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Have a question to ask?

Get Dr Terence Goh's opinions on your questions! Only approved questions are displayed.

Top Answers


HI Diamond, 

Thanks for your question. I echo some of the sentiments of the doctors who replied. Whilst  threads and fillers can be efficacious to effect a change in the nasal dorsum and improve tip projection, it may at best camouflage it, but it would not reduce bulbosity of the tip.

One of the reasons why patients undergo an open rhinoplasty is to create a more refined tip. This is done with careful debulking of the nasal tip, while preserving blood supply to the nose and using well placed sutures to manipulate the nasal cartilages to create a refined and projected nasal tip. If the tip bulbosity continues to bother you, I would suggest an in person consultation with a plastic surgeon that specialises in rhinoplasty. We have 3D software these days that are able to perform  a before and after simulation for you to see the possible changes that can be done. 

Hope this answers your questions! Have a great week ahead!

4 Sep 2018

Dear Allyj,

Congratulations on your rhinoplasty and I am glad that you are happy with the results. Before you proceed with the HA nose fillers, you should check back in with your rhinoplasty surgeon to see if he has any other solutions for you. 

Fortunately, one of the advantages of a total autologous rhinoplasty, of which I am a strong advocate of, is that in comparison with an implant rhinoplasty, the nasal dorsum is made of your own tissue. Hence, there is a lower risk of the HA filler injection causing an infection if done properly, and no risk of rejection of the nasal implant or capsular contracture.

Whilst it is safe for you to have fillers to the nose after autologous rhinoplasty, you should highlight this to the doctor that is performing the filler injections. As Dr. Justin Boey has pointed out,  the vascular anatomy of your nose may have changed after the rhinoplasty surgery and there is an increased risk of vascular complications with filler injections after surgery.

Personally, I have given HA filler injections without any complications to patients who have had previous rhinoplasty. Some of my patients have opted for a revision of the nasal dorsum using only autologous tissue so that they do not have to undergo repeated HA injections. Should this option be available to you, it could also be another possibility to consider. 

I hope this answers your queries. Have a great week ahead!

Dr. Terence Goh

4 Sep 2018

Dear Jean,

Thank you for your question on deviated nose with difficulty breathing after a basketball injury.

The nose is one of the most commonly fractured bone in the face. This is often as a result of road traffic accidents, accidental falls or from altercations. In your case its is probably from an elbow or being hit by a ball during basketball. The severity of the injuries to the nose can also vary from simple contusions to complex fractures.

Not all broken noses will require surgery. If the fracture is straight and minor and there is no deviation of the nose, surgery is not required and the bones will heal in-situ. Painkillers and antibiotics may be all that is required. However, if it is a true nasal fracture, it does take 2 weeks for the bone to become stable and about 6 weeks to heal completely. During this period of time, it will be advisable to avoid wearing glasses and engaging in contact sports.  

Sometimes the swelling from the injury can mask the underlying deviation of the nose or underlying septal injury. Besides the nasal bones, the septum (comprising of bone and cartilage) inside the nose also needs to be considered. In instances where the septum is deviated or there is difficulty breathing, septorhinoplasty may be required. In your case, as the injury was 1 year ago, the swelling would have subsided and you would have noticed this deviation and nasal blockage some time back.

For my patients who present early with a nasal fracture that is displaced, I usually recommend a closed reduction (resetting of the nasal bones and septum, without any other intervention) within the first 14 days from injury. This is especially so if the deviation is troubling to the patient or if breathing is obstructed. Occasionally a septorhinoplasty may be indicated. If there is persistent deviation of the nose, a formal rhinoplasty is usually performed 9-12months after the injury. So you would fall in the latter category. 

Depending on the severity and whether the septum (cartilage within the nose) is deviated, you may benefit from surgery to realign the nasal bones and cartilage structure to correct the broken nose and also removal of the broken septum to improve breathing. 

