Dr. Shapiro Interview - Chat

 

Chat - Start

Thu May 24 01:00:30 2001-general-Dean: M-are you joining in Romano's chat?
Thu May 24 01:00:34 2001-postop-||||||||| Sally just entered this channel.
Thu May 24 01:00:41 2001-general-||||||||| Sierra just entered this channel
Thu May 24 01:00:59 2001-revision-Sally: hi Thu May 24 01:01:09 2001-general-||||||||| susan w. just entered this channel
Thu May 24 01:01:27 2001-general-||||||||| Dr. Romano just entered this channel
Thu May 24 01:01:57 2001-general-Marianne: Hi Dr. Romano!
Thu May 24 01:01:57 2001-general-Dean: Hi Dr.Romano,we'll go into the revision room if that's okay
Thu May 24 01:02:05 2001-general-Marianne: okay i am off to the revision room - see you all later
Thu May 24 01:02:09 2001-general-susan w.: A very happy belated birthday to you Miss M!
Thu May 24 01:02:10 2001-revision-||||||||| Marianne thank you susan!
Thu May 24 01:02:10 2001-revision-||||||||| Marianne just entered this channel.
Thu May 24 01:02:24 2001-revision-||||||||| Sally just entered this channel.
Thu May 24 01:02:26 2001-revision-||||||||| Krista just entered this channel.
Thu May 24 01:02:26 2001-general-||||||||| BH just entered this channel
Thu May 24 01:02:26 2001-revision-||||||||| Dean just entered this channel.
Thu May 24 01:02:28 2001-revision-Marianne: Dr. Romano is here
Thu May 24 01:02:32 2001-revision-||||||||| BH just entered this channel.
Thu May 24 01:02:32 2001-revision-||||||||| susan w. just entered this channel.
Thu May 24 01:02:36 2001-general-Sierra: how do i get in the revision room
Thu May 24 01:02:42 2001-revision-Dean: Hi Shelly,Krista,M
Thu May 24 01:02:58 2001-general-Dr. Romano: Hi Marianne, happy birthday from me too
Thu May 24 01:03:02 2001-revision-Krista: 'sup
Thu May 24 01:03:02 2001-revision-Dean: Hey BH,Queen never called me
Thu May 24 01:03:03 2001-revision-||||||||| Sierra just entered this channel.
Thu May 24 01:03:07 2001-revision-||||||||| Dr. Romano just entered this channel.
Thu May 24 01:03:11 2001-revision-BH: I figured.
Thu May 24 01:03:25 2001-revision-Marianne: HI Dr. Romano! Welcome!
Thu May 24 01:03:39 2001-revision-Dean: Hi Dr.Romano,welcome
Thu May 24 01:03:40 2001-revision-Dr. Romano: Hello Marianne
Thu May 24 01:04:04 2001-revision-Dean: Okay guys,fire away!!
Thu May 24 01:04:16 2001-revision-Dr. Romano: Who wants to start off with any question about rhinoplasty
Thu May 24 01:04:29 2001-revision-||||||||| mtwago just entered this channel.
Thu May 24 01:04:29 2001-revision-Marianne: should we do it in alphabetical order or anything so as not to rush Dr.R? Thu May 24 01:04:46 2001-revision-Sierra: Can we ask questions yet? I;ve never done this before?
Thu May 24 01:05:00 2001-revision-Dr. Romano: Yes, Sierra, go ahead
Thu May 24 01:05:18 2001-revision-Dean: If noone else wants to,I just wanted to ask about what you think of Bromalain (sic) Dr. R Thu May 24 01:05:40 2001-revision-||||||||| Todd just entered this channel.
Thu May 24 01:06:14 2001-revision-Dean: M,I think it will be fairly orderly
Thu May 24 01:06:40 2001-revision-BH: Are you experienced doing secondary & salvage rhino?
Thu May 24 01:06:54 2001-revision-Dean: Anyone who has a question go ahead,please just wait for Dr.R to finish the previous one Thu May 24 01:06:57 2001-revision-||||||||| Dr. Romano just entered this channel.
Thu May 24 01:06:59 2001-revision-||||||||| Naomi just entered this channel.
Thu May 24 01:07:09 2001-revision-susan w.: Just curious. I don't need info about revision. Can I ask about artecoll?
Thu May 24 01:07:10 2001-revision-||||||||| dd just entered this channel.
Thu May 24 01:07:37 2001-revision-Dean: Hi Naomi
Thu May 24 01:07:57 2001-revision-dd: hi everyone
Thu May 24 01:08:06 2001-revision-Naomi: Hello Dean
Thu May 24 01:08:11 2001-revision-Dr. Romano: Dean, I think bromelain is excellent. It is an enzyme that helps to digest red blood cells and help them to be removed from the tissues. It is also found in pineapple. I have all my patients take this.
Thu May 24 01:08:23 2001-revision-||||||||| Todd just entered this channel.
Thu May 24 01:08:32 2001-revision-Dean: Thanks Dr.R
Thu May 24 01:08:37 2001-revision-Shelly: Hi Dr. R. I am considering a primary and am 30 years old. Someone said that 'older' people have a harder time adjusting to the change. DO you find this to be the case?
Thu May 24 01:09:12 2001-revision-||||||||| Sara just entered this channel.
Thu May 24 01:09:13 2001-revision-Dr. Romano: Susan: I think Artecoll is excellent. It does have some limitations and is not perfect for every situation. It is permanent but still needs repeated treatments. I have used it about 100 times or more with no problems and like it a lot.
Thu May 24 01:09:20 2001-revision-Sara: Hola! :-)
Thu May 24 01:09:26 2001-revision-Marianne: susan Dr. Romano's articles are online about Artecoll, this is a rhinoplasty and revisionrhinoplasty chat and anything other than that can be answered after the chat
Thu May 24 01:09:38 2001-revision-||||||||| susan w. just entered this channel.
Thu May 24 01:10:03 2001-revision-Sierra: Dr. Romano, I have had several surgeries and my nose looked pretty good except there was a tiny amount of a graft that was visible on the inside of my right nostril. The doc went in to remove it and now I have a nasty dent in my right nostril.
