Posts Tagged "Dr. Karan Dhir"


Rhinoplasty for long nose aims to provide results that are ethnically consistent with the rest of the facial features and the patients’ gender and body frame (particularly their height).

But what makes a nose look disproportionately long?

rhinoplasty for long nose

Before-and-after photos of a rhinoplasty patient with long nose

A long nose is often described as having a droopy tip or over-projective tip, or even both.

While a nose whose tip droops significantly looks unflattering in men and women, it has a more detrimental impact on femininity. Because female faces in general are smaller than male faces, a nose that is long and big looks out of sync.

One of the key variables that determines the amount of reduction is the patient’s gender. According to studies, male noses look attractive if they have a straighter profile, or an angle of rotation that is about 90 degrees; however, their tip can tolerate a slight droop without obviating their level of attractiveness.

Women, meanwhile, will look more attractive if their nose is slightly upturned—or having an angle of rotation that is between 95 and 110 degrees—leading to a shorter, “cutesy” nose.

Aside from gender, the skin thickness will also play a crucial role in determining the ideal length and projection of the new nose. It is important to note that a markedly thick skin does not fare well with excessive reduction due to risk of amorphous appearance especially at the tip.

The patient’s age is another key factor. In general, an older patient has a slightly longer nose, which tends to lengthen with time, compared with a younger person. Due to aging, the “connections” holding the tip cartilages weaken, leading to a droopier nasal profile.

Even if the main goal of rhinoplasty is to shorten the nose, seniors may have their new nose appear longer than the teenagers’ to achieve an age-appropriate, natural-looking result.

It is not uncommon to combine rhinoplasty and facelift surgery in one surgical setting to achieve a more youthful and balanced result, as suggested by leading Beverly Hills plastic surgeon Dr. Karan Dhir.

Sometimes, a nose surgery is necessary to improve breathing functions affected by the age-related drooping of the tip. But to achieve long-lasting effects, it is a sacrosanct rule to create a strong cartilaginous framework to support the new contour, which is typically done through grafts—i.e., using donor tissue from the nose itself, behind the ear, or rib.

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Rhinoplasty price range greatly varies depending on the extensiveness of the surgery, surgeon’s reputation, use of implants and other medical devices, and geographic location. For instance, the cost of minimal correction may be around $3,000, while a procedure that requires a great deal of improvement might cost up to $15,000, especially if the surgeon’s clinic is in a posh area.

Dr. Karan Dhir, one of the leading Beverly Hills plastic surgeons, explains the factors that have the most influence on the rhinoplasty price range.

rhinoplasty price range

  • Geography

Posh areas and large cities where the demand for plastic surgery is high generally translate to a higher cost.

While it is ideal to have one’s surgery performed by a local doctor, sometimes it is necessary to travel long distances if the patient thinks that there is no qualified surgeon nearby.

However, traveling long distances for “cheap” plastic surgery without taking into account the surgeon’s qualifications and experience does not equate to good value. In fact, a price tag that is way below the average could mean that patient safety has been compromised.

  • Amount of correction

A complex nose surgery will almost always cost higher compared with minimal refinement due to longer operating time and more extensive surgical maneuvers.

  • Insurance

If rhinoplasty is performed at the same time as septoplasty or other procedures in which the goal is to improve breathing functions, this could lead to a lower overall cost if insurance coverage is applied.

  • Surgeon’s fee

Rhinoplastic surgeons who cater to high-profile clients may charge higher than doctors who serve middle-class patients. Nevertheless, an exorbitant fee does not necessarily mean better results, qualifications, education, and training.

According to surveys, most rhinoplastic patients can expect to pay anywhere from $3,500 to $6,500.

It is important to choose one’s surgeon based on qualifications, with price being just a secondary factor. It is important to note that poor or unsatisfactory results will require revision surgeries that are almost always more expensive than primary rhinoplasties.

Aside from being more expensive, revisions also result in longer recovery and higher risk of complications due to additional scarring and the fact that the baseline of the nose has already been altered by the initial surgery.

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A revision rhinoplasty on thick skin poses certain challenges. First and foremost, the overlying skin makes it difficult, or sometimes impossible, to show a high level of refinement.

Nonetheless, most patients can still expect a great deal of improvement after a revision rhinoplasty or corrective nose job.

revision rhinoplasty on thick skin

To achieve good results, primary and revision rhinoplasties should ensure that the overlying skin can “shrink wrap” around the altered bony and cartilaginous framework. For this reason, over-reduction and over-narrowing will not provide any real benefits to patients with thick nasal skin.

Leading Beverly Hills plastic surgeon Dr. Karan Dhir warns that a thick nasal skin will not redrape well over the altered framework after an over-aggressive surgical maneuver, leading to an amorphous-looking tip.

Having a thick skin also results in longer recovery and more postop swelling and bruising. But regardless of skin thickness, most patients will look socially presentable at 2-3 weeks since the external swelling tends to dissipate quicker as compared with the internal swelling.

Despite the challenges brought on by thick skin, it is good at concealing minor irregularities that could easily show through a markedly thin skin.

