Tag Archives: handsome noses

Revision Rhinoplasty Patients Studied

A lovely, young woman searches records"A common situation in rhinoplasty was shown in a recent study of 150 revision, or secondary, rhinoplasty patients.

A New Hampshire plastic surgeon, Mark Constantian, M.D., collected the records of 121 women and 29 men who had revision rhinoplasty over 16-months. And, get this: the study group previously had anywhere from one to eight previous nose jobs and rhinoplasty revisions, with the average being 3.6 each. That’s a lot of surgery on one nose!

(Read the revision rhinoplasty study.)

Revision rhinoplasty helps unhappy patients with a first – or even a secondary nose job.  Dr. Constantian studied the various complaints and found 41 percent of revision rhinoplasty patients want the revision surgery for the same reasons people look for a first nose job: they crave a nose that fits their faces and does not call attention to itself.

Typically, a once straight nose had become crooked after surgery, the study revealed. (Continued below.)


The patient below and left was left with an overdone, scooped out nose in a first rhinoplasty done elsewhere. Using non-surgical rhinoplasty, the bump on her nose was corrected a little at a time with the facial filler Silikon 1000 injected above and below the bump. (Robert Kotler, M.D. photo)

"A woman with a bad nose job shows her correction after non-surgical rhinoplasty"_____________________________________________________________

(Continued.) In particular, 33 percent said a first rhinoplasty did not correct the deformity. Another 15 percent complained about loss of personal or ethnic characteristics of the nose.

(Read more about the concerns of Asian rhinoplasty, the African-American nose job and Middle Eastern Rhinoplasty patients.)

The study illustrates one consideration in rhinoplasty. And that simple truth is: there’s just no accounting for Mother Nature’s handiwork.

Often, a cosmetic plastic surgeon will use the patient’s own tissues to improve the look of the nose’s outside. But in some cases – as in many of Dr. Constantian’s patients – the added tissues in a first or revision rhinoplasty might continue to:

  • Grow
  • Shrink
  • Slip out of position

While the plastic surgeon probably did faultless surgery, Mother Nature’s doings are beyond a surgeon’s bailiwick and control.

However, there is a way around the conundrum: non-surgical rhinoplasty, a procedure that changes a nose’s appearance without operating on the inside.

Used only if no internal surgery for better breathing is needed, non-surgical rhinoplasty uses a syringe and tiny, micro-droplets of a facial filler to repair a nose with marks, scars, pocks, divots or even a low bridge or a nasal hump.

The best news of all: the procedure – also known as injection rhinoplasty – costs 80 percent less than surgery.

Injection rhinoplasty is completed in three to five short office appointment separated by waits of about six weeks each.

(Learn more about non-surgical rhinoplasty.)

Injection Rhinoplasty: Top 9 Reasons to Have It

"A lovely woman shows how her nose fits her face and flatters her profile"
A Nose that Fits the Face, Flatters the Profile

You’ve probably already read how some nose job patients can have non-surgical rhinoplasty while saving time, money and inconvenience.

Here are the top nine reasons for going ahead:

  • ”WYSIWYG” (What you see is what you get.) You can have a small test that shows exactly how your nose will look afterwards. However, the outcome of nasal surgery, cartilage replacement, bone reduction or even transplanted fat is never 100 per cent for sure. Mother Nature often rules during healing and changes things up!
  • You receive the injections during short, office appointments, not by going under the knife.
  • Down time? Forget about it! Non-surgical rhinoplasty injections require a matter of minutes. Afterwards, go back to work, school or have lunch, showing no bruising or swelling. (Continued below.)


The patient below and left suffered a collapsed  nose during rhinoplasty done elsewhere.Right, the correction was done via permanent non-surgical rhinoplasty with no surgery whatever. (Robert Kotler, MD, photo.)

