Rhinoplasty (Nose Job, Nose Surgery) Questions and Answers

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Question:

I was told that the left side of my jaw has not developed since I was a elementary age child or before, and diagnosed with TMJ symptoms. I have had artherosentesis and therapy and a nerve block. Is there anything I can do to ease the pain, or to stimulate bone growth?

Answer:

The only way to get both sides symetrical is with surgery. Get the TMJ symptoms under control before proceeding to surgery. I would recommend discussing options with your oral surgeon.

Question:

I have a cyst(hard) in my right cheek, over my sinus cavity and need to have it surgically removed. It is about the size of a quarter, but feels like it goes deeper than that. Should I have an ear, nose and throat surgeon do the surgery or an experienced plastic surgeon do it? I have seen an eye doctor (since it is located under my eye also) and he was going to do it, but my insurance will not let an ear, nose and throat surgeon assist him during the procedure. Plus, they will have to cut the outer corner of my eye, then pull down the skin to remove it. This sounds like it would be awful! They said the worst that will happen is I would have some bruising around the outside of my eye. Please give me your input on this and who I might go see to take care of this. It makes me feel terrible to have something like this on my face and I really want it taken out, but I am scared to have surgery on my face. Input, PLEASE!!!!Thank you so much..............

Answer:

Dear Kimberley, I take it that the cyst is a benign growth and not a cancer and that it is localized under the skin so that there will be no skin defect once it is removed. I would suggest that, at least, you get an opinion of what in involved in the removal, in terms of risks and goals from a plastic surgeon. Hopefully, there is one which will be covered by your insurance plan.

Gregory Caputy, MD, Chief Surgeon
Honolulu, HI

Question:

I have chronic sinusitis, and have been fighting a rather severe infection since August. I began to have dizziness, and my optometrist diagnosed what appeared to be a 3rd nerve palsy, however, I've just seen a neurologist who thinks I should have a brain MRI, and apparently suspects a lesion. He is also looking for the cause of a ptosis! If a lesion is found would surgery be required?

Answer:

It depends on where the lesion is and what the lesion is.

Question:

There is an area on my back that at one time was a painless lump the size of a dime it is now red, swollen, and has caused tenderness around the area, I was told by one person that it was a white mole and someone else said it was a cyst that has become inflammed? What does it sound like to you?

Answer:

Dear Jay...being a Nurse, I can't diagnose but...working at the VA Hospital Surgical Clinic, I saw lots of cysts like you describe. What we usually saw were hair follicles that became infected, producing fluid that caused the swelling and redness. If it is a cyst, it may need to be removed. We frequently removed them in our minor surgery clinic...not a big deal...Sometimes they resolve on their own, but, I would recommend you have it checked out by your family physician and see what he says... Good Luck Julie Adinolfe RN AskANurse

Question:

I have been seeing Doctors for about 2 1/2 years now. This has resulted in many tests with no results. Here are the symtoms that I have on a daily basis. 1) BAd tasting mucus from my sinus'. 2) Ears are plugged (like on an airplane) can't get them to open up, has pressure. 3) Excessive under arm sweat, just sitting doing nothing, armpits become soaked. 4) Bleeding from fishers while useing the rest room. 5) Soft stool with a really bad oder. 6) Oil floating in water from stool. 7) Sense and feeling of not getting a full breath while breathing. I have had surgery for Reflux (full nissan), colon probe, allergy tests, several blood test, PH monitor after the nissan surgery and head and neck CAT scan. I would try and consider any suggestions at this point, I'm running out of options and Doctors. Can you please help me? I really think all my symtoms are related somehow. Carl

Answer:

HI Carl...just got an answer back from our Allergist....Dr. William Holland..He states..."I don't think all are connected. GI symptoms are of malabsorption, many causes, see GI specialist. Sinus, ear symptoms could be due to sinusitis (should have been seen on cat scan) or a tumor in the nasopharynx (needs to be scoped by Ear nose and throat specialist). Hope this helps alittle more.. Julie Adinolfe RN AskANurse

Question:

I have Hidradentis Suppurativa. I also have Diabetes. My family doctor is recommending surgery. I'm having a hard time finding out any information about Hidradentis. Could you please give me some information about this condition and the pro and con of surgery. THe surgery would be the nodes in my groins. Thank you for any help you can give me.

