Getting the Best Results Possible? (photo)

I am interested in a primary rhinoplasty and am considering flying to LA from NY. What problems can I encounter by doing my rhinoplasty in another state? Open Or closed? The doctor I'm considering does closed. I have attached my photos, Do you think I would have a better outcome with open?My nose has a deviated septum, very assemtrical thin skin, tilts to side. My doctor sug. Spreader graft does it show through thin skin? How can I be certain my nose will not collapse? Is ENT doctor necessary?

Doctor Answers 9

Select your doctor well, then let him make most of those other decisions

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The fact that you are considering traveling is not a problem. About 50% of my patients travel to see me.  If your care is good, you would be able to go home after the splint is off in about a week. Many of my patients go home a day or two after surgery, and then come back to have the splint removed.
See the Web reference link for a digital modification of your profile. I deprojected your tip, bringing it back closer to your face, raised the tip a small amount, and took down the gentle hump along the bridge. Digital modifications are important, because they let you see what the surgeon has in mind. You need to see whether his plan fits with your idea of what you want for yourself, and the computer imager is an excellent tool for that.
Considering the question of open vs. closed, spreader grafts vs. none, or ENT doctor: you do best to choose your surgeon by looking at his before and after photos. See whether he has been able to accomplish for other people what you want for yourself. That's mandatory. If he has, then let him decide whether to put spreaders in, and whether to do the operation open or closed.
In cosmetic surgery, you have the chance to evaluate your doctor, by looking at his photos. Once you've done that, don't micro-manage the experience: you liked his photos because of the good judgment he exercised on other people -- trust him to exercise that same good judgment on you, once you and he have agreed on a surgical plan.

Traveling and rhinoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
There are many excellent doctors in the east coast.  It is always better to be close to your doctor in case of any issues.  A spreader graft can make your nose more broad as it is spreading the space between your septum and upper lateral cartilages.  We frequently have out of area patients.  It is best to stay for about a week before going back.   Best of luck. Dr. Michael Omidi

An in-person exam with a board-certified plastic surgeon is the best way to assess your needs and provide true medical advice.

Rhinoplasty Preparation

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Since you have a deviated septum the  very best approach for top quality is to have a plastic surgeon do you rhinoplasty and an ENT doctor present to simultaneously  do the very best for your septum.   Since NYC is well blessed with very fine surgeons I doubt the need to fly to LA and simply complicate your life.   Dr Sherell Aston does beautiful noses in NYC.   The grass being greener on the other side of the fence is kind of silly in your case.  It is always best to work with a great surgeon in your area.........particularly if your area is NYC.   You have a quite simple nose and I would recommend a closed procedure with concurrent tip reduction and dorsal reduction to straight.  You want to end with a fine featured masculine nose.  Your greatest risk is an overdone rhinoplasty so  do seek a seasoned doctors.   Experienced doctors rarely make mistakes.   My Best,  Dr C

The best result does not depend on open or closed but the overall skill of the surgeon

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

There are excellent rhinoplasty surgeons in New York as well as California. Many patients travel across the country for surgery. The one big problem with that is follow up and if there are any issues after surgery. Most noses require at least some grafting in primary rhinoplasty. For the photo posted, it's hard to be specific but likely, spreader grafts and a columellar strut to help hold up the tip. These can be placed through and open or closed technique.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 134 reviews

Getting the Best Results Possible?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I have a lot of patients who travel from other states as well as other countries who fly in, have surgery, stay for a while and when stable return. Complication can occur and you will have to have a back up plan. A surgeon who can see you if you will need immediate attention. It is important to give yourself enough time to recover before flying back. 

Mohsen Tavoussi, MD, DO
Orange County Facial Plastic Surgeon

Interstate Rhinoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Hi NewYork31

1. I consider interstate surgery not much safer than overseas surgical tourism. An important part of your operation is after care and long term follow up. Unless you fly to New York frequently for work or family, it is probably better to find a local surgeon with a good reputation. Your nose will change for up to a year after your surgery, and being away from your surgeon will hinder your ability to get things checked out (and possibly fixed if required).

2. The differences in scars between open and closed techniques are over-stated in most circumstances. The small scar on the underside of the nose (columella) that is needed in an open technique usually heals imperceptibly, and the only people that see it under normal circumstances are children and dwarfs. Closed rhinoplasty needs a greater level of technical skill for some adjustments, but the post operative swelling does settle faster due to less disruption of blood supply & lymphatic drainage.

3. Spreader grafts may not be necessary for your nose, but it is not always that easy to tell until in the middle of the operation. They are not visible unless something goes wrong.

4. Your nose should not collapse if enough septal cartilage is left behind. All rhinoplasty surgeons are taught sets of rules as to how to make sure this does not happen - although the 'rules' vary slightly between countries and specialties.

5. Your choice of Plastic Surgeon vs ENT surgeon is complicated. Both specialties are trained to perform rhinoplasty surgery. They are good (and bad) rhinoplasty surgeons form both specialties. A recommendation from friends, family or your family doctor are better indicators of a good result than getting caught up on which training scheme the surgeon went through.

Good Luck

Dr Gavin Sandercoe

Rhinoplasty to give the best results

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

  There are very experienced rhinoplasty surgeons who performed open or closed rhinoplasty and get equally good results. Thin skin does have a tendency to show any little irregularities which can show up from either open or closed techniques. Spreader grafts will help the mid third of the nose from collapsing and can be inserted at the time of the primary rhinoplasty. They usually do not show through the skin since there inserted underneath the  upper lateral cartilage and the skin in that area. Followup will be difficult since  you will be having  your surgery performed out of state and is something to consider

Getting the best result possible with rhinoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The difference between open vs. closed rhinoplasty is one very small incision that typically heals to the point of being very difficult to find. A good rhinoplasty surgeon can offer either approach. I would allow the surgeon to use the approach he/she feels will yield the best result in your case. When deciding on a surgeon to perform rhinoplasty, it is extremely important to visit with a surgeon who performs many of these procedures as rhinoplasty is one of the more technical procedures performed on the face. Spreader grafts are commonly used in the "crooked" nose and should not be seen after surgery, rather they provide straightening of the middle part of the nose.

Ronald Caniglia, MD
Scottsdale Facial Plastic Surgeon

Getting the Best Result Possible with Rhinoplasty Surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Consult with Board Certified Plastic Surgeons regarding your Rhinoplasty Surgery.  You should go to a surgeon that is very experienced in this surgery.  He will determine the need for grafts, and explain open and closed to you. Also, where ever you have it done, be sure you are able to follow up with your surgeon for post op appointments as he recommends for the first year.  This will require several visits.   Best wishes!

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.