by Bellevue | Seattle’s Dr. Philip Young | Aesthetic Facial Plastic Surgery:
Choosing a Rhinoplasty Surgeon should be taken from multiple different approaches. I think research over the internet is a good place to start. This is a way to get to know the rhinoplasty surgeon and to see if you get the right feel from this initial experience. I would look up the doctors credentials. Look for things that set him apart from the competitors. How are the before and afters? This is vital. I wouldn’t necessarily go by reputation. You want to find someone that will take care of you personally and will pay attention to your needs. If you go to someone that is really busy they may not spend enough time during your consultation or during your procedure. Look for testimonials. Ask for references. Get multiple opinions, any good doctor / surgeon will tell you to do this (if they are confident). I would at least see 3 different surgeons to get the right feel that you are looking for. How accesible is the doctor. Can you get a hold of him via email, phone etc? Hope this helps!
Below is a Rhinoplasty consult that could help you during your consultation with your Rhinoplasty Surgeon.
Rhinoplasty Consult Dr. Young Seattle / Bellevue Hi. I’m Doctor Philip Young. I’m a facial plastic surgeon in the Seattle and Bellevue area. And what I want to talk about today is the rhinoplasty consult and just answer as many questions that I commonly get in our office. When we talk about rhinoplasty, essentially what that means it’s a surgery that entails changing the shape of the nose. There’s a lot of things that you can do with rhinoplasty in terms of making the size of the nose smaller, the bridge. And what that means is we can make it smaller in the bridge area and the nasal-tip area and around here and even around here, as well, the side of the nose. There’s a lot of things that can be done with rhinoplasty. You can even lengthen the nose longer. And you can shorten it. You can rotate it up or rotate it down. And it really depends on the particular person and whatever that person needs. And what we do is we try to individually tailor the procedure and our approach with the particular patient. In terms of our consultation, we usually do a consultation first, of course. And we go through all the concerns that our particular client is concerned about. And we try to answer as many questions as possible regarding what they are wondering about. And before we actually do the procedure, we go through the consultation. We go through pictures. We go through some of the desires and questions they’re wondering about. We morph the pictures on our computer, so you can see somewhat how the results can be, although these computer-imaging programs are more of the ideal type outcome. We do everything we can to try to get those results. But rhinoplasty is a very difficult procedure, and we do the best we can to try to keep that as much as possible. But these pictures aren’t a magic thing where, boom, your nose looks just like that. In terms of shaping the nose, I think that rhinoplasty can be one of the easiest ways to bring balance to the face. Now, in the face you have major components that comprise of what people think is beautiful. For example, you have the eyes, the nose, and mouth. But, specifically, in each of those areas there’s a particular thing that is important. And in the eyes it’s the iris that’s the most important anatomical structure. And in the nose, it’s the nasal tip that assumes the most prominence. In the mouth, surprisingly, it’s the lower lip. And you can tell how important any structure on the face is when you see that face in the light. And whatever shines most in light, and that can be interpreted in so many different ways, but the light hits the face at different angles, different distances, and so forth. But, in general, your mind can appreciate what is the most prominent in those areas. And in the nose it’s the nasal tip area. So the eyes, nose, and mouth are the main structures of the face. And they comprise, or make up, what people assess to see if there’s beauty in the face. And one of the easiest ways to change the shape of the face, or, actually, the way everything is related, is by changing the shape of the nose. So rhinoplasty can have a huge impact on the way the whole balance the face is put together. So this procedure can be quite important to the way your face looks. Now, I’m going to talk about different things that people come to ask me about. One of the most common things that people ask me is how to take down this bone here. Well, usually how that’s done is you have to shave off some cartilage here and bone. The dorsum, or the nasal bridge. is made up a bony part and also a cartilaginous part. And each of those structures needs to be reduced incrementally. And I do all my procedures with an open approach. So we make a little incision here. We lift everything up. And we take down this cartilage, and we take done this bone. And after doing that, you will sometimes have an area that is open, meaning that it’s not forming a complete roof. And what rhinoplasty surgeons call that is an open roof, simply stated and defined, is called an open roof. And they actually use the word deformity, but it’s not really a deformity. But it’s an area that’s open. So in order to readjust your nose, you have to shape these bones to close the open roof. And a lot of times people use the term breaking the nose. But I think that word is quite harsh in terms of what we’re actually doing. We’re not really breaking the nose. We’re actually shaping the nose very carefully. There’s nothing gross about that or menial about the way that we’re approaching shaping the nasal bones. The common term, or the scientific term from a rhinoplastic surgeon standpoint, is called an osteotomy. Osteo is defined by bone, or