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00:00:00:07 – 00:00:30:09
Follow your nose and you will follow your beauty on this episode of follow your beauty. Hi I’m Dr. John Mendelsohn medical director of the advanced cosmetic surgery Laser Center. And stay tuned as we bring Josh back. Josh we’re gonna talk about your rhinoplasty TODAY AND WE’RE GONNA WALK THROUGH WE for anybody who hasn’t met Josh yet. He’s been a longtime friend and patient of the practice and he. Knows a lot about this topic.

00:00:30:10 – 00:00:59:04
So let’s let’s go back a little bit and I want to. I want to start by showing some photos that we found here and this was I believe in two thousand and eight. I was just going to say that right. OK hands right. So Josh when you when you look at the photos these are some photos of Josh before his rhinoplasty. We were talking about it back then. Tell me what you’re saying and tell me what you are hoping to to achieve here.

00:01:00:11 – 00:01:39:23
Well this is probably not the best way to describe it but I would say it My nose is like the shape of a beak it almost you know or they call it like I guess the Roman shape. So I didn’t like the curve in my nose I wanted a straight flat nose. I wanted that little hump the hump that I would say most people don’t like. And looking at me straight on in photographs. Growing up I looked great but whenever somebody would snap a picture of me and they would get this side profile I felt so ugly and like that’s not the way out I want to look.

00:01:40:18 – 00:01:46:01
So when when did that first. When did you first not like your nose I guess or want to change it I should say.

00:01:46:20 – 00:01:55:13
Well I’ve always been in the beauty industry so as soon as I started looking at other men’s perfect noses you know Zac Efron knows all these celebrities knows this.

00:01:57:02 – 00:02:08:06
And then I was I met you early on. So I knew where to go. And so yeah that got me started wanting one.

00:02:08:22 – 00:02:15:00
My fear is what kept me from doing. And let’s talk about that. Well what were your fears. Yeah. Oh my God.

00:02:15:00 – 00:02:35:13
Well you could just Google Nose jobs and it’s very it’s a you know it looks like it’s going to hurt you only have the hammer going in there and they’re slicing your nose open and go into town and the chiseling and so that I was really really worried about and also getting put to sleep. Oh that was a little worrisome too.

00:02:35:15 – 00:02:55:07
OK. So you worried about the safety of going to sleep. You’re worried about the pain or just whatever you’ve thought based on based on how rhinoplasty is performed. What about the outcome. Because at the time you know I mean the Internet existed but well I guess there’s only 10 years ago. But what what did you discover when you were you know online about rhinoplasty.

00:02:56:07 – 00:02:56:22

00:02:58:15 – 00:03:02:03
I you know after reading about it.

00:03:02:04 – 00:03:08:09
It was I early on I was worried because of all of the packing.

00:03:08:09 – 00:03:28:02
They would call it. So I think it was that having to go back to the doctor after you had the surgery to have the packing removed all of the comments or that was so painful you know. And so that was another reason why I did not do it because I was I didn’t want to get packed you know online. They would people would say there’s feet of packing.

00:03:28:03 – 00:04:08:13
They just keep packing and packing in six feet used to be six feet on each side. So twelve feet total that. So there you go. You know a lot of pack. And so what Josh was referring to is his back in the day we used to place six feet seventy two inches by half inch gauze at the completion of the procedure packed in the nose and yes the nose can handle that. Sure that’s not a problem when you’re asleep unaware. But a couple of days later when the package comes out it’s gross it’s filled with mucus it smells it bleeds people pass out. So you know when we do talks or seminars you know and I say OK who here wants admit they’ve had a rhinoplasty a few hands go up and what the hold I’ll say what can tell me about it.

00:04:09:00 – 00:04:30:23
Oh that’s all they talk about. They don’t they really don’t recall anything else except except for that pack and so just so you know and I know you know this but I haven’t put packing in a know since about nineteen ninety seven. So I think you were pretty three years old or something so. But so we don’t use packing anymore and that and that is a big deal. I just want to say with this episode this is going to run a little bit longer.

