6 Days Post-op and All Bruising is Faded to Yellow. However I Notice a Purple Bruise Under my Cast?

Q: I had primary rhinoseptoplasty with turbinate reduction and tip definition/bridge straightening 6 days ago. Went well and healing well. Cast comes off tomorrow. All bruising is yellow now–worse on right side near the worst of the c-curve. From under the cast I can see a deep purple bruise about an inch long running parallel and under the cast that has remained purple. Dr mentioned he had to do some bridge filing. Why might this bruise be in this location and hasn’t faded at similar rate?

A: Bruising and swelling are almost always asymmetric.  Don’t worry too much about uneven bruising.  Bruising is simply the product of red blood cells being broken down.  The skin on the bridge (dorsum) is very thin relative to say the skin over the nasal tip or cheek.  In order to “file” the bridge he had to lift the skin over it, and in so doing probably broke a few blood vessels (which is completely common and normal).  Ask your Dr. when you follow up if he recommends Arnica.

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Question About Splints and Packing After Rhinoplasty?

Q: Do all surgeons put splints into a nose after rhinoplasty that consisted of breaking bones, removing a bump from the top of the nose, making the nose narrower, and straighten the nose? Why would you and why would you not put splints and/or packing after rhinoplasty? I see that some people don’t get packing but a lot have splints after rhinoplasty. I would like to understand the benefit and reasons why some surgeons put them in while others don’t.

A: Surgeons typically will use splints or packing whenever work is done on the septum.  If no work is done on the septum, then neither of those two things is necessary.  The benefit is the same benefit as the splint or cast that goes on the top of your nose after rhinoplasty – it limits the amount of swelling and it provides some support to the septum as it is healing.  The question of packing vs. splints relates more to the surgeon’s personal preference.

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I Have an Upward Tilted Nose. Is There Any Correction Other Than Surgery?

Q: Hello, my name is Brian. I have a slightly upwardly tilted nose. Whenever I look around when I’m in public I see that every other guy has a nose where the nostrils come back at about a 90 degree angle or maybe a little less. I don’t necessarily feel bad about my nose because it really isn’t bad. If you saw me right in front of you and facing you, you could see a little bit of the bottom of my nostrils. How come I have this and nobody else does?

A: Unfortunately there is no great nonsurgical way to counter-rotate your tip (give you closer to a 90-degree angle).

Fortunately, with surgery this can be accomplished and give you excellent results.  Everyone’s nose is different, and you were blessed with one that is slightly rotated up.  While you may want closer to a 90-degree angle, believe it or not, others seek a 100-degree angle or even more.  Everyone has their own sense of beauty.

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What if my doctor shaved my hump down too much?

Q: I’m 2 weeks post op. I honestly hate my new nose! Everyone keeps telling me it’s the swelling and I’m so tired of hearing that. Swelling has nothing to do with the hump I had. I feel my doctor shaved down too much! I would love my new nose if it wasn’t shaved down so much, it’s really pretty drastic. Should my doctor have to fix this? Or am I being too dramatic? Will things get better? I just wanted a really nice nose so I wouldn’t be self conscious anymore but I feel I didn’t get that.

A: Your profile has not reached its final appearance.  Once the majority of the swelling resolves (in 3-6 months) then you can start to judge whether the hump was over-resected or not.

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Should I get a nose filler?

Q: I have a hump on my nose and it is because the skin above it is very flat. When I make the skin above the bump bigger it camouflages it. Should I get a non- surgical nose job? And how much would it cost? I live in Canada, British Colombia.

A: Based on your description it does sound that your profile can be made straighter and the appearance of your nose improved with nonsurgical rhinoplasty.  In-person evaluation with a rhinoplasty specialist experienced in nonsurgical rhinoplasty will give you the best nonsurgical vs. surgical options to improve the appearance of your nose.

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What can be done about a bulbous Asian nose?

Q: Quite tired with the way my bulbous nose looks. Probably a complaint so common it sounds cliché. I know that surgery can do little to actually shape the thickness of my fat alar, so what is possible? My nose bridge tapers from nonexistent to large and amorphous, what can and should be done about that? What is realistic for my face? I’m okay with expending ‘ethnic identity’ and don’t want a mere reduction in size. Would like a new shape.

A: Reshaping the nose during Asian rhinoplasty does require a great deal of technical expertise, but is something that is done frequently by a rhinoplasty specialist experienced with Asian noses.  You can achieve the changes you seek by using grafts from your own body (rib cartilage, fascia) to augment your bridge, refine your tip, and reduce the size of your ala.

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Upturned nose Asian Rhinoplasty. Do I need revision?

Q: It’s one month since I got open rhinoplasty in Jakarta, but I am living in Europe. My surgeon put I-shaped implant with ear cartilage for the tip. He also changed the shape of my nostrils. He works gentle and most of his patients have good results. But I now have uneven nostrils, hanging ala, the bridge is like ski slope, and frontal view also makes me unhappy and uncomfortable. I am thinking of having a revision.

A: Early in the recovery period after Asian rhinoplasty the tip of the nose will be rotated up slightly more than the position it will be after full healing.  This is largely due to swelling in the nose after surgery.  You can expect your tip to lower slightly.  Whether that amount is satisfactory to you or not, only time will tell.  Give your nose 3-6 months for the majority of the swelling to resolve.  If you can see that the shape is not heading in the direction you like then you can consider a revision in the 9-12 month post-operative period.

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How long should an out of town patient stay in the area after rhinoplasty with rib grafting?

Q: I am a 19-year-old Asian female from Singapore. I want to fly to CA to have rhinoplasty with rib grafting since I have thick skin and a flat nose. How long should I stay in the area after the procedure? I really worry about graft infection and absorption due to thick and oily skin. Also, is the infection rate a constant as long as I have the grafts in my nose? Or the rate is the highest during the first couple of months and decrease to almost 0 after I fully healed? Thank you!

A: Surgeons will vary on their preference, but for my out of town/out of country patients my preference is a 2 week stay in Beverly Hills/Los Angeles.  The highest risk of infection is between 1-2 weeks after surgery while the nose is early in its healing stages.  Sutures and a cast will be on your nose for a week, but the incision lines are still a little raw until 2 weeks after surgery.

2 weeks after surgery the incision lines will be nearly healed, and makeup can be applied to the nose.  This is the point that most patients feel comfortable going back to their daily routine.  With autologous grafts (rib grafts) the risk of infection is exceedingly low, and after the nose is healed there is no increased risk of infection over your natural nose.

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Are the nose reshaper products effective or not?

Q: My nose is curve. Please tell me if the nose reshaper products are effective or not?

A: The nose reshaper products on the market are ineffective at best, and hazard to the safety of your nose at worst.  The best way to reshape your nose safely is with nonsurgical or surgical rhinoplasty with a rhinoplasty specialist.

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Can I add more filler to my nose?

Q: Hi! 3 days ago I had filler injected to my nose to make my nose straight and hide the bump. He injected filler into two areas (top and bottom of my nose) and I loved the result but now 3 days later the bump is coming back!!! What can I do? When can I add a little more filler and why have the results changed? Please help!

A: After nonsurgical rhinoplasty there is always a period of initial swelling (typically 3-4 days) followed by resolution of the swelling.  Once the filler has had a chance to fully “settle” (~2 weeks) this is an appropriate time to go for a touch-up if necessary.

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