Mark B. Constantian, M.D., FACS
I am looking for a top doctor for a secondary rhinoplasty. Who are the top doctors for this in the U.S.? I know that it is important to find a very skilled and experienced surgeon for a secondary rhinoplasty. I am looking for the doctors that are well-known for this. I would like to ask doctors, "Who would YOU go to for this?"
I understand your dilemma, but the question is an impossible one to answer. The reason is that you are you--every patient is looking for a certain mix of skill, personality, warmth, and ethics, and those characteristics vary in importance among patients just like they do among surgeons.
There are many resources available--you have already found one of the best in ASAPS. My best advice is to find several surgeons within the area you are willing to travel, read their web sites, and invest the time in some consultations. You have already had an unsatisfactory experience or you wouldn't be looking for a secondary surgeon. You should look for someone whom you trust, who explains a plan that makes sense to you, and whose results in other patients with nasal problems like yours you like. A very good working relationship with a skilled surgeon is the best way of ensuring success next time.
I wish you very good luck.
I've gone to three consultations and most doctors want to cut the skin separating the two nostrils to pull the skin back and shave down a small bump and remove some cartilage at the tip of the nose...is there any way to not have an exterior scar? One surgeon is willing...
Yes. This procedure is called "closed" or endonasal rhinoplasty. It is the oldest rhinoplasty method and I use it exclusively. The open approach became popular in the mid 1980's because surgeons were frustrated at not being able to perform the new grafting methods the way they were described endonasally. The open approach is more popular in the US, though not overseas. Among the plastic surgeons who lecture and appear on panels, I am unfortunately usually the only surgeon who uses the open approach exclusively. I wish that were not the case.
I do not prefer closed rhinoplasty to avoid the scar, though that is a benefit. I prefer the closed approach because it is gentler, less destructive of normal support mechanisms, less likely to cause new deformities, and because it gives the surgeon more control over the result, especially in the tip.
You should be able to find a surgeon in your area who does closed rhinoplasty. Just make sure that you like his or her results in nasal shapes like yours, and that you trust and like the surgeon.
I had a silicone injection nose lift about 15 yrs ago. I've noticed a blue discoloration of my nose. It looks like a hematoma and sometimes I experience head aches. What's the best alternative cure for discoloration of my nose?
I agree with Dr. Culbertson. Without examining you I cannot be sure, but the discoloration is often the silicone showing through the skin circulation of the nose, giving a bluish tint. Remember, though, that the silicone is there for a reason: to avoid a deformity from just removing the implant, you and your surgeon must be prepared to replace the silicone with a rib graft. This is an excellent solution, but you must see a surgeon who is experienced in that type of reconstruction--one who can show you good results and whom you trust.
I had rhinoplasty and I hate the outcome. I don't have a botched job but this nose is not what I asked for and I look much less attractive. I want my nose tip round again, and also my hanging columella and if possible my bridge bump. Also, I'd like my nose to be smooth again, and to move when I smile, when I make faces (it does not move that much anymore). The overall shape of the nose is not SO different, but as my nose was already small, it looks too small for my face. What can I expect? Thank you!
The question you ask is actually very common. In a paper I published last year, about 20% of the 150 secondary patients I had operated on were having surgery to restore a prior shape. You have the right to your own body image. It is also common for patients to want to restore bridge height--even a bump--and the old tip shape.
You also mention the stiffness of your nose, which is very likely the result of the "open" technique you had performed. You therefore need to be revised by a surgeon who can confidently change shape without losing support and give you what you wish. I do not want you to have another unhappy experience. Find a surgeon whom you trust who can show you examples of cases like yours with results that you like.
Good luck, Fatima.
To achieve the best results in rhinoplasty surgery, do I need to choose a surgeon who is an ethnic expert in this field?
I have a long nose and a wide chin. I want to have rhinoplasty and surgery to improve my chin. I want to choose a good plastic surgeon so that I will have the best results. Do I need to choose a surgeon who is an ethnic expert that performs these surgeries?
I think that ethnic rhinoplasty is somewhat of a misnomer. After all, who isn't ethnic?
What is important is that each change that the surgeon plans is one that is explicitly decided between patient and surgeon. However, there is no technical difference in carrying out the operation - in other words, creating a straight nose with better shape requires exactly the same techniques in an Eastern European as it does in an African American. The plan, however, must be clear to patient and surgeon, because some patients wish to retain certain ethnic or familial characteristics and some patients wish to lose them.
Finding a skilled surgeon whom you like, who can produce your intended result, and who listens to you is the most important goal.
M.B. Constantian, MD