Narrator: What factors contribute to a successful nose job?
Robert Kotler, MD: At consultation, the evaluation includes a lot of factors some patients aren't aware of. It's not just the shape or size of your nose,it's the quality, the material there that is available to work with.
Robert Kotler, MD (cont.): For example, thick oily skin tends not to drape down, it tends not to shrink down, even though you shave down the bump and narrow the tip.Because what you are doing is narrowing the under the surface structures, the bone and the cartilage.But the upholstery, meaning the skin, it does best when it's thin and will shrink down uniformly and give a nice contour. So thick skin is a bit of a challenge for us.And oily skin has a greater tendency to have breakouts and all those things that kind of can be a bit of a hassle for the patient.
Robert Kotler, MD (cont.): And the other question is even the strength of the cartilage, because strong cartilages are really ideal, because you can work with them easier.People that have very soft cartilage, there's a very narrow window in which you can work,because if you're a little over zealous and take out too much, that cartilage is so weak that often the nose will kind of start to collapse and dip down.
Robert Kotler, MD (cont.): You've got to factor all these things into your decision making, but that decision making is done really at the time of consultation.That's where our most intense thoughts are being hatched because we have the patient in front of us. We have the ability to feel, to look, size up the situation.We need to look inside the nose and see if there's blockage because often if you make the nose a little narrower and the airway isn't so super to begin with,the patient may note afterwards that my breathing isn't quite as good as it was before, what's going on here?So that patient may need to have the discussion about, I think we need to open up your air passages a little bit while we're there, because after all, the nose is still a functional organ.Regardless of how good it looks, if it doesn't work, the patient is not going to be happy.