"A woman shows a collapsed nose and the surgical after result"






  • (Continued.)You take part. Watching your nose change in a mirror during the process, you can decide how much is enough…or too little. (Read more about the “test drive” demonstration involved in non-surgical rhinoplasty.)
  • No “ouch!” factor. Before proceeding, the doctor numbs the skin of the nose with an anesthetic cream.
  • Low cost when stacked up against the costs of surgery.
  • Had a previous rhinoplasty? Or even a revision rhinoplasty to repair a bad nose job? No problem. However, the unattractive marks must appear only on the outside of the nose.
  • You choose the filler. While many nasal surgeons offer injection rhinoplasty, most use facial fillers like Juvederm or Restylane that dissolve back into the body in a matter of months. But if you want a permanently repaired, pleasing nose, there is only one Beverly Hills cosmetic surgeon super-specialist who has 30+ years of appropriate experience to do it.
  • Are you having functional nasal surgery on, say, a deviated septum or swollen turbinates to improve breathing, stop snoring or constant sinus woes? O.K. again.  Permanent injection rhinoplasty can be performed after the surgical segment.

Nasal Surgery Costs over Skype, E-mail

"A lovely young woman talks on her phone while working on her computer"
Cosmetic Surgery Consultation

Many cosmetic plastic surgeons offer consultations via:

  • Skype
  • Phone
  • The Internet.

In most cases, the patient sends or emails a picture of the bodily part in question and the conversation flows from there.

(Read more about live, remote contact for nasal surgery consultations.)

Obviously, patients also want to know the cost of cosmetic plastic surgery.

For rhinoplasty, a cosmetic plastic surgeon, working remotely, can get a pretty good idea of:

  • What can be done
  • What needs to be done
  • If the patient is making a realistic request

So the surgeon can provide a fairly accurate quote during the remote conference.

But in the case of, say, functional nasal surgery for healthy breathing in a case of deviated septum or turbinate reduction, the nasal surgeon needs to see inside your nose.

Some patients opt to save time, money and inconvenience by having not only a cosmetic rhinoplasty but an additional procedure like septoplasty to repair a deviated septum in one surgical session.

But the fees for internal nasal surgeries are just too hard to pin down without a personal exam.

It’s too difficult for any cosmetic plastic surgeon to give a patient a fee quotation on internal nasal surgery, based on the photos and information gleaned remotely.

Eventually, the patient must see the doctor in a personal consultation before receiving, solid, take-it-to-the-bank advice and, of course, a carved-in-stone fee schedule.

Several factors come into play about the cost of a nose job, like:

  •    How difficult is the rhinoplasty?
  •    Is a  chin augmentation required?

But for functional surgery, the surgeon needs to examine the inside of the nose to determine its structure and airway function.  The doctor also needs to manipulate the nasal cartilage with his fingers to get an idea of the tissue’s strength.  Likewise, the thickness of your skin is a factor.

So, you may be misinformed by receiving quotation about internal nasal surgery like turbinate reduction via long distance without first being seen by the prospective surgeon.

Also keep in mind, the complete costs of plastic surgery involve not only the surgeon’s fee, but:

  • Charges for the surgery center, hospital, or doctor’s office
  • Additional fees for a doctor/anesthesiologist
  • Pre-surgery exams and blood tests

So be sure and ask your surgeon for the total costs of your plastic surgery.

Cosmetic Surgery Implants – for Faces

"A young woman becomes lovely with only the addition of a chin augmentation device"
Chin Augmentation Only

When people hear the words “cosmetic surgery” and “implants” used in the same sentence, they usually think of buxom Hollywood movie stars and models who sometimes overdo it while going for a more feminine figure.

But implants are not just for bosoms, any more. Some are used in facial cosmetic surgery. Solid silicone facial implants are perfectly safe; in fact, the same material is routinely used in artificial joints and heart valves.

Probably the most common are the implants that augment a weak profile when a patient is having rhinoplasty or a revision nose job.

Other facial implants include those for:

  • Jaw
  • Cheek
  • Chin

Unlike breast implants which come with a choice of saline or silicone fillings, facial implants are made from a solid medical grade silicone.

A soft but solid implant – for the lips – came into the world of cosmetic and plastic surgery in 2007 but did not go over big with patients because time and many flapping jaws showed the kisser augmentations made quite a few unkissable due to:

  • Hardness
  • Scar tissue
  • Infections
  • An unnatural appearance
  • Breaking back through the skin

According to the American Society of Plastic Surgeons (ASPS) 17,143 lip augmentations – not involving injections – were done in 2010. But that was a 21 percent reduction from those done in 2009.

