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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.

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  • 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: rhinoplasty

Dear Dr. Bermant,

I am considering getting rhinoplasty to remove a hump on the bridge of my nose. I am concerned about post-operative pain. I have difficulty 'stomaching' several medications (I have irritable bowel syndrome). Can you give me any information on possible pain medications that might be used? Thank you.

Dr. Bermant answers

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

Most rhinoplasties are not very painful. Although I may give a pain medication prescription for comfort after surgery, most of my patients tell me they do not need the medication or only take one or two pills for the discomfort. Some take plain Tylenol, Advil, or over the counter strength Motrin.

There are many types of rhinoplasties however. Pressure pain or sinus pain is another issue. Nasal packing or sinus obstruction from swelling or turbinate resection can be very uncomfortable. Antidecongestants, cool compresses, and elevation can be helpful in such conditions.

You will have to check with your doctor for the appropriate treatment. If you want to find how we can help you, please call.

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.

Michael Bermant, MD


Question: Re: rhinoplasty

Dear Dr. Bermant,

I am considering getting rhinoplasty in May. I am fairly certain that my plastic surgeon utilizes nasal packing. I am allergic to pollen and experience ''hayfever" around the end of May. My concern is that my frequent sneezing is a threat to the nasal packing and the healing process in its entirety. Is this problem serious enough to consider postponing the surgery? I would appreciate your advice on this matter. Thank"you!!

Dr. Bermant answers

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

Not having the advantage of examining you, your doctor has a much better ability to give you such advice. The good news about packing is that the region packed is no longer exposed to environmental allergens. However, packing in itself tends to irritate the nasal lining. If you are going to sneeze, you will sneeze. Packing sometimes is necessary to maintain internal pressure, control bleeding, etc. There is sometime no choice. I spend extra time with sutures that permit me to not use nasal packing in mose cases. If I have to use packing, I use material that is less uncomfortable but unfortunately more expensive. It has been a long time since one of my patients needed nasal packing.

Medications can minimize some of the irritation but sometimes operating during the peak allergy season for some patients can be a problem.

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. We go out of our way to accommodate our out of town patients if you chose to have us evaluate your problem.

Michael Bermant, MD


Question: Re: Nose changing shape

Hi!

Recently, I noticed that my nose changed its shape a little the forward part of it is a little slanted downwards. Why did that happen?And is there any way to get it back? Oh... there seems to be a crease where it happened appearing when I blow my nose.

Thanks in advance

Dr. Bermant responds

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

There are many reasons for the nasal shape to change. Growth and trauma are the two most common. The nose projects from the face. There are significant forces needed to keep the tent on skin out as far as it needs to be. The tip is mostly supported by cartilage. This material can bend under stress and trauma.

Sometimes the nasal shape can be changed with surgery. I cannot comment without 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: I have a question about Asian rhinoplasty.

I'm Asian and I basically have a nose that has no bridge, a flattened tip, and wide nostrils. I'm planning to get my nostrils shaped and the tip done. Can you tell me exactly what you do for wide nostrils? Do the results come out unnatural? Plus what types of materials do they insert for tips and bridges?

Thank you very much.

Dr. Bermant answers:

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

Consultation by computer mail/bulletin board is not safe nor appropriate. There is too much information missing. My typical evaluation takes 30-60 minutes face to face. Depending on the problem, the evaluation may take much more time. You really need an examination before any advice on what would be best in your situation.

The nostrils are the entrance for air into the nose. There is a "natural" proportion of alar width to nasal boney width. What constitutes "wide" nostrils varies from person to person and culture to culture. The Oriental nose has a naturally wide lower nose. Some prefer a less "Oriental nose or find their nose too wide for what they consider a desired proportion. So a "natural" outcome is a relative statement.

Ethnic Rhinoplasty the Asian Nose

Wide nostrils can frequently be reduced by removing a wedge of tissue along the floor of each nostril near the alar margin. The ala are then advanced towards the columella (the vertical strut that holds up the nasal tip). This advancement makes the nostrils smaller.

Other types of large nostrils need to be managed by removing a section of the vertical section of ala near the junction of nose and cheek. This addresses a height problem more than the first method which is for width.

Other types of wide nostrils need a wide columella narrowed. The nostrils themselves may be normal. Here the tissue is removed from the central column and the nostril moved or rotated into position.