is the root– the Latin root is bone and otomy is essentially changing it. So we’re doing an osteotomy to shape the bones. And, essentially, we cut through the bone very carefully and refining it, we close this open roof. And there’s many ways to do those osteotomies to make your nose different. Now, if it’s really wide here, you can take that the osteotomy more outside or laterally. But if you don’t want to change the width of this bottom part, then you can put the osteotomy more closer to the nasal bridge. So there’s many ways to shape the bridge. After you take down the dorsum, then you’ll have to decide how wide you want your nose. And there’s many ways to control that, too. And these are all the things that we talk about. How wide you want your nose, and based on my theory of aesthetics, I think that the nasal bridge should be about an iris width to be most ideal. Now, for women it can be a little smaller than that, not too much smaller. In fact, some people think that, well, if I make the nose smaller, it’s going to look prettier, but that’s not the case. That nasal bridge should be around an iris width. Now, for men, it’s not always ideal to be super attractive. And I’m talking more about facial beauty attractiveness. And when I talk about facial beauty, I’m mainly concentrating on female beauty because that’s what’s has been studied and has been elusive to many scientists. But for the bridge, the male nose, and in the male, the male nasal bridge can be slightly larger than an iris width. However, in a female it’s mostly ideal when it’s about an iris width. And the same thing goes for the tip. It’s a natural flow from your eye area into your nose should be about iris width, into the nasal tip. And even this area here should be about an iris width when you look at someone from the frontal view. So the bridge can be taken down. And what we usually do is we look at the computer images. And we try to decide where you want that bridge and how wide you want that bridge. And these same kind of discussions can be discussed for your nasal tip, as well. There’s many things you can do with your nasal tip. You can make the nose come out more. You can make the nose come in more. And you can make the nasal tip more cinched here or wider. There’s a lot of things you can do. Now, with rhinoplasty the nasal tip is the part of the nose that takes the longest to come down in terms of the swelling. Now, when you make an incision here, that somewhat interrupts the lymphatic flow and the flow of all the fluid and swelling, so that it has to go this way. So the tendency is for the nasal tip to accumulate most of the swelling. This area goes down the fastest, up higher, and this goes down the slowest. So the swelling can take a little while in the nasal tip, and that’s something that you should be aware of when you get rhinoplasty. What I usually tell people in terms of the swelling is that you’re going to get about 60% to 70% of your healing, and that includes your decrease in swelling, at about the six-week point. And you’re going to get about 90% of that healing and decrease in swelling at about six months. The rate at which you lose the swelling or the swelling comes down is really fast that first couple days or the first week and first month. And then at six months, it starts tapering off. So that from six months to two years you might get some decrease in swelling, maybe about 10%. So you actually keep healing for about two years in any kind of procedure that you do. Surprisingly, not very many people know that. But you actually keep healing for about two years. And there’s a lot of things that you can do with the nasal tip, and that can be all discussed. You can rotate the nose upward and downward. You can lengthen the nose. Again, you can change the nostril shape. You can change the way this ala sits. This alar rim, where it goes higher or lower, there’s all sorts of things you can do. These are all things you can discuss with me, in person, and we can go over more of those things. So it kind of helps to know what you’re thinking about because then you can ask more questions when you come in, in terms of how you want to change your nose. Now, a lot of times in my ethnic client base is they often come in with desires to change the shape of the nose where the nostril is. And that can be done. There’s many different ways that you can approach doing that. A lot of times that entails making an incision on the side to bring the nose in. Now, what that does, it can also bring your nose closer together here. In addition, it can change the way, when you look from the bottom, how it shapes. When you take that tissue away, it tends to want to bring that bow of this area more straight. And that’s something that you can do to change the nose from a more rounded appearance to a more triangular appearance when you look at nose from the bottom, this way. You can change that by taking tissue here. Of course, there are drawbacks with that because you have to make in incision on the side. And that’s something that you should realize when you consider changing the shape here. There are other ways to change the way this shape, the nose is here, by making an incision inside the nose. You can bring this base here more closer to this center part. And that entails making an incision inside the nostril area. And those are all the things you can discuss with us. There is a way that you can avoid taking much tissue out in this nostril area by actually doing a cinch procedure where I make incisions here. And then I use sutures to bring the nose in. And I have videos that discuss that particular approach. And there are ways that you can change this center part here where you can change the way it relates. You can make it closer together. And you can also improve the airway that way. I think that when you talk