Q: Dr. Eppley, I have had a open rhinoplasty during June of 2012. My nose in the beginning looked great, but gradually it got a bit more but it went down gradually in time, though it is still swollen on the tip. But approximately two months ago I was washing my face and pressed on my nose and I heard a “click” and some blood came out. Since then I always get a bit of blood from my nose in my snot. I put vaseline inside my nose, which made the blood to stop coming, I guess it was dry on the inside. A month after the “click” in my nose, it became really swollen. Even though people don’t see a swollen nose, I know that my nose don’t look like this. Ive cleansed my nose with salt and water on the inside, I’ve used cortisone nasal spray, I’ve got antibiotics and cortisone tablets. The cortisone tablets really helped but only for a day or so, after that my nose went back being swollen. I do not know what to do, and would really appreciate your help.
A: I am going to assume that your open rhinoplasty was done using your own cartilage and no synthetic implants. In an open rhinoplasty a columellar strut graft is often used and this is really the only thing that can cause any clicking after a rhinoplasty if you move the nasal tip. But this is a natural material and not a source of infection or would cause an open areas inside the nose where the incisions where. At 10 months after surgery you are rapidly approaching the time when you are reaching the final result although I would not pass final judgment until a year from surgery. You may consider doing some low dose kenalog injections in the nose to get some further nasal tip refinement.
Dr. Barry Eppley
Q: I have been researching for the options to remove the silicone on my nose bridge. I saw some chat group people talking about Korean plastic surgeons removing injected silicons from the nose bridge from inside of the nostrtil and implanting a new bridge at the same time, supposedly leaving no visible scar left after the surgery. As far as I have seen, this approach seems like only available in South Korea, Thailand and Singapore so far. What is the feasibility of using this method in U.S? Will this be easier than accessing the injected silicon from behind the hair line? I will continue to search options. Hope I will not have to go overseas to remove the little piece of silicon. Thank you very much for your time and consideration.
A: What is not clear in your inquiry is whether the silicone that in on your nasal bridge is a solid implant or is from silicone injections. Furthermore, I am assuming when you say nasal bridge you are referring to the length of the nasal dorsum as opposed to just the nasal bone area at the upper one-third of the nose.
Regardless, a nasal approach to its removal would be certainly be preferable and easier. Whether this is best done through a closed or open rhinoplasty approach is not clear just based on the information you provided. I see no reason or benefit to using a superior or scalp approach for its removal.
Immediate replacement with another nasal dorsal implant, if desired, could also be done at the same time as well.
Dr. Barry Eppley