Rhinoplasty

 

Unnatural plastic surgery is in the spotlight in 2016.  There are lies on the Internet showing celebrities who have ruined themselves or have become unrecognizable by bad plastic surgery.  Similarly, there are many people who circulate among us who have had bad plastic surgery.  The hallmarks of bad plastic surgery are the over-large lips, the turned up nose, the expressionless face, etc.  New, inexperienced surgeons, surgical tourism, and bargain surgeons have created scooped, crooked, upturned, asymmetrical noses that are like a red flashing LED saying bad nose job.  A patient who gets a bad nose job does not know what to do or where to go and thinks he or she is all alone.  Usually, they go back to the same doctor to fix it.  Fixing a bad nose job is an entirely different skill.  In fact, plastic surgeons used to say 15% of nose patients will find unsatisfactory or will get a revision or two.  The number today is closer to 50% of patients disliking their new nose and half to three-quarters are getting them done again.

Revising A Bad Rhinoplasty 

Revising a bad rhinoplasty requires an expert both in handling a patient whose trust has been breached as well as a scarred nose where you require grafts from the ear, rib or cadaver.  It is almost a unique specialty or subspecialty of rhinoplasty.  I just returned from a cadaver dissection rhinoplasty course where the anatomy was in direct vision. The defects in anatomy could be seen and repaired directly.  Techniques can be improved anatomically but does not necessarily give a better, more aesthetic nose job that the patient likes better.  Of course, understanding the anatomy is important, but that does not guarantee an acceptable or perfect result to a patient. 

My Approach To Rhinoplasty

My portrait training is vital to my results.  My eye quickly picks up asymmetry or size which does not fit.  Overall understanding the cadaver anatomy does not necessarily guarantee that the desired result is attainable.  Every nose is different.  Some patients require thinner, smaller, straighter noses.  Others want a larger ethnic nose.  I rarely perform open rhinoplasty anymore, although I have done hundreds.

Closed rhinoplasty gives a better result, rarely requires pain medication, has little ecchymosis and swells much less, getting the final result much sooner. 

The combination of my comfort with the closed technique and my artistic training allows me to create a nose I almost never have to operate on twice.  The most important thing in rhinoplasty is to listen to the patient what they want.  The doctor must also know what the limitations are and what is improbable to create.  Never promise something that cannot be done.  I use a computer and imaging.  For years I painted a portrait to show what they would look like.  I could do this very rapidly. I did this with people from out of town as well as from in town. Now, however, I use imaging software to show them what they will look like and I can almost always get the result I image in actuality on the patient.  I show the result I will get from both profiles and the front, and I explain to patients the side view and three-quarter views is the way other people see you.  The front view is where you see yourself.  The computer is not as accurate from the frontal view, and I tell patients this.  The computer company actually addresses not do to front on imaging of the nose. 

The decision in most cases is not an immediate one.  The patient will buy copies of magazines and make the decision over the next few weeks looking at numerous pictures.  There will usually be family members and friends involved in the decision.  Patients should be shown other patients' results and even speak to other patients if requested.  The revision patient is very hesitant in speaking to another patient I have helped, if beneficial.  The decision is almost always a cosmetic change in the revision, but a few revisions require breathing surgery as well, or are done entirely for breathing surgery.  In most cases, the surgeon fee for the revision is greater than the original surgery.  Rarely is the decision to sue the original surgeon involved. 

You must realize that there are different styles that different surgeons prefer.  Some prefer thin, aquiline noses others find thin noses artificial.  A doctor who does good aesthetic noses are women may make his male patients too girly and vice versa.  A careful perusal of the noses on the website gives you a good idea of the doctor's taste. 

There is a professionally society called The Rhinoplasty Society which approves the skill and ethics of applicants.  Generally, members of The Rhinoplasty Society will have better overall results and understanding of desire of the patient and those that do not are not qualified to be members. It does not matter if the doctor is board certified under plastic surgery or facial plastic surgery, but generally, the plastic surgeons have better results and more experience in cosmetic or revision rhinoplasty. 

In certain patients, liquid rhinoplasty is performed with fill that is injected to straighten the nose, create a pointier tip or show a hidden columella.  All fillers will be absorbed in time, as short as three months.  An extraordinary, non-repairable, catastrophic loss of tissue of the nose has been reported.  That is not uncommon.  Skin tumors and cancers do occur on the nose and are very invasive and require excision with checks on the borders by a dermatologist to prevent recurrence.  All in all, rhinoplasty is one of the most common operations in the world.  With the information on the Internet, it affords the patient Internet information on what to expect.  It also is an end-road for incompetent surgeons to advertise.  Be very wary.  Look at the gallery.  Make sure he is a Rhinoplasty Society member.  All Rhinoplasty Society members are board certified, and enjoy your adventure. 

If you’re resident of the Beverly Hills, California area and you’re looking for a proven rhinoplasty surgeon, please contact Beverly Hills Body today. 

 

Meet Dr. Ellenbogen

Dr. Richard Ellenbogen began his medical career at the University of Florida, where he showed advanced skills in both pre-medicine and art courses...

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