Thu May 24 01:10:05 2001-revision-Marianne: wow you're quick! There's your answer susan!! thanks
Dr R! Thu May 24 01:10:47 2001-revision-Dr. Romano: Shelly: it does not really depend on your age but your "body focus" is what I call it. When I see patients in their 40's or even beyond I ask them "What have you been waiting for" and mostly I wonder what now makes them want a surgery. I look for body ima
Thu May 24 01:11:05 2001-revision-||||||||| natalina just entered this channel.
Thu May 24 01:11:20 2001-revision-||||||||| Marianne just entered this channel.
Thu May 24 01:11:34 2001-revision-susan w.: Thank you. Just wondered if you had seen any cases in which it hardened to the degree that it had to be taken out? Thu May 24 01:11:34 2001-revision-Dean: Hi Nat
Thu May 24 01:11:35 2001-revision-Shelly: I have been waiting for financial reasons ;-) Had to get thru college first!
Thu May 24 01:11:54 2001-revision-Dr. Romano: Sierra: The dent may indeed be related. Is it on the surface or inside, and how long ago was your surgery?
Thu May 24 01:11:58 2001-revision-Shelly: I have wanted to have the surgery for years though
Thu May 24 01:12:10 2001-revision-||||||||| Todd just entered this channel.
Thu May 24 01:12:25 2001-revision-natalina: Hi Dean!
Thu May 24 01:12:32 2001-revision-Dr. Romano: Susan: I just finished a paper on Artecoll, it is rare that it hardens. See my website. Thu May 24 01:13:07 2001-revision-Naomi: Dr. Romano, can scar tissue leave you nasal tip looking bulky and undefined. Thu May 24 01:13:09 2001-revision-Sierra: Surgery was 9 months ago . Also have noticed skin changes and womnder if its possible that the scar has caused circulatory problems?
Thu May 24 01:14:17 2001-revision-natalina: (and Happy Birthday Miss M, you child you!)
Thu May 24 01:14:27 2001-revision-Dr. Romano: Naomi: yes indeed. It really depends on the nature of the surgery. We often casually refer to a bulbous tip as "scar" when in fact, it may be persistent cartilage. Try taping your nose as often as you can!! Thu May 24 01:14:31 2001-revision-||||||||| BH just entered this channel.
Thu May 24 01:14:37 2001-revision-Marianne: *tee hee* thank you miss natalina
Thu May 24 01:14:46 2001-revision-Sara: Have you guys discussed scar tissue around the tip after primary and revision yet? Thu May 24 01:15:08 2001-revision-natalina: Dean, can we jump in with questions?
Thu May 24 01:15:26 2001-revision-Dean: Sure Nat
Thu May 24 01:15:40 2001-revision-Dean: No Sara,not yet
Thu May 24 01:15:53 2001-revision-Naomi: Dr Romano, I had my nasal tip reduced in size and I am afraid that scar tissue will keep it from getting thinner. I have thick skin. Where should I be taping my nose.
Thu May 24 01:15:55 2001-revision-Sara: My tip is not as refined as it should be and a little asymetrical after my revision although it is better and the hanging columella is fixed.
Thu May 24 01:16:03 2001-revision-Dr. Romano: Sara: scar tissue can also be really persistent edema. This is more often seen after a revision. IF you can hold your finger and press on the nose and see a dent, it is probably edema, and will resolve with taping. sometimes I use steroid injections
Thu May 24 01:16:12 2001-general-Scarlet: This is my first time so I'm not sure what to do. What happens next?
Thu May 24 01:17:04 2001-revision-dd: Dr. Romano thank you for helping us, have you heard of the medpor nasal shell
Thu May 24 01:17:15 2001-revision-Sierra: THere was also a very tight splint ,two piecec of plasic one inside one out sewn very tightly together. My mother believes the splint caused the dent or collapse. The nostril is now sort of concave. Is it possible a splint can do this much damage?
Thu May 24 01:17:18 2001-revision-Sara: I have had a few injections to one side but now think I need it on the other side. I will try the test. I am 8 months post revision.
Thu May 24 01:17:53 2001-revision-||||||||| Sally just entered this channel.
Thu May 24 01:17:53 2001-revision-Dr. Romano: Naomi: Excellent! Thick skin and revision surgery responds well to taping. I have almost all of my patients doing this now. Put two pieces above the tip, one around the tip, and a fourth just in the supratip. Send me an email and I will send you my sheet.
Thu May 24 01:18:18 2001-revision-Marianne: one question at a time please
Thu May 24 01:19:09 2001-revision-Dr. Romano: DD: Medpore, of course! I am one of the pioneers for this substance and worked with the company to help develop it and have written papers on Medpore. I love it and use it as a dorsal augmentation material, especially in my Asian patients.
Thu May 24 01:19:10 2001-revision-Krista: What sort of tape do you use for this?
Thu May 24 01:20:01 2001-revision-Dr. Romano: Sierra: usually a splint will not cause a problem unless it was tight and constricted the blood. Then you would see an ulcer where you had it.
Thu May 24 01:20:13 2001-revision-||||||||| Jessica just entered this channel.
Thu May 24 01:20:17 2001-revision-Sara: How long post can you tape? Post primary and revision?
Thu May 24 01:20:57 2001-revision-||||||||| susan w just entered this channel.
Thu May 24 01:20:59 2001-revision-||||||||| Julia just entered this channel.
Thu May 24 01:21:09 2001-revision-Dr. Romano: Krista: I use the paper 3M Micropore tape. It is sold in any medical supply store. Think of the tape as a tight "nasal bra" to squeeze out the edema!
Thu May 24 01:21:10 2001-revision-||||||||| Dean just entered this channel.
Thu May 24 01:21:27 2001-revision-Krista: Where does that fluid go?
Thu May 24 01:21:46 2001-revision-dd: Thank you Dr. R, would you still use the medpor before considering autologous cartilage grafting? What advantages does it have to autologous material? thanks
Thu May 24 01:21:48 2001-revision-||||||||| Jessica just entered this channel.
Thu May 24 01:21:48 2001-revision-Sierra: What does an ulcer look like/ actually the mark is still there where the stitch was holding them together. I am not sure what an ulcer looks like.
Thu May 24 01:21:56 2001-revision-||||||||| Jessica just entered this channel.
