Archive for the 'Rhinoplasty Recovery' Category

Should you massage your nose after rhinoplasty?

In general, it is best not to massage your nose after rhinoplasty as it is possible, although unlikely, that vigorous rubbing or manipulation in the first few weeks could pop a delicate stitch and disturb the corrections made or affect the cosmetic result. Some people habitually rub the tips of their noses. Recognize that this will not likely ruin the result but may cause more irritation and swelling.

That being said, your nose is not glass after surgery. In fact, it can often feel quite stiff and wooden for a period of several months after surgery. Rolling over onto your nose during sleep or lightly bumping your nose will not make it end up on the side of your head. So, you don’t have to walk around in a bubble after surgery.

After about a month, the skin starts to wrap around the cartilage, and the bone is pretty much set, so contact to your nose is less likely to cause any shift or problems with healing. Likewise, a small rind of fibrous tissue or scar has started to form that will likely hold the cartilage in place even if a stitch were to loosen at this stage.

Some surgeons recommend ‘nasal exercises’ which essentially amount to light lymphatic drainage. These will not be harmful but may not do much either. Instead, we ask patients to tape the nose at night for the first month to help skin contract and push out swelling. If you have any questions about nasal massage, ask your surgeon for his or her preferred routine after surgery.

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Steroids and Rhinoplasty

Please note: We are happy to see that our blog is of some help to many of you who are considering or recovering from rhinoplasty. While we would like to address your concerns directly, we are not able to dispense medical advice over the internet. Your own surgeon is your best resource in the first weeks and months after surgery. If, after 5-6 months, you continue to feel unhappy with your result, feel free to contact us via our practice site www.beverlyhillsprofiles.com and we can arrange time to discuss your concerns. All the best for a happy outcome.

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Lines and gaps at the sides of the nasal bridge after rhinoplasty

February 26th, 2009 | Category: Rhinoplasty Recovery,Rhinoplasty Techniques

Here is another one from the Q&A file that can be a source of concern for people soon after a rhinoplasty. We were recently asked about vertical lines/shadows showing up after rhinoplasty on either side of the bridge. What was more worrisome for this person was the fact that she was able to feel small gaps when she pressed on the area. Read more

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Is fluctuating swelling, redness, or bluish discoloration normal a year after Revision Rhinoplasty? Will it go away?

February 25th, 2009 | Category: Revision Rhinoplasty,Rhinoplasty Recovery

We were recently asked this question by someone who was understandably worried about these persistent symptoms about one year after a revision rhinoplasty. She wondered whether steroid injection would still work at this stage.

While discoloration is admittedly unusual at this stage, the key to this question is fluctuation. If swelling and redness were persistent and not getting better, we would be concerned about a possible low grade infection or chronic inflammatory condition, especially if there were a graft of foreign material placed in the nose. When swelling or discoloration fluctuates between being present and then going away, we are not nearly as concerned. Read more

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Rhinoplasty Mistake #2: The Pollybeak Deformity

So, what is a pollybeak deformity? Well, that’s the unpleasant and unkind name we give to a nose in which the area just above the tip is too full. Normally, there should be a little dip or depression just above your nasal tip that defines the transition from your bridge to your tip on profile. When that area is high or filled in, we call it a pollybeak.

When it is very full, it can even make the nose look down-turned like a parrot’s beak, thus the name. The reason for this is that the area above the tip often becomes the part of your nose that sticks out or projects the most from your face. This is not the way it should be. Your tip should be the most projecting point of your nose.

Check out the photo below to see a pollybeak deformity indicated by the arrows.

nose pollybeak deformity photo

OK, what causes a pollybeak deformity? Read more

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Why don’t you use nasal packing after Rhinoplasty?

March 02nd, 2008 | Category: Rhinoplasty Recovery,Rhinoplasty Techniques

Want to know the most significant complaint we hear about after Rhinoplasty surgery?

It’s not pain, pressure, headache, or even discomfort. In fact, rhinoplasty is rarely very painful.

The symptom we hear about most is nasal congestion.

nasal packing after Rhinoplasty photo

The picture above shows one technique that some surgeons still use to pack the nose. Most surgeons still use some form of packing or splint, which can either be merocel, gauze, xeroform or a variety of other forms. The end result unfortunately is more discomfort for the patient.

While not being able to breathe through your nose is not earth-shattering, it is extremely annoying. Think of it like a bad head cold that lasts. So, anything we can do to prevent this symptom is meaningful to you, and therefore important to us. And the biggest thing we can do to help, is to avoid nasal packing.

Packing is routinely used by some to help prevent excessive bleeding or dripping. We find we almost never need it. By handling tissues exceedingly carefully and gently, we find that we can generally keep bleeding, bruising, and swelling to an absolute minimum…and the benefit to you is an earlier return to breathing through your nose, less blockage from the beginning, and no painful removal of crusted packing.

We really have a passion for rhinoplasty, and we do all we can to help make your experience with us the best it can be… so we encourage you to come in and experience the difference.

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I read your recent blog about rhinoplasty in African American patients but I have a problem with keloids and was wondering how big of a problem this will be if I do have rhinoplasty.

Your concerns are valid and it is important to discuss your history of poor scarring whenever you undergo any type of surgery. You should note however that different parts of the body will heal differently. The simple answer is that keloids rarely develop in the central face and we here at Profiles have never seen a keloid develop after we have done rhinoplasty.

