Mark K. Markarian, MD, MSPH, FACS

Hello and thank you for your question. Although an exam in person is ideal, from your story alone it appears that you have internal nasal valve collapse which may be due to either a deviated septum or collapse of your "side cartilages". In such an instance you can likely benefit from a septoplasty where the deviated septum is revised, excised, and re-set as necessary. Moreover, any further breathing difficulty can also be improved with spreader grafting -- most PPO health insurance plans can cover all this at minimal cost to you☝️ If you have any cosmetic concerns, the cost of a revision rhinoplasty may also be reduced if your PPO health plan will cover your nasal breathing difficulty. The next step for you is to pursue the right plastic surgeon for your septoplasty, with or without a rhinoplasty. In your consultation, be sure your surgeon addresses all your functional (and aesthetic) goals and concerns specifically, IN PERSON, and discusses the surgery details including the position and size of the incisions used (with actual photographs and not just digital animations), the risks and benefits of the procedure, recovery time, and post-operative course. I also think a key component of your consultation is to establish a good connection with your plastic surgeon. This is difficulty to do without seeing your surgeon in the office, in person. It’s the connection that allows you to clearly define your desired nose outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you. For more information on septoplasty, please refer to my link below. Good luck. Mark K Markarian, MD, MSPH, FACS Harvard-trained Board Certified Aesthetic Plastic Surgeon

Hello and thank you for your question. First off, it's important to recognize that complications happen to ALL surgeons, and any surgeon that does not have complications or any suboptimal results is either not operating enough or lying. With that said, although an exam in person is ideal, from your photographs alone, I agree that your tip appears slightly over-rotated and has some supratip fullness. I would recommend (1) extended spreader grafts with MTF costal cartilage to de-rotate your tip and bring it out to length and (2) a hybrid graft with mastoid fascia and diced cartilage to augment your dorsum. Also note that if your septum is deviated and you have breathing difficulty, a revision septoplasty may benefit you as well, which can be covered by health insurance, and reduce the cost of the procedure. As you are 7 years out from your rhinoplasty, the skin has likely healed and is pliable enough to handle the surgical changes -- no tissue expansion is necessary; also note skin expansion on the nose is not a common procedure... The next step for you is to pursue the right aesthetic plastic surgeon for your revision rhinoplasty. In your rhinoplasty consultation, be sure your surgeon addresses all your aesthetic goals and concerns specifically, IN PERSON, and discusses the surgery details including the position and size of the incisions used (with actual photographs and not just digital animations), the risks and benefits of the procedure, recovery time, and post-operative course. I also think a key component of your consultation is to establish a good connection with your plastic surgeon. This is difficulty to do without seeing your surgeon in the office, in person. It’s the connection that allows you to clearly define your desired nose outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you. For more information on MALE rhinoplasty, please refer to my link below. Good luck. Mark K Markarian, MD, MSPH, FACS Harvard-trained Board Certified Aesthetic Plastic Surgeon

Hello and thank you for sharing your concerns about your breasts. Typically, correction of tubular breasts involves not just placement of breast implants but also manipulation of the breast tissue, and potentially a lift. Since it doesn't sound like you had a lift, you likely had some breast tissue manipulation in addition to your implant placement during your surgery to improve your tubular breasts. As such, if you were to remove the implants, the appearance of your breast may not be exactly what they were before the implants were placed, but likely very similar. The size would be very similar too. If you're concerned about the breast size following implant removal, and planning a breast lift, please know that a breast lift will reduce your cup size about a third to half a cup, because a breast lift involves excising skin which makes the breast smaller overall. Also, any decision to fat graft has to be made carefully as fat grafting can not only cause asymmetry (as fat necrosis and/or fat graft survival varies), but will only increase breast volume and not provide a lift, if that's what you're interested in... The next step for you is to find the right board-certified plastic surgeon who specializes in aesthetic plastic surgery. In your consultation, be sure your surgeon addresses all your concerns and discusses the surgery details including the position and size of the incision used, the type of breast implants available, the risks and benefits of the procedure, recovery time, and post-operative course. Also, be sure to see plenty of before-and-after pictures in women who have a similar breast appearance to yours, and preferably at different time frames (3 weeks out, 3 months out, etc) to more accurately predict your own surgical outcome. And lastly, I think the most important component of the consultation is to establish a good connection with your plastic surgeon. It’s the connection that allows you to clearly define your desired breast outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you. For more information on Tubular Breasts, please refer to my link below. Good luck. Mark K Markarian, MD, MSPH, FACS Harvard-trained Board Certified Aesthetic Plastic Surgeon

