Plastic Surgery Videos
Dr. Shah - Rhinoplasty Recovery - What to Expect? - Denver, CO
Hi there, it's Dr. Shah from Shah Aesthetic Surgery, and today's topic is going to be about rhinoplasty recovery. When discussing rhinoplasty recovery with patients, we do like to make sure that patients are optimized from the beginning of the operation. That starts with the preoperative evaluation. When I evaluate a patient, I want to make sure they're safe for surgery. They have to be health and they have to be of an age of consent. To get ready for surgery we have patients stop smoking, stop drinking, stop taking any drugs or nasal medicines that can cause wound healing problems like nasal cocaine or nasal steroids. We try to get people onto a healthy diet to maximize wound healing. That would include things like protein shakes, vitamin C supplementation, certain kinds of alternative supplements, and the use of vitamin K. During surgery, to make sure the patients are able to heal as quickly as possible and try and keep recovery as efficient as possible, there are things that we do pay a lot of attention to. Of course, trying to make sure that the patients have really stable blood pressure during surgery to reduce bleeding and reduce swelling are very important. Meticulous attention to detail during surgery helps reduce the risk of later wound healing complications and need for revision surgery. Finally, I'm very, very, very much opposed to excessive bleeding, because I know that it can create a lot of problems both in the final product and during surgery, so meticulous attention is paid to hemostasis. I will often, after cleaning out the nose prior to closing it, will flush a little bit of dilute steroid solution into the tissues so that they don't experience as much swelling in that first week of recovery. It's worked out very well for my patients. At this point, I've had no complications, such as wound healing problems. The postoperative segment of rhinoplasty recovery is, frankly, the longest. I mean, it will take up to a year for a first time rhinoplasty patient to see their final results. Now, for revisional rhinoplasty patients, it could take much longer than a year, because of changes in blood supply and scar tissue burden from previous rhinoplasties. In the initial, or first time rhinoplasty patient, also known as a primary rhinoplasty patient, I like to break down their recovery into three basic phases. Obviously, they have surgery, they have their operation, and they get sent home, usually, with a splint on top of the nose and some type of nasal drip pad on the outside. Occasionally, we'll put some packing in the nose. Occasionally, if I do a lot of intra-nasal breathing reconstruction, I will leave what are called Doyle nasal septal splints. They are silicon rubber splints that hold everything in place on the inside of the nose and allow for the creation of really nice patent airways to allow for good breathing capability. Patients are going to keep their heads in bed elevated for the first week. They're going to ice around the eyes, and they're going to use my preoperative rapid recovery system. After that first week, they come into the office and we remove the external nasal splint that's been molding their skin. If they had an open rhinoplasty, they have sutures that need to be removed, and those are removed by myself. If it's time to remove intra-nasal splinting, we will remove intra-nasal splints at that time. For the next two months, I have patients using night-time soft tissue taping techniques, and three times a day, soft tissue massage using tongue depressors. We allow them to sleep with nasal humidifiers and use nasal toilet or saline washing of the nose to make sure things stay clean. Patients are going to be congested for up to three months after surgery in most case, especially if intra-nasal work has been done. The upper two-thirds of the nose will settle down, typically, in that first two to three months. If the patient has had some type of nasal fracture, also known as an osteotomy, to narrow the nasal bones, it'll be between two or three months before those nasal bones are solidified enough. I have patients on activity restrictions that first couple months, because I don't want you getting hit in the nose and repositioning the freshly broken nose bones. Usually, after the first three months, I have the patients stop their nasal taping and stop the massages. It really doesn't make any changes at that point. The only thing we'll do to try and enhance recovery is take a look at the nose and see if there's been a lot of extra swelling in the nose, primarily in the nasal tip. In those situations, we'll often sometimes offer nasal tip steroid injections of what they call a dilute Kenalog solution. What that does is it helps decrease some of the scar in the nasal tip, improve the drainage of lymph in the nasal tip, and decongest it a little bit. After that first three months, a lot of patients will not really see any major changes for the next six months.
Dr. Shah - Non surgical Rhinoplasty (Nose Job) - Denver, CO
Today we're going to be talking about nonsurgical rhinoplasty. The definition of nonsurgical rhinoplasty is any rhinoplasty methodology that minimally, non-invasively changes the shape and contour of the nose. In current terms, that means that patients come in asking for nonsurgical adjustments to their nose. In my practice, that typically involves the use of injectable filler material. Now injectable filler material can be made out of hyaluronic acid. It can be made out of a product known as Radiesse. Some patients benefit from the use of their own fat, and occasionally, but not in my practice, patients get injectable silicone in their noses, which, when done properly, can be safe, but I don't believe in taking that risk for patients. The thing that most patients have to understand is that nonsurgical rhinoplasty actually makes a bigger nose, and most people who come in actually want a smaller, nicer nose. In my practice, I typically use nonsurgical rhinoplasty for very focal changes. If somebody has a very small radix, like in my situation, this whole area of my nose right here is relatively small and nonexistent compared to the rest of my nose. A little injectable filler in that area could improve my dorsal-nasal lines and make things look a little bit more aesthetically pleasing. The other situation that I've used filler material would be after a rhinoplasty or after somebody has had a rhinoplasty and come in with certain kinds of concerns and considerations like a mismatch between the dorsum and the tip or a little depression on one side or another of the nose. Injectable filler can be used in a similar way to calking material in your house to smooth out contours. Because of that, it's a really good material option for nonsurgical management of the nose. One thing that patients need to understand is that they need to be real careful about which product they chose to use for their nonsurgical enhancement. I prefer to use hydraluronic acids simply because they do go away completely. They typically will go away within a year of injection. They also don't leave any significant collagen scarring. The reason I chose this material is that many of these patients who, at this point, want nonsurgical rhinoplasty, are going to want a surgical rhinoplasty in the future, and there's been a lot of controversy about using more permanent materials like the Radiesse or the injectable silicone. What a lot of people will find when they go back into operate on a nose to do a surgical rhinoplasty is that there's a lot of foreign body material in the way, making it very difficult to do a safe rhinoplasty, especially in terms of health of the skin envelope of the nose. If I know that a patient is very definitive about never wanting a surgical rhinoplasty, then I will opt to use a product like Radiesse, and I do find it a very good product for nonsurgical rhinoplasty. If you have any questions, you can call me at the office and make an appointment to talk to me more about your options for nonsurgical rhinoplasty and to see if you're a good candidate. Have a good day.