Thu May 24 01:22:08 2001-revision-Dr. Romano: Sara: I recommend taping for first six weeks in most patients. If you take the tape off in the morning and head to work and your nose still swells, then you need to do it longer! Its that easy.
Thu May 24 01:22:32 2001-revision-||||||||| Barry just entered this channel.
Thu May 24 01:22:53 2001-revision-Sara: At 8 months post is it too late??
Thu May 24 01:22:59 2001-revision-Dr. Romano: DD: really hard to answer that. It depends on your anatomy and what we are trying to achieve. Be more specific. I use both depending on the situation.
Thu May 24 01:23:11 2001-revision-Naomi: Thank you Dr. Romano for you in depth explanation on tip swelling and scar tissue.. Thu May 24 01:23:23 2001-revision-||||||||| C.J. just entered this channel.
Thu May 24 01:24:00 2001-revision-Dr. Romano: Sara: maybe most swelling is gone by 8 months. Try it a few nights and see if it looks like it makes a difference, then you will know.
Thu May 24 01:24:33 2001-revision-Sara: Thanks :-) I'll try it. :-)
Thu May 24 01:24:39 2001-revision-||||||||| Jessica just entered this channel.
Thu May 24 01:24:43 2001-revision-Julia: Dr. Romano, I had a revision rhino 3 months ago (my third surgery) and have developed what I've been told are epicanthal folds near my eyes. Have you heard of this?
Thu May 24 01:24:48 2001-revision-Dr. Romano: Sierra: an ulcer is where there is a black scab that comes off and leaves pink bleeding tissue underneath and later heals with a white tight scar.
Thu May 24 01:26:14 2001-revision-Dr. Romano: Julia: I have seen this and it is disturbing but usually goes away, sometimes it takes 3-4 months. Did you have a dorsal augmentation, or what was done differently the third time?
Thu May 24 01:26:25 2001-revision-||||||||| Sara just entered this channel.
Thu May 24 01:26:50 2001-revision-Jessica: Dr. Romano, is it possible that your lips sort of drop if you had a hump removed? Are there any changes in the face when a hump is removed?
Thu May 24 01:27:30 2001-revision-Julia: My nose was narrowed and it was also lowered a bit. It's been three months though, do you think it will still go away?
Thu May 24 01:27:49 2001-revision-Sierra: I would also like to know if a persons skin is less likely to rebound, so to speak, after rhino the older they get. Following this surgery, my skin appears as if it were shrink wrapped to the bone. I can see marks now from my previous surgeries that were
Thu May 24 01:28:22 2001-revision-||||||||| Boomer just entered this channel.
Thu May 24 01:28:29 2001-revision-Todd: Hi Dr. R. My PS during my revision claimed that thick skin prevented him from reducing my long projection. He also stated that any further removal of cartilage would result in a "droopy" nose or "flapping" nostrils. Does this sound legit, or not. Thu May 24 01:28:52 2001-revision-Boomer: hello room, hello Romano
Thu May 24 01:28:58 2001-revision-Dr. Romano: Jessica: Should not be any facial changes with hump removal. Somethimes we want to release a tight upper lip and help lengthen the lip and this is done by releasing the "nasalis" muscle from the base of the columella or from inside the upper lip.
Thu May 24 01:29:48 2001-revision-Jessica: thank you Dr. Romano
Thu May 24 01:29:50 2001-revision-Dr. Romano: Jessica: hump removal may "free up" some extra skin if you had a big hump, and this settles at the sides like epicanthal folds. This will get better or a light TCA peel later may shrink the skin.
Thu May 24 01:30:31 2001-revision-Boomer: Dr. Romano, I have had 2 nose surgeries and I have problems with cartilage, i.e., some it being visible inside the nostril (which I had removed) and some cartilage that can be seen as a protruding bump on the outside lower part of my nose.
Thu May 24 01:30:37 2001-revision-Boomer: It feels really hard. Can anything be done to smooth this out without affecting the appearance of my nose? My surgeon said no
Thu May 24 01:30:45 2001-revision-||||||||| susan w just entered this channel.
Thu May 24 01:30:45 2001-revision-||||||||| Dean just entered this channel.
Thu May 24 01:30:58 2001-revision-Jessica: what is a TCA stand for Dr. Romano?
May 24 01:31:25 2001-revision-dd: Dr. R i have a scooped out dorsum from my last rhino, i need the defect filled in, some have suggested the medpor would be more sturdy since i am very active, thanks Thu
May 24 01:31:41 2001-revision-Dr. Romano: Todd: thick skin will not interfere with reducing projection, It just makes it harder. There are many techniques to decrease projection and they work well. Taping helps here also to pull the tip down if needed.
Thu May 24 01:31:59 2001-revision-C.J.: Hi Dr Romano. I'm thinking seriously about a liplift. Do you ever narrow the nostrils and remove alittle skin by the cheeks to achieve a little mid facelift? It sems like you could get a lot of improvement with not a lot of incision..Do you follow me?
Thu May 24 01:32:31 2001-revision-Dean: Hold off a minute on questions please
Thu May 24 01:33:24 2001-revision-Dr. Romano: Boomer: Of course you can make this better. It is a judgement and technical call. IF it was put in, you can take it out. Better if you can do less or wait longer, but I have removed, reshaped, and reinserted cartilage grafts. It is tricky. He may not want
Thu May 24 01:33:28 2001-revision-C.J.: Sorry..
Thu May 24 01:33:31 2001-revision-Dr. Romano: Boomer : to take the risk
Thu May 24 01:33:50 2001-revision-Marianne: Jessica: Trichloracetic acid (TCA) Thu May 24 01:34:15 2001-revision-Boomer: A follow up question if I may Dr. Romano. How does the aging process affect the visible bump that I have?
Thu May 24 01:34:28 2001-revision-Dr. Romano: CJ: I love the lip lift but be careful. If your lip is not long, then it could do more harm. If you have 2mm or more of "tooth show" at repose, thats normal.
Thu May 24 01:34:28 2001-revision-Barry: Dean, think it would be possible to get taping technique posted on the board? Thu May 24 01:34:37 2001-revision-Jessica: thanks Marianne, this is good to know.