At this juncture, we should perform a CT Scan and review your old X-ray to have an idea of what needs to be corrected. Depending on your insurance policy, this should be covered, but you would have to check with your provider about the claim periods. 

In addition, we are able to perform 3D realtime simulation of before-after impressions for rhinoplasty. I would recommend seeking an in-person consultation with a board-certified plastic surgeon who has a 3D-simulation software so that you can have a better idea of what your results would look like.

I hope I have answered your queries. Have a great week ahead!

Dr. Terence Goh

Plastic Surgeon, Singapore


The information provided is purely for educational purposes and does not constitute medical advice or create any physician/patient relationship. Results may vary between individuals.

16 Sep 2018

Dear Moses Jeffrey, 

Thank you for your question. I'm not exactly sure what you are referring to when you mention a huge dent in the nose. As you rightly pointed out, one of the common causes for depressions in the nose is from traumatic injury to the nasal bone.

If you are sure that there is no previous trauma to the nose, the other possibility is acne scars. Depending on the severity this can be treated with CO2 lasers, fillers or fat grafts. I had a patient once who had  a depression in the tip of the nose, known as a bifid nasal tip (see below) and this could be caused by the separation of the nasal cartilages at the tip. This can be easily corrected by a tip rhinoplasty where sutures are used to align the cartilages and cartilage grafts are added to create additional tip support.

Bifid nasal tip. (Image courtesy of Rhinoplasty Archive)

Bifid Nasal Tip. (Image from www.rhinoplastyarchive.com)

I hope this answers your questions. I would recommend an in-person consultation with an experienced plastic surgeon who is able to manage both the functional aspects and cosmetic aspects of rhinoplasty. 

Have a great weekend ahead!

Dr. Terence Goh

Plastic Surgeon, Singapore


The information provided is purely for educational purposes and does not constitute medical advice or create any physician/patient relationship. Results may vary between individuals.

23 Sep 2018

Dear Tamara Sofia,

This is a common question that I get asked all the time. It is good that you are asking these questions ahead of your surgery to prep properly. Plastic surgery is a journey and part of it requires you to be patient to give the body time to heal. 

Every surgery goes through the same stages of healing - hemostasis, followed by inflammation then proliferation and finally maturation.  I routinely provide this advice to my patients:

WHAT TO EXPECT AFTER YOUR RHINOPLASTY SURGERY:

Swelling varies from patient-to-patient and it also depends on what was done - simple dorsal augmentation with an implant versus tip-pasty. Generally speaking, your nose will be swollen after the surgery and it is usually worst in the first 3 days before it starts to settle. I routinely review my patients on the 5th post-surgery day to remove the stitches.

When the nasal splint is removed at this point, the nose may still appear more swollen and up-turned. This is to be expected. Most of the swelling should resolve over the next two weeks. At the end of the two weeks, most patients will be comfortable with returning to their work or school or social functions. The swelling will continue to improve over the next few months with the best results at 12 months. Do expect minor fluctuations in the swelling of the nose over the course of the next few months. 

Bruising will vary like swelling from person to person. Most bruising, if it occurs should resolve over the first 10 days. It will turn from pink/red to a purple/bluish colour before it becomes green and finally orange and then it fades away.

Nasal Drip. Some patients have allergic rhinitis or persistent nasal drip after rhinoplasty. We will prescribe a course of antihistamines to help you to reduce the nasal drip. 

Numbness. Your nose will be numb following surgery. This is normal and the numbness willl subside over the next few weeks to months. Occasionally you will feel pins and needles and this is a sign of the body healing. The nose will be hyper-sensitive during this time and accidental brushes against the nose may cause pain that is more severe than normal. 

Bleeding. Depending on the surgery performed, you may have some residual bleeding from inside the nose. This may trickle to the back of the throat or through the nose. If bleeding occur, lie down with your head elevated. You may pinch the sides of the nose gently and swallow the blood. Cold compression over the forehead in-between the eyes will help. Most of the bleeding should stop within 10 to 15 minutes. If bleeding continues, please contact our nurses or clinic.

RHINOPLASTY POST-OPERATIVE CARE INSTRUCTIONS 

1. Apply cool compress across the nose for the first 48 hours after surgery. This involves multiple washcloths and a basin of ice water. These washcloths should be changed out of the basins every twenty to thirty minutes to keep them cool. The washcloths should be applied diagonally over each eye and crisscrossed over the forehead. The nurse will demonstrate how to do this before you leave recovery.

2. The suture lines should be cleaned 3-4 times a day just before you apply the antibiotic cream. There will be absorbable stitches inside the nostril. You may apply antibiotic cream to the suture line inside as well. 

3. Patients may shower the second day following surgery, but it is important to keep the tape and splint on your nose dry at all times. 

4. You should try and avoid wearing eyeglasses for 2 weeks after your surgery. If necessary, eyeglasses may be worn with the nasal splint in place. If you are wearing glasses after the removal of splint ensure that the nose pads are not compressing the nose.

They should be either suspended from the forehead or supported on the cheek for a period of six weeks or until the swelling subsides. This is extremely important as the pressure on the nose may change its final shape. 

5. Avoid taking traditional medicine such as garlic, ginkgo and ginseng as these may increase the risk of bleeding. Avoid a high salt diet as this may cause increased swelling. Most other foods are fine as long as you do not have any food allergies.

I hope this answers your question. Have a great week ahead and all the best!

Dr. Terence Goh

Plastic Surgeon, Singapore 

24 Oct 2018

Dear Jerald,

Understanding the difference between a rhinoplasty and a septoplasty is key to help you to choose the best treatment to fix a crooked nose. Both surgical procedures are meant to target issues with the nose but they have different objectives. 

RHINOPLASTY. WHAT IS IT? A rhinoplasty or nose job is a general all-encompassing term for a surgical procedure that enables patients to correct the shape, size, symmetry of their nose. The term is more commonly associated with cosmetic concerns - a rhinoplasty is able to correct a nasal hump, or a bulbous tip or large and wide nostrils. However, reconstructive rhinoplasties are also performed for noses that have been deformed by trauma, for reconstruction of defects after cancer surgery and for reconstruction of cleft noses in patients with cleft lip and palate deformities.

SEPTOPLASTY. WHAT IS IT? A septoplasty is a specific procedure that targets functional concerns with the nose, specifically relating to a crooked or deviated septum. The septum is the middle support of the nose that comprises of bone and cartilage and partitions the nostrils. Deviation of the septum from birth or as a result of nasal injury can lead to the appearance of a crooked nose, and difficulty breathing through one or both nostrils. As such, these patients would be an ideal candidate for a septoplasty procedure. A septoplasty can be performed alone or as part of a rhinoplasty procedure. It can also be performed as an open or closed procedure depending on the severity of the septal deviation. When performed as a closed procedure, a small incision is made in the inner lining of the nose to access the cartilage and bony septum, without a visible external incision.

What is a septoplasty?

(Photo credit: https://mychart.geisinger.org/staywel/html/Inpatient/3,89977.html)

RHINOPLASTY AND SEPTOPLASTY. WHICH IS THE SURGERY FOR ME?

If you have a visibly crooked nose and a deviated septum that affects your breathing, a septoplasty can be performed with the main objective to fix a deviated septum, whilst leaving the external shape of the nose untouched. However, a rhinoplasty can also be done during the same surgery if you have intentions to correct other parts of the nose eg. dorsal hump, bulbous nasal tip or droopy tip.

I hope this answers your question. Have a great weekend!

Rgds,

Dr. Terence Goh

Plastic Surgeon

8 Dec 2018

Top Questions


I want to get a rhinoplasty to fix my crooked nose. What should I discuss with my surgeon to ensure that I can get the results that I want from my procedure? I don’t want to be disappointed.

I’m quite disappointed with the results of my rhinoplasty. How long should I wait before getting it corrected?

How much does rhinoplasty cost? What affects the cost of a procedure?