Is My Nose Broken?

Broken noses happen.  Pretty frequently in fact, especially in individuals who have a propensity for getting hit in the face (hello, contact sports!)  But I think there are a lot of misconceptions out there about how to tell if a nose is broken, and what to do about it.

Broken noses can be difficult to diagnose.  The bones are very thin, so x-rays are not helpful in determining if a nose is broken.  Yet I still see patients in my office who are x-rayed by well-meaning ER physicians.  My first piece of advice for you today- if you go to the ER with a possibly broken nose, and the doctor orders an x-ray, politely decline.  It’s just not useful, and whatever specialist they refer you to (Plastics or ENT are the options) will not need the films.  Or the ER may order a CT scan- this is useful if the doctor suspects you may have broken bones in your face other than your nose.  But if the nose is your only injury, CT is overkill.

Here’s my second piece of advice for you today: the important question is actually not if the nose is broken, but whether or not it needs treatment.  A broken nose may need to be treated operatively for two possible reasons:

broken nose - shutterstock.com

broken nose – shutterstock.com

  1. If the nose is crooked.  It may appear flattened, or pushed off to one side. Check out the photo to the right to see what I mean- this nose is definitely broken. (Does anyone else wonder why Shutterstock has stock photos of broken noses?)
  2. If there is breathing obstruction.  There will be some breathing obstruction for the first 7-10 days due to swelling, but this should resolve as the swelling goes down.

Treatment of a broken nose involves a trip to the operating room, where your nose and septum are straightened out. This should be done within about three weeks of the injury, or the bones will have started to heal.  Afterwards you have a splint over your nose, and packing inside of your nose.  This packing stays in about a week, and the external splint stays on for about two weeks.

If your nose looks like it did before you got hit, and you are not having difficulty breathing, then you don’t need treatment even if your nose is actually broken. It will heal on its own over a period of about 6 weeks.  I would recommend not getting hit in the face during that time period, although honestly I have a general policy against getting hit in the face at all.

 

Have you ever had a broken nose?  How did it happen?

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

What is the Difference Between Botox, Dysport and Xeomin?

Botox® Cosmetic entered the market in 2002, when it was FDA-approved for the treatment of glabellar frown lines (between the eyebrows).  It was the only player in the game until 2010, when Dysport® was FDA-approved for the same indication, with Xeomin following closely on its heels.

botox bottle

So what is the difference between the three, and why should you care?

Let’s answer the second question first.  You, the consumer, may come across the other neurotoxins, Dysport® and Xeomin®, because they are often offered at a lower price compared to Botox® Cosmetic.  Knowing a little bit about the three medications allows you to make a more informed decision, rather than just assuming that Dysport® and Xeomin® are “alternative brands of Botox”.

This brings us to the first question- how do the medications differ?  Dysport® and Xeomin® are only FDA-approved to treat glabellar frown lines, but Botox® Cosmetic is also FDA-approved to treat crow’s feet.  This additional FDA approval means that Botox® Cosmetic has been studied more thoroughly than the other two medications for safety and effectiveness.  This doesn’t mean you can’t use Dysport® or Xeomin over crow’s feet, or Botox® Cosmetic over the forehead, but this is considered an off-label use.  All three neurotoxins work by blocking cell acetylcholine receptors, resulting in muscle paralysis where the medication is injected.  But the three medications differ in how they are made, how they are processed, and what inactive ingredients are part of the formulation.  These differences mean that the three neurotoxins are not interchangeable.  So it is important that your physician be very experienced in whichever neurotoxin he or she is using.

Experience injecting Botox® Cosmetic does not translate to being able to provide safe, consistent results with another product such as Dysport®.

The dosing is also different between the products: Dysport® often requires over twice as much product as Botox® Cosmetic, so even if the per unit price is half the cost of Botox® Cosmetic, you may end up paying more.  If you are considering one of the other neurotoxins, I recommend asking your injector how much experience he or she has with that specific medication, and what the estimated price would be for the area you would like treated, not just the per unit price.

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

What is a Mini-Brachioplasty?