Answer:

Here is an archived Q&A that should give you some good info from Dr. Taub. Question: Oct 08, 2001 My father in law has been diagnosed with hidradenitis suppurativa and has had 20 surgeries to help out with his pain. It has reached a point where the pain has become unbearable for him. He has lost a lot of weight and the condition is spreading. Do you have a name of a doctor who can help him? Is there anything that we can do to get him to feel a liitle better? We are desperate... Answer: I am so sorry to hear that your father-in-law is in such terrible discomfort. I did a literature search and found that there are really two main treatments for hidradenitis. One you might consider is oral isotretinoin, brand name Accutane, which is usually used for severe acne but has been shown to be successful in suppressing (not curing) the symptoms of some cases of hidradenitis. The most widely accepted treatment, however, appears to be radical surgery, that is wide excision of the entire skin surface in the affected area. With 20 surgeries behind him, it doesn't sound like this option is going to be one that gives him much hope. The authors that were associated with these papers about surgical procedures included Drs. Ratz and Finley at the Department of Dermatology at the Ochsner Clinic and Alton Ochsner Medical Foundation in New Orleans, LA and Drs. Brown, Rosen and Orengo, from the departments of dermatology at Baylor College of Medicine and Veterans Administration Medical Center in Houston Texas. Perhaps contacting one of these doctors for consultation on your father-in-law's case would prove fruitful. In addition, please have him checked carefully as squamous cell carcinoma, a type of skin cancer, can develop in long-standing open wounds. If he has hidradentis in the groin, he also may need to be evaluated by a gastroenterologist as this has been associated with rectal cancer. Good luck! Amy Taub M.D. Hope this helps you. Good Luck. Julie Adinolfe RN

Question:

All my life i have had a large raised mole on my nose. It is about 6 millimetres all the way around and i hate it. It makes me feel unattractive and whats more i often worry that one day it may become cancerous. My mum says because i've had it all my life it'll probably be fine because its sort of like a birth mark, but that still doesn't solve that fact that i hate the way it looks. Whenever i meet someone new i can always tell that they are looking at it and it makes me feel selfconsious and embarrased. Because its so big would it be possible to have it removed? would i need plastic surgery? the thought of a big operation really scares me.

Answer:

Dear Sarah, You mother is right and there is only a slight chance of this becoming a cancer, however, appearance is very important and I understand how you would like it removed. The procedure would not be a big one but that area is particularly difficult to remove a largish lesion from without special techniques. I would suggest that you visit with a plastic surgeon in your area to discuss the options. Unfortunately, lasers, dry ice, etc. will not permanently remove a mole and so surgery is necessary.

Gregory Caputy, MD, Chief Surgeon
Honolulu, HI

Question:

Yesterday I was referred to the local emergency room by my ppd for the lancing of an infected boil under my arm. The e.r. doctor sliced it open (extremely painful) He diaognosed it as Hidradenitis suppurativa explaining that the ducts become blocked creating bacteria and pus. Two questions: 1) Can I continue to work out at the gym thereby creating lots of sweat or is that bad for the condition? 2)What action if any can I do to prevent reoccurances? Please advise post haste. Thanks much, Susan

Answer:

Sorry to take so long for the answer. I would get some topical antibiotics like Clindamycin solution (you'll need a prescription) to use regularly as well as buying baby powder cornstarch to put under the arms before you work out. The sweating isn't inherently bad but the sweat rubbing agains the skin is. Hook up with a dermatologist (go to www.aad.org to find one in your area) to help you to deal with this problem, which tends to wax and wane and may require periodic oral antibiotics. Sometimes Accutane, an oral medication which is a Vitamin A deriviative can help and occasionally people get surgery to remove all the glands from under the arms to prevent this from occurring.

Amy Taub, M.D.
Lincolnshire, IL

Question:

My father in law has been diagnosed with hidradenitis suppurativa and has had 20 surgeries to help out with his pain. It has reached a point where the pain has become unbearable for him. He has lost a lot of weight and the condition is spreading. Do you have a name of a doctor who can help him? Is there anything that we can do to get him to feel a liitle better? We are desperate...

Answer:

I am so sorry to hear that your father-in-law is in such terrible discomfort. I did a literature search and found that there are really two main treatments for hidradenitis. One you might consider is oral isotretinoin, brand name Accutane, which is usually used for severe acne but has been shown to be successful in suppressing (not curing) the symptoms of some cases of hidradenitis. The most widely accepted treatment, however, appears to be radical surgery, that is wide excision of the entire skin surface in the affected area. With 20 surgeries behind him, it doesn't sound like this option is going to be one that gives him much hope. The authors that were associated with these papers about surgical procedures included Drs. Ratz and Finley at the Department of Dermatology at the Ochsner Clinic and Alton Ochsner Medical Foundation in New Orleans, LA and Drs. Brown, Rosen and Orengo, from the departments of dermatology at Baylor College of Medicine and Veterans Administration Medical Center in Houston Texas. Perhaps contacting one of these doctors for consultation on your father-in-law's case would prove fruitful. In addition, please have him checked carefully as squamous cell carcinoma, a type of skin cancer, can develop in long-standing open wounds. If he has hidradentis in the groin, he also may need to be evaluated by a gastroenterologist as this has been associated with rectal cancer. Good luck!

