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Demetrio J. Aguila III, MD, FACS

Board Certified Plastic Surgeon
529 Pinnacle Dr., Fl. 2, Papillion, Nebraska
5 | 6 Reviews
118 Questions Answered
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QUESTIONS ANSWERED

Can bulbous nose tips be fixed? (photos)

Asked By:AnonymousANSWERS (1)
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.
provider-Demetrio J. Aguila III, MD, FACS-photo

Demetrio J. Aguila III, MD, FACS

Board Certified Plastic Surgeon

5 | 6 reviews

Antibiotic Ointment or NO?

Asked By:AnonymousANSWERS (1)
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.
provider-Demetrio J. Aguila III, MD, FACS-photo

Demetrio J. Aguila III, MD, FACS

Board Certified Plastic Surgeon

5 | 6 reviews

If I can't stop smoking should I forget about having a breast augmentation?

Asked By:AnonymousANSWERS (1)
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.
provider-Demetrio J. Aguila III, MD, FACS-photo

Demetrio J. Aguila III, MD, FACS

Board Certified Plastic Surgeon

5 | 6 reviews

How can I treat my tummy tuck seroma?

Asked By:AnonymousANSWERS (1)
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.
provider-Demetrio J. Aguila III, MD, FACS-photo

Demetrio J. Aguila III, MD, FACS

Board Certified Plastic Surgeon

5 | 6 reviews

Rhino/Septoplasty without turbinate reduction?

Asked By:AnonymousANSWERS (1)
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.
provider-Demetrio J. Aguila III, MD, FACS-photo

Demetrio J. Aguila III, MD, FACS

Board Certified Plastic Surgeon

5 | 6 reviews

Can my nose be more even with plastic surgery? (Photo)

Asked By:AnonymousANSWERS (1)
Thank you for your question and for the photo.

It's difficult to tell from the single picture that you sent, however straightening of the nose often involves some surgery on the lower lateral and upper lateral cartilages as well as possible osteotomies of the nasal bones (cutting the nasal bones in order to reposition them).

In cases of subtle asymmetry, it can be very difficult to achieve complete straightening of the nose. This is due in large part to the tendency of the cartilage to want to stay in the position that it is in now. This is will be referred to as "memory." It is a significant challenge in many cases to eliminate all of the memory in the cartilage.

I suggest that you see and experienced rhinoplasty surgeon for a complete examination. Such an examination would help you delineate whether or not he would be a good candidate for surgery and what your surgical options might be.

Best wishes!
provider-Demetrio J. Aguila III, MD, FACS-photo

Demetrio J. Aguila III, MD, FACS

Board Certified Plastic Surgeon

5 | 6 reviews

Breastfeeding but would like tummy tuck

Asked By:AnonymousANSWERS (1)
Thank you for your question.

Your question is a common one - whether or not it is okay to undergo an abdominoplasty / tummy tuck while still breastfeeding.  The information that you found online suggesting that you should wait at least 6 months after completion of breastfeeding is generally good advice.  This is due to the fact that while breastfeeding, there are still hormonal changes going on that will affect your body composition in terms of the ratio of subcutaneous fat to other tissues in the body.  This will affect your weight as well as your body fat percentage.  I suggest that you discuss your concerns with your OB/GYN and/or your primary physician, as well as the surgeon that you've chosen for your abdominoplasty.  I think you'll find that they're in agreement that body contouring surgery should be considered only after you have reached your goal weight and after any other physiologic changes have stabilized.

Best wishes!
provider-Demetrio J. Aguila III, MD, FACS-photo

Demetrio J. Aguila III, MD, FACS

Board Certified Plastic Surgeon

5 | 6 reviews

Vertical Incision - Fluid Pocket - Packing wounds daily (Photo)

Asked By:AnonymousANSWERS (1)
Thank you for your question, and for the photos.

I'm sorry to hear that you've been having problems with your wound.  It sounds as though your surgeon has been managing your wound attentively and aggressively.  The wound management you describe is tried and true, and will likely heal you up.

The type of incision that your abdomen required is a difficult one to manage.  The junction of the two incisions in an "upside-down T" as we sometimes call it, is an area where the blood supply is most tenuous, and where the risk of wound breakdown is the highest.  Aggressive wound management is the key.

One option to ask your surgeon about is a "Wound VAC" to help heal the wound faster.  Many surgeons are reluctant to consider this in cosmetic cases because it can significantly increase the cost to the patient if the wound care is not covered by their insurance company (as is usually the case).  Another option to consider would be to ask your surgeon about referral to a dedicated wound care center.  I work closely with one that is outstanding at helping me with stubborn wounds, and the team approach that comes from wound centers partnering with surgeons can often yield better results than one person alone.

The good news is that at some point down the road, once everything is healed, you may be a candidate for scar revision to help with the scars that might result from your wound healing.

I suggest that you have an in-depth conversation with your surgeon about these concerns the next time you see him - that's the best way to find out what your options are and how best to pursue them.  Of course, if you're still concerned, you would be well-served by a second opinion.  You are entitled to be comfortable with your surgical plan and the team you've chosen to carry it out.

Best wishes!
provider-Demetrio J. Aguila III, MD, FACS-photo

Demetrio J. Aguila III, MD, FACS

Board Certified Plastic Surgeon

5 | 6 reviews

Is it OK to mow the grass after breast augmentation? (photos)

Asked By:AnonymousANSWERS (1)
Thank you for your questions, and for the photos.

First of all, congratulations on your surgery - you've made a big decision, and as your rightly mention, a significant investment.  You're right to do everything you can to protect that investment.