00:04:31:18 – 00:04:54:09
We’ve got a lot to get through. My goal is for anybody who is thinking about this who anybody has questions about it. Hopefully by the end of this episode you’re going to know what you need to know you’ll be able to analyze your own nose you’ll understand Even some things that are need to be done for your nose and it’ll it’ll get you started in the right area. I was gonna break this up but so.

00:04:54:12 – 00:05:31:06
So anyway I appreciate I appreciate you listening or watching this and we’re gonna go through the surgery as well in a few minutes. But what I want to do first is I and I think that this is probably the best way to do this and Josh you may remember some of this but I do want to say that there’s a big difference today how we conduct the the whole process. OK. Now there were a few things a we’ve changed things over time how we do it and b we already had a relationship established so there was some trust there and we would talk a little bit you know maybe not each time but over the years about goals and so you had time to just you know digest things a little bit.

00:05:32:22 – 00:06:06:23
So the Internet is a great resource. I think it’s great. Our rhinoplasty patients are probably with some of the best educated patients anywhere because they have a lot of resources and it’s not just because you’re looking at botched rhinoplasty it’s because there’s a lot of good stuff out there too so patients come in they understand a lot of this terminology and sometimes they don’t. But it’s our job when we see patients to make sure that we’re communicating effectively this is true for everything. But it’s particularly in or especially true for in rhinoplasty. It’s the difference between a good outcome and a great outcome.

00:06:07:01 – 00:06:36:16
And and it used to be and you probably did this honestly just remove the bump whatever. Yeah I trust you. Go ahead. OK. And that’s fine. And things worked out and generally they do but sometimes it’s the nuances or the assumptions that that patients make that make a difference in terms of not being happy with things. Also because of the high level of fear with these things because you see so many botched rhinoplasty as is we have difficulty sometimes getting patients to communicate with us what their real need is.

00:06:37:08 – 00:07:08:05
I know this isn’t your example but I’m going to use you as an example. Let’s just say let’s say you were female and you had this bump on your nose. One of our big questions is OK I understand you don’t like the bump. We can remove the bump but do you want that Dawson to be slightly concave. Oh right away. People you know they they worry they freak out because you know that they think about this and the old rhinoplasty so it takes it takes a little bit of trust and communication to get through. So what I want to start with is just naming some of the anatomy.

00:07:08:14 – 00:07:21:13
And the reason for this is important is because that way we’re all speaking the same language when we talk about rhinoplasty and there’s no confusion when you say you want. You want to slope a certain way. Well what does that mean. So I’m going to go through this it’s really pretty some basic stuff here.

00:07:22:11 – 00:07:55:05
So I’m going to try to use my nose here. So this is the Dawson. OK that’s pretty easy the bridge of our nose. Here’s the tip. This is called the nasal labial angle the nose lip angle. And we commonly like that Angle to be about ninety five to one hundred and five degrees and then 100 degrees to 110 degrees in women. Do we take a protractor out measure it. No we don’t. But generally speaking it’s a very important angle. And this is why when the nose is more obtuse when the angle is more obtuse we don’t wanna be walking in your nose full.

00:07:55:13 – 00:08:15:20
It’s called over rotated right. As we age and things tend to droop just like the rest of our tissues it might become more acute and it’s under rotated. So this is called the rotation. OK. The other term that’s important is Pinocchio is over projected. OK. If you have an African-American Asian nose it’s a flatter nose it’s plateau Ryan probably under projected.

00:08:16:03 – 00:08:19:12
OK projection projection.

00:08:19:13 – 00:08:33:20
OK. In terms of what we’re doing. So those are two very important terms and this needs the labial angle is part of it the way we measure things and then go over things. And I’m going to show in a moment some of the anatomy but a couple other terms. So this is

00:08:40:05 – 00:08:41:14
It’s going to click now.

