Expert: Alan M. Engler, MD, FACS - 5/2/2006

Question
Thanks Dr. Engler for your swift and certain reply. I just have a couple of other questions regarding my new nasal tip and sleeping. My doctor told me that he'd used my own cartilage and fibrofatty tissues to 'cap' my tip as a precaution against implant extrusion and greater projection ( I'm Chinese and have a typically flat Asian nose with a fat tip). I was just wondering if the cartilage and the fibrofatty tissues be absorbed back into my nose? If they are indeed absorbed, wouldn't the desired aesthetic shape of my nasal tip be compromised, and wouldn't the absorption defeat the purpose of reducing the extrusion risk?

My doc. also said that he had removed some fats from my nose. I was wondering if they would grow back due to genetic reasons or say weight gain?

My last question: Is the risk of sleep trauma i.e. knocking or tumbling on your nose while sleeping and causing damage great for someone who has had Rhinoplasty?

Thank you so much! You've been most patient.

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Followup To
Question -
Hi Dr. Engler,

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.

I hope that this helps, and good luck,

Dr. E
www.bodysculpture.com

Answer
Justin,

Cartilage can resorb or shift slightly over time, but it's the best material we have.  I agree with your surgeon's choice of it.

Fat would only come back with a massive weight gain.  It needed to be removed to complete the contouring.

Sleep should not be a problem - unless you are a very violent sleeper!

Good luck,

Dr. E