There are an increasing number of patients needing to have a second or even third cosmetic nasal surgery. Unfortunately, for many reasons, sometimes including surgeon in-expertise, inexperience, this revision rhinoplasty rate continues to climb.
Often, patients are unhappy because the nose may have grooves, depressions, appears too pinched or is scooped. Certainly, patients don't relish the thought of having a second, third or fourth operation.
For many, but not all patients, there is a way to improve the nose but without another operation. When the problems are grooves, dips and depressions, a too-narrow tip or bridge or low profile or too-short a tip, injection droplets of the permanent filling material, liquid silicone, work very well to correct these irregularities. This is an office procedure with minimal discomfort; the nose painted with an anesthetic cream. The injections take only seconds, and there is no residual swelling or bruising. The return to work or normal activities is immediate.
Liquid silicone is an FDA-approved substance. Approved for use inside the eye, it is a veteran, reliable and safe material for off-label use under the skin. I have 33 years experience with hundreds of cases. On the cover of my book, SECRETS OF A BEVERLY HILLS COSMETIC SURGERY, the young man’s nose was improved by both surgery and the silicone.
Since the material is permanent and cannot be easily removed or altered, it is wise to provide gradual filling in small doses. Typically, anywhere from three to five sessions are required, each separated by at least six weeks. This allows acceptance of the product by the body without rejection. Plus, the patient participates in treatment decisions. When the patient is happy with the corrections, injections are done.
Contrasted with having another operation, with time off from work, discomfort further expense and yet no guarantee of 100% success, when appropriate, filling injections make sense.
Sometimes there is no choice other than to have another operation. For those patients who have had surgery involving straightening the nose and its deviated septum whether it was a broken nose or a crooked nose, with nasal obstruction, the recollection of having nasal packing is never fond. I have developed an answer to address the need for packing and yet to provide a comfortable airway so the patient, despite having the packing, can breathe normally.
The Post-op Nasal Airway System consists of soft silicone plastic tubes that sit on the floor of each nasal passage. Air passes through the nose as it normally does. Easily installed while the patient is asleep under anesthesia, it is removed in the office at the same time the nasal packing and nasal splint are removed. There is very little discomfort; the interior of the nose is numbed by a liquid anesthetic.
Patients having a rhinoplasty or revision rhinoplasty, septoplasty and turbinate resection have concerns about the nasal packing and the inability to breathe because of the packing. Then, there’s the dry and sore throat and for some a feeling of claustrophobia and anxiety because they cannot breathe.
Knowing that there is an alternative — that one can have the surgery and yet breathe adequately immediately after surgery — makes it much more attractive to have the surgical procedure.
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