00:08:43:20 – 00:09:13:00
So I’m going to show some other terms here. I’m going to show some other anatomy. This is called the call you Mila. OK. This is called the filth thrum and I’ll go through that. And this is called the a la Ram. But those aren’t terribly important for for what we’re talking about. So I did this ahead of time and I want to walk through this. It’s not a great drawing but it’s me just sketching on the I pad what these some of these structures look like. With regards to

00:09:14:12 – 00:09:49:06
to the anatomy rather than you talking there I’m going to show you here so it’s a great drawing. These are called Lower lateral cartilage is. And those are where your nostrils are and you can see where your skin would be so if you put your finger on the tip of your nose or that God is you’re going to feel the right and the left lower lateral cartilage. OK. So that’s. Yeah. Right. So that’s an important step. Here’s my feel a little more stiff. We’ll talk about that in a minute but we’ve got to right the left side. These little maneuvers that you see here commonly these are common maneuvers they aren’t always used but they commonly are.

00:09:49:07 – 00:10:23:08
This is called the phallic trim CFL it just means towards the head trimmings we’re removing it they’re just removing a little bit of that. These are some things where we can refine the tip. OK. We can we can help set the projection and rotation of the tip. We do that commonly by borrowing a piece of the nasal septum if you put your finger inside your nose and you feel that rubbery thing. That’s our nasal septum. And people have a deviated septum. A lot of times we’ll fix the functional part of that but we’ll borrow that and we’ll recycle that part by placing it between the right and the left lower that cartilage there.

00:10:23:19 – 00:10:57:19
And now this becomes a strut it becomes what we call a collar you mellow strut. I told you before that’s the location of it and we’ll take a little suture and we’ll sort of zip up we’ll stabilize that and that claim it was struck X just support the nose. It acts to help again deliver some of the appropriate projection or deep projection and rotation. OK. So these are very common maneuvers both of which we performed when we did your rhinoplasty. So you can see here where we can draw the tip together sometimes patients have a bulbous tip or a white tip Josh.

00:10:57:20 – 00:11:02:05
That wasn’t a complaint of yours at all but one of the important things about this is

00:11:04:00 – 00:11:34:18
I’ve got longer hair than you do. But let’s say a woman or me wearing a ponytail. If we pull our hair back OK something looks different about our face even though we haven’t changed our face. OK. And most women and men who have long hair might know that if they wear their hair back the same thing here. If we’re reducing a bump on the nose. Now all the sudden something might look different. OK. Did we even though we really haven’t changed it. So our job is to make sure not that we’re trying to do more we don’t want to do more.

00:11:35:05 – 00:12:10:22
We just want to fix things appropriately one time. And have you live happily ever after. OK. So make sense. Yes. So a few few basic things you’re about rhinoplasty as you would call we perform this under I.V. sedation. That means you come in we start an I.V. you’re breathing on your own you’re not intubated. There’s there’s an oral airway I’ll explain that in a minute. But you’re not intubated. There’s no there’s not a machine breathing for you. You’re not paralyzed. Sometimes you get a little bit light during the anesthesia. I just give them more. But it’s a nice safe way to do it where we don’t have post-operative a lot of nausea vomiting those things can lead to bleeding and other problems of course.

00:12:11:09 – 00:12:43:04
And so we find that a very safe way to do it for anybody who’s had a call and ask AP It’s the same type of medication that we use for that. Additionally we’ll localize the area will numb it up you won’t feel that. And from prior episodes you might recall that the light came numbs it but there’s also epinephrine in the solution and that reduces the blood flowing to the area. So we have virtually no blood loss during this procedure and that’s what we want. OK. So that’s the setup for what for what we’re doing here. So Josh I know you’ve never seen these photos because I just uncovered them.