A more in depth explanation begins with an explanation of scarring. First, we need to help you in understanding the difference between a hypertrophic scar and a keloid. Clinically, hypertrophic scars are enlarged scars that stabilize or shrink with time. Keloids, however, initially develop as hypertrophic scars but later extend beyond the original injury area. They rarely regress on their own and have a propensity for recurrence after excision.

Keloids may affect virtually any surface on the body with the central chest, deltoid/shoulder region, and back having the highest frequency. And this has led some doctors to speculate that motion and tension play a large role in causing keloids to develop. While this may be true to some extent, the earlobes, which are one of the most frequent sites affected, are obviously subject to minimal motion or tension forces.

photos Before and After Earlobe Keloid Scar Excision

photo Before and After Earlobe Keloid Scar Excision

This African American patient demonstrates a typical example of a large keloid scar of the earlobe that was removed in one session with flap reconstruction of the back of the ear. The After photo to the right shows her postoperative result over 6 months after the procedure.

All this being said, while you should explore this issue with your doctor before surgery, you should feel some comfort in knowing that the nose is rarely a site for keloid development after rhinoplasty or nasal surgery. In fact, we did a literature review to check on your answer and were unable to find any papers which could point to a case of a keloid after rhinoplasty.

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I had surgery with another surgeon and am not happy with my Rhinoplasty result after 1 month. What should I do? Can you help?

February 25th, 2008 | Category: Revision Rhinoplasty,Rhinoplasty Recovery

First and foremost, do not panic.

Early changes after Rhinoplasty are influenced by swelling and do not necessarily reflect the end result nor what was done during your operation. Trust your instincts and talk to your doctor about your concerns. There may be a perfectly good explanation for what you’re seeing. Sometimes, reassurance is all that is needed.

Once the cast comes off your nose, the natural tendency is to stare in the mirror for far too long- looking for the smallest of changes. This is precisely the most harmful thing to do because it will not change your healing and will only make you more nervous.

You will find that you are more swollen in the morning, when you are more active, or after lying down for long periods of time. This is because blood and fluid pools in the area of your nose and cheeks. Aside from that, healing happens in drips and drabs. You may not notice any changes for a few days, and then suddenly see a big reduction in swelling. There is a range of ‘normal’ healing. Don’t be alarmed if you are on the edge of that range. Your surgeon should let you know if anything unexpected is happening. If you are still unhappy at six months or a year, it may be time to talk about your options for improvement.

Your original surgeon is still the best place to start with this conversation, if he or she still has your trust. If not, consult a surgeon who has an experienced practice in Revision Rhinoplasty to see if this is a good option for you.

If you have any questions, please feel free to give us a call or send an email.

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I am considering rhinoplasty but don’t know whether I should tell my family and friends. What do you think?

February 15th, 2008 | Category: Rhinoplasty Philosophy,Rhinoplasty Recovery

We find that the decision to tell friends and family is a very personal one that largely depends on you and your relationships. For most of our patients we find the question of telling friends and family is very simple and they find that the added support helps in making the entire process easier.

Occasionally, however we have some patients who feel that they have family or friends who simply will not accept their decision to proceed with surgery. Occasionally, these patients want to remove some family defining characteristic such as a nasal hump that they feel their family would want them to keep. For other patients, especially those who are still in school, we will wait to have surgery over the winter or summer break so that changes are not quite so obvious to classmates. Overall, however we have found that the social stigma that used to be associated with plastic surgery is no longer really an issue and in general when our patients discuss their reasons for wanting to pursue surgery, their families and friends are generally much more supportive throughout the process than you may otherwise expect.

In those cases, when our patients are from out of town or when they do not have support, at PROFILES we have developed a comprehensive team and program to help take care of all your postoperative needs and to make you feel comfortable every step of the way.

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After my rhinoplasty, when my surgeon removed my cast he found I had red, swollen skin with multiple tiny pustules. Is there anything I can do?

February 12th, 2008 | Category: Rhinoplasty Recovery

We recently received a question from a patient who had underwent rhinoplasty elsewhere and noted that a few days later her nose was very itchy. Upon removal of the cast she had red, swollen skin with multiple tiny pustules. She wrote to us in a panic wondering what had happened.

Of course without an evaluation, we told her that we would only be speculating. But we did note that on rare occasions, there are people who have allergic reactions to the adhesive on the tape that is used on the bridge of the nose after surgery. The tape and splint are intended to help keep pressure on the skin in order to help reduce swelling and to prevent the nasal bones from moving after surgery.

allergic skin

When an allergic reaction occurs, most patients generally report in hindsight that they noted some itchiness starting as soon as the day after surgery but that it only became intolerable after a few days. Of course once the tape is removed the allergen- the thing that is causing the allergic reaction- is gone but it generally takes days for the swollen, red, itchy skin to return to normal. The long term consequences of this are generally negligible outside of the transient initial itchiness and discomfort, but it does occasionally mean that it will take a while longer for you to see the final results of your surgery.

Depending on the severity of the reaction, some surgeons will provide anything from a topical to an oral steroid to help in treating your itchiness as well as in helping to reduce the swelling and inflammation. Hope this helps.

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