Question:

Hi, I suffered facial trauma a week ago.  Bruising and swelling.  No nose bleed. Can you please interpret my CT report (what these term mean) and let me know if it is indicative of a new broken nose?  FYI, I broke my nose 23 years ago playing sports and had a correction for a deviated septum.  THANKS A LOT!!!  

CT: 

“Bruising and tender.  Rule out orbital fracture.”

 

FINDINGS:

“The Paranasal sinuses are clear.  No facial bone fractures.  

“There is a leftward bony nasal septal deviation and a small septal spur.”

 

 

 

 

 

Answer:

It appears that there are no broken nasal bones. You do have a deviation or a curvature of the septal. Even when they are straightened, as you did years ago, the cartilage in the septum is rubbery and can deviate again. The bone spur is not uncommon and usually is not from a broken bone recently and usually does not need any correction.

Question:

My daughter turned 15 last december.

Answer:

If the teenager has an issue that can be fixed, they are bothered by it, and the parents feel it is fine to proceed, I am happy to do the surgery. Usually I will not do it on anyone under the age of 15 unless they are being made fun of by their peers. In that case I will do it on younger patients.

Question:

None surgical nose procedure.

Answer:

I do surgery on the nose but I no longer perform septoplasties. If the issue is one of appearance and breathing, I refer them to someone I know, if it is purely a cosmetic issue, then I perform that kind of surgery.

Question:

I has small simple cartilage grafts (non-composite) placed to my alar rims bilaterally on Monday to lower them just a bit. The surgeon didn't think that composite grafts were necessary, so she just tunnelled small piece of cartilages into the skin inside the nose. Both sides are growing increasingly red, the outline of hte cartilage is becoming increasingly visible.  I'm on cipro so I don't think it's infected. Does this sound like the grafts are preparing to extrude? I saw the surgeon on Friday for a follow-up, and she thought it was just swollen -- but I must say that it's gotten much more red and much more "outlined" than it was since I saw her 48 hours ago. I really hope that these grafts don't fail because they have vastly improved my my nose, which has been hideous due to nasal retraction since an aggressive tip-plasty several years ago by another surgeon. If they extrude, what should be my next step? She tells met that I'm out of useable cartilage behind my ears, so I don't think composite grafts are an option. Thank you, Dr. Garcia.

Answer:

Although you are on Cipro, it can still be an infection by an organism that is not sensitive to the drug you are on. If it is going to extrude, that would happen through the incision used to place the grafts and can take time to occur. If there is an infection, the small pieces of cartilage can dissolve from that. Hopefully it is just some blood underneath the skin that is causing the problem and over the next few weeks should absorb on its own. If the grafts are lost, or extrude, and you have no septal cartilage left, the options are limited. Remaining options may be ear cartilage if you have any left, silicone or another synthetic product.

Question:

I had a rhinoplasty done 9 months ago with no tip work done other than colomella shortening and bridge work but my tip cartildges must have been weak because the scar tissue from sutures inside my nostrils in the higher part of the tip (which can be seen and felt as slight lumps) must be contracting and buckling the cartilage because my nose is pinching a bit at the tip.

Two questions:

Can steroid injections to the scar tissue stop this pinching from worsening? And can filler be used to conceal the tip pinching?

 

Thank you

Answer:

Sorry to hear about the issue you are having. I do not think a steroid injection will help to any degree and it might have some negative consequences in terms of skin atrophy. As to filler, that is a viable option. Fillers in the tip can be done to mask irregularities and in my experience they tend to last longer than fillers in the face due to less motion in the area. I wish you the best.

Question:

A year after a rhinoplasty revision, I can't sneeze out of my nose. I can only sneeze out of my mouth like a bark. Do you know why this may be?

Answer:

at this point it is most likely a persistant deviated septum or hypertrophy of the turbinates. Seeing an Ear, Nose and Throat specialist is the best option

Question:

In my primary my tip got a little piched, but not enough to redo the tip.

I'm getting bridge work only done in a closed revision because it came out bumpy after the primary.

