I was told my one doctor that I should get a chin implant along with my nose job. I was not really planning on this. I am open to the idea and would like to know what sort of complications are associated with chin implants and how often they occur.
Answer:
A chin implant is an excellent operation to do with a nose job because, for the most part, you are really are talking about effecting your profile entirely and making an improvement to your whole look. A chin implant is usually inserted from underneath the chin so that you do not have to worry about infection and the scar is usually 1 cm to 2 cm in size, which is very small. The chin implant is placed underneath the periosteum of the bone and adheres to this area so that the implant itself does not move when you move the chin and simulates just having an extended piece of bone over the chin area. It is an absolutely excellent procedure, it heals over about one week, it is permanent and the chance of infection is extremely small. The one particular possible complication that we all pay attention to is to make sure that the mental nerve, which is laterally out over the chin, is not disturbed so that you do not get any numbness around the chin. In my practice of over 25 years, I think I have not had more than one or two of the most minor complications with chin implants, which is an absolutely excellent procedure.
Posted in Rhinoplasty on July, 07/01/2010 - 18:01 PM
Question:
I had my nose job about five weeks ago and the swelling seems to be coming and going on a daily basis. In the morning the swelling is really extreme but then it sort of fades as the day goes on and it is significantly less by the end of the day. I knew to expect swelling but I did not expect this. Is it normal or should I be concerned?
Answer:
The type of swelling that you are describing is very normal after a nose job. Five weeks is not very long and we see swelling to some degree for two to three months after a nose job. Also, there will be some residual swelling possibly for up to a year. The kind of swelling you are explaining, which is more noticeable in the morning and disappears by the end of the day, is significant for the fact that when you lay down flat your head has more fluid in it and there is obviously more swelling in the nose. As you spend most of the day standing up or sitting and gravity can take hold, it removes much of the swelling that is in the face and the nose. This is very common in anyone who has surgery on their face, whether it be a nose job or a facelift. If you do not have redness or tenderness or any evidence of an infection, I would say your swelling at this point sounds very normal to me and with a little patience should disappear nicely.
Posted in Rhinoplasty on June, 06/29/2010 - 14:33 PM
Hi! I am Dr. Epstein. I am with a patient today who is around 10 weeks status post rhinoplasty of African American ethnicity. That is the only identifying characteristic I am giving so she can stay anonymous.
Her main complaint was that she wanted to preserve her ethnic features which we all agree is important but at the same time she was concerned about the width of her nostrils that especially extenuated when she smiled. You can see how wide her nasal tip appears on smiling. She has a pretty smile but this really became the focus, that very wide nostril area. You can see from another before view.
What I did for her was a combination of refining the tip, narrowing the nostrils. You can see her here and you can see how nicely she has healed and the greater symmetry. She is still a little bit off but there is just a limit to the amount of symmetry that I can create.
You can see if we look down at the bottom view she had an external approach. You cannot even find the incisions, barely if at all perceptible. I also made incisions inside the nostrils to go ahead and deal with the nostril narrowing. You can see I was able to bring it in quite nicely.
Smile for me. You see when she smiles now she still has some widening but at the same time she goes ahead and it is a more refined look.
She is around 10 weeks post operative. We may want to do a little touch up at some point just to bring in one of the nostrils to create a little more symmetry but that was the challenge that she did have this asymmetry.
She is happy and she was nice enough to sit for the video.
Posted in Rhinoplasty on June, 06/28/2010 - 10:51 AM
Question:
My husband has a very nice nose but it seems to hang over to one side of his face. I think it does not look good on him. Can rhinoplasty straighten out his nose without changing the shape too much?
Answer:
Rhinoplasty is a very difficult operation if not done by an experienced surgeon. However, a good and experienced surgeon can both make an appropriate change to correct a particular problem and leave a person with the original character of their nose. I particularly like patients to have a change in what seems to be bothering them but I like the nose to be consistent with their facial shape and with the personality and character of that individual patient. To answer your question, yes the nose can be straightened without changing the shape too much.
Posted in Rhinoplasty on June, 06/21/2010 - 10:35 AM
DR. EPSTEIN: Hi! I am Dr. Epstein. This is one of my favorite parts of my job which is taking off the splint when the patient has had a rhinoplasty. In this case my patient is six days status post a rhinoplasty.
You can come in and see what some of her concerns were. She had a hanging tip, over-projected profile. You can see especially when she smiled the tip would get pulled down and she just had an overall wide look to the tip of the nose and took away the attention of what really is what I think is her prettiest features which are her eyes.
She is six days out and here she is. Today we are going to go ahead and take her splint off, which is always the fun part. You can see the stitches done here. We have already taken the tape off from the tip of the nose.