Thu May 24 01:34:54 2001-revision-Dean: Definitely Barry
Thu May 24 01:35:03 2001-revision-Marianne: I'll put it on teh site as well Barry
Thu May 24 01:35:10 2001-revision-Sara: I have noticed a longer nose to lip length and less tooth show after bringing down the bridge a tiny bit and refnining the tip and shortening the nose and columella. Looser skin too around the nose. Is this common, fixable?
Thu May 24 01:35:11 2001-revision-natalina: Dr. Romano, thanks for being here! Is is true that cartilage can continue to grow indefinitely? If true, is that only cartilage that has been operated on? Does that mean that an operated nose always has the potential to do something strange? change? Thu May 24 01:35:12 2001-revision-Barry: Cool!
Thu May 24 01:35:36 2001-revision-Dr. Romano: CJ: remember, any incisions near the nose often tend the pull out the nostrils, NOT pull in the cheeks. It is the "tug of war" concept and the loosest structure looses.
Thu May 24 01:36:08 2001-revision-Naomi: Barry I am with you on the taping technique. I just tried and I have tape all over the place. Not sure if I am dong it right.
Thu May 24 01:36:17 2001-revision-Dr. Romano: Boomer: aging should not effect a hump ever, all it will do is MAYBE make your tip droop some over time or give you a crease at the root of the nose
Thu May 24 01:36:36 2001-revision-Dean: Please wait to ask furhter questions,there are still 3 Dr.R is trying to answer
Thu May 24 01:36:51 2001-revision-||||||||| susan w just entered this channel.
Thu May 24 01:36:57 2001-revision-Dr. Romano: Marianne: Iell help you with the taping insturctions, ther are pretty standard for most doctors Thu May 24 01:36:57 2001-revision-||||||||| susan w just entered this channel.
Thu May 24 01:36:58 2001-revision-||||||||| susan w just entered this channel.
Thu May 24 01:37:25 2001-revision-Dr. Romano: Sara: a lip lift may work
Thu May 24 01:38:06 2001-revision-Dr. Romano: Natalia: I have never seen cartilage "grow" so to speak, that is why we use it so much, because it is "stable" and predictable.
Thu May 24 01:38:13 2001-revision-Barry: Thanks Doc!
Thu May 24 01:38:40 2001-revision-||||||||| Ellie just entered this channel.
Thu May 24 01:39:05 2001-revision-Boomer: Thank you Dr. Romano for taking the time to answer our questions!
Thu May 24 01:39:09 2001-revision-Sally: hi, why do like medpore so much, can you get infections like silicon?
Thu May 24 01:39:19 2001-revision-Dean: Barry,Naomi, can yu go to the postop room for a minute with me?
Thu May 24 01:39:21 2001-revision-Boomer: take care room
Thu May 24 01:39:38 2001-revision-||||||||| Boomer just logged off.
Thu May 24 01:39:38 2001-revision-Sierra: How long can scar tissue continue to form after surgery?
Thu May 24 01:39:43 2001-revision-Naomi: yep
Thu May 24 01:40:00 2001-revision-Jessica: Dr. Romano, after a hump is removed, can it ever grow out again? I know this sounds strange, but I heard that from someone?
Thu May 24 01:40:02 2001-revision-||||||||| Todd just entered this channel.
Thu May 24 01:40:44 2001-revision-Dr. Romano: Sally: because it has the lowest infection rate, easy to carve and work with, and does not dissolve. It is very "biocompatible" and I use it in special situations where there is not enough of your own tissue or I need something stronger
Thu May 24 01:41:07 2001-revision-Marianne: Dr ROmano, thanks whever you get a chance just send it to me and I will construct a sectionfor it (taping) Thu May 24 01:41:20 2001-revision-||||||||| Jessica just entered this channel.
Thu May 24 01:41:30 2001-revision-susan w: What is medpore???
Thu May 24 01:41:39 2001-revision-Marianne: Sally, infections are caused by silicone they are caused by bacteria
Thu May 24 01:41:44 2001-revision-||||||||| Jessica just entered this channel.
Thu May 24 01:42:15 2001-revision-||||||||| natalina just entered this channel.
Thu May 24 01:42:23 2001-revision-Dr. Romano: Sierra: scar tissue is a byproduct of the surgical process and is always there and is then our friend. IF it forms too much or pulls in a certain direction, then it is our enemy. It is hard to predict. It should be "soft" in 3-5 months, depending
Thu May 24 01:42:59 2001-revision-Marianne: Porex rather
Thu May 24 01:43:36 2001-revision-Marianne: susan: medpor is an implant made of high-density polyethylene by Porex
Thu May 24 01:43:54 2001-revision-Dr. Romano: Susan W: Medpore has been around for years and is a porous polyethylene implant. I use if on occasions for nasal dorsum, chin implant, cheek implant and so on
Thu May 24 01:44:23 2001-revision-dd: Dr. R, when you do have your dorsum filled in with cartilage, medpor etc, will it ever be as strong as your original dorsum
Thu May 24 01:45:44 2001-revision-susan w: Thank you.
Thu May 24 01:46:07 2001-revision-Dr. Romano: DD: The dorsum is only as strong as the underlying support. If you have a weak dorsal strut to your septum, the implant will not make this stronger. Sometimes we need to reconstruct the dorsum, then this is different and we use a cartilage and sew it in
Thu May 24 01:46:19 2001-revision-||||||||| Jessica just entered this channel.
Thu May 24 01:47:37 2001-revision-C.J.: Thanks for answering my lip lift question. It's kind of hard to explain, but I meant if the incision were taken up to the sides of the nostrils, narrowing them and at the same time taking up a small amout of slack in the cheek. I wasn't sure if you un
Thu May 24 01:47:39 2001-revision-dd: Maianne and Dr. R isnt polyethylene another name for gortex (polytetrafluoroethylene )? just wondering (Happy B day M) (thanks Dr. R)
Thu May 24 01:47:44 2001-revision-||||||||| Ellie just entered this channel.
Thu May 24 01:48:05 2001-revision-Marianne: Dr. R did you ever use Artecoll for any filling of dents in the nose? ot are injectables a really bad idea for this application?
Thu May 24 01:48:33 2001-revision-||||||||| Jessica just entered this channel.
