Carlos L. Wolf, MD

Too early for surgery right now.Your nose looks very swollen and it might be too early to tell what he did. I would expect you to have some changes, however you should wait another 2-3 months before deciding that this would not work. If you nose however does not change you will certainly need a revision surgery to make the tip much smaller and the nostrils less wide. 

Based on your pictures I can understand why you are unhappy. People heal differently and scarring can occur. The biggest shoe you have to determine in order to decide whether you are going to have her operate on you is do you still have confidence. Once a patient loses confidence in their physician the likelihood of a good outcome is near zero. I would get other opinions in your area and if you feel or they feel that they can improve your results I would then talk to your doctor again. If after talking with her you find her to be evasive and not willing to help I would not consider the surgery again.

You have obvious asymmetry in your face. When you have fillers it makes it more evident. Botox is not indicated for your problem. I think you need to have either a more experienced injector or more filler in the asymmetry that you have.

Your asymmetric nostrils may be due to swelling or poor planning by your surgeon. It may be due to the fact that you already had some asymmetry before your surgery and it’s now more obvious. Before you inject silicone ( Not FDA approved) into your nose, I recommend you see a facial plastic or plastic surgeon for a second opinion.

 It is not advisable  to undergo a revision so quickly. I would say you should wait at least 6 to 9 months. Although I do not believe your problem will go away with time if you are going to have a revision you should make sure that it addresses all your concerns. Your tip is swollen and is rounder than it might be once the swelling goes down. Your bones however are definitely deflected. It appears that you had a complete osteotomy (nasal bone fracture) on the right side but not on the left. Because of this your nose looks deflect. I suspect that when all the swelling is gone you may need to have a repeat complete osteotomy, reduction of the nasal bone on top. In addition you may need to do tip work if you do not like it. Because of all the above reasons you should wait at least 6 to 9 months to contemplate a revision rhinoplasty.

 Botox is a great product to use for wrinkles around the eyes. It is used to give brow elevation and to get rid of wrinkles between the eyes. Botox has very limited used for under the eyes. If you have bags and  use  Botox,you may increase  the size of the bags because the muscle relaxes and the fat pushes out. Botox is primarily used for the four head in the area where the crows feet are.

 Not every doctor uses steroids during and after rhinoplasty. You should pick your doctor based on his or her results not on how they  do the procedure.I rarely ever put patients on steroids.I do not use packing. Most of my patients can breathe out of your nose immediately and improve weekly there after. Your primary concern should be finding  a board-certified facial plastic surgeon or  plastic surgeon who can give you your desired results.

I understand what you don’t want, but if you want to ask a question you should listen to the answers. For you, wrinkles around the eyes are best treated with Botox. Dysport can also be used for that problem.  Your pictures are not clear but if you have bags under your eyes with a depression ,you may need to use a filler such as a Hyaluronic acid such as  Restylane,Voluma or Juvederm.If however this would not help, you may require surgery. This can be done without outside incisions with a trans conjunctival blepharoplasty. Obviously you have to make a choice but if you don’t like your aging look these are great options with minimal to no downside when done with a board certified facial plastic surgeon, plastic surgeon or dermatologist.

Botox is a neurotoxin  that weakens  or paralyzes muscles. Over the last 20 years I have been using Botox to even out peoples faces with synkinesis secondary to bells palsy. While in may not completely correct the asymmetry it certainly helps. It last for approximately three months. When initially injecting botox it may take one or two sessions to get the symmetry completely corrected,if possible.

That’s a very good question. You should lose weight before your surgery as if you lose weight after you may compromise the results. When you lose weight you lose Facial fat and your skin may become more lax. It is imperative that you try to do the weight-loss prior to surgery. If however you are going to lose weight I would do it over a long period of time and not more than 5 to 10 pounds.