Scars usually are not noticeable this however depends on the type of surgery and how the patient heals. I try to minimize notching which can create a very unnatural appearance.

I use various materials to augment nasal structures. The type of material depends on what needs to be done. Bone and cartilage are the most common and have the best results. Man made materials can also be used but have their own complications.

Realistic expectations are essential to a happy outcome. I try to help my patients understand what can and cannot be done. There is a limit on how much the nose can easily be changed. Go beyond those limits and complications are much more common.

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: need some advice

hi i live in memphis tennessee and recently had a rhinoplasty------however where my nose meets my forehead is still very thick --i just want a smaller nose and thats not what i really got------i was wondering can this type of thing be done-and if so how long should i wait before i go back to surgery--considering i had mine about two weeks ago--anyway i hope you have some advice because my doctor is a dunce giving me the runaround

Dr. Bermant answers:

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

Noses are frequently swollen after surgery. You will need to sit down with your surgeon to understand what was done and what may or may not happen. Communication between doctor and patient is the key to realistic expectations. In my practice, we spend a good deal of time with patient education.

Secondary rhinoplasty becomes possible after the tissue has had a chance to heal and soften. I usually like to wait at least 6 months.

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: What about African-Americans

In a message you wrote:
Hello! Do you have any results for Blacks that may have had plastic surgery. I myself have a very wide nose and I want to make it a little smaller. How do you fix noses that are wide. How did Janet Jackson get her nose fixed....and What about Michael Jackson. I don't want to look like Michael Jackson for heaven sakes......but I would like to know how did they take such a wide nose.....and make it so small. Can you send me information on how you would do this procedure!

Thank you

Dr. Bermant answers

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

Yes I have operated on blacks asking for cosmetic surgery. However, to publish a result on the web or show other patients, I need the patient's permission.

Depending on the person's nasal shape, the nostrils can be made less wide. A wedge of skin is removed from the nostril sill. This can sometimes result in an obvious scar if that patient has a bad tendency towards scarring. In most cases this is not a major problem. For patients who form bad scars, I do not recommend such surgery. The bridge of the nose width can also be reduced by breaking the bones and moving them together.

You need an analysis by a competent surgeon to see what is practical for your specific problem. You should establish a satisfactory education and relationship with the doctor who will be operating on you. Part of our success with our practice is the commitment to our patient's education.

I have an extensive introduction to this surgery on my website. Start here

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: septo/rhinoplasty

In a message you wrote:
I had a septo/rhinoplasty one month ago. At first, I was pleased with the shape of my nose but now the hump on my bridge appears to be coming back. This was gone after surgery. I wear glasses and my doctor would not let me wear them for the first three weeks. I have tried wearing my glasses a few hours a day for the last week and it causes much discomfort. Is this normal? And could the glasses have caused the hump to reappear again? Thank you.

Dr. Bermant answers

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

Nasal shape frequently evolves after a rhinoplasty. It depends on what type of surgery the patient has for the changes. I usually like to see my patients 6 months, 1 year and 2 years after surgery to see the evolution myself.

I usually tell my patients, if the nose is still sore, it is not yet ready for glasses.

Check with your doctor about these questions. Having done your surgery and examined you, your doctor is in a better position to provide such 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


Question: Re: injured nasal mucosa

Dr. Bermant:

I have been writing several of the ENT doctors on-line and I am sorry if I have already approach you with this question, but, if I haven't, I have a real problem that no one can seem to help me with.

16 months ago I had septoplasty performed for headaches under my right eye. The surgery when great. I no longer have the headaches. BUT! The day the packing came out, my ENT started to anesthetizing me with a 3:1 solution of Pontocaine and Ephedrine. He ran out of the solution and went and had some made. He came back and began to spray my right nose again. I complained of a terrible taste and burning sensation. I was dismissed and he sprayed my left nose. After about 5 minutes, he laid me back in the chair where my body began to shake, my face turned red and tears began to flow. He left the room and ten minutes later, returned with a cup and had me flush my throat with water.

At that point he began to tell me what happened. Instead of the original 3:1 mixture, indicated above, he grab a bottle of trichloroacetic acid, instead of the pontocaine. My mucous membranes are shot. The tissue that one produced moisture is dry and feels like the palm of my hand. I can not blow my nose, because the mucous is so thick. I have been irrigating my nose daily to keep the crusting down.

