ExclusiveTwo Most Common Reasons People Seek Cosmetic Rhinoplasty

What are the challenges for a plastic surgeon only that enjoys rhinoplasty? So when we look at the the face you know the average person on the street just sees the nose right but as a plastic surgeon part of the anatomical learning and the breakdown of that is understanding what lends itself to that shape. So the nose is a beautiful orchestrated symphony of various parts of working together. You've got the bones, the cartilage, the breathing aspects, all these different things that come together and there's really nothing else shaped exactly like that in the human body. So it's so specific and you want to make sure that your surgeon understands that and also understands how to solve problems when they're in rhinoplasty. Because when we go into surgery and we open everything up and take a look sometimes it may look different than what you were expecting and so as a surgeon you need to have a plan B, C, D in the back of your mind. You'll be able to know how to get yourself through a particular problem to solve it and so it comes from having that experience and knowing the various solutions and techniques that can get there especially in revision cases. Revision cases involved a nose that's been scarred that's been operated before and so it's a little bit of a mystery exactly what's going to be seen in there until you actually go into surgery and do it. You know I can read the operative part of what another surgeon did or examine the nose but a little bit of it is discovering sort of as you go on. Sort of like we're going through the rainforest together like hacking down brush and exploring something new right. So we're going to open everything up and take a look and at that time is truly when we get to make the diagnosis of what are the structural elements and how is that contributing to either a tip that droops or an over-rotated tip or a bump that's still there or a base that's too wide. Understanding what causes those aspects and then having all the abilities to address those right. If your first plan doesn't work what do you do for the second one. The nice thing about rhinoplasty is we get to reshape it on the table and see how it looks. That way we walk out of the operating room feeling happy and content that we did the right operation because we actually got to see it and you get to restructure everything sort of in the moment. You've got to think pretty quick on your feet then haven't you. You know if there you've got a time limit to be able to make the best choice for the patient at that time based on what you've discovered. Yeah well we don't want to rush things that's important. We want to make sure we get the patient through things as safely as possible but also with the right outcome possible. But you're right there are definitely safety concerns. We want to make sure that we are not turning a one-hour operation into an eight-hour operation right. So part of that is having that training and having in your head that preparation of what could happen here what could happen there. You know being able to yes think on your feet but also be able to follow through. You know I think about NASA astronauts for instance right like those people have to think on their feet too. They have to be able to respond to different bells and whistles and alarms and changes that happen right. But it's because they trained at their NASA facility for years and years for every single one of those possibilities and that's a lot of what surgery is. Like part of that ritual of me going through and preparing is thinking okay what if this happens what if this happens and knowing in your back pocket that you've got these skills and abilities to to address that right. So preparation or being able to be quick on your feet is actually all about what you did the day before what you did the hour before in terms of being mentally ready and also having the tools and techniques ready for you. That way when you encounter something you're not nervous you know you know the steps to address it to solve that problem. Well there's a new it's a new technique liquid rhinoplasty. Can you tell us a bit more about that one? Liquid rhinoplasty is basically using fillers which people usually know from lip filler cheek filler and place them into the nose and importantly the only thing filler can do is make things bigger. It adds volume. Most people that want a rhinoplasty do not want a bigger nose. So liquid rhinoplasty can only make the nose bigger that's all it does. But it can do it in a special kind of geometric almost like a magic trick area right. So most common reason for a liquid rhinoplasty will be someone that has a bump or that convexity of their dorsum right of their bridge. And so what can you do? You can put a little bit of filler above and below it and turn that convex shape into something more straight. So it definitely is a bigger nose right but the the eye of someone looking at you from afar it no longer looks as crooked or convex because you've added filler in the other locations. So sort of like filling in the the holes to create that shape. We can do with a rhinoplasty really well and actually make things smaller and more delicate. But yeah liquid rhinoplasty is only adding volume and adding volume in a few particular areas. It doesn't last as long as a rhinoplasty. You know filler lasts six months to two years whereas most people who have rhinoplasty have one and they're content with that the rest of their lives. So I mean I get it someone might want a rhinoplasty. It takes five minutes. It's less invasive. It's less expensive. The recovery is quicker. But most people that get filler in their nose are eventually going to want an actual rhinoplasty. So you could spend thousands of dollars and keep coming back every year to get touch-ups and that sort of thing or you could solve the problem with a rhinoplasty. Okay thank you. Okay let's imagine then if you were the patient what would be the questions that you would want to go through in your mind that you'd want to bring to your surgeon if you were looking for having rhinoplasty done? You want to make sure that the surgeon and the patient have the same eye view. You know if a patient says I've got this problem and the surgeon says I just don't see it that way that's a very polite discussion you should just go see someone else and get surgery with someone that does see it. I never want to disappoint anyone so if a patient has a concern and I just don't see it that way I'm very happy to tell them you know I'm not the guy for you you know. So I think it's an important factor is if you can identify the patient identify three things about their nose they don't like have a surgeon that also sees that right and make sure you agree