Consequently, most patients who want fuller lips now choose injections of Restylane, Juvederm and other facial fillers.

In about 20 percent of rhinoplasty cases, a chin implant is also used due to the patients’ receding chin lines. Rhinoplasty done alone in such cases usually does not improve patients’ facial appearances because the profile isn’t balanced.

Jaw and chin implants are often placed from inside the mouth while cheek implants can be inserted through the lower eyelid, leaving no scars whateve on the facial skin.

Nasal implants are small and can be inserted from inside of the nose, again leaving no surgical marks on the facial skin.

Patients should select their cosmetic plastic surgeons with great care because facial implants require a perfectly sized pocket which can’t be too large or too small or problems with the implant will show up later. For instance, the implant could slip out of its chamber.

Top facial plastic surgeons make sure some implants last by stitching the implant to the fascia, a tough sheet of tissue that covers the facial bone. Sometimes, surgical screws fasten implants down.

Cosmetic Plastic Surgery Patients Write to Us

"Two women lean over a table writing letters"
Dear Dr. Kotler

We’ll never forget the letter from Miss Piggy.

No, not the real Miss Piggy but a patient whose nostrils you could look into  if you were looking at her eyes.

Cosmetic surgery patients often say they have newly found confidence after rejuvenating an unattractive facial feature. But what form does that confidence take?

You decide from the letters, below, of those who’ve found it.

We gave the girl nick-named Miss Piggy a rhinoplasty, restoring a more normal appearance so she later wrote:  “…I was always made fun of and was called ‘Miss Piggy’ as long as I can remember. ..After surgery, I still look like me but better. Much love and thanks, Ex Miss Piggy!”

A gentleman wrote, saying how pleased he was that his rhinoplasty caused people to think he was 10 years younger. “..  I was happy because I was 80!” wrote J.R.

T.D. needed to correct a deviated septum for better breathing (“I could not take a deep breath, even with my mouth open,” she wrote) and reduce a larger than normal nose. “But to get me the best result possible,” penned T.R., “you suggested that I also get rid of a bump on the bridge of my nose and stop my tip from drooping when I smile.” After T.D. saw how a rejuvenated nose enhanced her facial features, she lost 60 pounds, changed her hair color and ended the note with: “I love the new me!”

From D.D. a young person after a rhinoplasty: “I love the results and how friends think I look younger without knowing what I did. My secret weapon, Dr. Kotler.”

Three years ago, K.E. had a first nose job that did not turn out well. She was referred to us by the receptionist (who had her own rhinoplasty with us) in another surgeon’s office while looking for a revision rhinoplasty surgeon. She wrote… “I’m only two weeks out from surgery but I can see my profile has improved, my bridge is higher and my tip is more refined…Overall, my surgical experience with you, Dr. Kotler was extremely positive.”

D.A.’s nose was in such a state she shied away from any cameras or even talking to some people. Four months after giving her a nose job, she reported: “I went to Israel…and was comfortable with pictures, not worrying about how my nose looks in snap shots.”

When A.R. from Beverly Hills was a teen, she broke her nose badly while cheer leading. A month later, A.R. had a rhinoplasty someplace else but it did not go well with continuous bleeding, hampered breathing, excess swelling and more health woes. Finally, she covered all the mirrors in her house. Eventually, A.R. read about us in an airline magazine, made an appointment and asked us to do revision rhinoplasty. She closed her letter saying, “I actually look more like ‘me’ than I did before my nose injury!’”

"A lovely woman shows her nose before and after rhinoplaty
Before and after revision rhinoplasty

After Rhinoplasty: Nose Packing Relief

"A sketch shows where in the nose a nasal airway is implanted"
Kotler Nasal Airway

We once once saw a patient who wanted a revision rhinoplasty to correct a bad nose job done elsewhere. Before leaving, he said: “Hey, wait! Does this involve nasal packing after the surgery?”

