New Hope for Unhappy Nose Job Patients
Office Injections Save Patients a Second (Or Third) Trip to The Operating Room and Thousands Of Dollars
I've unfortunately noticed that there is an increased number of patients coming to my practice needing "touch-up" cosmetic nasal surgery. Their original surgery, performed by other surgeons, was unsatisfactory. Nearly 20 percent of patients consulting with me have had poor work done elsewhere. In a future post, I will discuss the "why" of this problem and how you can avoid being a dissatisfied patient.
These patients are unhappy because, typically, the nose was "overdone" with grooves, moguls, depressions. Too much bone and cartilage was taken out. That's why these patients complain that "my previous rhinoplasty makes my nose appear too-pinched and too-scooped." Fortunately, for some patients unhappy with their result, and even unhappier with the prospect of more surgery, now there is a better option.
Surprisingly, few patients know about a highly predictable and reliable non-surgical alternative: filler injections. I was recently consulting with a patient who was unhappy with her original rhinoplasty, followed by multiple other surgeries to correct the damage done at the first session. She came to the consultation resigned to having another complex operation. When I informed her about the benefits filler injections, she became overwhelmed with emotion and began to cry. She was so thrilled I could fix the appearance of her nose, without yet, another surgery.
I favor such filler injections when appropriate. Droplets of liquid silicone, deposited just under the nasal skin with a short, ultra-fine needle, work magic to correct nasal irregularities. Typically, patients are only offered expensive, complex operations, usually with somewhat unpredictable bone and/or cartilage tissue grafts.
Cosmetic surgery re-do's require additional time off from work, another trip to the operating room, some discomfort and more money. Yes, there are some situations whereby surgery cannot be avoided, such as when breathing is still blocked. But, doesn't it make more sense, whenever possible, to permanently correct an imperfection - more handily - by a series of office injections, with no down time, very little pain, back-to-work immediately with no swelling or bruising?
Silicone-gel breast implants, with FDA approval are back and popular. The liquid form of silicone is FDA-approved for use inside the eye, a pretty delicate and critical area. So, we nasal surgeons feel comfortable and safe using it, off-label, for droplet placement under the nose skin. The total amount needed to do the job is less than 1/5 of a teaspoon. Silicone, a great man-made material - in its solid form - is used for FDA-approved artificial joints and heart valves. And, nearly everyone has had exposure to the liquid form; hypodermic needles to draw blood or give injections are coated with it for ease of puncturing the skin.
Incidentally, lest there be any confusion, liquid silicone as a filling injection is permanent. Other fillers that are sometimes used for the same purposes, such as collagen, Restylane and Juvederm are not permanent. They may last up to six months but ultimately will dissolve away and need to be repeated.
To Demonstrate the Final Result, There's Even a "Demo"
For patients who are reluctant, unsure, or just curious, I have devised a clever and practical "Salt-water Demo." I demonstrate to the patient, mirror-in-hand, the predicted result by injecting sterile saline (salt-water). This "test-drive" allows immediate visualization of how the permanent injections will correct the dents and defects. The saline filler dissipates within an hour. We take before and after digital photos, which we can e-mail to the patient, to show the family for their input.
Related:
Technorati Tags: cosmetic surgery, rhinoplasty
I've unfortunately noticed that there is an increased number of patients coming to my practice needing "touch-up" cosmetic nasal surgery. Their original surgery, performed by other surgeons, was unsatisfactory. Nearly 20 percent of patients consulting with me have had poor work done elsewhere. In a future post, I will discuss the "why" of this problem and how you can avoid being a dissatisfied patient.
These patients are unhappy because, typically, the nose was "overdone" with grooves, moguls, depressions. Too much bone and cartilage was taken out. That's why these patients complain that "my previous rhinoplasty makes my nose appear too-pinched and too-scooped." Fortunately, for some patients unhappy with their result, and even unhappier with the prospect of more surgery, now there is a better option.