An arm lift, or brachioplasty, is an operation to remove excess skin over the upper arm.  This is commonly done after weight loss, but may also be done to remove the “bat wings” that develop in aging arm skin.  In a traditional brachioplasty, excess skin is removed along the entire length of the upper arm (see the area marked out in blue on the diagram below).

original photo from shutterstock.com

original photo from shutterstock.com

This results in a scar which is very noticeable.  Not only does it run down the back or inside of the entire upper arm, but scars in this area tend to widen and thicken as well.  Some patients are turning toward a mini-brachioplasty to avoid this significant scar.  In a mini-brachioplasty the incision is horizontally oriented along the edge of the underarm area, making it much less visible. This is only able to remove excess skin from the proximal part of the upper arm, right near the underarm (the area marked in green on the diagram).  The mini-brachioplasty may also be combined with liposuction to address excess fat further down the upper arm.  Not everyone is a candidate for the mini procedure, however, as it only addresses excess skin over the upper ⅓ of the arm.  If there is excess skin along the entire upper arm, a traditional brachioplasty would still be needed.

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Will I Have Wrinkles After a Facelift?

Facelifts are a very popular and very common plastic surgical procedure; they were one of the top five most popular cosmetic surgery procedures in 2010.  Despite this popularity, there are many misconceptions about what exactly a facelift does.  Patients often expect that having a facelift will rejuvenate everything from sagging eyelids to loose skin over the neck, but this is actually not the case.  A standard facelift addresses only the mid-face: the area from your cheekbone to your jawline.  The main area of improvement is along the jawline where jowling starts to show as we age.  Facelifts may also soften the lines around the mouth.  Any lax skin over the neck or under the chin is treated by a neck lift.  This is commonly done at the time of a facelift, but is actually a separate surgical procedure.  Facelifts do not address the forehead, eyelids, or overall skin texture, a fact which surprises many of my patients.  To treat these areas may require additional surgical procedures, such as a brow-lift or eyelift.  Overall skin texture is generally treated by a laser peel. Look at the graphic below, and you will see that several separate procedures are actually required for “full-face” rejuvenation.

 

original image from shutterstock.com

original image from shutterstock.com

I think that part of this common misconception may be due to advertising.  I have seen many before and after pictures on television and in magazines advertising a facelift, but if you read the fine print, the patient actually had several other procedures done in addition to the facelift.

 

Do you have any questions about facial rejuvenation?

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

What Can I Do About Saggy Breasts?

Deflated, ptotic (saggy) breasts are a common complaint, especially after having children.   So how do we reverse this process?  Like many things in Plastic Surgery, the technique for correction depends on what is causing the problem. Two factors contribute to this complaint:

courtesy of office.com

courtesy of office.com

  1. Loss of volume.  Breasts change size with puberty, pregnancy, and changes in weight.    They may actually be smaller, or they may just appear smaller (see #2 below).
  2. Ptosis.  This describes the actual droopiness of the breasts.  Medically speaking, there are three grades of ptosis.  In grade I ptosis, the nipple is at the level of the inframammary fold (the skin crease below your breast).  In grade II ptosis, the nipple is below the inframammary fold.  In grade III ptosis, the nipple is at the lowest point of the breast.  Severe ptosis can make a breast appear smaller because all of the volume is spread out, and sitting lower on the chest wall than it should be.

It is possible to have only volume loss, only ptosis, or a combination of the two.  If the only problem is lost volume, then a breast implant will correct this by filling out the excess skin.  If ptosis is the issue, then the treatment is a mastopexy.  This involves an incision at least around the nipple.  For more severe ptosis, the incision may be extended down the breast and even along the inframammary fold, similar to the anchor style incision used in breast reduction.  Moving the breast tissue back where it belongs will make the breasts appear fuller.  If volume is still deficient, however, then a breast implant may be needed in addition to the mastopexy.

Mastopexy and breast augmentation is frequently done as a single operation, if the ptosis is fairly minor (e.g. grade I ptosis).  But correction may require two separate stages if the ptosis is very severe (e.g. grade III ptosis).  This is because a mastopexy has the goal of lifting the tissue, but adding an implant at the same time adds weight.  This added weight can compromise the results of the mastopexy, leading to a less optimal result than if the mastopexy is done first and the tissue allowed to fully heal before placing the breast implant.

 

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.