about changing this area, you want to make sure that you’re not affecting the airway too much. Yes, changing this base here can make your nose look better in a lot of ways. But you always have to consider how it’s going to affect your airway. And these are all things that we can discuss with you. And we always want it to be, when we do the rhinoplasty, to be a functional improvement or maintain your function because you don’t want to lose your function. And these are all things that I’ll discuss with you. Also, it’s nice to change your nose. But you don’t want to make it so you can’t breathe through your nose. Your nose is so important in terms of your health like breathing through your nose, in terms of moisturizing your nose– or, excuse me, moisturizing, also, the air that flows through your nose. It helps expand your lungs. And there’s a lot of effects that it has with just your general body. And not everyone knows that in terms of rhinoplasty. I discussed how many people want to decrease the nasal bridge and make the nose go backwards. A lot of times that’s very common in the Caucasian population. Now, when you start talking about ethnic rhinoplasty, a lot of that entails augmenting the nose or making it smaller in different ways. Now, many of my Asian clients want to increase the nasal bridge. And many times they want to decrease the size of the nasal tip. Now, augmentation rhinoplasty and reduction rhinoplasty is quite different. When you augment your nose, you’re going to want to have tissue. And you can use silicone implants that help increase the bridge. You can use the medpor implants can also increase the bridge. And there’s positive benefits of silicon and medpor. I think silicon never really gets incorporated in your tissue, and your body constantly fights it. It’s not my first choice of putting in the nasal bridge. That’s my opinion. But I think the nose constantly fights that silicon. And, eventually, sometimes it can come out here. And I have many patients that I’ve treated where it has come out in this area that have gotten the procedure from someone else. I’m not completely disagree with it, but I think there’s better ways to make that bridge. One is using medpor. I’ve had really good results using medpor in the bridge. But the key point is you want to avoid implants in the nasal tip area. Now specifically what I mean is that you don’t want an implant next to the skin om the nasal tip. But you can use implants to present your cartilages in a way that refines the nasal tip. But you maintain the natural cartilages against the skin. But you use the implants to thrust the natural nasal cartilages forward and the more refined cartilages in this nasal tip without presenting implants next to the nasal skin. I think the area that’s most at concern is this nasal tip area. And sometimes it’s inside the nasal tip area that can have issues with the implant. So my usual approach is to augment the nasal dorsum with medpor and then using sheets to present the nasal cartilages in a more refined position. There’s other ways to do this, though. You don’t necessarily have to use implants in this area. You can also use cartilage. And the choice of this dorsal area is they’re using your cartilage or rib cartilage. Those are the main things. You can use septal cartilage. However, the amount of septal cartilage that is in the septum in here, deep inside, is usually scarce and doesn’t give you enough cartilage to form that nasal bridge. But there are ways to use rib and ear cartilage here. Now, of course, when you talk about rib cartilage, you’re talking about a significant procedure where you make an incision in your chest wall area to bring out a large piece of cartilage to make that bridge. And I think that’s not a common choice that my patients choose to have rib taken. So we’re always trying to find new way to, or better ways to, augment the bridge. For me, that’s using medpor implant or using your cartilage. To start out with, I think that using medpor implant is a good choice in that area to avoid extra procedures, extra incisions, and using extra tissue in your body that you don’t necessarily need. And my first choice is to use a medpor implant here. And if it comes to a point where it’s not working out, then you can always use your own cartilages and have that extra incision. But that’s a part of the discussion that we can have. And you can come up a decision on what’s best for you. So I also wanted to talk about whether we use packing for rhinoplasty. We, probably 99% of the time, do not use packing in the nose. And the way we avoid that is we do a special stitch, a septal stitch, where we take the stitch and go back and forth in the middle part of your nose to prevent any sort of collection of tissue. A lot of times the reason why they use packing is to avoid blood collecting inside the nose. So we don’t need to use packing. And thank you very much. If you have any questions rhinoplasty, you can always write as through our website. And we can always do consultations through the phone or through the video. We do video consults all the time through Skype. And this is possible. And you can send us some pictures. And we can discuss how you want your nose to appear more like. And the key word is improvement. We always want to get perfect. But sometimes perfect, of course, as you know, is not obtainable in many situations, but we always do the best we can try to make it as close as possible as your desires are. Thank you.
Hope this helps!
Dr Young
Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington
This entry was posted
on Wednesday, December 15th, 2010 at 8:44 am and is filed under Rhinoplasty / Nose Surgery / Nose job / Nose Reshaping / Nasal Reshaping .
You can follow any responses to this entry through the RSS 2.0 feed.
Both comments and pings are currently closed.