00:12:43:06 – 00:13:13:20
We haven’t used them anywhere. I don’t know how you are. But I’m going to show you some of the surgical procedure with photos if you don’t want to look don’t look. But for those viewers who are out there who do want to look we’re going to walk through this. OK so this is pretty straightforward. Here you can see this little purple marking this is where we make what’s called the Trans call you Mila incision a little marking here anytime you see this or and this is a common way to approach it it’s called an open approach rhinoplasty. And the majority of rhinoplasty is performed these days are probably open approach.

00:13:15:02 – 00:13:42:03
We can talk about the differences between open and closed but this is commonly what we do. And so here I am marking Josh’s nose you can see that yellow thing in your mouth there Josh. That’s the oral airway. We do that because just like when you sleep your tongue may fall backward. And we want to make sure that you’re breathing that your tongue is not obstructing your airway. It’s a good thing. We’ve got that little oxygen cannula in there and you can see we’re marking your main area of concern which is that nasal dorsal area

00:13:43:23 – 00:13:57:11
as we move into the inside of the nose here. There’s a marking we don’t always market. I’m doing this just for for these purposes. Is this is called a marginal incision and it’s placed right along the lowest part of that cartilage that lower lateral cartilage. And we’ll plan to make an incision there.

00:13:59:05 – 00:14:10:12
So here we are making the incision and you can see we’re going to come right along. It’s basically where the hair inside the nose stops it’s right along that edge and that’s where we make our incision

00:14:12:08 – 00:14:45:21
then we’ll dissect we’re just going to elevate over this area. And while you’ve probably never seen that before. That’s. That’s what those lower lateral cartilage is look like. Okay so we’re retracting that scan and we’re looking in what we call an anatomic position. What that means is this is the way your nose is we’re not pulling it or bending it we’re just looking at what’s going on. Some of the things that you alluded to earlier this is a little nasal rasp so it’s just like a little nail file that may take down the top portion of the bump the top portion is bone.

00:14:46:06 – 00:14:53:16
The lower portion is actually sculpt It’s cartilage. So the rasp won’t work. So we actually sort of sculpt that ear. So the top part we’re using the rasp bomb

00:14:55:05 – 00:15:34:02
and then I’m just showing here that these lower lateral cartilage is generally we want to make sure that we leave 7 millimeters behind. That’s what people talk about and that’s the general we want to leave enough structure behind. However that’s the phallic trim though will be made that skin care isn’t meant to be a pointer. But that’s right at the area for the tissue that we would actually be removing we can perform removing some of that so that we can reduce that. This is a small piece of cartilage we took from your nasal septum that we fashioned and then we’re going to dissect and place between the right and the left lower lateral cartilage this graft it’s called the collar Miller’s struck remember that and then we’re going to suture it into place

00:15:36:01 – 00:15:37:09
we’re going to kind of check things out.

00:15:38:22 – 00:16:10:23
And at this stage what I want to say is this this this really differs a lot. I want just one to go back to something in the overall process. So you meet with me. Well here let me let me go through the whole process. You come in for a consultation you don’t know me. We talk about it you’re all excited you want to sign up. Guess what. We don’t usually allow you to sign up right then. What we do is there’s a little bit of homework and there’s a little bit more communication. You just showed me some things before we got started here with Snapchat or face or whatever faced or whatever you were showing me I don’t I don’t know but there were filters.

00:16:11:10 – 00:16:43:11
And so a lot of patients will come in with their filters and they’ll play with their nose and that’s a good tool. It’s a great tool to say this is kind of what I was interested in. OK. There’s an app called Face tune. Not that we promote Phase Two but rhinoplasty patients brought it to me. It’s a wonderful way to manipulate your own profile to move things around it really makes you think you’ve got to be very thoughtful about what you’re doing. What do I really want that is that too much and then so in our second meeting we’ll also do some computer imaging so we’ll we’ll go through that. And it’s a tool to communicate.

