In order to fix a nose that is too long, is it necessary to remove tissue?
It is usually necessary to remove tissue to shorten a nose. Tissue removed may include cartilage or internal lining. There are specific instances when a nose can be shortened by changing the shape of the tip cartilages, rather than removing anything to rotate the tip up.

I it possible to fix a nose that is both too long and has a bulbous tip during the same surgery?
To improve a nose that is both too long and has a bulbous tip I first determine how much of the excess length is attributable to the tip cartilages themselves. If the tip cartilages are a main part of the length then I have a good chance of righting the problem by manipulating their shape or shortening them. However, often I need to address both a long septum as well as elongated lower lateral cartilagesand yes, they always can, and should, be done at the same surgery.

I have a broken nose. Are nasal packings are used to repair it and what exactly are they?
Nasal packing is simply used to minimize bleeding or dripping from the nose after surgery. They are also helpful in compressing the internal tissues to prevent collections and swelling. Packing is generally comprised of some sort of soft absorbent material or strips of gauze. Occasionally I will use stents which are firm pieces of silicone that act to stabilize the internal structure of the nose and prevent internal adhesions from forming.

Is it true that swelling can disguise the end result of surgery? How long does this last?
Swelling is a normal and expected part of the healing process and may last 18 months. Usually the acute swelling subsides and the nose begins to look normal by three weeks. As the months go on the nose becomes thinner, smaller and more refined at the tip as the edema resolves.

Are your rhinoplasty techniques different from those of other doctors and how?
I cannot speak to what other doctors are doing with the noses they operate on.  I am very innovative and feel entirely comfortable trying most anything that I feel will yield the result I am looking for. Sound surgical techniques are published and available to all surgeons, yet very few study all of them and utilize them.

I have a long nose. Will rhinoplasty change its look from the both the front and the side?
When a long nose is shortened is usually changes the way it looks from both the profile and the front.

Before the rhinoplasty procedure, can the analysis be sufficiently performed over the Internet?
While computer imaging can be employed to photos sent via the internet and communication can be productive, it is always relevant to examine the patient to determine the specific characteristics of the skin, cartilage, bone and other related features.

Can you fix my nose if I've already had rhinoplasty and am unhappy with the results?
Revision rhinoplasty is the process of improving on the aesthetics and function of a nose that has already been done. I can almost always help these cases, even after several prior rhinoplasties.

You have great before and after photos. When can I expect my results of rhinoplasty to look like your after pictures?
Before/after photos should reflect all of the views of a patient, not just a single angle. I usually don't take photos for 6 months but I prefer to wait for 1 year to see the final result.

How do you correct a nose that is broken and twists to the side?
Noses that are twisted can be straightened by a variety of maneuvers including breaking the bones and re-setting them, straightening the cartilage, applying sutures, and camouflaging things with grafts. Sometimes a combination of these things is necessary to achieve a straight nose.

Does the repair of a broken nose result in a lot of post-op bleeding?
There is usually very little post-op bleeding from repair of a broken nose.

How long after a fractured nose repaired is a cast worn?
I have my patients where a splint or cast for 6 days.

Is it true that nothing can be done for a nose that's been broken many times or can it still be fixed?
Although it becomes more and more difficult to repair a nose that's been broken several times, it can be done.

I have a bulbous tip and I was wondering how this is fixed and if tissue is removed during surgery.
Correction of a bulbous tip is very common and requires a great deal of pre op planning. There are many ways of dealing with the bulbous tip and which way is chosen will depend on factors that relate to what the underlying cause of the problem is. I often remove some cartilage, cut and re-connect cartilage as well as us grafting techniques along with sutures to achieve my goals.

I would like to have my round nose straightened and narrowed, but I'm worried that it won't match my face. How do you ensure that the changes you make to the nose stay in balance with the other facial features?
Ultimately the question of balancing the nose with the other facial features is one of judgement, and each surgeon will have a slightly different aesthetic sense.  There are never any guarantees that the patient will love their nose, however with the use of computer imaging I can discuss this more fully with them ahead of time in an attempt to understand what they are hoping to achieve.

[next]