Thu May 24 01:48:37 2001-revision-Dr. Romano: CJ: we make that incision besides the nostrils only to narrow them, exactly right. Never to take up cheek skin. If this happens I tell the patients it is a "bonus"
Thu May 24 01:48:58 2001-revision-Dr. Romano: DD: Gortex is profoundly different from Medpore
Thu May 24 01:49:20 2001-revision-susan w: Can I ask you about the cost and longevity of 6.5%collagen and Formacryl in the us? Any opinions? Thu May 24 01:50:05 2001-revision-Marianne: (thanks dd)
Thu May 24 01:50:18 2001-revision-Marianne:
Thu May 24 01:50:21 2001-revision-Dr. Romano: Marianne: I use some injectables for exactly that. Artecoll will be great for this once it is released in the US and I look forward to using it for very minor "touch up" areas. I use fat grafting in the nose and it works well in some situations
Thu May 24 01:50:33 2001-revision-C.J.: Thanks. I'll send pictures. Can't wait to consult with you!
Thu May 24 01:51:03 2001-revision-||||||||| Julia just entered this channel.
Thu May 24 01:51:16 2001-revision-||||||||| Adam just entered this channel.
Thu May 24 01:51:27 2001-revision-Marianne: thanks Dr. R. I should have discussed my nose with you - I will meet with you again - I hope soon. if you have time
Thu May 24 01:53:14 2001-revision-dd: Dr. R, i may need an alar base reduction, due to the flared nostrils that were left after much cartilage was removed damaging the elastic support of the columella, is there anyother way to fix this problem, without the alar base reduction?
Thu May 24 01:53:23 2001-revision-Jessica: Dr. R, when a hump is removed, is the tip always reduced as well?
Thu May 24 01:53:35 2001-revision-Naomi: Dr Romano, will Johnson & Johnson first aid tape work for nose taping
Thu May 24 01:53:38 2001-revision-Marianne: where'd you guys all go?
Thu May 24 01:53:45 2001-revision-||||||||| Adam just entered this channel.
Thu May 24 01:54:00 2001-revision-Naomi: Marianne we are in post op room chatting
Thu May 24 01:54:07 2001-revision-Dean: M-We had to talk on the lowdown for a minute
Thu May 24 01:54:35 2001-revision-Marianne: ohh okay got it. I thought guys got booted gotcha!
Thu May 24 01:54:53 2001-revision-Naomi: Dean I am asking about the first aid waterproof tape.
Thu May 24 01:55:02 2001-revision-Sierra: DO you have any idea why my nostril overall is now larger even though it has a dent in it than before surgery. Thu May 24 01:55:17 2001-revision-||||||||| Adam just entered this channel.
Thu May 24 01:55:22 2001-revision-Dr. Romano: DD: Exactly right. IF you have lowered (de-projected) the tip then the nostrils flare. This is an expected byproduct of that maneuver. Sometimes we can narrow the base with a "cinch" suture underneath. If you really have a "flare" then an excision is OK
Thu May 24 01:55:59 2001-revision-||||||||| Naomi just entered this channel.
Thu May 24 01:56:26 2001-revision-Dr. Romano: Jessica: only if the tip is out of balance or out of "harmony", which is usually the case. They are not always done together.
Thu May 24 01:57:12 2001-revision-Dr. Romano: Naomi and others: I think any kind of tape is fine. I like the #M Micropore because it is easy to put on and remove and doesn't traumatize the tissues.
Thu May 24 01:57:19 2001-revision-Dean: Dr R-How soon after surgery can something be done to camouflage visible grafts? Thu May 24 01:57:32 2001-revision-Jessica: Do you mean that I would need another rhinoplasty to reduce the tip is it's not done w/ the hump removal?
Thu May 24 01:57:47 2001-revision-Dr. Romano: Sierra: no, need to see you for this.
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Thu May 24 01:58:54 2001-revision-Naomi: Dr. Romano, when I am taping do I anchor it to my cheeks. Is it suppose to feel tight. Sorry if I am confused about the taping method.
Thu May 24 01:58:57 2001-revision-||||||||| Ellie just entered this channel.
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Thu May 24 01:59:14 2001-revision-Dr. Romano: Dean: it is really a judgement call. In my patients I want to make sure all the swelling has gone away so that WYSIWYG and it will not need to be re-redone later! T
hu May 24 01:59:36 2001-revision-dd: Dr. R thanks again, can this 'cinch' suture be removed if it i feel the nostrils are to narrow, or is it perminent? Is there anything i can do that is not perminent?
Thu May 24 01:59:57 2001-revision-Marianne: in case any of you dont know WYSIWYG = what you see is what you get Thu May 24 02:00:32 2001-revision-Dean: M-Thanks,I know that is an HTML expression,lol T
hu May 24 02:00:42 2001-revision-Dr. Romano: Jessica: Yes, but it is okay. Sometimes I suggest to my patients that they consider a rhinoplasty in stages if they are not sure (this is rare). It can usually be determined and predicted by your doctor in the beginning. BE ADVISED if you had an open rhinoplasty...
Thu May 24 02:01:02 2001-revision-Dr. Romano: Jessica: rhinoplasty that the tip stays swollen a long time!
Thu May 24 02:01:49 2001-revision-Dr. Romano: DD: Yes, computer imaging is not permanent and will give you a "look"
Thu May 24 02:02:11 2001-revision-Dr. Romano: Dean: I know you knew that Thu May 24 02:02:16 2001-revision-Naomi: Dr. Romano, why does tape help reduce swelling when the pressure of tape is slight pressure.
Thu May 24 02:02:19 2001-revision-Marianne: LOL!! dean! that's the ONLY way I knew what it meant LOL!!! good for you
Thu May 24 02:02:21 2001-revision-dd: but the 'cinch' is right Dr. R?
Thu May 24 02:03:09 2001-revision-Dean: M-I had no clue actually until you told me,lol
Thu May 24 02:03:29 2001-revision-dd: sorry but the cinch suture is perminent, is what i ment to say (?) T
hu May 24 02:03:37 2001-revision-||||||||| natalina just entered this channel.
Thu May 24 02:03:40 2001-revision-Dr. Romano: Naomi: you pull the tape down TIGHT over each side of the nose and pinch it TIGHT over the tip. It is not a lot but enough to make a difference. Wait for Mariannes new page, and maybe our instructional VIDEO!!