00:16:43:12 – 00:17:15:11
It’s not. Here’s your result. Right. OK. It’s a direction that we’re headed and that’s very important. But as we do this in another episode we had a guest who was worried about her friend having eyelid surgery. And what we talked about was encouraging those significant others to come in for the consultation or at any point so that they’re part of it. So they’re involved OK so that they understand what to expect. All right. So that’s important to kind of set things up set the right expectations.

00:17:15:15 – 00:17:47:23
The next thing is let’s say somebody you decide to schedule will schedule a preoperative consultation and with one of our nurses and we’ll further review medical history that sort of thing. But more importantly you’ll also review the same sorts of things with her. OK. And the significance is at this point in the operation once we’ve gone through the first hour and a half usually it takes between an hour and a half in two and a half hours. But once we’ve done 90 percent of the work we’ll go back. I hand everybody a q tip. OK. And they’ll start pointing out the flaws or where we need to do more. OK. And that’s the test gets involved now or scrub tech our nurse.

00:17:48:11 – 00:18:23:16
So we’re really trying to bring everybody together. And it’s not about their views about how your nose should look. It’s about how your nose how you desire your nose to look. So collectively we do a better job of not leaving the operating room until we’re all satisfied. OK. That’s a big big difference in terms of how we used to do things. If you look at your next photo here which we took at some point you can still see on your door some a little bit of a bump there. So we’re just kind of stabilizing you know the nose and we’re you know we’re just kind of taking photos so we’ll go back and we’ll then trim some additional cartilage that a white vertical cartilage there in the middle that you see is is your nasal septum.

00:18:24:09 – 00:18:27:13
OK this is another part that this is part of the most common question.

00:18:28:00 – 00:18:30:00
Doc do you need to break my nose.

00:18:31:11 – 00:18:50:03
Well I phrase it differently. I say we’re making a cut in the bone but yes this instrument that I have in my hand here is called an austere tone. And what we’re doing again if we take the bridge of your nose down I’m going to try to do this is maybe I’ll try to do the best I can. Our nose is roughly triangular in shape.

00:18:51:03 – 00:19:21:03
If you take the bump down we flatten the top. Now it’s more of a trapezoid. OK. If we left you like that then that’s what we call an open roof deformity. OK. So we make the little cuts in the bone so that we can bring the nasal bones back down to reconstitute a nice triangular shape. Does that make sense. So that’s that’s why we are making a cut in the bone and asked the Artemis breaking the nose. OK. It doesn’t add any more time in terms of recovery. We don’t use any packing.

00:19:21:04 – 00:19:26:15
It’s not always done. But I would say probably 75 percent of the time it is OK. OK

00:19:29:02 – 00:19:29:20
and then no.

00:19:30:00 – 00:19:46:08
And there’s. That’s what you were talking about right there. So that’s called a mallet and somebody. Yes. I see that. He was our nurse at the time she’s helping us out here and then and then we’ll meticulously go ahead and close close the incisions on the table. This is kind of what we’re seeing there’s already some swelling there. Do

00:19:46:08 – 00:19:48:22
Do you like it a salve on my eyes.

00:19:49:16 – 00:20:00:14
Yes we do. So. Good point. So and you’ll see in the next photo here. Yes we do we do that to protect your eyes during the procedure so they don’t dry out because you may not be blinking as much.

00:20:00:17 – 00:20:14:11
Got it. And we don’t want to cause problems. Yeah. So that’s what you’re saying. This is what we call Aqua plastic. It’s a little tiny piece of plastic that when we put in hot water it’s very malleable. And then we go ahead and we’ll tape your nose and we’ll put the Aqua plaster over it.

00:20:14:12 – 00:20:24:01
This little piece here to stabilize from the Ostia Artemis that we just performed and we’ll put some tape over that and we’ll put little tiny pieces. It’s

00:20:24:01 – 00:20:43:06
It’s called surge itself up. We just took a put a little bit something right under your nose there just in case there’s any bleeding overnight. We don’t want it to crossed at all. So we put some ointment it’s really just a hold that won’t meet in that area. But that’s not packing it’s a little tiny piece of gauze OK. So I don’t know if you’ve approached your prior rhinoplasty like that before.

