4 months before and after of my wonderful patient who underwent a rhinoplasty. This is an incredibly wonderful patient of mine that underwent some changes to her dorsum and nasal tip to enhance her look while improving her breathing. She is still only 4 months out and still has some swelling that will only continue to improve! I feel blessed to be trusted with my patient’s appearance.
One of my patients underwent a rhinoplasty only 1 month ago. She just needed some tip refinement and a lowered nasal hump that made a world of a difference! It enhanced an already harmonious and aesthetically balanced face. You can appreciate the gentle slope of her dorsum and the refinement of her tip in her after photo on the right. I feel so fortunate to be trusted by my wonderful patients with their appearance.
The patient presented with complaints of an inability to breathe after a reduction rhinoplasty many years ago. She underwent a revision rhinoplasty to improve her breathing.
She had complete blockage of her nasal breathing from prior surgeries that left her nose weak and collapsed. In the past, rhinoplasty was performed by removing and weakening nasal cartilages and bones that was designed to give an aesthetically pleasing result, but over time would cause collapse and nasal obstruction. The patient presented here was overall pleased with her external nasal appearance but could not breathe. This is a challenging case as the internal structure of the nose needs to be reconstructed without drastically altering the external appearance, especially in a young female patient. .
In order to make the nose stronger and open up the breathing passages, grafts need to be placed. Typically in primary rhinoplasty septal cartilage is used. However, this patient was missing the majority of her septum. Instead, through a 1.2 cm minimally invasive incision, the patient’s own rib cartilage was used to reconstruct the vital structures of the nose. I employ a very special technique that is low risk, and adds nothing to the recovery post operarively.
The patient subsequently underwent major nasal reconstruction with an enhanced look to an already aesthetically pleasing nose, and breathing better in the process.
The patient presented with complaints of “looking tired”. She underwent upper eyelid surgery to give her a rejuvenated and refreshed look.
She was given a more youthful and refreshed look with youthful eyes.
Before and after of a young female that had an ethnic rhinoplasty. It is important to recognize inherent differences between people based on region of origin as this impacts the internal structures of the nose. A rhinoplasty should not be one size fits all. You should communicate with your physician your desired aesthetic goals. Many patients want to maintain their identity with slight enhancements. It is important to find a surgeon that understands these differences and can offer you the best possible care.
Thrilled to share before and after results of my patient after a revision rhinoplasty. The patient is a very pleasant 39 year old woman that came to me complaining of a long standing infection for a year. She had a rhinoplasty 17 years ago, in which the original surgeon placed a synthetic implant. This became infected about 1 year ago!
In her preoperative photos, you can see that she has swelling, redness, and drainage from her nasal bridge. She also has what we call “saddling” of her nose. This refers to collapse of the nasal bridge. The goals of treatment were to eliminate the infection, correct the nasal deformity, and maintain the integrity of her breathing. She underwent a rhinoplasty with me with rib reconstruction through a minimally invasive 1.2 cm incision.
It is important for patients to recognize that placing foreign and synthetic implants in the nose carries a serious risk of infection, not only at the time of surgery, but many years later. This patient developed an infection after 17 years! In my practice I see infections that arise on average 11 years after the original surgery! These are extremely complicated problems as antibiotics typically cannot resolve the infection, and the implant usually is a major supportive structure. This patient was on antibiotics for almost a year, that failed to clear the infection. She sought treatment from multiple surgeons who recommended removing the infected implant and allowing her to heal for 1 more year followed by a second surgery for definitive reconstruction. Looking at the intraoperative photos after implant removal you can appreciate the gravity of this approach. She would essentially have no nose for a whole year! I offered her implant removal with reconstruction during the same surgery.
Many times, patient’s are worried that implant removal will alter the shape of their nose. This patient was particularly worried because she liked her overall nasal appearance (minus the infection!). Fortunately, using the rib made her nose look even better, and I am pleased to say that she extremely satisfied with her results. Feel very fortunate and blessed to be trusted with a patient’s face.
