Samir Undavia, MD

I am not sure its resistance to Botox, but its something to consider. It could simply be the batch that he  tried using.  Especially since it seems you have used Botox before and didn't have this reaction.  I would consider trying one last time, possibly with a different injector.  If he offers to do it for free, then I would consider sticking with the same injector.  Sometimes the Botox rep can help and provide a sample for patients that don't respond appropriately to the medicine.   Alternatively, you can try another product, like Dysport or Xeomin.  Good Luck!

Great question. While some patients can get pretty quick results, its much more common to have no results for a few days. By 7 days, you can expect 85% of the intended results, and by 2 weeks 100%.  If at 2 weeks its not enough, consider more Botox. But I would be conservative and go slow. You can always add more, but its difficult to deal with a droopy upper eyelid from excessive Botox.   Next round of Botox, you will have a better idea of how much Botox you eventually needed!

Revision osteotomies can be helpful in realigning nasal bones that didn't heal right from the first rhinoplasty. It is always difficult to get the nasal bones to heal perfectly in place, and one can make the argument that there might have been an internal nasal reason for them not settling in the intended spot.  I would suggest waiting a full year before signing up for revision rhinoplasty.  Good Luck!

I'm sorry about the Muscle tension Dysphonia. I would certainly see a Laryngologist (an ENT that has extra specialty training in the voice). I am certain there are some in Pittsburgh.  With regards the the nasal tightness, there are things that can be done to "loosen" up the nose. However, it depends on how far out of surgery you are.  If its within the first few months of surgery, its completely normal and does take just a little bit longer to soften up.Good Luck!

Its sometimes difficult to have a nose be less dynamic during smiling. This is because there are many muscles that are moving during smiling. Some are outside the structure of the nose ( like in the cheeks).  If they are excessively pulling on the nose, no surgery would be great in dealing with that. However, sometimes Botox can help in those instances. You would need to be evaluated in person to see if that was a realistic option for your. Other more definitive options include resecting the depressor Septi muscle to help stop pulling on the tip. Adding nasal tip support with grafting can also help, but all of these later options require a third surgery.Good Luck!

I am sorry you are still experiencing trouble 2 years post op. Its certainly time to seek a second opinion to see if there are solutions for you. I would start with a  board certified Facial Plastic Surgeon who can assess the breathing and aesthetic aspects of your nose.  

Joseva,I would certainly wait. Its quite early in the healing process, and you still have almost half the swelling still to come down.  Breathing improvement can also take some time to get better, since there is so much swelling inside and out of the nose. Usually by 6 months some plans can be made if your still unhappy.   But even then your surgeon might say wait for the year for all the swelling to come down. It would be a shame to operate early and somehow make you worse off if all that was needed was time.  By 12 months, however, you can expect little to change.Good Luck!

Please don't touch it. I would have your surgeon take a look at it. It may just be crusting that appears discolored.  It usually just needs to be cleaned by your surgeon with direct visualization.  Good Luck!

5 weeks is quite early in the Revision Rhinoplasty time line. I would give it more time. Remember, in any nasal surgery, the nasal tip is the last area of swelling to come down.  You may ask your surgeon if a small kenalog (steroid) injection is warranted to bring down swelling. Good Luck!

Its very common to have swelling in revision rhinoplasty that lasts longer than primary rhinoplasty. Sometimes, you can double the swelling recovery time. If there were grafts used ( as is common in revision rhinoplasty), swelling can persist in those locations. I would bring these concerns to your physician. There maybe a specific reason for the swelling.  Swelling does also follow gravity, which means that the lower third will be the last area of the nose to decrease in swelling.   And yes, thick skin certainly retains water for longer than thinner skin.Good Luck!