Can scar tissue/stitches ect make the tip pinch worse if I'm getting bridge work only and is there any measures that can be taken to stop this from occurring if so?

Answer:

The internal access and procedure done to smooth an irregular tip should not in any way affect the tip. Although close, the rasping and smoothing of the bridge/ dorsum will not go low enough to affect the tip adversely

Question:

I had a tiny bit of ear cartilage placed in the rim of one retracted nostril last week. The surgeon did an amazing job. It looks perfect. He's due to remove the sutures in two days, 9 days post-op. Unfortunately, the implant site is beginning to peel at the point of insertion, and it appears to me that the graft is about to extrude. Also, there's mild erythema along the length of the whole graft. I don't think it's infected because it's not swollen, warm, or issuing exudate; and I did take the entire prescribed course of antibiotics. Does this sound like an extrusion-in-the-making to you? I'm heartbroken because this minor change improved my appearance markedly. This defect has been bothering me for years, and it was a huge relief to have it repaired in 20 minutes. Thank you, Dr. Garcia.

Answer:

An extrusion is still a possibility. The surgeon may elect to leave the sutures in place to keep the graft in position and not allow it to extrude. If it does extrude, it is allowed to heal and when the tissue are soft again, the graft can be redone. I wish you the best, and follow up with your surgeon to see what is happening

Question:

After primary rhinoplasty 5 months ago I was left with a bit of a midvault narrowing and residual hump on both the bony and septal part of my dorsum. The problem I have now is that my primary ps only wants to address the hump but not the mid vault issues during the touch up revision. I'm kind of worried this will lead to disaster (ie collapse) and whether I should have him do the touch up or just go elsewhere to have a full on proper revision with spreader grafts ect... but then that is going to cost me and probably make my nose wider. Do you think my risks are great to proceed with the touch up without spreader grafts being placed given my description? Thank you.

Answer:

whether you would get a midvault collapse woul depend greatly on how the dorsal hump is treatred and how aggressivley. It will not always collapse. I think a second opinion might be in order for you to get another viewpoint beofre you decide which surgoen to go with

Question:

I have a slight depression in the mid 1/3rd supratip of my nose after a rhinoplasty. I went in to get filler but it did absolutely nothing. The doctor used a very small amount of filler though.
Is it possible that this area cannot be filled in to be leveled to the rest of tbe bridge for some reason? If so do I have any other options? It looks strange from the profile.

Answer:
Question:

So here is a pic of the damage. I tried to take it in as harsh lighting as possible. You can see the tip pinching and the middle vault depression above it. I have done some research and found out that the vault depression was likely caused when the cartilage was separated from the septum during surgery, but I am perplexed by the tip pinching because I had no tip work done other than deprojecting by 1 mm and retracting the columella by 1 mm. No thinning of the tip. Maybe they are both related?
What do you think could have cause this and what is the surgical fix for these issues should they worsen over the year?
http://i63.tinypic.com/15dm8fm.jpg

Answer:

The difference in the tip might be because of the deprojection and the retraction of the columella you now have pressure being applied to the skin from the septum as the tissue between the septum and the tip cartilage has been reduced, causing somewhat of a pulling effect on the skin over the septum. Besides that, I am unsure why it might have happened.

Question:

I have mildly retracted nostrils from an aggressive resection of LLC. The left nostril is a tiny bit more retracted than the right. Might it be possible to harvest a composite graft from just one ear and divide it between the two recipient sites instead of harvesting from both ears? And how well (and how quickly) do the ears typically heal? I have seen some patients with no visible scars at the harvest site. Is that common?  Finally, and unrelatedly, what do you think of Tria (OTC) laser? Thank you for your help.
 

Answer:

The scar for taking the ear cartilage is from behind, so its hidden. I am unable to tell you if you have enough ear cartilage to do it though. I have no personal experience with the otc product so I cannot help there, sorry

Question:

I have always had a bulbous looking tip to my nose, but as I have gotten older it has gotten worse. I would like to know if it's painful and how long would the recovery be?