Hello and thank you for your question. First off, it's important to recognize that complications happen to ALL surgeons, and any surgeon that does not have complications or any suboptimal results is either not operating enough or lying. With that said, although an exam in person is ideal, from your photographs alone, I agree that your tip, supratip, and middle third of your nose is asymmetric and could benefit from a revision RHINO-plasty. In your rhinoplasty, your boney base can be adjusted to narrow and striaghten the nose, and your rigid and soft nasal cartilage can be modified by stitching, trimming, and grafting to improve the overall aesthetic. Another septoplasty would only help if you have residual breathing issues, but would not improve the actual appearance of your nose. It is important to note that due to your prior rhinoplasty, the cartilage in your septum was likely harvested and so you will likely require MTF (Musculoskeletal Transplant Foundation) aka cadaver cartilage to perform this revision rhinoplasty. If your septum is indeed still deviated and you have breathing difficulty, a revision septoplasty may benefit you as well, which can be covered by health insurance. Once you are at least 1 year out from your surgery, the nasal skin has likely healed overall and is healthy enough to undergo a surgical intervention. The next step for you is to pursue the right plastic surgeon for your revision rhinoplasty (and possible septoplasty). In your consultation, be sure your surgeon addresses all your aesthetic goals and concerns specifically, IN PERSON, and discusses the surgery details including the position and size of the incisions used (with actual photographs and not just digital animations), the risks and benefits of the procedure, recovery time, and post-operative course. I also think a key component of your consultation is to establish a good connection with your plastic surgeon. This is difficulty to do without seeing your surgeon in the office, in person. It’s the connection that allows you to clearly define your desired nose outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you. For more information on male rhinoplasty, please refer to my link below. Good luck. Mark K Markarian, MD, MSPH, FACS Harvard-trained Board Certified Aesthetic Plastic Surgeon

Hello and thank you for your question. First off, it's important to recognize that complications happen to ALL surgeons, and any surgeon that does not have complications or any suboptimal results is either not operating enough or lying. With that said, although an exam in person is ideal, it is not unusual to have nasal congestion and difficulty breathing after such surgery, even 3 months postop. However, such breathing difficulty tends to be bilateral, and not on one side alone. I would recommend returning to your surgeon for re-evaluation. The septum may be deviated or inadequately excised, potentially requiring a revision, a re-excision and possible re-set as necessary; any further breathing difficulty can also be improved with spreader grafting -- health insurance can cover all this at minimal cost to you☝️ If you have any cosmetic concerns, a rhinoplasty can also be performed. If you are unable to go to your primary surgeon, the next step for you is to pursue the right plastic surgeon for your septoplasty, with or without a rhinoplasty. In your consultation, be sure your surgeon addresses all your functional (and aesthetic) goals and concerns specifically, IN PERSON, and discusses the surgery details including the position and size of the incisions used (with actual photographs and not just digital animations), the risks and benefits of the procedure, recovery time, and post-operative course. I also think a key component of your consultation is to establish a good connection with your plastic surgeon. This is difficulty to do without seeing your surgeon in the office, in person. It’s the connection that allows you to clearly define your desired nose outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you. For more information on septoplasty, please refer to my link below. Good luck. Mark K Markarian, MD, MSPH, FACS Harvard-trained Board Certified Aesthetic Plastic Surgeon