Demetrio J. Aguila III, MD, FACS

Thank you for your question.

In answer to your first question, yes, a bulbous tip can be fixed, and it is one of the most common procedures done as part of a rhinoplasty.  It can be corrected through an "open" or a "closed" or endonasal approach equally well in the hands of an experienced rhinoplasty surgeon.

As for the photo you included, the morphed photo is not representative of a bulbous tip, so if the photo is the type of nose that you're interested in correcting, those specific concerns would need to be addressed also.

In the photo in question, the preoperative image demonstrates a dorsal hump and a ptotic tip.  Both of these can also be addressed in either an "open" or "closed/endonasal" approach.

You would be best-served by a face to-face consultation with an experienced rhinoplasty surgeon who can evaluate your needs and make recommendations on how best to address them.

Best wishes.

Thank you for your question.

The question of antibiotic ointments nor not is a much-debated one, and I'm certain your surgeon has a good explanation for why you weren't supposed to use an antibiotic ointment.

I typically recommend to my patients that they NOT use antibiotic ointment, and instead use something like Aquaphor or A&D ointment.  The reason for using any type of ointment is that it provides a moist environment in which epithelial cells (the skin cells) can migrate more easily and heal better.  The reason for avoiding the antibiotic is that in many patients, the antibiotic ointments can predispose them to various types of rashes or fungal skin infections, and the potential benefit in my patients is far outweighed by the downside.

Additionally, if your incision was closed with a surgical glue, such as DermaBond, then the use of any ointment would be ill-advised, since many ointments can break down the glue prematurely, leading to opening of the wound and poor wound healing.

I would suggest that you speak with your surgeon to find out the rationale behind the decision to avoid antibiotic ointments.

Best wishes.

Thank you for your question.

Smoking and breast augmentation generally don't mix.  While it is possible to get away with the increased risk, I wouldn't recommend it.  I liken it to Russian roulette, but adding a few more rounds to the revolver.  There's a possibility you'll have a good result, but the likelihood that you'll have problems is greater than if you're a non-smoker.  

I generally will not perform cosmetic breast surgery on a patient who has any nicotine in the bloodstream.  The risk of wound breakdown and capsular contracture defeats the purpose of having the augmentation in the first place.

Ultimately, you'll need to decide for yourself what is best - speak with your surgeon and proceed accordingly.

Best wishes.

Thank you for your question.

I'm sorry to hear that you've been having problems after your abdominoplasty.  While recurring seromas are rare, they do happen from time to time.  

At this point, you have a few options for management.  One option is to continue needle aspirations to see if it will resolve.  Ultimately, however, this is unlikely to prevent further seroma formation.  Typically, if your seroma returns after multiple attempts at drainage, a more aggressive option is warranted.

Another option would be placement of a drain, which could be a passive drain (such as a Penrose drain) or a suction drain (such as a Blake or Jackson-Pratt drain).  The advantage of the Penrose drain is that it's a simple, in-office procedure that doesn't require anything other than local anesthesia and some antiseptic.  A small incision is made into the seroma pocket, and the drain is placed.  The disadvantage is that while the drain allows the fluid do escape, it doesn't actively try to close the pocket - it relies on the body to try to get the pocket closed.

With the suction drain, the primary advantage is that it simultaneously evacuates the fluid and applies negative pressure to try to get the pocket to heal faster.  The primary disadvantage is that placing it can be more involved, and in some cases, requires sedation or image guidance, though not always.

Another option is to try a sclerosing agent, such as doxycycline, a common antibiotic.  This can be done at the same time as a needle aspiration.  During this procedure, the fluid can be drained through the needle, and afterwards, while the needle is still in place, the doxycycline can be injected into the pocket.  The sclerosing agent then scleroses (scars) the tissue shut, thus preventing recurrence of the seroma.  The effect isn't instantaneous, but typically will be effective within a few days.  This will sometimes need to be repeated.

Ultimately, your surgeon knows you best - I would suggest that you should express your concerns to your surgeon and make sure your questions get answered.  Additionally, you're always  entitled to a second opinion - if you're not satisfied with the answers you're getting, then get another perspective.

Best wishes.

Thank you for your question.

Nasal surgery to address nasal obstruction and difficulty breathing through the nose is a complex and multi-layered set of procedures that work together to correct various parts of your nasal airway in order to improve airflow.  In order to properly improve nasal airflow, it is necessary to first understand the anatomy and physiology of the nose, and then treat each portion of that anatomy and physiology that are functioning suboptimally.  In the right patient, a turbinate reduction can be a transformative procedure that helps patients breathe like never before.

Certain types of turbinate reductions have been more associated with empty nose syndrome than others, and other types of turbinate reduction have been associated with only temporary results.  The "Gold Standard" of turbinate reduction is the submucous resection of the inferior turbinates.  This prevents empty nose syndrome while also yielding long-lasting results.

I suggest that you ask your surgeon these questions specifically and find out how he plans to avoid this potential complication.  Of course, you're also entitled to a second opinion if you need more reassurance - you deserve to be happy with your surgical plan, as well as the team you've chosen to carry it out.

Best wishes.