Thu May 24 02:04:20 2001-revision-Naomi: Thank you kindly Dr. Romano
Thu May 24 02:04:29 2001-revision-Dean: Those videos will be sold for $19.95 at revisionrhinoplasty.net
Thu May 24 02:04:41 2001-revision-Sierra: How difficult is it to fill in a dent. i am afraid of it not being filled in smoothly. again, it is running diagonally on the side of my nostril.
Thu May 24 02:04:42 2001-revision-Marianne: YEAH!! definitely that video is a GREAT idea! but who knows how much they will go for...
Thu May 24 02:05:05 2001-revision-Marianne: I am glad you let me know DeanLOL!
Thu May 24 02:05:19 2001-revision-Dean: along with hats,tshirts,cereal,etc...
Thu May 24 02:05:25 2001-revision-Dr. Romano: Sierra: even a small dent can be a major technical challenge depending on where it is and why it is present, or it can be a very simple thing
Thu May 24 02:05:37 2001-revision-Sara: Is it common to develope excess scar tissue around the tip after a revision and then remove it later?
Thu May 24 02:05:41 2001-revision-natalina: Dean, will you be modeling? Thu May 24 02:05:43 2001-revision-Julia: Dr. Romano, I don't mean to bother you again with the same question, but do you think there is a chance that the epicanthal folds will be permanent?
Thu May 24 02:05:56 2001-revision-Marianne: i meant *about what it is sold for* lol! and whose nose gets the honor of being operated on and shown all over the world?
Thu May 24 02:06:04 2001-revision-Dean: Nat-unfortunately not
Thu May 24 02:06:16 2001-postop-||||||||| Barry just entered this channel.
Thu May 24 02:06:18 2001-general-Adam: anyone here?
Thu May 24 02:06:20 2001-revision-Marianne: LOL!!!! you are so funny! DB
Thu May 24 02:06:24 2001-revision-||||||||| Barry just entered this channel.
Thu May 24 02:06:34 2001-revision-Dr. Romano: Sierra: if your dent is a groove following the edge of your nasal bone, above the nostil, then you should look up "inverted V" deformity. It is challenging.
Thu May 24 02:06:57 2001-revision-Marianne: *dean is afraid of people seeing him* I am as shameless as they come
Thu May 24 02:07:00 2001-revision-Sierra: Is there a certain age when a persons skin does not recover from rhinoplasty as well. Thu May 24 02:07:22 2001-revision-Dean: M
Thu May 24 02:07:24 2001-revision-Jessica: Dr. R, how does a doctor predict how much the tip will be reduced while doing the surgery
Thu May 24 02:07:32 2001-revision-Marianne: ACK!! i wonder if this is what I have Dr R! the V thing
Thu May 24 02:07:41 2001-revision-||||||||| Adam just entered this channel.
Thu May 24 02:07:52 2001-revision-Dr. Romano: Julia: Don't worry about things too early! Time will tell and be patient if you can. What does your ps say? Thu May 24 02:08:10 2001-revision-Naomi: Marianne, when will the taping instruction be up on the site. thanks.
Thu May 24 02:08:18 2001-revision-Sierra: Thats it!!! the inverted v . What caused this
Thu May 24 02:08:31 2001-revision-Dr. Romano: Sierra: no
Thu May 24 02:08:34 2001-revision-dd: Dr. R, we are getting to know each other really well here, is the alar base reduction surgery a risky procedure? And if it is reduced to much, can it be reversed or are you stuck with narrow nostrils??
Thu May 24 02:08:50 2001-revision-Marianne: Naomi as soon as Dr R sends it - it's up there
Thu May 24 02:08:53 2001-revision-||||||||| Joe just entered this channel.
Thu May 24 02:09:09 2001-revision-Joe: Hello everyone
Thu May 24 02:09:12 2001-revision-Dean: Hey Joe
Thu May 24 02:09:18 2001-revision-Dr. Romano: Jessica: it is the art and science of rhinoplasty. I use the computer to help "predict" this for us both prior to surgery.
Thu May 24 02:10:03 2001-revision-Barry: Hi Joe
Thu May 24 02:10:07 2001-revision-Dr. Romano: Sierra: it is usually collapse of your upper middle cartilages and you need spreader grafts to cure this.
Thu May 24 02:10:13 2001-revision-||||||||| Cindy just entered this channel.
Thu May 24 02:10:14 2001-revision-natalina: Marianne, I've seen an inverted V and I don't think you have one! Trust me a certain ps would have told you if you did.
Thu May 24 02:10:18 2001-revision-Marianne: asking my nose question... you have seen my nose but not touched it, what do you think of it, pinched huh? *wah* the crookedness and dents bother me do you think I am a dificult case or would you have to poke at my nose to be able to tell that?
Thu May 24 02:10:21 2001-revision-Naomi: Dr. Romano is it possible for a PS to reduce a tip but then one's healing process doesnt allow it to shrink down that much.
Thu May 24 02:10:27 2001-revision-Joe: are we supposed to be quite?
Thu May 24 02:10:45 2001-revision-Dr. Romano: DD: alar base reduction is hard to reverse
Thu May 24 02:10:53 2001-revision-Sara: SSSSHHHHHHH *joking* :-)
Thu May 24 02:11:10 2001-revision-Dean: Mostly Joe,but ask Dr.R a question if you want
Thu May 24 02:11:16 2001-revision-Marianne: ok thanks natalina I always wondered what those people have that have a line dent right in the middle of their tip, ya know?
Thu May 24 02:11:23 2001-revision-Sierra: Do you know of any site that might show a picture of inverted v?
Thu May 24 02:11:45 2001-revision-Marianne: Joe, we are just asking questions in turn and Dr. R is typing as fast as he possibly can - and he's a good chatter! LOL! FAST
Thu May 24 02:12:15 2001-revision-Joe: oh, i'll just be quite then
Thu May 24 02:12:16 2001-revision-Dean: It's called ButtNose M
Thu May 24 02:12:36 2001-revision-natalina: Inverted V is higher up, I think where bone meets cartilage, not on the tip. Just call me Dr. N, LOL! Thu May 24 02:12:38 2001-revision-Dr. Romano: Naomi: yes, your tip can be reduced by reducing the underlying cartilages, and I occasionally thin the tip fatty tissues. It then molds down. It depends on many factors including the skin and size. Thu May 24 02:12:47 2001-revision-Marianne: oh thank you for the layman's term DB LOL!!
