injury at childhood alter the shape of ones nose that it becomes totally large and takes on a different shape or is it genetics (if one parent has a particular nose, the child inherits) Up till a certain age, my nose was normal and I had no problems. After which, no one failed to miss an opportunity to point out how big and long my nose was.

Answer:

It is a matter of both, one is not more important than the other in your case. JG 3.17.06

Question:

I have a wide nose. Is it possible to use a non-surgical method to correct or coverup this problem? (airbrushing?)

Answer:

place a thin line of a white concealer over the width of your nose to cause what looks like a light reflection and then your powder over it. JG 3.16.06

Question:

Hello Dr Garcia! im 3 months post-rhinoplasty that left me with terrible deviation and a thin asymetric nose! Cartilage was taken off from the nostrils leaving me now with collapsed nosetrils on the side! another PS suggested to wait 3 extra months than to perform a revision rhinoplasty! he suggested using implants (sponge??) to fill in the spaces but said that those implants might get infected! He said that he cant also do anything to the nostrils! Isnt it a better solution to use cartilage graft? he said he doesnt use cartilage cause it shows under the skin and doesnt give a smooth and natural effect? is this true? Can cartilage be grafted again to the nosetrils in order to give it volume again or its true that nothing can be done in there? i would appreciate ur opinion! Any referal over Montreal, Canada would be much appreciated!

Answer:

I think the cartilage grafts are the best way to go. Maybe reasearch a little and find a different surgeon who does the cartilage grafts. Due to potential legal issues, and some doctors wanting to know why I referred a patient to someone else and not them, I think you are best to go to this website and look for a plastic surgeon in the area you desire. I wish you all the best. JG 3.36.06www.surgery.org/public/findasurgeon.

Question:

hi i am 2 weeks post rhinoplasty and i was doing graet all my swelling and bruising was gone .i have now picked up a very heavy cold and my nose has gone puffy and swollen again like it was after cast removal. will this go down or have i damaged it by sneezing . i have been really careful not to blow my nose .its very frustrating!

Answer:

All will go away in time. JG 3.7.06

Question:

Dear Dr Garcia, I had rhinoplasty two weeks ago and one side seems wider and the other narrow - could this be swelling? It makes my nose look asymmetric. On the wider side there is a very noticeable dent by the top of the bridge ? I have discomfort on this side aswell, especially by the dent -stings and have sharp pains now and again. There is also a dent on the other side, but that is half way down the bridge - will the dents go away? Does this sound common? and will I have to have further treatment? Kind regards

Answer:

yes, still due to swelling, give it some time. All common things. JG 3.6.06

Question:

I had nose surgery when I was 17, now I am 28 and my nostrils/wholes are bigger than after the surgery...Can I get surgery again to make the nostrils look smaller like before? 3/3/06

Answer:

it depends greatly on how you look and the tissue, hard to say without examining you, but possibly. JG 3.3.06

Question:

Hi Dr Garcia, I had a rhinoplasty about 15 years ago, a few days after I had the cast off I noticed a lump on the left side nasal flap. The doctor said some cartilage had snapped and bunched up. Can this cartilage be repositioned and sutured back into place or will it need a graft?

Answer:

It might need to be repositioned or just smoothed out with a rasp. JG 3.3.06

Question:

Hi Dr. Garcia, I had a revision rhinoplasty 3 years ago and the doctor used an open rhinoplasy where the columella area was cut and a scar is visible. One side of the columella area is fine but the other side of the columella area looks like he accidentally cut a part of my cartilage. It looks the same as it did 3 years ago after my stiches came off. I was wondering if I can do anything about this like a scar revision. Also, have you heard anything like this. Thank-you! S.P. 3/3/06

Answer:

y