Having said that, the bouncing that you describe should not be a problem for your implants.  I commonly tel my patients that by 6 weeks after surgery, they can return to all their previous activities.  Of course, you're best served by consulting with your surgeon - that person will know how best to address your question in light of the particulars of your specific surgery.

Best wishes!
provider-Demetrio J. Aguila III, MD, FACS-photo

Demetrio J. Aguila III, MD, FACS

Board Certified Plastic Surgeon

5 | 6 reviews

I had cartilage taken from my ear for reconstructive rhinoplasty. Do I have an abscess? (Photo)

Asked By:AnonymousANSWERS (1)
Thank you for your question and your photos.

Cartilage from the ear is often used for nasal reconstruction, and there are a number of ways in which it can be harvested.  It appears that you had an anterior / lateral approach to the cartilage, which uses an incision on the outside of the ear to access the cartilage.  This is a common and reliable approach that yields good results in the long run.

From your photos and description, it's difficult to say whether or not you have an abscess.  An abscess is a collection of pus, but without an examination, it's difficult to differentiate that from cellulitis, which is inflammation in the tissue, in the absence of pus.  The severity of the discomfort and the size of the area affected are not reliable ways to differentiate the two.  Your best bet would be to see your surgeon again to ensure you don't have an abscess - don't be shy about asking directly whether or not you have an abscess.  If you're still concerned, I suggest that you pursue a second opinion.  You are entitled to be comfortable with your surgical plan and the team that you've chosen to carry it out.

Best wishes!
provider-Demetrio J. Aguila III, MD, FACS-photo

Demetrio J. Aguila III, MD, FACS

Board Certified Plastic Surgeon

5 | 6 reviews

Demetrio J. Aguila III, MD, FACS reviews

Demetrio J. Aguila III, MD, FACS

RATING DETAILS

5.0
6 reviews

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Demetrio J. Aguila III, MD, FACS
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6 Results
Tummy Tuck Revision

stubbysmom

Saved my life...

Dr. Aguila saved my life. He figured out something 16 other doctors could not figure out. I was suffering horrible pain for a few years after abdominalplasty (from a different doctor ), and I finally learned from Dr Aguila that I have nerve entrapment. I'm not sure why 16 doctors failed to consider nerve damage, but Dr. Aguila has a specialty in peripheral nerve surgery as well as cosmetic surgery. This man is an angel on this Earth. I do not know where I would be without him.

$8,5008 months post-opTummy Tuck

brandibartels

Frowning Belly Button - Norfolk, NE

I had tried multiple ab workouts and diets to try to change the appearance of my stomach after having children. I had a layer of fat and stretched out skin over my abs. My belly button looked like it was frowning all the time. I like to stay in good physical shape but my ab area was something I could never improve no matter what I did. After the initial surgery things looked a lot better. My belly button looked normal but my stomach was a little off balance. My surgeon did a follow up procedure to balance out the appearance with no additional cost! I am pretty satisfied with the results. My stomach is not completely flat. There is some fat in my mid to lower ab area but I am very satisfied with the surgery. To remove all of the fat, I would probably have to have a vertical scar. My belly button was high so we decided to just move it down and not redo the belly button so that I would not have a vertical scar. I am very satisfied with the results and now feel that I can wear cloths that would not have looked good before.

12 days post-opRhinoplasty

ljones60

I Wanted to Walk & Breathe - Norfolk, NE

For decades, I was not able to breathe through my nose and walk, do yard work, housework, or sleep. It worsened [of course] as years went by. I finally decided that it was time to look into identifying & correcting the problem. Dr. Agula recognized the issue quickly after getting test results he presented me with the option of a surgical procedure which would open my nasal passages with cartilage from my rib area. I agreed. There was very little post surgical pain. The rib area did hurt with certain movements. It was never painful enough for me to use anything stronger than Tylenol. By day 3 post surgery, my nose breathing was much easier & continues to improve. At the same time I opted to undergo an eyelid and brow lift (of sorts). This was in an effort to improve my peripheral vision, which was obstructed by my large saggy eyelids. This too was very painless! Within 9 days the difference was undeniable. Not only could I see better, I felt I looked better, more refreshed.

2 months post-opBreast Reduction

huskerfan19

Young Adult - Norfolk, NE

I wanted this procedure done because I was confused on what was going on with me, but knew something wasn't right. I took lifting pills that had the side effect of this extra muscle tissue forming and it was very uncomfortable. Dr. Aguila fixed the problem and there's been nothing but good things that came from this procedure. There is no scarring and healed quick.

Rhinoplasty

mbgates

Couldn't Breathe for Years! - Las Vegas, NV

I have not been able to breathe through my nose for as long as I can remember but was very worried about having a surgical procedure. Dr. Aguila was highly recommended by other physicians so I had a consultation with him and was immediately put at ease. Not only can I breathe again, but I love the appearance of my new nose!

15 months post-opBreast Augmentation

AnnemarieS

Finally Proportionate and Proud! Las Vegas, NV

I have had two different sized breasts for as long as I can remember. I have an athletic body type, and having an A and a small B made it very thought to wear bathing suits, dresses, and low-cut shirts. I was really shy about saying anything to my regular doctor, but when I did, he referred to me to Dr. Aguila. Five minutes into the first visit, I didn't feel embarrassed anymore. Dr. Aguila's professionalism and 'human' manner makes it really easy to talk about anything. I was able to describe what I was looking for, and he understood perfectly. His staff was great about always staying in contact and answering questions, so I was not nervous at all for the surgery. The procedure went really well and I healed quickly. Dr. Aguila called personally the day after surgery to check on me, and also the day after. I was 100% healed within a few months and now I LOVE the way I look! My breasts look really natural and now I can wear normal sizes. The only regret I have is not doing this sooner. For future maintenance, I will ONLY go back to Dr. Aguila.

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