by Bellevue | Seattle’s Dr. Philip Young | Aesthetic Facial Plastic Surgery:

Generally, fixing a nose is a cosmetic undertaking and is not suggested during pregnancy. Especially if it is done under general anesthesia. General anesthesia is not recommended during pregnancy unless for almost life threatening situations let alone cosmetic purposes.  I would highly recommend postponing fixing your fractured nose until after pregnancy and breast feeding.  Another alternative is to do it under local anesthesia but this is rather a difficult option as it is hard to completely make the nose numb at times.

rhinoplasty-before-after-images

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Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Rhinoplasty / nose shaping techniques can be done to improve your current condition. For your situation, you would only need some small incisions inside your nose.  Then a rasp and other instruments can be used to take down the sharp bony area.  If this is a new situation, it is possible that this will go down with time.  Sometimes, swelling next to the bone can feel like bone and this may all that it could be. Only time could tell sometimes in this situation but I would ask your physician for more details.  Rasping the bone should range from 2000-10000 or more depending on the extent of the injury and that should cover all of the costs.  It will vary with the surgeon and the area of the country.

These are what rasps look like.

The arrow shows where you can approach your rhinoplasty to rasp the nasal bones. Some surgeons can do the whole rhinoplasty without an external incision. This limits your ability to shape the nasal tip through a closed approach.

The external open approach to rhinoplasty entails an incision where the green arrow is pointing below:

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Composite grafts through rhinoplasty principles can help. What this is means is that you can take a graft from your ear or other area which will include a composite of skin, cartilage and intervening tissue that can be implanted within the nostril to enlarge the aperture.  Also different tissue advancing techniques and transposition of  close tissue from the mouth or around the nose can be done to also enlarge the nostril.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Recovering from rhinoplasty can be from something very minimal to something more significant.  It really all depends on what you do with the rhinoplasty.  Sometimes, the rhinoplasty entails just tailoring the sides of the nose which one can recover from very quickly.  Certain tip refinements can have quick recovery times as well.  One thing to know is that refining the tip as a whole may entail a quick recovery, but the refining process can take several weeks to months to take significant changing to take place.  When you work on the bridge and take down a significant hump, this usually requires controlled shaping of the nasal bones which will lead to more bruising and swelling. This will extend the recovery to time to a week or more.   So based on these variables, your recovery could take from as little as 3-4 days to a week or more.  Most of the time your surgeon will put on a nasal splint to protect your nasal bones especially if you have the shaping of the nasal bones and this is usually left in for at least 6-7 days.  Nasal obstruction is something that can be bothersome for the patient and this is variable as well.  It also depends on how much is done with the septum or midline cartilage structure.  I tend not to place splints inside the nose and hence breathing is usually alot better for my patients.   If nothing is done to the septum your breathing can be pretty much unaffected.  Pain is variable and also depends on how much is done.  If you get the works for your rhinoplasty, you could had significant discomfort for a few days to a week or more.  Bleeding is usually more significant the first 24-48 hours.  It should be no more than a trickle.  More significant bleeding should be discussed with your doctor.  Swelling also depends on how much is done.  The swelling in the tip could take months to resolve.  It goes away quicker in the bridge area.  Sutures usually are removed 5-7 days later and depends on your surgeon.  If you have any questions you can always reach me through our website. Here is a video on rhinoplasty showing a live demonstration but be forewarned this may be too graphic for some.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Revision Rhinoplasty (Dr Young specializes in revision rhinoplasty as is located in Bellevue / Seattle Washington) is a very difficult procedure.  Rhinoplasty itself is one of the most difficult surgeries that a plastic surgery will perform during his career.  Usually there are a lot of anatomical issues that are much different in a revision rhinoplasty as opposed to rhinoplasty done on a nose that has not had anything done.  The first major thing is scarring from previous procedures that obscures your view of the existing anatomy.  The scarring makes it harder to dissect through the planes and identify important structures.   Sometimes it is simple where there is a persistent hump on the bridge that needs to be lowered.  If the lowering involves removing bone, you may need to get your nasal bones restructured which could increase the recovery with more bruising.  If too much bone or cartilage was taken, you may need an implant or graft from somewhere else.  Silicone, and medpor can be used (goretex is another option) and these are some options.  Rib or ear cartilage are other options that will require harvesting from those areas of the chest wall or back of the ear.  Whether rib or ear is chosen depends on the size of the defect.  If it is larger, a rib graft might need to be used.  If the defect is smaller, ear cartilage could suffice.  Your surgeon could determine what is the best choice with your understanding and together you can decide.    Many people don’t want to harvest a rib cartilage graft given the extent of the surgery.  This is when an implant might be better.  Implants with silicone, medpor, and goretex are options as I mentioned.  The benefits of these implants are that they keep their shape,  they don’t require harvesting from another site, they don’t cause cancer, they don’t get absorbed so the augmentation you acheive is likely going to stay for a very long time.  The drawbacks are that there is a higher risk for infection, chronic pain, extrusion, etc. These are all in contrast with tissues that are harvested from your own body.  Many times, with revision rhinoplasty you also need to use grafts to replace missing tissue in the nose.  This needs to be done to either correct the irregularities of the nasal tip, the collapse of the middle part of the nose that is above the nasal tip, or improve the relationship between the nostril rim and the flaring of the nostrils. When you go into see your doctor, he should explain to you that they are planning to do to correct, options that they have for you, choices that you can have a say in, etc.  They should be an open book about how they are planning your revision and you should all of your questions answered.  If you have additional questions you can always write me here or contact me through my website at www.drphilipyoung.com.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