Answer:

It is not very painful, should be back to light activity in about 10 days and full activity in one month. I will say that a bulbous nose is usually due to excess cartilage, but more importantly due to thick sebaceous skin. A lot of work can be done on the cartilage, but if the skin is thick, the detailed chances in the cartilage may not show through. The final result after surgery can take 6-12 months to be seen.

Question:

As you can see... I don't have much luck lol... my last question on the subject.
What is the difficulty level of the procedure to remove/and or repostion fascia temporalis in the radex area that  has come out of place? Is it open or closed?
Many thanks for always helping and educating others good dr.

Answer:

It is simple, can be done in a closed fashion. I suggest applying steristrips to the skin to get  the skin to stick back down and would wait 3-6 months before trying another dorsal implant

Question:

My nose tip looks good from the front... but my ps wants to reposition it slightly. 1mm up, qmm back... just so it suits my new shaved bridge better. He is doing this through closed approached. I'm not getting my tip narrowed or anything like that. How is this accomplished and is does this type of tip work lead to post operative tip swelling that people talk about that takes months to resolve? Thnaks.

Answer:

it is done by removing either a small part of the distal septum to allow the slight depression or removing a very small strip of the lower lateral cartilage where it meets the upper lateral cartilages.Tip swelling can persist for months done both open or closed, maybe a little less when done closed, but the final result will take 6-12 months

Question:

My ps wants to raise the tip of my nose and deproject it both by 1mm and shave down my dorsal hump. My nostrils are large and flare outwards though, but it's thankfully not noticeable and concealed due to the slightly droopy angle of my nasal tip (I am not willing to have an extensive rhino that reduces my nostril size). However, when I try to simulate what raising the tip would look like with my finger pulling it up... by even 1 mm, I look completely bizarre and piglike... even 1 mm completely changes my appearance bc my nostrils seem to sit unnoticable and just right as is.
My question is, does raising the tip a mm with my finger give and idea of what my nostrils would look like if raised by 1mm in a rhinoplasty? Or is it somehow raised from a different angle? If it does, I think I will simply opt not to touch my nose tip and simply have the hump reduced.

Answer:

I do think raising the tip with a finger does give somewhat of an approximation of what can happen to the nostrils. You need to discuss your concerns wit your surgeon some more it seems

Question:

I had nose surgery a couple months ago using ribn graft. I took a prescribed antibiotic (started with the letter C) for 5 days instead of 10. I took probiotics during this tiime and continue to this day. But, I have this loud and constant gas. Could have I developed a superbug? 

Answer:

Superbugs typically do not cause gas, it is something else causing that in my opinion

Question:

Does the lower end of the columella tend to swell much after rhinoplasty if it is cut or shaped? how long does it take for swelling to resolve in the lower end of columella (if this area swells)?

Answer:

It all depends on if something is done to the columella or the medial crura. As the columella is the lowest point, swelling tends to accumulate there and can take 6-8 and sometimes more for a complete resolution, but it usually looks very presentable in 3-4 weeks.

Question:

Ho many days do you prescribe antibiotics for a rhinoplasty?

Answer:

usually I just use them on the day of surgery. If there is nasal packing then I continue it until the packing is removed.

Question:

How many days does one wear a nose cast after rhinoplasty surgery?

Answer:

typically a week, and then I have my patients place it over their nose at night while sleeping for another 2-3 weeks to protect them from hitting their noses while asleep

Question:

I have alar rim made out of rib above one nostril. This area is noticeably raised so the tissue is even whither alar rim that did not have rib graft. The skin is also white or blanched. Why is it this color. Is it that there is too much graft pushing onto skin that is turning it white. Will shaving it make the white go away and even the tissue with other alar rim?
Is there any other way to correct collapsed nostril than alar rim graft?
 

Answer:

The color difference is likely due to the skin being so thin and stretched over the rib graft. It is due to the pressure, but there is not much you can do to thicken the skin in that area. Thinning the graft can be attempted but doing so can weaken its strength and allow it to collapse again.  Nostril collapse can also be repaired with cartilage which is more flexible then the rib and can give adequate support.