Surprisingly, few patients know about a highly predictable and reliable non-surgical alternative: filler injections. I was recently consulting with a patient who was unhappy with her original rhinoplasty, followed by multiple other surgeries to correct the damage done at the first session. She came to the consultation resigned to having another complex operation. When I informed her about the benefits filler injections, she became overwhelmed with emotion and began to cry. She was so thrilled I could fix the appearance of her nose, without yet, another surgery.
I favor such filler injections when appropriate. Droplets of liquid silicone, deposited just under the nasal skin with a short, ultra-fine needle, work magic to correct nasal irregularities. Typically, patients are only offered expensive, complex operations, usually with somewhat unpredictable bone and/or cartilage tissue grafts.
Cosmetic surgery re-do's require additional time off from work, another trip to the operating room, some discomfort and more money. Yes, there are some situations whereby surgery cannot be avoided, such as when breathing is still blocked. But, doesn't it make more sense, whenever possible, to permanently correct an imperfection - more handily - by a series of office injections, with no down time, very little pain, back-to-work immediately with no swelling or bruising?
Silicone-gel breast implants, with FDA approval are back and popular. The liquid form of silicone is FDA-approved for use inside the eye, a pretty delicate and critical area. So, we nasal surgeons feel comfortable and safe using it, off-label, for droplet placement under the nose skin. The total amount needed to do the job is less than 1/5 of a teaspoon. Silicone, a great man-made material - in its solid form - is used for FDA-approved artificial joints and heart valves. And, nearly everyone has had exposure to the liquid form; hypodermic needles to draw blood or give injections are coated with it for ease of puncturing the skin.
Incidentally, lest there be any confusion, liquid silicone as a filling injection is permanent. Other fillers that are sometimes used for the same purposes, such as collagen, Restylane and Juvederm are not permanent. They may last up to six months but ultimately will dissolve away and need to be repeated.
To Demonstrate the Final Result, There's Even a "Demo"
For patients who are reluctant, unsure, or just curious, I have devised a clever and practical "Salt-water Demo." I demonstrate to the patient, mirror-in-hand, the predicted result by injecting sterile saline (salt-water). This "test-drive" allows immediate visualization of how the permanent injections will correct the dents and defects. The saline filler dissipates within an hour. We take before and after digital photos, which we can e-mail to the patient, to show the family for their input.
Related:
Technorati Tags: cosmetic surgery, rhinoplasty
5 Comments:
What do you recommend for ethnic rhinoplasty patients?
I had a rhinoplasty several years ago and it has been a disaster. My nose keeps growing.
Now, it is bulbous.
It's horrible. It's worse than it was ever before the surgery.
When I think about it, I cry. I try not to think about it.
I do not EVER recommend that anyone go through this unless you get a 100% guarantee that you won't end up like me.
It's interesting that Dr Kotler speaks of injecting silicone into the nose and in his post there is a link to an articles regarding injectable fillers which states that silicon injections are illegal. Why would a reputable surgeon recommend this? I just happen to be a patient of Dr Kotler's and my new nose is asymmetrical and will probably need reparing in the future. He suggested to me the collagen injections. Luckily, I did my research and found out that they are, in fact, illegal.
I too am a patient of Dr. Kotler's; however, I did take his suggestion of having filler injections to correct deformities in my nose due to a tumor that was removed when I was a child. The injections were successful! He could of recomended a rhinoplasty because that's what I was expecting but he suggested the filler injections which are less invasive. He even showed me within minutes what the results would look like when he used saline during my initial consultation. When I seen my nose after the saline test, I cried! I took picutres with my cell phone when I left his office and called my entire family to tell them about the simple solution to my lifelong problem. I was hesitant to get the filler injectins but I did trust Dr. Kotler after I did extensive research and discovered he is a respected physician, researcher, author and professional. After careful thought, I trusted him to "fix" my nose and he did. My treatments were less than $1000 and his treatments have changed my life. I no longer fear mirrors and having my picture taken. I no longer wonder if people are talking about my nose or looking at it. I am very grateful to Dr. Kotler for being a thoughtful, creative and professional physician.
Anonymous 12:42 AM: The link you referred to in your comment has been temporarily removed while we review the content you cited.
I will post a clarification along with a corrected link as soon as it's available.
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