When evaluating a surgeon for rhinoplasty (Dr Philip Young of Bellevue / Seattle Washington), it is a good idea to look at as many before and after photos as possible.  One thing to realize is that there may not be that many photos for the particular surgeon even if that surgeon does these all the time.  Many people don’t want there pictures to be shown so that can limit the number of photos that a plastic surgeon is able to show someone.  The quality of the work is important to assess.  When the after photos were taken is important as well, as the results change over time.  In fact, the results of rhinoplasty can continue to change for 2 years and longer.  So you should look at afters that with that in mind.  During the recovery, the tip is usually the last to go down in swelling.  It can take several months for this to go down and could also change for many years.  This is good in many ways because your results will be gradual and it won’t look like something was done right away and it won’t be so obvious immediately. This can be good for your associations to get used to your look as it changes.  There are some things that you can do to speed up the recovery during the procedure.  I usually tack down the areas that are worked on so that the fluid doesn’t build up and the results become more apparent faster.  You should feel comfortable to discuss what things you notice, what things you like and don’t like with the surgeon and he should be really open to discussing things with you.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Correction of the nose bleeds is possible after rhinoplasty (Dr Young from Bellevue near Seattle). Based on what you said, the ENT doctor might have diagnosed what is called Ozena which is when the nostril passages are so open, the mucosa dries out which can lead to crust formation, bacterial overgrowth and bleeding.  You would need a thorough exam to evaluate why you are bleeding.  You could have prominent vessels that is causing the bleeding that could be taken care of.  If it is ozena, you can reconstruct your nose to prevent this drying through controlled narrowing of the nose, mucosal grafts, flaps into the nasal cavity, etc.  Exposure of cartilage, grafts, stithces, or implants could all be possibilities that could be the cause.  Get multiple opinions, is my best suggestion also.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Rhinoplasty (Dr Young Aesthetic Facial Plastic Surgery 1810 116th Ave NE #102, Bellevue, WA) when you are having a cold can increase your risk of complications.  There are always variables though that can increase or decrease this relative risk.  But with a cold, you can be more likely to have a cough after the procedure that could increase your risk of causing bleeding after your procedure.  Also if you are getting general anesthesia, the cold can increase your risk of having airway issues such as laryngospasm.  Most anesthesiologists will cancel a case if the person has a significant cold and with fever.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

There are many things that I ask to assess whether a patient is a good candidate for a rhinoplasty. One of the things that I want to make sure of is whether rhinoplasty is the right procedure for the patient.  I always ask what the patient is desiring from the rhinoplasty procedure as well to find out if what they are asking is possible with rhinoplasty.  I want to find out if their expectations are realistic and that the procedure will be able to achieve these realistic goals.  The one thing to remember is that perfection is not possible but we try to attain it as much as humanly possible.  I ask patient what they expect the surgery will do for them, if it will change their whole life, etc.  I also want them to see if I can be the right surgeon for them as well.  I get a sense during my conversation if this person will fit well in our practice in terms of coming back for follow ups and if their personality gels well with our staff.  My staff usually has a good sense of whether they will fit in and handle the post operative period and recovery well. The best situations are when the patients know what they want. The most difficult patients are those that are not able convey what they don’t like about their nose or the ones that demand a certain look. I usually ask them about the 2-3 things that they would like accomplished. I also put these in order. Understanding what the patients want is more than half the battle and is really the most important thing to find out. I try to find out also why they want surgery at this time. Some of the patients that I get worried about are the overly narcissistic person, the perfectionist, the person concentrating on a minor element but wants major improvements, and someone I don’t think will be happy no matter what the outcome. Rhinoplasty won’t change your life, but it can improve it. If you think it will change your life then you might consider something else in your ire. This is a video on Rhinoplasty.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington