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Explore what others have to say about Rhinoplasty Plastic Surgery of the Nose with answers by Dr. Michael Bermant, MD.

Michael Bermant, MD
Board Certified by the American Board of Plastic Surgery

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This is the page where you can review questions and stories from patients, view the opinions of lay persons, and see answers from Dr. Bermant and other physicians. Do you want to ask a question, post an answer, or make a comment? Information E-mailed to me will be considered for posting.

  • Why did you choose to have the surgery?
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  • Did it have any effect on your life
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  • How did others react to your surgery?
  • Did you learn any lessons?
  • What would you advise others?
Information posted in this section does not necessarily reflect the opinion of Dr. Bermant.

E-mail to Dr. Bermant

Rhinoplasty Nasal Surgery Important Information

Question: Re: Unsatisfied open rhino septo plasty, got any advice?

Hi, I had an open septo rhino plasty done at the University hospital in Madison,WI. I had basically two problems. First, the septum was curved, effectively blocking both nasal passages. Also, the bone was crooked, further complicating my breathing. So, I had both fixed on January 14th. Now, about 4 1/2 months later, the verdict has been in. While the septum seems to be somewhat straighter, the bone (which had been broken about a 1/4 inch from the top), while seemingly looking somewhat straighter right after the surgery, has drifted (even further I think) in the crooked direction it started out from. It is angled to my right, and has a pronounced bow curve to it. My breathing problems seem to have gotten worse and worse as this thing keeps drifting more and more out of place. Even though my surgeon said that drifting often happens after surgery, I have my own opinion. I have some swollen, sensitive tissue on which extends outward and blocks my breathing in my right nostril. As my nose healed (at first it looked pretty straight), this tissue would cause me to sniff and wheeze through the other nostril (which I have been doing my whole life because of this swollen tissue blocking.) Anyway, it wasn't long before I figured out the sniffling was slowly drawing the whole works over and defeating the progress that had been made. But it was too late, and the thing just kept going and now I am back where I started, constantly sniffing and wheezing all the time, sounding like I got a couple socks stuffed up my nose, and believe me it is hell! At one follow up appointment in April, my surgeon told me he could cut off the "nodule" that extended out blocking my right nostril. But even if nose sat perfectly straight, the nodule would still look lopsided and stick out. Because the nose is crooked, it makes it 2 1/2 times worse. When I asked my surgeon if he could perform another surgery to re-break the bone and reset it, he told me he would have to break it further up the bone, and it would be too close to the brain, and too risky. I think he should have used a brace for at least a couple of months (I had only a bandage on for two weeks, so it did little to keep it steady while healing). I'm really tired of a nose that doesn't function correctly, that is why I'm writing desperate letters like this. After checking through some of your web page case files, I would have to say my case is most similar to your case 5, except my nose is more crooked and has a bow shape. Looking at the picture of the woman, I am very impressed with how straight her nose looks now! Did she wear a brace at all? I would kill to have had my nose straightened like hers. If you could give any advice at all, it would be appreciated. My plan right now is to go out and get a few consultations and opinions, and go from there. I won't accept my surgeon's solution to have cartilage "stints" imbedded on the other side of the nose to make it "look" more balanced. I think it can be rebroken and with something holding it (like a brace) it can heal correctly, but maybe I do need to get some of the swollen tissue cut off. What do you think? Sincerely and extremely appreciative of your time and feedback, j (tormented soul).

Dr. Bermant answers:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Correcting the deviated nose is very difficult, not because of surgical skills but because of the nature of the material we are working with. Cartilage tends to have a "mind of its own". It bends when you do not want it to and does not bend when you do. The material is fickle and we have evolved many techniques to deal with this nature. Internal cartilage batons (pieces of cartilage to help keep structures in place are sometime one answer. Rarely we use bone or metal pins but nasal flexibility is lost. Other times a piece of material to camouflage the underlying deformity can be of benefit.

Splinting is not usually the answer. My patients are splinted for 4-10 days only. These splints can be on the outside and or internal.

Nasal obstruction can be from both external and internal deformities. Only an examination can help determine what is best for you. I hope you can find satisfaction.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Question: Re: Nose surgery

I am VERY serious about getting nose plastic surgery I want a nose like Pamela Anderson Lee, no joke. Please send me info? Can you do this procedure? What is the price range?
Thanks,

Dr. Bermant answers:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

It depends what your nose looks like and if what you are asking is within what can realistically be offered by available techniques. I can make any nose look like any nose on a computer screen. Reality is a little different. Flesh cannot be molded like computer pixels. You need an evaluation, examination, and education as to what surgery can realistically offer. Without such education your expectations may exceed what reality can offer and you may end up very unhappy!