Question:

So I had 2ccs hydraulic acid filler 8 month ago in the nose by a different ps... the new guy who's doing my rhino was only concerned about dissolving the filler in the bridge  before the surgery... but he left the filler in the tip even though he knows its still in there as well... i'm having tip work done as well... should i be concerned? Thanks

Answer:

Should not present a problem. It can be removed at the time of surgery

Question:

I have a nose sugery for tues in canada, and didn't realize the forms they sent me asked for preoperative history/physical exam rec with my family doctor on surgery day but the office is closed! What is this and can I go to a walk in clinic for this? I don't have no family doctor.

Answer:

It is just a medical exam to make sure you are healthy. A walk in clinic should suffice, I wish you the best

Question:

How many days does it take for swelling on eyelids or upper eye area to vanish after rhinoplasty surgery?

Answer:

It can take up to 10 days in some cases where there is  a lot of swelling initially

Question:

I had revision rhinoplasty 3 years ago, in which my own rib was grafted in my nose. There has always been an uneven lump from the rib grafted on bottom side of my tip...I guess because my skin is thin there. Just this week I my skin looked brown there with foundation makeup applied. I thought I had brown stain on skin, but my skin is actually dicolored. It looks more like a reddish gray discoloration without makeup. There is a chicken pox type scar indentation on bottom of this graft. I just noticed it today. For the past week, I have had to walk to work 20 minutes there and back in cold weather. I usually do not walk in cold water. Can cold weather eat away the rib graft. Can rib graft start resorbing at 3 years? And why the chicken pox type scar. What is happening.

Answer:

the cold weather cannot dissolve the graft but it sounds like you skin overlying the graft has thinned from time and possibly pressure applied by the graft. I strongly suggest you go back to your surgeon for an evaluation to make sure that is not what is occurring. I wish you the ebst.

Question:

I am scheduled for non surgical rhinoplasty in toronto next week (juvederm) because I want to get a feel for the change before going ahead with my actual rhinoplasty, which I have my consult for next march in Belgium. So the surgery will be roughly a 7-9 month window after the juvederm non surgical procedure. If this is too soon, is there anything i should request from the doctor in toronto, such as before and after photo's, or something written about where he injected, so that the doctor in belgium knows better where to dissolve the juvederm prior to the surgery, or will this not be a problem?  Thank you.

Answer:

The Juvederm will not present a problem, it will be easily removed at the time of the rhinoplasty. Just having copies of your pictures before the filler will suffice for the surgeon in Belgium to know where it was placed.

Question:

Hi Dr. G., How old is too old to have a nose job?  I have never liked my nose and wondering if, at 58, I should just learn to live with mine or if the right PS can do something.  I am Asian, and believe my nose is too bulbous.  A doctor injected Artefill on the bridge and it helps some but ...  Thank you!

Answer:

if it bothers you it can be operated on, older age does not change it. I will say that depending on what you are trying to achieve that there are limitations. For example in Asian's, the skin on the tip can be thicker ad that will limit the ability to make the tip look smaller or more refined. In those cases a cartilage graft may need to be used and that has its limitations. Speaking with a plastic surgeon can help you find out what can be done and cannot be done in your particular case.

Question:

Is one has the radix (the area between the eyes) lowered a little, would cartilage or bone be removed? Or is the radix made of cartilage or bone? And is it a hard procedure to lower it a little?

Answer:

it is mostly bone but it transitions to the cartilage of the dorsum of the nose, so a little of both.It is easily reduced by using a metal rasp.

Question:

Can a wide and indented scar on columella from nose surgery be fixed? If so, how ca it be fixed?

Answer:

three are options depending on how it looks, it might be able to be improved with a filler injection or it might be better to cut the scar out and re-approximate the edges closer so it blends better. Fairly straightforward things to do and are quick and can be done in the office.

Question:

Hi again Dr. G, I had a general question about rhinoplasty. Can a nose that is subtle off-center (leaning to one side), can be `straightened` without opening the nose up and/or cutting the alar base? Ty

Answer:

yes, usually that is a septal and bone problem so there is no need for alar base changes unless it is that way form a cleft lip problem.