Redoing a Nose

Correcting deficiencies after a rhinoplasty (secondary rhinoplasty) can be difficult. Depending on what was done in the first surgery correction can require simple rearranging of misshaped cartilage to a complete redo where cartilage is harvested from the nasal septum or the external ear and grafted in to place. Bones may even need to be reset. In some extreme cases where there is little cartilage to harvest or the nose is markedly depressed rib and even synthetic bone may be needed to achieve an acceptable result. All of this is done through an open approach where a small incision is made in the columella (little column) between the nostrils and then carried in to the inside of the nose to allow adequate exposure of the internal structures of the nose. The resulting scar is minimal and the results that can be achieved are more predictable than doing the procedure "closed" where the only incisions are on the inside of the nose.

One of the more interesting cases I've had through the years involved a young man who might be described as a 'street pugilist'. His nose had been hit several times and the last altercation had resulted in the nose being very crooked and pushed to the right side of his face. I started the operation and after opening the nose and seeing how badly the septum (the wall that separates the nostril passages internally and supplies the support for the nose) was twisted I knew something more than the standard scoring and suturing would have to be done. I elected to separate the mucosa from the wall from above and completely remove the septum. I cut is out and put it on the sterile surgical table to try to straighten it. It allowed me access to parts of the septum that I otherwise couldn't get to and allowed me to reshape it with incisions and stitches. When I was done I put it back in place but it still wasn't good enough. I noticed the bottom half was much straighter than the top so I flipped it over and put it in upside down. The nose looked great. I sewed it in to position with the other cartilage and closed the soft tissue over it holding the mucosa (and blood supply) to it with sutures. The patient healed uneventfully and the nose was markedly improved with better function (he could breath) and a straight appearance.

If you have a nose that needs redoing I would be happy to see you.

All the Best,

Dr. J

Bad 'Nose Jobs'

Ever notice a bad 'nose job'? Have you stopped to think what it is that makes it look bad? Often it is overdone, meaning it looks as if too much has been changed, amplifying certain aspects while juxtaposing one ethnicity's traits next to another that you would never see in the general population. A good example was Michael Jackson's nose. It just didn't fit his face or features. You see this sometimes in celebrities. They want something that just doesn't conform to their face and they have the influence and money that can sway some surgeon to give them what they want, even if doesn't look right.

If you don't like the way your nose looks, the best thing you can do is to spend some time with a mirror to figure out exactly what it is that bother's you about it and then look at people with a similar ethnic background to find pleasing noses. They may not be an exact fit for your face but at least you will be starting in the right direction. Once you have an idea of what you would like to change then visit a board certified plastic surgeon or E.N.T. to determine if it is even possible and to have an imaging session to see how you might turn out.

Remember, plastic surgeons are human and can make substantial positive changes but they don't have a magic wand and some things are just not possible, and in some cases not desirable.

Have a great Thanksgiving Holiday.

All the Best,

Dr. J

Compassionate Doctor Award

I have been notified that I was selected by patients as a "most compassionate Doctor".
Evidently of the 720,000 active United States physicians, only 3% were accorded this honor. It is the most important recognition a doctor can receive: the recognition of our patients.

I am thrilled to receive the honor and rededicate myself to patient care.

All the Best,

Dr. J

Life Changing Plastic Surgery

So often plastic surgery is thought of as "fluff" or "vanity" surgery that is not needed and selfish. The truth is changing one's appearance, especially a trait that causes embarrassment, can have profound effects on how you see yourself and your ability to deal with society.

I had a patient today return after treatment for gynecomastia. The man had lost over 80 lbs and the resultant excess skin and floppy breasts were a big embarrassment to him. He didn't feel confident taking his shirt off in front of anyone. The feelings had profound effects on his feelings of self worth. He didn't like undressing in front of his girlfriend, at the beach, or in the gym.

Today he told me I had changed his life. When I asked how so he told me he was now a full time student in Physical Therapy. One of the requirements is for the students to practice their art on each other. He now has the confidence to remove his shirt in front of his fellow students and not feel bad about himself.

So much for "fluff" surgery.


All the Best

Dr. Jabs