Thu May 24 02:13:09 2001-revision-Marianne: oh I know what you are talking about then Nat
Thu May 24 02:13:11 2001-revision-Sara: I had a little crease in my tip.
Thu May 24 02:13:14 2001-revision-Dean: sure M
Thu May 24 02:13:22 2001-revision-dd: i am having surgery soon, should i stick with the 'cinch' suture instead of the alar base reduction, since it is probably easier to reverse? i am pushing my panic button!
Thu May 24 02:13:32 2001-revision-Dr. Romano: Naomi: I tell patients if you have a really big tip I can not always make is SMALL, just LESS BIG. Sometimes I need to reduce the tip in TWO stages just for this reason. Depends on your anatomy.
Thu May 24 02:13:58 2001-revision-Marianne: can I ask my nose question yet?
Thu May 24 02:14:25 2001-revision-Dr. Romano: Natalina: exactly right. Looks just like it says, inverted V
Thu May 24 02:14:45 2001-revision-Marianne: you have seen my nose in person and in pics - would you have to poke at it to be able to tell or is my dent and crookedness pretty easy to fix in your opinion?
Thu May 24 02:15:03 2001-revision-Dr. Romano: Sara: a crease in the tip is usually when the skin is thin and shows the separation between the two cartilages.
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Thu May 24 02:15:41 2001-revision-Dr. Romano: DD: you need to see me or your ps for another visit and ask him. It depends on YOUR anatomy and YOUR expectations and HIS skills.
Thu May 24 02:16:04 2001-revision-Naomi: Thank you Dr. Romano
. Thu May 24 02:16:19 2001-revision-||||||||| J.A. just entered this channel.
Thu May 24 02:16:19 2001-revision-dd: thanks
Dr. R Thu May 24 02:16:35 2001-revision-Dr. Romano: Marianne: your nose looked great. I will take a closer look so come by anytime.
Thu May 24 02:17:16 2001-revision-||||||||| Joe just entered this channel.
Thu May 24 02:17:18 2001-revision-Marianne: I have a long divot on the left side of my nose where the osteotomy was performed - I have considered Hydroxy appatite paste but am afraid of the inability of osteoinduction due to the paste being non-porous. IS there anything that can fill it?
Thu May 24 02:17:22 2001-revision-Marianne: okay will do
Thu May 24 02:17:43 2001-revision-||||||||| Barry just entered this channel.
Thu May 24 02:17:59 2001-revision-||||||||| Cindy just entered this channel.
Thu May 24 02:18:00 2001-revision-Joe: Can we make noise yet?
Thu May 24 02:18:05 2001-revision-Dr. Romano: Marianne: is the divot near the nasal facial junction (lower osteotomy) or on top? Thu May 24 02:18:34 2001-revision-Marianne: top
Thu May 24 02:18:45 2001-revision-||||||||| Naomi just entered this channel.
Thu May 24 02:18:48 2001-revision-dd: Dr. R, where are you located??
Thu May 24 02:19:12 2001-revision-Naomi: Joe how are you doing. Can you go to post op so I can ask you something.
Thu May 24 02:19:20 2001-revision-Dr. Romano: Marianne: if it is on top, then a crushed cartilage graft heals well and should camoflage nicely.
Thu May 24 02:19:33 2001-revision-Marianne: it isn't likethat on the right side tho - just the left side right under the top - but not ON the bridge - not like open roof or anything
Thu May 24 02:19:51 2001-revision-Marianne: San Francisco, CA - DD
Thu May 24 02:19:53 2001-revision-Dr. Romano: DD: I am in San Francisco, looking right now at the sun setting over Alcatraz. Thu May 24 02:20:31 2001-revision-Marianne: I would hope I had enough septal cartilage left for this - I will come by your office on a Friday Thu May 24 02:20:54 2001-revision-Dean: Is this Pimpsy or Powerlifter Joe?
Thu May 24 02:20:55 2001-revision-Marianne: oh I am jealous you have an incredible view Dr. R!
Thu May 24 02:21:05 2001-revision-Sara: Is it common for post op patients to feel their tip is still not refined enough?
Thu May 24 02:21:10 2001-revision-natalina: Since Dr. R has so kindly spent so much time with us, I thought I'd ask: have any of you read his plastic surgery book? It's great, I picked it up a couple of years ago. It made me want to run right up to S.F. and have him do multiple procedures, LOL!
Thu May 24 02:21:21 2001-revision-Dr. Romano: Marianne: that is a little unusual. May be a nasal bone that fractured during osteotomy. Sounds too high to be the lateral osteotomy and too low to be the medial one. Does this make sense?
Thu May 24 02:21:29 2001-revision-||||||||| HOPE just entered this channel.
Thu May 24 02:21:36 2001-revision-Dean: I want to visit Dr.R just for the view
Thu May 24 02:22:01 2001-revision-Sara: No, but I would love to read it! I do love his site !
Thu May 24 02:22:30 2001-revision-||||||||| Cindy just entered this channel.
Thu May 24 02:22:31 2001-revision-natalina: Yes, Dr. R your website is awesome. So much info there.
Thu May 24 02:22:42 2001-revision-Dean: No Nat,didn't know the great doctor had a book
Thu May 24 02:23:02 2001-revision-Dr. Romano: Sara: absolutely! It really takes a while to develop some definition especially if you have thick skin, had tip suturing, or tip grafts. I can see some definition by about 4-8 week then it only gets better Thu May 24 02:23:44 2001-revision-Marianne: Natalina, no I haven't read it - where can one buy it - shame on me I was unaware you had one. Thu May 24 02:24:29 2001-revision-Sara: I had tip graft to hide the crease, primary, revision to fix hanging columella and refine the tip more but at 8 months post I still see a little excess in the tip at some angles. I think they did suture together the tip to pull those cartilages closer.
Thu May 24 02:24:54 2001-revision-Marianne: Dr R: I wil show you when I come in (then you can explain what may have happened) and we can discuss other larts too, because it is getting near to us selling the house WOO HOO!! surgery time!.
Thu May 24 02:25:31 2001-revision-Dean: You have offers on the house M?
