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Smile has changed....question for you....

Dr. Naderi answers your questions about all facial plastic surgery procedures, from facelift, rhinoplasty (nose job), to eyelid surgery (blepharoplasty), and dermal fillers.

Smile has changed....question for you....

Postby suzie01234 » Sat Jul 23, 2011 11:36 pm

Dr. Naderi,

I recently had a devastating, overly aggressive, revision rhinoplasty/sinus surgery which will require another revision. I have 3 questions for you....

My surgeon cut under my top lip to prevent my nose from pointing down when I smile. This totally changed my smile and how my lips come together (but he neglected to mention any potential changes to my smile could ever happen). My upper lip does not have the definition is once did and is much flatter. When I asked him afterwards if he cut the muscle under the lip, he said no, but that he "cut the footplate of the lower lateral cartilage and separated it from the scar tissue".

1. Can this be fixed in the revision surgery so that my old smile can be recovered and so that my upper lip will once again have the definition it used to?


3 weeks after the splint was removed, an extremely large indent (which almost reached the center point of my bridge) was glaringly obvious. A great deal of Restalyne was injected to fill in the indent, however, the bridge is missing a continuous "line" from the top of my bridge to my nostrils, leaving a crooked appearance (it's puffy where the filler is).

2. Will this ever fill in and heal completely or will cartilage need to be added during the revision surgery?
3. The skin was extremely thin where the filler was added (and it throbbed for 4 days). Will thicker skin generate over time or will I continue to have damaged thin skin where the filler was added?

thank you in advance for your honest feedback..........
suzie01234
 
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Re: Smile has changed....question for you....

Postby Dr_Naderi » Thu Jul 28, 2011 12:30 pm

Hi

Sorry to hear about your outcome.

In cosmetic surgery getting something "back to the way it was" is often not possible. While certain things may be adjustable, once certain changes are made, going back becomes a fruitless journey.

You said your surgery was "recent." Give things at least 6-12 months prior to deciding that you need another revision. The lip issues may even out. You have to realize that smiling is dynamic and when the nose droops down with smiling it means that the nose and the lips and the smile are connected and disconnecting this "connection" will change all of the components. Again give it time.

Your nose will change no doubt over the next few months to years and only then can you say for sure if you need cartilage grafts to fill in the bridge and create nicer brow-tip-aesthetic lines. I cannot comment on this without seeing you.

Skin can and will change during rhinoplasty but more so if the dissection was done in the wrong depth damaging the actual skin. I can tell you that usually when I have to do a minor touch up of one of my own previous rhinoplasties, I can get back into the nose very easily and entounter minimal scar tissue but some times when I do a revision of other surgeons' I encounter very heavy rock hard scar tissue and skin changes that take 30-40 minutes simply to enter the nose. This problem is encountered due to the previous surgeon lifting the skin in the wrong depth and damaging the muscle layer and subcutaneous layer of the nose skin rather than elevating the skin right on top of the cartilage and bone.

Give it time but you may require a fascia graft or Alloderm if the skin is very thin there.
www.VirginiaFacialPlasticSurgery.com

www.VirginiaRhinoplasty.com

www.RhinoplastySpecialistSurgeon.com


[Online replies to questions are NOT a substitute for actual consultation & exam & should not be considered "medical advice."]
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Re: Smile has changed....question for you....

Postby suzie01234 » Sun Jul 31, 2011 7:43 pm

Thanks very much Dr. Naderi. I also want to let you know that a thick piece of scar tissue was placed between my upper lip and the bottom of the tip of my nose to try to help the tip move upward. The piece of scar tissue (the surgeon said he double reinforced it--ugh) is very annoying and although it no longer hurts (it's been 2 months since the surgery), it has created a visible ridge above my lip (and has barely made a difference in helping my nose not point down when I smile). Will this ridge go away in time?

Most importantly---Can I get the piece of scar tissue removed during a revision surgery without causing a lot of damage to the area above my lip? I assume I get grafts to help my nose point upward when I smile.

thank you again in advance for your honesty.
suzie01234
 
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Joined: Sat Jul 23, 2011 10:57 pm



Re: Smile has changed....question for you....

Postby Dr_Naderi » Mon Aug 01, 2011 8:58 am

HI Suzie,

That scar tissue graft should melt down with time and if not steroid injections can help with that. Removing is an option after a year at least has passed.

As far as what would be needed to improve your nose, I would have to see you and examine you because it could be grafts, sutures or excision techniques or a combination.
www.VirginiaFacialPlasticSurgery.com

www.VirginiaRhinoplasty.com

www.RhinoplastySpecialistSurgeon.com


[Online replies to questions are NOT a substitute for actual consultation & exam & should not be considered "medical advice."]
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Posts: 3130
Joined: Thu Nov 23, 2006 11:48 pm
Location: Herndon Virginia & Chevy Chase Maryland



Re: Smile has changed....question for you....

Postby suzie01234 » Tue Aug 02, 2011 5:34 pm

thanks again very much Dr. Naderi
suzie01234
 
Posts: 4
Joined: Sat Jul 23, 2011 10:57 pm



Re: Smile has changed....question for you....

Postby Dr_Naderi » Tue Aug 23, 2011 5:55 pm

You're welcome.
www.VirginiaFacialPlasticSurgery.com

www.VirginiaRhinoplasty.com

www.RhinoplastySpecialistSurgeon.com


[Online replies to questions are NOT a substitute for actual consultation & exam & should not be considered "medical advice."]
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Dr_Naderi
 
Posts: 3130
Joined: Thu Nov 23, 2006 11:48 pm
Location: Herndon Virginia & Chevy Chase Maryland




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