I tell patients that they can restart their nasal steroid spray 2 weeks after a rhinoplasty and I recommend that they direct it toward the side of the nose and not toward the center of the nose so that they avoid drying out the nasal septum, which is toward the center.  If they are having a significant amount of congestion after a rhinoplasty, my rhinoplasty patients are allowed to use Afrin nasal spray even in the first few days after surgery to try to decongest the nasal membranes and improve their ability to breathe through the nose.  Due to the fact that I never place packing in the nose, never place splints in the nose, and typically make a small drainage site for any excess fluid to escape from the nasal septum, patients rarely have complete nasal obstruction after a rhinoplasty procedure.  Nonetheless, if they are slightly congested, they can use Afrin early on and as I said, typically by 2 weeks I allow them to go ahead and use a nasal steroid spray directed toward the side of the nose.

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Yes, I am sure it is quite appropriate to undergo Botox treatment at the same time as rhinoplasty as long as the Botox treatment involves the upper third of the face or any other area of the fact that is not directly related to the nose.  I have had patients that requested Botox while they were under general anesthesia for a rhinoplasty; however, once they ended up following up with me and getting Botox in the office, they quickly realized that Botox is a nearly painless procedure when performed appropriately.  I personally use 32-gauge needles and a specialized injection technique to virtually eliminate any discomfort during the Botox treatment.  So, though Botox can be performed at the same setting as a rhinoplasty, I certainly would not postpone it just so you can have an injection while under general anesthesia as this, in my opinion, would be rather unnecessary.

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I typically tell my patients that after 2 months, 70 to 80% of the swelling will be gone and only 20 to 30% of the swelling will still be present.  This is for my average primary rhinoplasty with relatively normal thickness skin.  If a patient has extremely thick skin, I will actually tell them it will be 2 years before their final rhinoplasty result will be visible due to the fact that residual swelling in thick-skinned patients seem to take much longer than in patients with thinner skin.  You should; however, see the majority of improvement from the rhinoplasty within those first 2 months in that if you had an overly large nose, the nose should be quite a bit smaller and near the expected outcome by 2 months after the procedure.  I will mention that is it quite common to inject Kenalog or triamcinolone, which is a steroid, into swollen areas of the nose if the swelling does not spontaneously resolve. This is virtually an expected injection in patients who are undergoing a revision rhinoplasty and maybe a third of the patients who undergo primary rhinoplasty will end up with an injection of steroid in my hands, but I do request that my patients be rather patient as the final result from a rhinoplasty does typically take 1 to 2 years to be visible.

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Yes, it is definitely safe to do water sports a year after a rhinoplasty procedure.  In fact, most patients can go back to pretty strenuous activities within the first month of having the procedure done.  Certainly a year is more than long enough to allow for adequate healing and any sort of injury that could theoretically occur would not only injure an otherwise normal unoperated nose, but could theoretically also injure a nose that has undergone a previous rhinoplasty.  Typically after 2 weeks, the nasal bones are relatively well healed and certainly after 1 month they are very well healed and are very unlikely to be displaced due to some unexpected trauma.  That is why I typically allow my patients to return to overall normal activity including water sports within a month after the rhinoplasty procedure.

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AccuLift is a term trademarked by one of the laser companies that provides laser lipolysis, which is the dissolving of fat by the use of a laser.  In reality, this laser partially dissolves fat and then liposuction is used to clear this fat and, in the big picture, there is only minimal difference between a laser lipolysis liposuction procedure and a standard liposuction procedure.  The important part of any liposuction procedure is the contouring of the surrounding area and, in the face, this is especially important due to the smaller quantities of fat that are being manipulated and, thus, much smaller liposuction cannulas are used in the facial region as compared to the body.  I have personally been performing facial liposuction for over a decade and, up to this point, really have seen no added benefit that laser lipolysis gives to this otherwise successful procedure.  I have modified my techniques over the years, using smaller and smaller liposuction cannulas, so that areas such as the folds of the smile lines and even the small folds to the corner of the mouth can be treated via this removal of small quantities of fat.  The AccuLift has certainly gotten a significant amount of press lately but this is pretty typical of the cosmetic and rejuvenation industry in that, every so often, a newer technique or a newer name for an already existing technique or a modification to an already existing technique tends to be showcased by the press, mainly because of overall interest by the public in these types of procedures and certainly, frequently, it is due to unjustified claims that this is some sort of a superior treatment or product.  An AccuLift in essence is just a modification to liposculpturing, which has been around for many years.  I personally have treated many patients with liposculpturing techniques with excellent results without the need for a very expensive laser to assist in this process.  Ultimately, the cost of the laser gets passed on to the consumer and, unless the laser is providing some sort of a significant benefit, I really see no reason to invest in a very expensive laser just for marketing purposes.  Interestingly, the AccuLift procedure actually does not provide any significant lifting.  It only removes volume from the face in order to give the appearance of a jowl lift when, in fact, it is really a jowl reduction.  Nonetheless, this significantly improves the overall appearance of patients’ features when patients are appropriately selected for this type of a procedure.  It is a mildly invasive procedure in that there are very small incisions made to pass the cannula under the skin and remove fat.  One possible benefit is that the laser can theoretically heat up the underside of the skin and create some skin tightening, which would benefit patients with moderate skin laxity.  All in all, it is always very exciting to see new devices and procedures for facial rejuvenation but I feel that the buyer beware as many of these really hold no significant improvement over existing standard therapies.

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