My question is in the form of needing help. I am looking for articles, or information on whether or not my mucous membranes will ever return to normal again. Or is there some type of surgery that could be performed in the future to regenerate my moisture building tissue? My ENT told me that it could be 3 years before anything could be determined, if ever. He did not know of any case were acid was sprayed on the membranes. However, he did indicated to me that there is a doctor in Japan who is using the TCA for septoplasty surgery, but, only on the turbinates, not the membranes. I have e-mailed a doctor in Japan searching for the name of the doctor using this concept, in hopes of getting a copy of his study.

Any information you can give me or direct me to would be a great help.

Thank You!

Dr. Bermant answers

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

It sounds like you have some significant problems. The mucous membranes in the nose humidify the air as it comes through the nose. The turbinates increase the surface area of the mucous membranes so that the humidity can be increased. Humidity and comfort therefore is related to how much mucous membrane is available for this process.

Burned mucosa can look and act like normal skin and loose most or all of its humidification capability. Turbinates can enlarge in some patients, but what is the condition of yours? Only an examination by a competent surgeon can answer that question. Your doctor has the best information having examined you. Perhaps regeneration is still a possibility. Patients who have enlarged turbinates complain of obstruction of nose or sinus. We sometimes reduce the turbinates to lessen this problem. Overzealous reduction can produce similar problem to what you seem to be complaining about.

Complaints of inadequate humidification include crusting, dryness, thick mucous and discomfort. Increasing your environments humidity is one method of decreasing the problem slightly. Frequent washes with an artificial mucous like liquid (yes up your nose) also gives some relief. None of these methods restore mucous membranes.

I am not aware of any surgery to transfer working mucosa from another part of the body to the nose to correct such a problem. The problem is fairly unique and would be experimental surgery at best.

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: Rhino-Tip Plasty question?
Dear Dr. Bermant,

First off great Web site!! There are some really fine Plastic Surgery WEB sites out there and yours is one of the best for sure....very well put together!!!!

My question is this, I am a 31 year old male who since the age of 12 or so has always wanted a thinner nasal tip. The bridge of my nose is fine aesthetically to me. The tip is somewhat bulbous and I have explored cosmetic surgery and educated myself to the point of finally being ready to move forward with having the surgery very soon. I have a good understanding of the procedure and understand that it is less costly and easier for the surgeon to some degree than other procedures where the nasal bones are involved? The nasal tip is simply Cartilage/Soft tissue...correct?

I also have had a breathing problem that seems to have worsened within the last year or 2 and I have become totally reliant on nasal spray to re-open my nasal airways. I believe it is swelling of the Turbinates from the info I've gathered but I'm not a doctor and not sure.

FYI - In your image (rhino2a_post1.jpeg) that seems similar to what I'd like to have done to my nasal tip. A more defined, straighter nasal tip and some reduction of the round/ball-like tip.

I'd like to get some idea of cost. I am just starting my own business (actually on the WEB) and do not have any Medical insurance right now. I will have coverage in the near future, but right now I unfortunately do not. I will be paying this "out of pocket" and would also be interested in any type of multi-payment structure you may have?

I live in Columbia, MD just north of Washington DC and Northern Virginia and would very much consider visiting your office and possibly having you do the procedure. Would it be worthwhile for me to E-mail you an JPG-image of my Face/Nose to give you some idea of my current nose? I have one of those Digital Cameras on order and will take some pictures soon. Off the subject...if you haven't checked out the Digital Camera scene yet, it is some neat technology and the images are super quality.

Thanks for reading and I look forward to your reply.

Dr. Bermant answers

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

Thank you for your compliments about my website. I have a 3 chip digital movie camera.

Tip rhinoplasty is one possible operation but it depends on what the patient needs and wants. Breathing difficulties can be mechanical or environmental. You need an evaluation to best help understand those needs. No a photograph over the web is not enough to determine much. My typical rhinoplasty takes almost 2 hours. We also sometimes examine inside the nose with a scope (endoscopy) when nasal obstruction is a factor. Computer imaging can sometimes enhance the teaching experience when the limitations of what can really be achieved in surgery are understood.

Tip work is usually cosmetic. Nasal obstruction is frequently functional and many insurance companies cover this problem. Prices depend on the extent of the operation. Here is an introduction to our prices.

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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