Brandon E. Kallman, MD

Hello, it doesn't affect anything. Both shots are unrelated.

Botox immunity is rare ( unless you are getting constant large doses of it ).

This is the sub pectoral implant problem. So the fact that you got 285 mL implants placed underneath your muscle, will indicate that every time you flex, either your implants will be jumping up because of the position of the muscle, or down. You should be able to, once you’re healed completely go ahead and lift weights unless you’re a competitive weightlifter. I don’t see a problem with weightlifting. Normally to build muscle and to weight lift, you’re not going to lift extreme weights. Extreme weights could possibly rupture the implants, or should not have been a choice if you are truly a competitive weight lifter! If you are a competitive weightlifter, they also could’ve been placed above the muscle. I hope that helps out.

Your body forms a capsule. This is a living breathing scar tissue, which walls off the implant from the body. If the implant breaks, normally within the capsule, there will be no extravasation( leakage) of silicone out of the capsule..If the implant breaks, and the capsule breaks, that can release some of the silicone into the surrounding tissues. This would only be a local problem, and silicone has not been shown to have any problems in the long term. If you are worried about your silicone implants being intact, an MRI with breast coils is a great way to find out with great sensitivity and accuracy, if your implants are ruptured. You may still have a ruptured implant and capsule, and extravasation which yes, would lead to little small siliconomas, little balls of silicone encapsulated as the original implant was, encapsulated.

There are many reasons why your nose appears large, the most important structure is being skin, with fat underneath your skin, cartilaginous structures, and bony structures. All these will contribute to your “large nose“ and make you unhappy. Dealing with large noses, is probably 50% of any real rhinoplasties surgeons practice. We have many techniques to make the no smaller, and you must be very certain that you don’t neglect the thickness of the skin. That can be addressed by removing some of the fat that is around your tip and the part just above your tip. That can be done with an open rhinoplasty, which will address all three of the most important things which give you knows it’s appearance. You should go to an experienced nasal surgeon who understands that skin is just as important, as Cartilage and bone.

Those “bumps” are the edges of your nasal bones. They are prominent at this point, but would be very difficult to assess without a “hands-on“ examination. If your nose is too wide, those are where breaking the bones would slide those bones out of the way, and give you a much better nasal curve. This is a desirable “C” curve. These are artist lines that are drawn on your face, to evaluate the beauty of your face. It would be helpful in certain cases to have your bones broken and moved more towards the center line. The only problem would be if your nose is already small, this may compromise your breathing. That would be something that no one would want to do.

After three years it’s impossible to know what your nose looked like first. A lot of things can change over three years, including bone growing, Cartilage growing, and the natural aging process. At this point, you will need a complete evaluation of your nose, including functionality. I would be interested to see what things are crooked. In my honest opinion after 27 years and practice, I understand that crooked nose is one of the most difficult things to fix In nasal surgery. I am certain that there are multiple techniques which would help resolve your breathing problems, as well as most if not all, of your crooked nose. It just depends on whether your problems are cartilaginous or boney! I would certainly seek a board-certified plastic surgeon who specializes in rhinoplasty.

I was very happy to hear that you are using Accutane. This is a very important drug in shrinking the thickness of your skin, which will truly determine One of the most important parts of your outcome from your rhinoplasty. Once you complete your Accutane, and undergo your laser, and let things settle down,Then you can be evaluated as to what would be necessary for your nose. Your skin is an integral part of your nasal anatomy, and should never be overlooked.

There are some serious considerations in your nose. The most important is functional. Your nose is a functional piece of your face. It is not just an ornamental nose. In terms of your over projected nose, which really tells me that you’ve been on the Internet( with your jargon) doing really good research, yes your nose is overprojected. Remember that the nose does not exist by itself, but in relationship to all the other pieces of your face. I do believe your nose is over projected, and there are many ways, and also many reasons for your over-projection. This over projection can be taken care of during your procedure. This type of surgery requires surgeons to be quick on their feet. When you open the nose, as I do approximately 95% of the time, The causes for your over-projection will be immediately determined. At that point a quick thinking surgeon can decide what might be the best option to ameliorate the over projection, and give you an extremely harmonious nose for your face.

Since the bone is the most important foundation of your face, I would not suggest to have any type of surgery until your bones are set, and your face can be evaluated in relationship to your nose. Moving of crossbite and that type of bony surgery should not be included in any type of rhinoplasty until your face settles, because the nose it’s supposed to be sculpted to fit into your face as a whole. It does not exist by itself. I would welcome for you to wait at least six months before you consider rhinoplasty.

There are many reasons for a large and wide columella. It can be attributed to the cartilages that lie within the columella. Sometimes they’re just too far apart and need to be narrowed . Sometimes it’s the skin, but most of the time this can be controlled with sutures. An open rhinoplasty would be able to assess the columella and “medial crura” which is the medical term for your columella cartilages. An experienced board-certified plastic surgeon, who specializes in rhinoplasty would be able to narrow your columella and give your nose a much sleeker appearance. I would definitely choose an open approach to your nose versus a closed.