AboutAlan M. Engler, MD, FACS Expertise Dr. Engler has answered over 2800 plastic surgery questions for Allexperts. His expertise is in cosmetic plastic surgery including breast surgery (breast enlargement with implants, breast reduction, breast lifts), liposuction, eyelid surgery, tummy tucks, facelifts etc.
Dr. Engler has been listed as one New York`s Top Doctors, and as "One of the World's Most Famous Aesthetic Surgeons" (Aesthetic Surgery, TASCHEN Books, Angelika Taschen, Editor). He is the author of 4 books, including "BodySculpture" (a best-selling plastic surgery book on breast surgery, liposuction and tummy tucks), "EyeScapes" (Plastic Surgery of the Eyelids), "Restylane," and "The Slim Book of Liposuction."
Dr. Engler has two US Patents for surgical instruments that he's designed, and has appeared on numerous television shows, including The Tyra Banks Show, The Ricki Lake Show (four times), and the Dr. Keith Ablow Show. Videos of his appearances are available on YouTube (SEARCH FOR "DR. ENGLER"). His website is www.bodysculpture.com.
Experience Dr. Alan Engler is a board-certified plastic surgeon in New York and the author of BodySculpture - Plastic Surgery of the Body for Men and Women (ISBN 0966382749) one of the top-selling plastic surgery books on amazon.com, barnesandnoble.com, etc.
Education/Credentials Dr. Engler graduated from Yale University (undergraduate) and the College of Physicians and Surgeons of Columbia University (medical school). He did his residency training in General Surgery and, after that, Plastic Surgery, at the Montefiore Medical Center in New York. He is on the faculty of the Albert Einstein College of Medicine in New York.
I've had Open Rhinoplasty on 23rd March 06. I would like to know when can I start 1) sleeping face down on my pillow 2) massaging my nose 3) vigorously doing high-impact jumps?
Also, I'm concerned about the risks of extrusion, asymmetry of nose and implant shift. Here are my questions for each of them.
4) Is the risk of extrusion a permanent one for life or is there only a probationary period where caution must be taken? If it's only a probationary period, how long and what caution should I take?
5) Is the risk of asymmetry a permanent one for life or is there only a probationary period where caution must be taken? If it's only a probationary period, how long and what caution should I take?
6) Is the risk of an implant shift a permanent one for life or is there only a probationary period where caution must be taken? If it's only a probationary period, how long and what caution should I take?
7) The skin around my implant feels tight especially when I'm making facial movements. Is that normal? Also when I tilt my head, I can feel the implant underneath my skin, it is as though it's shifting with my head tilting. Is this also normal?
I would greatly appreciate it if you can answer all my questions and concerns in the same numbered fashion (makes it easier for me to know which you've addressed). I've been brooding over all the above for quite some time but my doc. says that I can be 'normal' already. Somehow, I don't really trust that.
Answer Dear Justin,
Thanks for writing to me. There's lots more info about plastic surgery at my website, www.bodysculpture.com.
I understand that you'd like specific and precise answers to your questions but the nature of surgery, and individual healing, precludes that, particularly over the internet. You should, of course, follow the recommendations of your surgeon.
In general, though, I let my patients start exercise, slowly and then advance as tolerated, about three weeks after surgery, depending on how they feel. So that would apply to sleeping face down, massaging and - if you advance slowly as tolerated - eventually to high-impact jumps.
Extrusion refers to an implant or graft presumably. Grafts can protrude at any point and, arguably, are more likely to over time as scar tissue contracts and pulls the skin in. Most grafts, of course, do not extrude and, instead, do great. Asymmetry is a fact of life for the entire body, at all times. It is actually symmetry that is unusual!
The tight feeling is to be expected. It takes weeks to months for most of the swelling to go down after a procedure like this, and up to several years for all of it, particularly around the tip. I've had patients tell me that even 2-3 years after a rhinoplasty the tip has undergone some subtle changes. I doubt the implant is shifting; if anything, it's probably being held very tightly now by the swelling but even once the swelling has diminished, they do not normally shift as you tilt your head. It's not a wide open space with something falling around inside. Implants can shift over time, but that refers to small gradual and permanent changes of location/position, not the back-and-forth sloshing that would occur if a small object were loose in an open space.
It sounds like your surgery went well, and that your surgeon is giving you good advice.