We replied that virtually all nasal surgeries require packing after surgery, done to:

  • Hold internal structures in the proper place
  • Reduce bleeding, if any
  • Deliver important medications to nasal tissues

Often those meds are antibiotics and medicines that speed healing.

But, one to five days of nasal packing can be too much for some, including this patient who left the office, saying, “Forget it!”

Many nose job patients hate breathing through their mouths while some say that nasal packing makes them feel like they have clothes pins on their noses. Yet another said nasal packing was like being water boarded. Some can’t sleep. We’ve heard others complain of anxiety and claustrophobia.

Added it all up, it amounts to a lot of patient discomfort. In our specialty, surgery of the head, face and neck, nasal packing is used in:

  • Rhinoplasty
  • Sinus surgery
  • Septoplasty
  • Turbinate reduction

That amounts to about 1.5 million operations yearly. So we began to think: is there a way patients could breathe through the nasal packing?

After more thinking and tinkering, we developed a special twin airway tube , the Kotler Nasal Airway, which is inserted into both nostrils with the nasal packing placed around it.

We often wonder why nobody ever thought of it before; after all, it’s the same principle used for life masks made in the Middle Ages.

Back then, the artist put one straw into the subjects’ nostrils, packed the whole face and nose with wet clay – allowing the straws to emerge into the air, of course– and waited for the clay to dry.

The Kotler Nasal Airway was tested on 140 patients and is FDA-cleared.

One patient, Todd, later wrote he put up with a botched nose job done by a plastic surgeon elsewhere for seven years because he did not want to suffer through nasal packing again.

But when he found out about our nasal airway, he agreed to revision rhinoplasty. After surgery, he said he was comfortable and relaxed compared to his first experience with nasal packing which, he wrote: “I wanted to take out every minute it was in my nose.”

(Read patient Q&As about the Kotler Nasal Airway after nasal surgery.)

Or, watch a video in which a rhinoplasty patient talks about the airway.

"A patient's nose is shown with nasal airway tubes inserted after a nose job"
Kotler Nasal Airway

Rhinoplasty & Snoring

"A wife is wide awake and angry over her husband's snoring"
Before Rhinoplasty?

Snoring is often the stuff of which cartoons are made.

How many times have you seen an artist’s clever vision of snoring, including:

  • Window shades flapping in and out
  • A bedroom filled with giant Z-Z-Z-Z-Z-Z’S
  • A care-worn wife dashing screaming from the room, her hands clamped over her ears

But there’s nothing funny about snoring — it’s actually some very loud bad health in progress.

We note that because, in our practice, about half the patients coming in for cosmetic plastic surgery have breathing problems

Causes of snoring can be many, but you must be wondering what has snoring to do with the nose job procedure?

Simple answer: many snoring cases are abated or cured in connection with rhinoplasty.

Deeper answer: Before rhinoplasty,  the savvy nasal surgeon will examine the nose’s insides for blockages if the patient (or patient’s wife!) reports habitual snoring. The exam is a thorough look-see by a surgeon trained and experienced in head and neck surgery.

The surgeon best qualified to perform that inside the nose exam is also usually board-certified in otolargyngology.

(Read our post about plastic surgery’s board certifications.)

That surgeon thoroughly checks the inside of the nose because some conditions could exist which require a separate surgery before the patient can proceed on to the cosmetic rhinoplasty.

Internal nose passages include:

  • The septum – that thin wall of cartilage separating the nostrils. A septum could be bent, twisted or blocked
  • The turbinates, larger structures farther up in the nose, could require reduction because they sometimes swell
  • Untreated broken noses that healed on their own

Turbinates humidify, filter and warm air before it reaches the lungs. If you snore, you become a mouth breather and get second choice air. Lungs are healthier with nose breathing.

Another answer to snoring may also be found in the sinuses, throat or neck when polyps or allergies are discovered.

In some cases, the patient’s uvula, that dangling structure in the very back of the throat, hangs too far down into the throat and flaps back and forth, causing the sleep robbing Z-z-z-z-zs.

An enlarged adenoid can be the bugbear, especially in children.

But, of those many adult patients who come in with snoring problems, most are totally cured or significantly reduced.

Bottom line: healthy breathing is quiet breathing!