00:20:43:16 – 00:20:50:12
I have this is my first. OK. So you seem to do pretty pretty fascinating. It’s good stuff. And yes I need some of these pictures.

00:20:51:18 – 00:21:15:02
We we have I think we have like two hundred and thirteen photos or something that was taken at the time I don’t know. I remember Whitney. She’s the one who took the photos and I I uncovered them. OK. So. So let’s take a look at this. This is how well actually before we go there. Tell me how it was if you can recall that night and throughout the week in terms of the recovery.

00:21:16:06 – 00:21:41:07
I. I remember it. I remember every part of my surgery that with the exception of me being put out. It was I just followed directions. So I remember you have to sleep elevated. That’s important. So you need the blood to flow correctly that minimizes your swelling. And I do not get your face wet. You can’t get the splint wet.

00:21:41:09 – 00:21:43:02
Right. And let me share with you why.

00:21:43:18 – 00:22:01:18
What we don’t want is we don’t want the water or any moisture sitting underneath that splint your skin may break down and we could end up with some problems. So we do like to keep that dry. If it does get wet let me just say we advise patients take a hairdryer on cool and just to cool it off but that is important.

00:22:01:20 – 00:22:31:01
So thank you for sharing that. Yeah yeah. So I just followed you know I was extremely careful with not getting my face wet and sleeping correctly and I had it was insane. I had like no underwrite bruising I had just minimal kind of like the onset of a bruise it was more yellow but nothing like I seen most pictures people went through. So I don’t know if I was just you know. So it’s property. I’m

00:22:31:01 – 00:22:52:07
I’m sorry. It’s pretty typical. I mean we try not to bruise. And the other thing is the packing that we talked about that used to be in your nose there’s still blood that’s that’s in your nose and still mucous that’s produced. So it forces that into the tissues as well. So we rarely see much bruising. It’s surgery so I have to be careful. But but it is pretty typical not to see a big degree of bruising with this.

00:22:52:12 – 00:23:15:18
Yes yeah. So I and I went to the hair salon because the first thing you know I’d like to take two showers a day and I like to wash my hair twice a day or if I don’t do that I don’t feel clean. So I was freaked out like white I can’t get my head wet. But I did go to a hair salon and they washed my hair carefully for me. So. You know every day pretty much.

00:23:16:19 – 00:23:23:09
Yes. Well that’s good. Well that’s good advice. That’s a regular at the time. So they didn’t even charge me to wash my hair guys.

00:23:23:15 – 00:23:44:07
Yeah. Yeah. So I think that I didn’t feel any of it. So that was amazing. It looks scary but I honestly did not feel any of that. None of it. Did you take any pain medication afterward. Oh yeah. Oh yeah. That’s the best. OK. Yes. You’re set yourself aren’t you. That’s still OK.

00:23:45:16 – 00:24:07:14
I think that that what you need to do is make sure you when you leave here you know you’re still out of it. Your driver you don’t know what’s really going on. And so your pain medication is still there but it will start to linger and go away. So you need to make sure that you have somebody with you that can remind you here take your Percocet or whatever to help.

00:24:08:07 – 00:24:22:12
And I had that. So I really did not have any pain just a little discomfort you know more of that annoyance having this thing on your face or for a few days where you were able to.

00:24:22:18 – 00:24:24:22
Did you get out at all did you. Besides the salon.

00:24:25:07 – 00:24:48:01
Oh yeah yeah yeah yeah. You can watch. I didn’t have any swelling or bruising so I I went and bought new sunglasses because you shared with me in the not too heavy. So at the beginning so I was able to go buy some nice new shades. That was my excuse. I got real expensive ones because they were you know lighter weight why not lighter weight. I don’t want the pressure on my nose.