This is a little bit sore. We are going to go real gently on her. We are going to gently go ahead and take this off and then we are going to get to see at the same time she does what her nose looks like. She has a nice smile and you can see when she smiles her tip does not come down nearly as much.
I have no idea what her nose looks like but I am assuming that it is healing up the way we want it to. Feels good right?
PATIENT: Feels great!
DR. EPSTEIN: Chin up for me. Turn around this way Michelle and lets go ahead and take a look. You can see now what we have done for her is taken down the bump, did a lot of refining here in the bridge. This is probably pretty tender in here. Give me a smile. The tip stays up much more elevated. What I like to do at this point is put some tape on the bridge of the nose. We will let her take a look at it in just a minute.
As I said she is exactly six days out from her surgery. It was done through what is called an external approach. The reason I like this tape is it lets you see sort of what it looks like once the swelling goes away.
We are going to sit her up. Now we get to take a look. There you go! You are still quite swollen here and you can see how the bridge has been narrowed and the profile.
PATIENT: It's pretty! I'm so excited!
DR. EPSTEIN: What is going to happen over the next week or two is the swelling is going to go away. As I said, her tip was rotated up through a lot of different maneuvers because that was one of the biggest issues. To me the three main issues were the tip hanging down, the broad tip sort of a little bit wide and fat, and then the wide bridge. All those things were set in. You can see when I press down the nasal bones have been brought in quite a bit, the tip has been refined but it is still swollen and lastly the tip has been rotated up, not too much but enough to add to this.
Posted in Rhinoplasty on June, 06/21/2010 - 00:00 AM
Question:
I had a nose job several months ago. Within a few weeks after surgery I loved the result but since then the nose swelling seems to have gotten worse and gotten bigger. I loved the original result so much and now I am worried that my nose will not look that way again. Is it normal for swelling to return like this and will the swelling go back down?
Answer:
It is not unusual for patients to notice variable periods of swelling after a nose job; sometimes it is better, sometimes it is worse. A lot of this depends on the position of the patient. Usually when you sleep at night and wake up in the morning, your nose is more swollen from having been lying flat and as the day wears on the swelling decreases. Some individuals, if they spend a day working in the garden or doing something where the nose is more dependent, they may get a significant amount of swelling that will persist for four or five days afterward and then begin to resolve.
One must remember that after a nose job and for the first year, the nose is certainly more sensitive to the possibility of swelling depending upon the position of the individual. Care must be taken in all your activities to help keep the head less dependent and low down, and you should not have any significant problems of swelling. However, most swelling, if it is not related to infection or something unusual going on, should resolve once you begin to have the head elevated again.
When performing nose jobs on Asian patients, what are some of the more common changes that you make to the nose?
Answer:
Asian patients usually present with a situation where the nasal bone in the upper area of the nose between the eyebrows tends to be less prominent and, in some Asian patients, we then put a bone graft in this area to help extend it. Also, sometimes dorsal nasal implants are used for Asian patients if they want a more Westernized look with the nose. I, however, do not particularly like to change the character of an Asian nose with regard to the tip. In other words, if an Asian nose tends to be more rounded and less sculpted looking than a Western nose, I tend to go with that particular look unless someone has a particular concern and says that they would like to specifically westernize the shape of their nose.
Again, the big difference is the lack of bony projection in most Asian noses, which can be enhanced with a dorsal nasal implant or with a bone graft from the scalp and whether you want to make the nasal tip more angulated like a northern European Westernized nose which can usually be done surgically or with cartilage grafts.
Posted in Rhinoplasty on June, 06/18/2010 - 00:00 AM
Question:
I had a nose job several weeks ago and was really pleased with the results at first. Ever since the cast was removed, though, my nose seems like it has gotten bigger and bigger, like the swelling has actually increased. Is this common and is it really just the swelling or should I be concerned? When can I expect the swelling to fade more?
Answer:
It is totally expected that after a firm cast, whether it be plaster or an aqua-plastic type splint, is removed that the nose will then begin to swell a bit. The cast is placed on the nose to help compress the natural tendency for swelling after surgery and that is removed along with the cast so it is to be expected that the nose will get bigger and swell for a period of time once the cast is removed. Just as long as the swelling seems normal, in other words it is basically symmetric and there is no redness or unusual tenderness associated with it that could be signs of infection, I would have no concern regarding the increased swelling in the nose.
The swelling should begin to fade over the first post-operative month and will continue to do so over the period of a year. All nose jobs take approximately one year or even up to 18 months to resolve all of the swelling from the surgery and have the absolute final result visible to the patient.
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