Our office excels in this education process and assisting our patients understand what can be offered. The surgical experience has a much better chance of a happy outcome.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Re: Rhinoplasty

hi...my name is ... i was interested in obtaining information about rhinoplasty

I was not interested in changing the hump on my nose...i wanted to make the width of my nose smaller, I was interested in changing it, having the procedure done over the summer,,,,and I was wondering if a month was sufficient healing time. Thank you and please write back

Dr. Bermant answers:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

In most cases the nasal width can be made smaller. Healing time is usually satisfactory over one month but it depends on what is done, and what you expect to do after only one month. There are still some sensitivities at that time. If nasal bones are broken, although there is quite a lot of strength at one month, further strength develops over the next several months. Most patients can wear glasses on their nose by that time others wait a little longer. I can give better information after an evaluation and examination.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Question: Re: Secondary rhinoplasty

Dr. Bermant -

I had a septoplasty/rhinoplasty 14 months ago. It was done to relieve chronic sinus infections that were due to a deviated septum. While "in there" I figured what the heck! and had some cosmetic changes made as well.

Overall, I am very happy with the result. I have not had a single sinus infection since the surgery and I used to get 5-6/year. Cosmetically I like my nose much better as well.

However, soon after surgery (about 1-2 months) it became apparent that my nose was not entirely straight - it seems to curve to the right as you move down the bridge of the nose to the tip. My surgeon kept an eye on it, but did not recommend doing anything about it for at least 6 months, preferably 9-12 months. It straightened considerably over the last year, but is not perfect. Additionally (or perhaps related to this) my surgeon noticed a defect where the cartilage has "sunk in" on the right side. I cannot notice this cosmetically (he can) but feel it in terms of difficulty breathing out of the right side; it feels as though there is something pushing in.

My surgeon feels that additional surgery would solve the defect of the cartilage on the right side; he plans to use cartilage from the other side of my nose or from my ear. He feels that the indentation caused by this defect is what is primarily responsible for the slightly crooked appearance of my nose, and fixing the defect will solve the majority of the problem. He does not want to "straighten" the nose in any other way as he is very pleased with the results. He originally removed a dorsal hump and fixed a bulbous tip as well as cutting down my nostrils.

Honestly, while I would love for the nose to be perfect, no one notices the slight crookedness and sometimes, depending upon the lighting, it even looks straight to me. I would not undergo a second operation if it wasn't for the difficulty breathing on the right side. It is irritating to feel like something is blocking the passage, although I don't feel it all the time - usually when I get stuffy it is worse. It is really bad at bedtime though, because if I lay on my left side, the right side almost shuts down and I can't breath. Using the nasal dilator strips has helped.

The purpose of this long-winded E-mail is to ask you if in your professional opinion you feel that the second surgery is an "ok" idea. I do not take surgery lightly and do not have fond memories of the last one. I dread a second procedure, but realize that a lifetime of breathing better, no nasal dilator strips, and maybe a straighter nose, are worth a week's discomfort. Are my expectations realistic that this second procedure will be successful, or should I let a sleeping dog lie? And is it true that this type of secondary procedure (cartilage fixing) is not as "bad" as the original operation of straightening the septum, fixing the hump, and fixing the tip?

Sincerely,,,,,

Dr. Bermant answers:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Secondary surgery is not uncommon in rhinoplasty. You have to understand the nature of the material that makes up the nose. Tissue, in particular cartilage, has a tendency to evolve after surgery. That is why better rhinoplasty surgeons continue to evaluate their patients after the operation.

Secondary surgery can be less or more extensive depending on the problem addressed.

Your doctor has a better perspective having had the opportunity for an examination. I would need to see a copy of your records, preoperative photographs, and examine you to offer an opinion if secondary surgery has much to offer. Many times "a little touch up" is a reasonable option, other times it is better to "leave sleeping dogs lie".

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Question: Re: information rhino

Dr. Bermant,
my nose is a little bigger than I would like it to be and I am seriously considering an operation most of the cases I have seen involve removing bumps and such and I was wondering if it is possible to reduce the actual size I realize you probably need to see a picture first, but I would appreciate any information you could send me
thank you, ...

Dr. Bermant answers:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Yes, most noses can be reduced and the size made smaller. The nasal passages however still need to be big enough to carry air through the nose. Sometimes it is a combination of nasal size and chin size that makes the nose look big.

I only wish it was easy enough to evaluate a patient with a photograph only. You will need a more thorough evaluation and an examination.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Question: Re: bump on the nose

Dr. Bermant,
I recently had a combination rhinoplasty/septoplasty surgery. This helped my breathing, but there is a small bump on the side of my nose like a pimple under the skin. This is very noticeable when I yawn and from the left side and when I cock my head to the side. My doctor who did the surgery said that this bump is where the bone is mending to the bone. He also didn't give me a straight answer on rather or not it would reduce in size. He just said I was being vain. is he telling the truth, or did he mess up during surgery and is afraid to admit it. I would appreciate any help you can offer.
Sincerely, ....