1 month before and after pictures of my wonderful patient who underwent a Rhinoplasty. This is an incredibly wonderful patient of mine that underwent some changes to her dorsum and nasal tip to enhance her look while improving her breathing. She is still 1 month out and still has some swelling that will only continue to improve!
This young female patient that had a revision rhinoplasty with Dr. Mourad using her own rib. She came in 9 years after a primary rhinoplasty with another surgeon in New York City. She complained about her nose looking “deformed and unnatural”. The photo on the left shows her before photo. As you can see, she has asymmetry of her nasal tip. A functional and cosmetic surgeon Dr. Mourad looks at the “tip defining points”. These can best be appreciated by the reflective white light points at the tip. In her photo on the left, you can see that the patient’s right light point is higher then her left point. This was because her nose was twisted, with malformation and poor positioning of her cartilages.
Many years ago, when she had her original surgery, they removed cartilage that caused asymmetrical scarring and positioning of the cartilages as the years wore on. Over time, her nose began to droop looking unnatural. In her after photo on the right, you can see that her tip points are symmetric, with symmetric casting of light and shadows. Using her rib through a minimally invasive approach and access through a 1.2 cm incision, Dr. Mourad was able to recreate the natural contours of the nose. This photo is only 1 month after surgery, with still some swelling that should come down with time.
The patient is a 16-year-old female patient presented to Dr. Mourad for concerns with nasal breathing obstruction. She also complained of the appearance of her nose. The photo on the left demonstrates her preoperative view. She stated she did not like that her “tip was so big”, in addition to complaining of her tip “drooping.” The evaluation revealed the patient to have a bulbous tip. Dr. Mourad met with the girl and her family many times to help understand her complaints and understand her and her families expectations. After careful discussions with the family, she decided to undergo a closed rhinoplasty. This minimally invasive rhinoplasty, allowed for the patient to undergo the necessary modifications that maximized her outcome without compromising her future development. The photo on the right demonstrates a more refined and narrower tip, that is straight, without the “bulbous appearance” seen in the left photo. Her tip is also at a higher position, more elevated, and less droopy then seen in the preoperative photo. Her breathing is also improved after Dr. Mourad corrected her nasal airway obstruction internally.
This is a 41-year-old female who presented 1 year after rhinoplasty with complaints of 100% nasal blockage and unnaturally appearing nose.
Left Photographs: This photo shows her at presentation to Dr. Mourad’s office 1 year after her initial surgery. The black arrows show that she had an excessive amount of her nose removed externally, causing significant scarring and contracture. This scarring narrowed her nostrils and contributed to her inability to breathe. The blue arrows show that her nose has incomplete breaks in her nasal bones causing nasal valve collapse, further making her breathing worse. In the lower picture, the purple curved arrow also shows that she has a “droopy” tip that hangs low. The deformity is also from excessive resection of the internal structures of the nose. The blue star in the photo on the profile view also shows that the previous surgeon had left a bony hump, that also was made to appear worse by the droopy tip.
Right Photographs: This is a patient 1 year after surgery once the final healing has settled in. The purpose of the surgery was to restore her ability to breathe. The patient underwent a complete nasal reconstruction using her own rib. The orange arrow shows that her nasal tip was restored to a more natural, “higher”, position, no longer with a deforming “droopy” look. Her nasal tip has smoother contour. Her ability to breathe has been completely restored with improvement in her nasal valve structures.
This case demonstrates a 57-year-old woman that presented to Dr. Mourad after septal perforation secondary to a nasal surgery with a different surgeon many years before. Her complaints were nasal crusting, frequent infections, and bleeding. She attempted to use humidifying measures including ointments, humidified air, and nasal saline, which did not resolve her symptoms. The perforation is larger. The photo on the left demonstrates the 1.5 cm perforation as seen through the left nostril. Her repair required the use of a regional flap, using a right-sided Pedicled Inferior Turbinate Flap. The photo on the right demonstrates the immediate repair of the perforation intraoperatively.