00:24:49:10 – 00:25:20:06
All right. So you didn’t say you did pretty well that week. All right let’s let’s do this. I want to show you a little clip from when we took that splint off. So this is usually about five to seven days afterward. I want to make a few quick comments from Josh in terms of pain medication. We do give you the Vicodin or Percocet if you need it. Honestly most patients either take a half or Tylenol. It’s surgery. I don’t want to. So we’re not trying to create any pain. It does you know that when the local wears off there’s some discomfort but that’s probably how I would describe it.

00:25:20:06 – 00:25:37:14
That’s how Josh just described it. It’s not terribly painful. So if you if you did view these videos or if you’re still thinking Oh my God I could never do that it’s very painful. It’s amazing that it really isn’t. And I think most rhinoplasty patients are pleasantly surprised that that their experience is better than they anticipated.

00:25:37:21 – 00:25:45:03
I would do it again. I mean even though it does not hurt. I would say out of all the surgeries that’s probably even in the least. Right.

00:25:46:00 – 00:25:56:00
Well you know about for for you and for most but but it’s it’s a lot of anxiety so let’s look at this. This is you getting your splint off and I’m on just let when actually I think that

00:26:03:02 – 00:26:04:10
You can see it

00:26:05:19 – 00:26:12:05
Was Here. Here is this report is just one definition.

00:26:14:04 – 00:26:25:16
I’m going to pause it for Cyclops I don’t mean to do that. But what what. And I guess I’ll just stop. Maybe I’ll just narrate over it here instead is I just wanna go through the important things that that you would be seeing here.

00:26:25:20 – 00:27:06:09
So we take the tape off it takes about 10 or 15 minutes. It’s a fixed with M. to the sticky stuff that the tape is on with. We’ll take it off. So what you’re seeing Josh with your nose. I don’t know if you remember this but what I’m showing you is where the splint was so you can see a little depressed area. And we always point this out because you can see where the swelling is in the tip. Obviously you just had surgery right. This is six days later we’re taking the tape off. But within a few hours the swelling that that line goes away. And so for individuals who are at one of their primary reasons is to address the tip of the nose we want to point out that they have swelling OK because a few if you were concerned about your tip now you might feel that your tip is actually larger It’s wider.

00:27:06:10 – 00:27:17:12
Oh my gosh. All right what’s going on. So of course we go over all these things beforehand. You’re OK at this stage when you’re not ok sometimes as a couple of months down the road or you’ll come back to be real nice just say

00:27:19:02 – 00:27:38:06
I know there’s still swelling but is there really still swelling. OK so. So it’s really important to understand what you’re going through and what you could see it very well and you know in your photo there. So here’s here’s it while your eyes are closer but you’re admiring yourself. And we’re in the same ring too.

00:27:39:11 – 00:27:44:09
We’ve got some consistency going on with the same jury you like it. You like the same shirt

00:27:46:14 – 00:27:50:01
anyway. So what.

00:27:50:19 – 00:28:00:14
So I appreciate you being patient with us. I know it’s I know this is a little bit a little bit longer here. But do you have any advice for patients that might be seeking some changes in their nose.

00:28:01:05 – 00:28:32:23
Definitely check. You know your plastic surgery your plastic surgeon out make sure that they’re sort of board certified like you’re a board certified like one hundred and fifty times I believe. So you know and you’ve written books and so you when it goes to someone who has an amazing reputation and then I recommend getting you know speaking to people that have gone to that surgeon. So getting direct feedback from possibly be can their patients.

00:28:33:09 – 00:28:42:10
Have you spoken to people who are interested in their nose in it but who didn’t decide to do anything. And if so what were the reasons that they that they give you.

00:28:43:12 – 00:29:03:08
I would say 100 percent of the time it’s the the pain they’re afraid they’re just afraid and they think that I’m crazy that I think it doesn’t hurt because they see these pictures and they see what it looks like and how can that not hurt. But you know I just say you take a gamble take a chance. It’s worth it. Yeah.