Amy Taub, M.D.
Lincolnshire, IL

Question:

Hi Dr. Amy, I wanted to let you know that my husband went to the surgeon, the surgeon told us that the size of the melanoma was 0.8 and that it is stage 1 level 4. I know the staging part but do not understand the level part. He also did tell us about the eyes and we are getting that checked. My husband goes for surgery on Oct 8th, and they are shooting a dye into his back to see which lymph nodes if any the melanoma would spread to and possibly remove them. they are also doing a chest xray and blood work this week. I guess my question is once that gave it a stage does that mean it hasnt spread anywhere? or wont they know that til the surgery? my husband is very upset and I dont know what to do to comfort him, he is a smoker also so he is worried about that. thanks! amy

Answer:

The most important piece of information is that the melanoma is 0.8. This is relatively good news, since the tumor was not that deep. Depending on which scales you go by, less than .76 is the best, .76-1.5 is next best, 1.5-4 is third and over 4 is worst. Some, though make the first cutoff at 1.0 and your husband would be below this. The next most important information will come when they do the sentinel lymph node (dye in his back). If negative, this would be the best news and his risk of it having spread would be very small, since it would have spread to this lymph node first. If positive, one has to assume then that the melanoma has spread, and he would need some type of further treatment to kill off the cancer cells, such as chemotherapy, usually with a drug called interferon. Stage 1 means no clinical evidence of disease spread (can't feel lymph nodes), level 4 means that although the tumor was relatively thin, is went down fairly deep into the skin. I find this odd however because if the melanoma is on his back where the skin is thick then 0.8 and level 4 don't go together. It would be great for your husband to quit smoking, although it would be a difficult thing to do right now. But it would make him feel like he was doing something positive for his health. Try to distract him and give him things he likes, take him to movies or watch sports with him and try to be strong yourself and reassuring, even if you don't feel that way. It is very frightening to be diagnosed with cancer, but most people with melanoma survive and he has a very good chance, too! The surgery itself is not difficult. It sounds like his surgeon is doing all the right things.

Amy Taub, M.D.
Lincolnshire, IL

Question:

I have had a rhinoplasty, and I am unsatisfied with the results. My nostrils are uneven, and the bridge of nose is also uneven(one side is flatter than the other). I am considering having a revision rhinoplasty. But I am afraid my nose might look worse. What would you suggest?

Answer:

Dear Desiree, Unfortunately, rhinoplastic surgery is one of the procedures where there are often touch-ups and secondary procedures required in order for you to get the results that you desire. I would suggest that you visit with the surgeon who originally performed the surgery in order to see if he/she would perform the necessary revisions at a reduced cost (if you are comfortable with that surgeon).

Gregory Caputy, MD, Chief Surgeon
Honolulu, HI

Question:

I have been having headaches which have been diagnosed as tension/migraine combos. They have been getting progressively worse. They are here almost 24/7. If I awake w/o one, one comes on within an hour. My last migraine was an 11 day one, which just ended. I have seen a specialist who has almost given up on me & a neuro, who only advised I see a pain management doc. My MRI shows I have degenerative disc disease, but only mildly...normal for a person my age, I was told (I"m 45). My headaches get strong in my neck & wind up turning into migraines as they progress. I turn to the possibility of TMJ because most other options have been excluded. One main reason I am considering this is that I had brain surgery 8 1/2 years ago, removing my right temporal lobe & successfully ending 36 years of seizures due to epilepsy. BUT to get to my RTL, part of my upper jaw had to be removed & replaced. Chewing gum has given me headaches ever since then. I eat 2 apples every morning for breakfast & that seems to bring on the initial pain. If I can't get it under control, it spreads down my neck and up my head, turning into the tension/migraines. The tension in my neck seems to aggrivate the degenerating discs & making neck pain worse. Most of the time, no OTC meds will get my pain under control in time. I've lived on OTC meds for so long that my system is immune to them. I had a CT scan to check for tumors & the radiologist wanted to know what on earth happened to my head. I had told him about brain surgery, but failed to mention my upper jaw removal at the time. When I told him of it, he just kinda nodded & didn't mention TMJ possibilities. I was about to see an allergist & get checked for food allergies when I thought about the possibility of TMJ. Do I need to see a dentist to be checked for it? Can my regular dentist advise me yea or nay about seeing an oral surgeon? I'm searching for answers & am tired of 24/7 headaches for the past 3 years. I failed to mention that there is a very sensitive spot right above my right ear, which is extra sensitive during headaches. I have always attributed it to the jaw removal. I have not had jaw locking problems. If you can help me, PLEASE do. Thank you very much. Sorry if this is too long. Jacque

Answer:

The jaw removal may have something to do with it but I would suggest that you see your local dentist. I am going to refer you to a web site (www.drjimboyd.com) for more info on an appliance that may help you with the headaches. This device is called a NTI that is worn like a splint but has better success with treating TMJ problems and headaches. Good luck.

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