on those factors. Not only that but making sure that the surgeon has the education the experience to accomplish that. Not only do you see eye to eye on what are the issues or what are we trying to achieve but can you get can we get you there. And in general from a safety standpoint you know we do most of our surgeries at accredited surgery centers but a good question to ask your surgeon is could you do my rhinoplasty at a hospital? Because for people who are not accredited who have not actually gone through residency training in that particular area they're not allowed to. They can operate in their office all they want but an actual hospital with nursing boards and safety committees and everything are going to say they can't right. So for instance if I walk into a hospital and said I'm here to deliver babies or do heart surgery they would say no you're not like we know what you're qualified for. So there are a lot of people out there doing plastic surgery who are not actually specifically trained in plastic surgery and because they operate in their private offices they can kind of get away with it and get it. So one important thing would be asked like do you have hospital privileges and are you also accredited to do surgery at the hospital? You know so that's an important factor. So knowing your surgeon, knowing what they can do, can they see eye to eye with you on the different factors is important. And then asking some questions like what will the recovery be like? What if I'm interested in a revision six months later? What would that look like? You know can I add other procedures at the same time? So understanding those factors and where will the surgery be done? What sort of anesthesia will I have? You know as a doctor those are questions that I think about and I kind of will assess and know beforehand but rightfully so patients don't do surgery right. So they may not know to ask a hundred of these like qualifying questions that I'm trained to think about and do. So to do a little bit of your homework and ask your surgeon those questions either ahead of time when you're just researching your surgeon or in person when you're talking those are the important factors. So who's a candidate for rhinoplasty? It's somebody that feels like their nose is out of harmony with the rest of their face. Maybe there's a particular feature that bothers them. The tip is too wide or they've got a bump on the bridge. Those are people who benefit from rhinoplasty. There's someone that has a particular one or two or three things about their nose that are concerning to them and we can address those and now the nose goes back into blending with the rest of your face. Just having someone that understands reasonable goals and what can be expected from rhinoplasty like that's someone who's a good candidate. If someone has some breathing issues and they're having trouble breathing through one side or both sides of their nose, that's someone that can benefit from rhinoplasty. But you have to be healthy. You can't have a lot of other medical problems. If those other things are happening, we want to get those solved and those taken care of because we have such a luxury in plastic surgery where you're not dealing with life and death moments. So we have such opportunity to take an extra week, a month, however long it takes to prepare and make it so this is going to be the safest outcome possible. So I guess the converse would be that's who's not a candidate for rhinoplasty. Someone who has some unsolved medical issues that they're dealing with and their health maybe is not perfect. If someone has already had three or four rhinoplasties, maybe they shouldn't have a fifth rhinoplasty. Combination of both anatomic reasons and scarring but also perhaps their expectations are not aligned with reality if you keep going back to get the same procedure. That might be someone we have to just have a frank discussion and say, that specific goal that you've identified may not be possible in anyone's hands. Two ways to think about rhinoplasty. The first thing is we have to think about whether we're doing it for functional reasons or aesthetic reasons. Functional reasons are all about breathing and so that's where we restructure the inside of the nose. We fix a deviated septum. The aesthetic reasons are about how the nose looks, making the tip more delicate, taking down the hump on the bridge, all those different factors. The nice thing about rhinoplasty is we can combine them. Most cases are a little bit of one, a little bit of the other. Not only are we helping with the breathing but we're also reshaping the nose to get someone those aesthetic goals they have. In terms of technique, the main differentiator is whether you're doing what we call an open rhinoplasty or a closed rhinoplasty. Open rhinoplasty makes a small little incision on the bottom of the nose. No one really sees it. It's on the bottom so your dog looks up at you or something like that. It usually heals really well but the entire debate about open versus closed rhinoplasty is all about that several little millimeter incision here. Open rhinoplasty, we open everything up. We take a look at everything and we can diagnose everything and we can adjust things on the fly. Closed rhinoplasty involves only accessing the nose through the inside so there still are incisions but they're on the inside so where the inside of your nose is and being able to reshape things through tiny channels or tunnels and adjusting it that way. Most surgeons will do mostly open or mostly closed. It's a combination of their experience, where they trained, who trained them and a little bit of that pedigree behind how they were taught to do the procedure. For us, it matters a lot in terms of how we think about the technical aspect but I honestly wouldn't think it matters a lot to the patient. If I wanted, I do mostly open rhinoplasty but if I chose a surgeon, I want my rhinoplasty done and that surgeon mostly does closed, I wouldn't have a second thought about it. The scar isn't as similar sizing? Yeah, we're only talking about a tiny little scar here on what we call the columnella of the nose so it's a very little small area. In no way in open rhinoplasty do we have very many scars on the majority of the nose so scarring is very similar. Ninety percent of the scarring you get with the closed rhinoplasty, you also get with the open. It's that one little tiny skin adjustment that defines philosophically if we're calling this an open rhinoplasty or a closed rhinoplasty. Great. Well, thank you again for your time today. I learned so much and I'm hoping that our viewers will be able to make a better qualified decision now from finding out more in depth and yeah, wish you all success. Thank you. Appreciate you having me today.