00:29:04:07 – 00:29:18:09
Well I’ve known you for a long time. I’ve never known you not to have self-confidence but I. But I’m. But I’m curious. Looking back I don’t think I’ve ever asked you this. What is the rhinoplasty if anything done for you in terms of in terms of looking in the mirror and doing your thing.

00:29:18:17 – 00:29:31:16
Well I would say rhinoplasty. You can’t look at me before and after and say I don’t look any different. I mean definitely my side profile. I think I look more handsome I look more I just look better. I mean look at that.

00:29:31:23 – 00:29:37:01
What that I mean come on that’s insane. That is insane.

00:29:38:10 – 00:29:51:01
So I mean I look like two different people. So you’re right rhinoplasty it can change where you look. But I would say it changes you for the better if you go to someone who knows what they’re doing. It can. It makes you look better. Well

00:29:51:01 – 00:30:11:22
Well good. Well I’m glad. Yeah know you’ve done very well. I mean and and you and you look great and you didn’t have any any problems. I think I think for rhinoplasty there’s such a psychology and you mentioned you know when you were younger you looked in the mirror we see a lot of people who start and you know at a younger age and it’s difficult sometimes growing up especially these days especially if somebody is teased about about something.

00:30:12:03 – 00:30:42:09
Right. So it does have a very profound impact. And so it’s really important that things are communicated. Ok forget all the technical stuff about rhinoplasty. But it’s really important that that you as a patient understand what you desire and that you and that you communicate that very effectively. There are unfortunately patients who you know we do a lot of revision rhinoplasty as well.

00:30:42:23 – 00:30:43:14

00:30:45:11 – 00:31:23:14
I would say of all areas of the face this is the most complex one to to do well not every rhinoplasty turns out perfect in fact I’m going to say that another way no rhinoplasty is are ever perfect. There’s there’s always something. So we strive for perfection but we never achieve it. We let patients know that immediately everybody nods their head that’s fine. It’s just the reality of it. And it’s a tricky operation. So this is an area where there are some great rhinoplasty surgeons out there who are not facial plastic surgeons but I’m gonna give a little call too to our community of facial plastic surgeons.

00:31:24:05 – 00:31:57:18
One of the things that differentiates many rhinoplasty surgeons that our facial plastics is during their training during our training there are days that we may have performed multiple rhinoplasty is in a single day. OK. As primary surgeon some other types of general plastic surgeons may not have performed four or five rhinoplasty as general surgeon during their entire training. OK. So it’s kind of like going to a hand specialist. So this is and I’m not advocating for me. I’m letting patients know that it’s really important to make sure that you understand what that surgeon’s abilities are.

00:31:58:03 – 00:32:05:13
OK. So anyway with that being said we’re going to turn it over to Julie for what’s in and what’s out what’s hot and what’s not in plastic surgery.

00:32:05:16 – 00:32:10:19
Julie. Thank you Julie. Welcome back. Before

00:32:10:19 – 00:32:18:12
Before we go I’d like to send it over to Karen Whitney to say a few things about Studio A and what’s happening with some of the studio a rewards savings

00:32:20:21 – 00:32:38:08
that’s it for today. Thanks for tuning in for this and other podcast episodes. Please go to 3 5 1 face dot com forward slash follow your beauty. You can sign up and log in. Schedule your complimentary consultation we’re happy to see you for rhinoplasty or anything else.

00:32:39:01 – 00:32:53:19
Josh thank you again. Thank you for sharing your rhinoplasty with everybody now. Everybody knows what the inside your nose looks like. Thank you so much. So we hope to have you back again. We hope you tune in again for another episode of follow your beauty Live from Studio A.

00:32:54:10 – 00:32:56:14
The advanced cosmetic surgery and Laser Center