Dr. Bermant answers:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

It is common to be able to feel small bumps or tissue deformities after rhinoplasty. Hopefully they are not seen. Some deformities will reduce over time if due to swelling. Other deformities may increase as new bone or cartilage grows from the disturbed periosteum or perichondrium (the growth layers for bone or cartilage). Sometimes the healing of bone or cartilage itself can cause other bumps.

I cannot tell if your bumps are what your doctor says or not. Your doctor has had the chance to examine you and knows what was done surgically. Surgery is a series of technical maneuvers on material that has certain properties. Expecting perfection beyond what can be done can lead to dissatisfaction. In addition, you may not be expecting too much. I just cannot tell without an evaluation.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Question: Re: Question...sorry about all this mail!

All the information you have given on the message boards, and your web site, is so helpful! You are a life savor!
Thanks

Dr. Bermant,

Hi, sorry about all this mail. You have been really helpful. I am considering a nose job, and if I get it, it will probably be in December. My question is this; I'm still in high school, and with the exception of me possibly telling my two best friends, I'm not going to tell anyone about the surgery. Is this a good idea? Will everyone be able to notice? Also, what are some good excuses on why my nose looks different, other then the truth? Thanks so much! -...

Dr. Bermant answers:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Re change of nose:

It depends on the problem and the surgeon. Such a question can only be answered after an evaluation and education about rhinoplasty.

Re telling your friends:

This is something you need to decide. Some feel the need to hide any changes, others accept that they want to look better. Some wait for changes in school or summer vacations to have the surgery.

I try to work with my patients and not make a nose look over operated. On many noses it is better to just subtract the negatives and try to leave the positive features. The best noses do not look like they have had a rhinoplasty.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

Question: Re: Question...sorry about all this mail!

Dr. Mike-

Your the best! Thanks for everything!

-K


Question: Re: Rhinoplasty

Hello and Thanks for answering my question. I am thinking of Rhinoplasty but hesitate because my nostrils are slightly flared and the doctor wants to make incisons on the outside of my nostrils to bring them in. I am afraid of Keliods becase I have a small one on my stomach. I am African American and I have search the net for before and after pictures of African Americans but to no luck.

Thanks!

Dr. Bermant answers:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Different parts of the body scar differently. Just because you have scarred badly on the abdomen, does not mean you will scar in a similar fashion on your eyelids or nose. There are risks. I try to examine possible prior scars in that region to roughly predict the scar potential in that region. Prior scars however are no guarantee. You should discuss these concerns with your physician.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Question: Re: Revision Rhinoplasty

Dear Dr. Bermant

I am hoping that you could offer me some help or advice relating to a rhinoplastic operation that I have had previously and the possibility for revision/secondary surgery.

Some years ago I approached a surgeon since I had difficulty using peri-oral musculature. Essentially my lip raised poorly and felt "clamped" around the area of the nasal base, pressing against my teeth during animation resulting in an edentulous appearance when smiling. The surgeon performed a procedure which, was designed to raise and "debulk" the nasal base. He explained that the procedure was designed to improve lip mobility and raise my lip. This was accomplished by a long columella transfixion incision from the nasal tip through the vestibule to the lateral crus. A full thickness crescent of skin from the floor of the vestibule was removed as well as a wedge of the nasal spine and septum that defined the naso-labial angle. The nasal base was consequently raised into the defect on closure and advanced V-Y into towards the nasal tip in an attempt to raise the lip and free its use during animation. The procedure paradoxically exaggerated the original problem and has made expression difficult. It seems likely from observation and further consultation that the original problem was a hyperactivity/plasticity of the muscles of the lower nose, the nasalis complex. The debulking of the naso-labial juncture destabilised the area and increased the stress on these muscles during animation and their consequent activation which in my case pulls the naso-labial juncture caudally and resists the elevators and retractors of the lip.

Regardless of this analysis, imitating the bulk removed by restraining the central lip and manipulating the nasal base into its original position resolves the problems produced by the surgery and allows me a more normal/natural use of expressive muscles. I am aware of technical difficulties of secondary rhinoplasty but believe I have realistic expectations, hoping to improve rather than resolve the consequence of the previous operation. There are few local surgeons that involve themselves with secondary surgery especially where the problem is not clearly cosmetic, involves a functional component and insertion of graft material. I am looking for a competent surgeon who is comfortable with the use of graft material and is prepared to discuss the possibilities for reversal of the influence of my previous surgery.

Yours gratefully

Dr. M

Dr. Bermant answers:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

It sounds like you can express your problem nicely, but you will need an examination and evaluation. Dynamic scars and problems need to be seen and felt. The scars effect on speech needs to be heard. The doctor who has had the opportunity to examine you has a much better perspective than someone on the web. What was the problem with the evaluation and suggestions by the surgeon you mention?

Yes our practice evaluates secondary rhinoplasty patients and we deal with both cosmetic and reconstructive surgery. We prefer copies of the operative notes. Presurgical photographs also can give additional information.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

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