Walter Joseph, MD

Hi alcg2017! Dr. Walter Joseph here from Beverly Hills, CA! Based on your photos, I think your goals are certainly realistic! A dorsal reduction can be performed (i.e. removing the "bump"), while still maintaining a straight bridge WITHOUT a ski sloped or scooped appearance. As for your tip, it would totally be up to you as to if you want any tip work done whatsoever. Some patients choose to preserve their tip while only addressing the dorsal hump, which is both reasonable and achievable! I will say however, that with a significant hump reduction, it is often necessary to bring in the nasal bones via nasal osteotomies, which would result in a likely narrower appearance of the bridge of the nose on the frontal view. A thorough in-person physical exam would be needed to determine if this would be necessary. I hope this helps!

Hi Chlo98! Thanks for your question. At least from your photos, you are certainly a candidate for rhinoplasty. A surgical rhinoplasty would be able to lower your dorsum (remove the bump) and also de-rotate and de-project the tip of the nose so that your nostrils show less on both the front and side views. Also, with cartilage grafting and special maneuvers like an alar base excision (Weir excision), the nostril size can be decreased further and the ala can be better supported. Bruising after a rhinoplasty is nearly resolved at 1 week and almost always fully resolved at 2 weeks. Swelling can last anywhere from 2 weeks to 6 weeks or longer depending on your anatomy and the extent of the surgery. I always counsel my patients that in some cases for primary rhinoplasty, the final "product" is really not visible until 1 year.

Hi SpiceMix! Thanks for your question. Dr. Walter Joseph here from sunny Beverly Hills, CA! As we age, we lose bone density and develop some soft tissue atrophy in what's called the "pyriform" area of the nose, which is the structure deep to the alar crease that you're describing. Also, some people (regardless of age!) have a genetically deeper set pyriform than others, which can also make the alar crease more pronounced. A nice treatment for this is to inject a thicker hyaluronic acid filler deep onto the bone of the pyriform in the crevasse just beside the ala. This helps build up this area and lessen the depth and the shadowing caused by the depth in this area. I hope this helps!

Hello Cute7275! Dr. Walter Joseph here from Beverly Hills, CA. I hope you're well. It appears that you likely had an open rhinoplasty, where an incision was made across the columella at the base of your nose. If there is any sort of step-off at the closure between the skin edges, a "notch" or "dent" can occur. Sometimes, these scars can remodel and any irregularities can improve/resolve over the course of 1 year, however, if there is still an indentation at the 12 month point, I would recommend that you return to your surgeon for a small revision under local anesthesia. Happy to comment or help further if needed!

Hi Malo10! Dr. Walter Joseph here from Beverly Hills, CA. I hope you're well! For my patients, I typically recommend starting both Arnica and Bromelain 1 week prior to surgery. I then recommend that they continue the combination for at least 2 weeks post-op (a total of 3 weeks). As for red light therapy, you can actually begin red light therapy a day or 2 before your surgery, and then continue daily for as long as convenient. There is good data that red light therapy can decrease pain, swelling, and overall inflammation and also speed up healing/recovery. 

Hi Lipslikesugar! Dr. Walter Joseph here from Beverly Hills, CA. From what I can see in the photos, after your rhinoplasty, you were left with a very distinct demarcation between your ala and your tip. This can be fixed using cartilage grafts to smoothen that transition between your ala and your tip. By securing cartilage grafts from your tip complex and having those grafts articulate with your lower lateral cartilages and then having those same grafts extend laterally into the alar rims, it is possible to smoothen that transition that you're seeing and create a more natural appearing nose. I hope this helps!

Hi Morgiana! I think it is very realistic to improve the appearance of your nose to a more "natural" state that is proportioned and balanced to your face a bit better. This would likely require an open approach (incision across the columella) and cartilage grafting. Depending on how much cartilage your previous surgeon took from your septum at the time of your initial surgery, you may need ADDITIONAL cartilage (either from a cadaver or from your own rib). 

Hi Ash, Dr. Walter Joseph here from Beverly Hills, CA! I hope you're well. Although it's a bit difficult to tell from a photograph and without a proper exam, it does appear that you're having a bit of filler migration on your top lip. There seems to be some filler that is beyond your vermillion border (the border between the pink of the lip and the skin), particularly in the 2nd photo of the oblique view. In this situation, I would typically recommend dissolving the existing filler that has extended beyond the lip and the vermillion border and re-augment 2 weeks after dissolving. I hope this helps, and please let me know if you have any more questions!

Hello! Dr. Joseph here from Beverly Hills, CA! Typically to perform a "browlift" with any neurotoxin/Botox, the Orbicularis Oculi muscle in the lateral brow area/lateral canthus of the eye can be injected, which decreases the brow-lowering action of the Orbicularis, and therefore the Botox allows the lateral brow to raise due to the native action of the Frontalis. This creates the "browlift" effect. As such, in your situation, I would recommend AGAINST Botox in the right Frontalis over the lateral brow. Botox in this area would DROP the right brow, and somewhat defeat the purpose of the Botox in the Orbicularis.In general, I advise my patients to wait a 2 full weeks before any "touch-ups" or corrections with more product. Over this time, the facial musculature can acclimate and "settle", creating a more desired result. However, if you still feel your R lateral brow is heavy and low, I would recommend one of the following: -A few extra units of Botox injected into the R orbicularis oculi to further "lift" the lateral brow, OR...-A few extra units of Botox injected into the L lateral frontalis to lower to the L lateral brow just a bit for symmetry I hope this helps! Feel free to reach out with any further questions!

Hi Eliza! Dr. Joseph here out of Beverly Hills, CA. Typically, filler injected in to the pyriform area at the base of the nose/nostrils is injected quite deep right onto the bone. Therefore, it is quite unlikely that the filler would migrate from this area onto the supratip or the dorsum. However, any filler injection may cause swelling in the area, so it would be possible that the tip/supratip/dorsum of the nose may swell in response to this particular injection. I hope this helps! All my best.