Aside from skin thickness, the number of nose surgeries can also influence the length of recovery. In general, a person who has had multiple revisions should expect longer healing period.

Revision rhinoplasty on thick skin is inherently challenging because the baseline of the nose has already been altered, and the presence of scar tissue makes the skin harder to work with.

Aside from careful placement of incisions, steroid injections after a revision surgery can also minimize scarring. In addition, this treatment is known to control the amount of swelling especially at the tip, leading to quicker recovery.

A good revision rhinoplastic doctor will make every effort to avoid additional scarring, which can alter the way the nose heals and settles.

To achieve good definition and preserve the structural integrity of the nose, adding cartilage grafts—which are natural tissues from donor sites such as the septum (wall between the nostrils), ribs, and bowl of the ear—is common in revision rhinoplasty.

Preserving the structural integrity of the nose also ensures that the results can last a lifetime, look natural relative to the rest of the facial features, and less susceptible to the effects of aging, which are the main goals of any sensible surgeon.

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Having a thin skin and rhinoplasty (nose reshaping surgery) has its own benefits and downsides as well, which can be avoided or at least minimized by acknowledging the patient’s underlying anatomies.

Dr. Karan Dhir, a reputed Beverly Hills plastic surgeon, explains the pros and cons of having a thin overlying skin.

thin skin and rhinoplasty

Pros

  • Shorter recovery

Thin skin, which is commonly found in Caucasian patients, experiences less postop swelling and bruising and redrapes quicker than thick nasal skin.

At three weeks, about 80-85 percent of the swelling is gone that the vast majority of patients, regardless of their skin thickness, can resume social activities without drawing some unwanted attention.

But in general, most will need at least nine months for their skin to fully redrape to the new contour, while patients with markedly thick skin may even have to wait two years to see all the “details” brought on by their surgery.

  • High degree of refinement

Thin skin can show a high degree of refinement as it can easily and quickly shrink down to the new contour. For this reason, patients with this anatomy can tolerate more narrowing or reduction compared with individuals with a thick nasal skin.

Nevertheless, the amount of reduction, narrowing, and refinement should still be in line with the patient’s cosmetic desire, gender, ethnicity, and facial features.

Cons

  • Less forgiving

Thin skin is less forgiving, i.e., minor irregularities that are easily camouflaged by moderate or thick skin can easily show through its surface. As a result, there is almost no room for error if the goal is to achieve smooth results.

On certain occasions, rhinoplastic doctors use soft tissue replacement such as acellular dermal matrix and fascia to conceal minute irregularities and create a smooth result.

Note:

Aside from skin thickness and other nasal anatomies, Dr. Dhir highlights the importance of taking into account the patient’s gender, cosmetic goals, ethnicity, and facial features (and their spatial relationships from one another).

In general, ethnic patients have thicker nasal skin compared with Caucasians, so they often require a more conservative approach. For these individuals, excessive narrowing or reduction almost always leads to ethnically inconsistent results and ill-defined tip as the skin in the area is unable to redrape to the altered framework.

It is important to get the best possible results the first time around because revisions are inherently more difficult and involve longer recovery period than primary nose surgeries.

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Good cosmetic results from rhinoplasty and breathing without difficulties are the two main goals of any prudent plastic surgeon who specializes in nose reshaping surgery.

However, it is not uncommon to experience mild nasal congestion in the first few weeks after surgery, which is supposed to improve as the swelling subsides, as suggested by Beverly Hills plastic surgeon Dr. Karan Dhir.

rhinoplasty and breathing

In the past, nasal packing was typically used after surgery, which could lead to congestion and breathing difficulty until it was removed, typically at the end of the first week. But it is rarely used nowadays unless in situations in which there are excessive bleeding.

For this reason, most rhinoplastic patients today can breathe through their nose immediately after their surgery.

While nasal packing is rarely used today, “outside” splints and tapes are still needed in the first 5-7 days to support the new contour. But after their removal, the amount of swelling may slightly increase, leading to congestion or “stuffy” nose.

To improve healing during the initial healing stage, Dr. Dhir recommends keeping the swelling to a minimum, which can be done through icing, head elevation, and possible use of herbal supplements such as Arnica Montana and bromelain. (Note: Not every surgeon recommends homeopathic remedies since incorrect or prolonged use could affect healing.)

Minimizing physical activities and avoiding heavy lifting and bending at the waist at least in the first three weeks can also prevent persistent swelling and bruising and lead to quicker “social” recovery.

While it is normal to have temporary minor congestion, long-term breathing difficulties are a cause for concern, some of which may not be due to original surgery. For instance, the nose may heal in an unexpected way or the patient has encountered trauma during healing.

However, breathing difficulties after surgery are very rare if the surgeon has preserved the structural integrity of the nose, i.e., using supportive grafts and avoiding over-aggressive surgical maneuvers. These techniques could also slow down the aging process.

Meanwhile, it is important to note that sinus problems, allergies, and nasal polyps can also cause nasal congestion, which makes it important to ask for an evaluation performed by an otolaryngologist.

The results of rhinoplasty are supposed to be near permanent, although aging will still affect the nose, depending on the skin thickness and other anatomies.

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