Dr. Shah - Cost of Rhinoplasty (Nose Job) - Denver, CO
How much does rhinoplasty cost? That's actually a very interesting question. Rhinoplasties on the surface can cost anywhere between $4,000 and upwards past $10,000. It really depends on what type of rhinoplasty somebody's having. If it's a first-time primary rhinoplasty, it might be on a lower-end cost, but, revision surgery for reconstruction or other work, it may cost a lot more. I always caution patients, not to pick their surgeon based on price. A rhinoplasty is not the same thing as having a hamburger made at your favorite fast food chain. I mean, it's a customized procedure, and probably considered to be the hardest operation performed in cosmetic plastic surgery. The best thing I can always tell a patient to do is to make sure they do their homework and talk to a number of surgeons in their community who are known to do rhinoplasty surgery. The average number of surgeons in the United States do roughly 10 to 12 rhinoplasties per year. I, for example, do upwards of 50 rhinoplasties per year, and there are people in a community who will do 100 to 200 rhinoplasties per year. Make sure that your rhinoplasty surgeon has a very good revision policy and a very good revision history. Take a look at their before and afters before you decide on price as the only point of importance. Have a good day, take care.
Dr. Shah - Asian Rhinoplasty - Revision Rhinoplasty - Denver, CO
Today's case is that of a 30-something year old Thai female who's had four previous rhinoplasty procedures. She currently has a silicone implant and actual injected silicone in her nose and she'd like more projection and a better look to the dorsum of the nose. In this segment I'm going ahead and reopening her previous columellar incision. When you revise previous rhinoplasties you have to be extra careful that you're not damaging the blood supply to the nasal tip. She had a tremendous amount of scar tissue in her nasal tip so I had to do the initial dissection with a 15 blade but I was able to eventually use my favorite Converse scissors to open up once the scar was debrided. We went ahead and removed excess scar on top of the lower lateral cartilages to define them more and allow for more of a finesse small tip. Here I am making the pocket for the rib graft construct. The pocket is between the middle courora of the lower lateral cartilages. With this rib graft construct I'm going to be able to create a more advanced projected tip to give her a more Westernized look to the nose. Here's what the rib construct looks like. It's made out of custom shaved pieces of cadaver rib graft. The graft is being put in place. It will be sutured in with re-absorbable sutures that will disappear in about six weeks. Scar in the area will hold the new tip projection over the long run and this patient should be quite happy with the outcome. I then go ahead and close the nasal tip with interrupted 6-0 PROLENE sutures. They are very small but they need to be removed in about a week and they leave minimal scarring. As with most Asian noses, this patient has very wide nasal bones. If it wasn't for the silicone implant, it would look like she had no center of her nose at all so what we want to do today is identify her right and left nasal bone positions and then we are going to surgically break them with something called a guarded osteotome and you'll see this here in the next few seconds of footage. Here I am injecting with local anesthetic with adrenalin in it. This makes the area comfortable after breaks and the adrenalin decreases blood loss in the area of the fracture point. Here I am carefully fracturing the nasal bones in a continuous pattern. I'm always palpating far up near the corner of the eye to make sure I'm not injuring important tear drainage structures and that I'm not going into the nose too deeply, which could potentially run the risk of brain injury. Now that I've finished fracturing both right and left nasal bones, just gentle pressure allows the nasal bones to be pushed towards the center, creating a more narrowed dorsum or bridge, and this is what she's going to be most happy with. Here I am making the final touches on nasal bone position and position for the nasal tip. I wanted to make sure that everything looked good both externally and with the palpation of the nasal tip cartilage graft that I put in. The cartilage graft is quite strong and should serve her for a long time quite nicely. Here's a picture of the patient from a profile view just before we started the case. Here's a picture of her right after I was finished. You can see that there is more tip projection and better shape of the dorsum. This is the patient one month after on the right hand side showing a better look to the nasal dorsum and better position of the tip. Two-quarters view shows better tip projection and better tip shape. The worms-eye view shows better shape of the nasal tip and much better even shape to the nostrils. Her nose now looks normal on profile and the patient is happy.
Dr. Shah - Rhinoplasty - Nose surgery - Denver, CO
This is a recent story from my Snapchat @rhinoplastyjedi in which I am filmed performing a rhinoplasty procedure on a patient. She wanted the hump on her nose smoothed out, and the tip shape improved. For more information about rhinoplasty surgery please check out my rhinoplasty page at https://drmanishshah.com/Procedures/Nose