Your question: Do I have thin or thick skin? Which is better for the best Rhinoplasty results?
I'm getting a rhinoplasty in the next few months, and I am wondering whether or not I have thin or thick skin. I've read that thin skin will usually get the best results.
Dr. Denenberg's answer: You have good average-y skin, and a difficult nose to get right.
See the Web reference link, below I made a couple of computer morphs, showing what is possible for your nose with a rhinoplasty. The main goals elevate the tip so the nose doesn't look so long, reduce the hump on the bridge of the nose, bring the entire nose back closer to the face, narrow the strong tip cartilages.
A caution you have a few issues with your nose that make it very difficult to get it right. It requires advanced techniques that the great majority of plastic surgeons will not be able to accomplish with expertise. You absolutely must see before and after photos of patients of any surgeon you are considering, patients who have no offense larger noses, who achieved a large reduction in size. Board certification diplomas will not tell you if the surgeon has skill in rhinoplasty, and the last thing you want is to end up with a nose that's perhaps a little better, but still much too big.
Elevating a tip as much as your nose requires, and bringing the tip closer to the face as much as your nose requires, are very advanced changes to make in a rhinoplasty. Also, any time that the nose needs to be changed as much as I drew in the morphs, it becomes a more difficult operation. Most of the revision operations that I perform are on patients who needed more change in these areas, because there was inadequate change in the first operation.
1) Proposed before and after:
Here's an animation of those changes. Give it a couple seconds to load:
Another view. I'm not as good with frontal views, but the point is to raise the tip:
Here's the animation:
Does this fit with what you hand in mind for yourself?
2) Click here to comment on those changes, or to ask Dr. Denenberg a follow-up question.
3) Click here to see more rhinoplasty before and afters of patients with combinations of features to correct.
More info on Dr. Denenberg:
Click here for Dr. Denenberg's profile, and more before and after photos, on RealSelf.com
"I flew all the way from South Africa to Omaha for my rhinoplasty.
Click here for reviews of Dr. Denenberg on RealSelf.com
Patients from over 55 countries, ...
Plain talk about picking a plastic surgeon for your first-time or revision rhinoplasty.
I do lots and lots of revision rhinoplasties; I'll try to give you some advice here, to maximize the chances that you'll be happy after surgery, and to minimize the chances you'll need a revision.
Important!! How to tell whether your consultation was acceptable:
Photos. If a surgeon doesn't show you before and after photographs, scratch him off of your list. Period. No exceptions. Deal-breaker.
You pick a surgeon primarily from his before and after photos. Diplomas, board certifications, hospital affiliations, academic appointment, and even reputation tell you nothing: a surgeon is never tested for his skill, his artistic eye, the quality of his outcomes, or even whether he cares that his patients are happy.
You must see photos of other patients who had some features similar to your nose. For example, if your nose has a wide and drooping tip, don't accept profile-only photos of patients who had a hump carved down. You can't see the width of the tip on a profile photo.
Revision nose operations are much more difficult than first-time operations, so if you are consulting a surgeon about a revision operation, you must see photos of his revision patients.
If you do see the surgeon's photos, but you don't love them, scratch him off your list. You want to use a surgeon whose work you like. Don't assume that he'll do great on you when he didn't do great on the other people.
Thought experiment: you are going to hire a portrait painter to paint your portrait. Would you really hire the painter if he wouldn't show you any of his other portraits?! No, it would never occur to you to hire him. Well, now you're going to hire a surgeon to change your nose, in the middle of your face, and you aren't going to insist on seeing examples of his work, proof that he knows what he's doing? Think about it. Teach your friends.
Communication. If the doctor treats you disrespectfully, scratch him off your list. If he won't patiently listen to what you want for your nose, same thing. How will he know how to make you happy if he won't hear what you want for your nose?
If he conducts the consultation from behind his desk and doesn't examine your nose, deal-breaker. If it's the nurse and not the surgeon who conducts the consultation, run away fastest. All due respect to the nurse, she doesn't know what's possible and what isn't. If the plan is to see the surgeon for the first time on the morning of surgery, deal-breaker. For sure.
Computer morphing. If the surgeon doesn't do computer morphing of your nose, scratch him off your list. The morphing is crucial, so the surgeon can prove to you that he understands exactly what your goals are. Also, if the surgeon recommends some changes that you hadn't thought of, you need to see the morphs, so you can see whether you like those changes.
Your intuition. If your gut tells you "no," don't use the surgeon. Don't ever use a surgeon only because you know him, or your kids know him, or he lives on your street, or your primary care doctor referred you to him, or he did your breasts, or your tonsils, or your wisdom teeth, or you saw his advertisement, or his awards.
I hear these stories all the time from my revision rhinoplasty patients. You must do your own evaluation of any surgeon you visit. And by "evaluation," again, we're talking mostly about seeing his photos and seeing how well he communicates with you. Don't bother checking the surgeon's licensure and board certification and hospital affiliations and all that; it'll just distract you from what's important.
Conclusion. The fact is, the great majority of plastic surgeons who perform rhinoplasty shouldn't be doing the operation. It's an incredibly difficult procedure, technically demanding, requiring experience, skill, judgment, an artistic eye, an exceptional level of communication and thoughtfulness, and a rare level of empathy and caring for the patient. No hospital board protects you by judging the quality of a surgeon's rhinoplasties and prohibiting him from operating if he's terrible. It's the wild, wild west out there, folks.
More plain talk: should you let your primary surgeon perform your revision?
First, you need to consider whether things didn't turn out great on your first operation because of some unusual circumstance with the surgery or the healing, or whether things went wrong because your doctor was not expert in rhinoplasty in the first place.
Evaluate your surgeon again. Read the section above, on how to evaluate a surgeon for a rhinoplasty. If you saw lots of before and after photos of your surgeon's other patients who got excellent results, in noses at least somewhat similar to yours, then your surgeon probably knows what he is doing, and you can consider letting him perform your revision. Even the very best surgeon has the occasional disappointing result.
However, if, on looking back, you decide that you did not do excellent research on your original surgeon -- perhaps you relied on a referral, or on his board certification, without being able to see his photos -- then you probably should not have him perform the revision. If he couldn't get you close to your goal the first time because of a lack of skill, he will have no chance at all on the second try, and then you'll be in the tough position of looking for a third operation.
Are you "Following" Dr. Denenberg on RealSelf.com?
If you are following him already, drop him an email and comment about something!
Dr. Denenberg has been selected as one of America's Top Doctors by Castle Connolly Medical Ltd.
The America's Top Doctor award is not a popularity contest. Unlike all the local copycats and spin-offs, Castle Connolly allows only physicians to nominate, and vote for, Top Doctors. The "America's Top Doctor" is a doctor who is voted into that position by a national review of recognized experts in the doctor's field. Dr. Denenberg is one of the rare doctors to receive that award every year since the program began in 2001.
If Dr. Denenberg asked you to post or send better photos ...