Thu May 24 02:25:55 2001-revision-Marianne: larts = parts. lol!
Thu May 24 02:26:12 2001-revision-Marianne: mp it goes on the market in 2 weeks!!
Thu May 24 02:26:16 2001-revision-Dr. Romano: Sara: 8 months may really be a bit early even yet. Consult your ps to get the best idea. Show him what you see and ask "Will this get better and when". By 8 mos you should get a good answer.
Thu May 24 02:26:28 2001-revision-Dean: Dr Romano-Do you know how long the effects of general anesthesia can last,especially hair loss and lack of energy?
Thu May 24 02:27:11 2001-revision-Marianne: oh good one Dean! and what about meds, I hear peopel get depressed because of meds, anesthesia, and digestive system being clogged - is this true?
Thu May 24 02:27:36 2001-revision-natalina: Marianne, I think I got it from Amazon but I've seen it in bookstores. I'm looking for mine right now to find the title.
Thu May 24 02:27:44 2001-revision-Dr. Romano: Dean: wow, Good question. I have seen the hair loss go on for many months, then always gets better. Lethargy can last 4-6 weeks at times.
Thu May 24 02:28:11 2001-revision-Sara: What about twilight?
Thu May 24 02:28:20 2001-revision-Dean: What if I was born with lethargy? LOL
Thu May 24 02:28:21 2001-revision-Marianne: nat: okay cool thanks! I would appreciate it
Thu May 24 02:28:48 2001-revision-Dr. Romano: Dean: come by my office for vitamin B-12 shots.
Thu May 24 02:28:56 2001-revision-Marianne: Dean, then you better put a fire under your arse and get over it! LOL!
Thu May 24 02:29:21 2001-revision-Sara: Dr. Romano has a great page of recommended suppliments on his web site.
Thu May 24 02:29:40 2001-revision-dd: Is this a general rule with anesthia, i mean is it a common side effect?? (the hair loss) Thanks Thu May 24 02:29:48 2001-revision-Dr. Romano: Sara: twilight anesthesia is often worse than a good GA. I think many doctors just let the anesthetic build up and accumulate. I prefer a "light" general for this reason.
Thu May 24 02:30:00 2001-revision-Marianne: How is your time Dr. R? if you could tell me what in the world a V or Y lip lift is I would appreciate it -
Thu May 24 02:30:39 2001-revision-Dr. Romano: DD: hair loss is rare but has been associated with anesthesia, Vitamin A or (in my case) as straight razor.
Thu May 24 02:30:47 2001-revision-||||||||| Sierra just entered this channel.
Thu May 24 02:30:51 2001-general-||||||||| Sierra just entered this channel
Thu May 24 02:30:57 2001-revision-Marianne: dd: I had a hairloss but I had Light Sleep and lots of meds/antibiotics (4 surgeries within a year) barely any brows left
Thu May 24 02:31:10 2001-revision-||||||||| Sierra just entered this channel.
Thu May 24 02:31:17 2001-revision-||||||||| J.A. just logged off.
Thu May 24 02:31:41 2001-revision-Sara: I hope the hair loss comes back, is it permanent?
Thu May 24 02:31:54 2001-revision-Marianne: Hey I like the way you look with your head shaven! I wish we could have gotten a another recent photo of you for the site - O think your shaved head looks really great - you do it with a straight razor?? that's sweet. Thu May 24 02:31:58 2001-revision-Dr. Romano: Marianne: V to Y is a lip enhancement procedure, not really the lift. I make V incisions inside the lip and pull it out and close as a Y. It is a very extensive operation
Thu May 24 02:32:02 2001-revision-Sierra: What are bossae formations and what causes that.
Thu May 24 02:32:06 2001-revision-Dean: Dr. R-Would you like to headline here all week?
Thu May 24 02:32:24 2001-revision-dd: Thanks M, good on Dr. R (razor ), Dean how much have you lost?
Thu May 24 02:32:43 2001-revision-||||||||| Adam just entered this channel.
Thu May 24 02:32:51 2001-revision-Marianne: ahh I get it it now - thanks! (VY)
Thu May 24 02:33:07 2001-revision-Dean: DD-Not much but I use propecia,etc. and it seems like I'm thinning again
Thu May 24 02:33:20 2001-revision-Dr. Romano: Sierra: that is a very vague description of a bone that heals with excess calcium and a hard bony area
Thu May 24 02:33:46 2001-revision-Marianne: dd: mine all came back except the ends of my eyebrows which come in slow as mollasses anyway so I am getting them tattooed on!
Thu May 24 02:34:31 2001-revision-||||||||| Barry just entered this channel.
Thu May 24 02:34:40 2001-revision-||||||||| Joe just entered this channel.
Thu May 24 02:34:45 2001-revision-Marianne: well I am going to go make my veggie burger guys (and gals) Thank you so very much Dr. R! We'll get the chat transcript out tonight and set it up for all who missed it.
Thu May 24 02:34:46 2001-revision-||||||||| Naomi just entered this channel. T
hu May 24 02:34:51 2001-revision-||||||||| Joe just entered this channel.
Thu May 24 02:34:55 2001-revision-Naomi: Hello again.
Thu May 24 02:34:56 2001-revision-natalina: M, did you know that losing the outer third of your eyebrows can be a sign of thyroid trouble? My friend just told me this, she later had thyroid surgery.
Thu May 24 02:35:06 2001-revision-Sierra: Can you think of any reson the texyure of the skin on my nose changed after the last surgery? Thu May 24 02:35:06 2001-revision-Marianne: You've given us almost 2 hours of your time - that is really generaous of you Thu May 24 02:35:24 2001-revision-Dr. Romano: Marianne: thank you and Dean and all the visitors. Any last questions?
Thu May 24 02:35:34 2001-revision-dd: Dr. Romano thank you so much for your time hopefully i can come talkt to you (i live on a large frozen rock ...simliar to alcatraz....Canada). Dean if you wouldnt mind maybe i can call you this week sometime?? Bye everyone
Thu May 24 02:35:40 2001-revision-Sara: Yes, thank you so much.
Thu May 24 02:35:44 2001-revision-Marianne: really???????? nat?? My mom has MAJOR thyroid probs. How the heck can I find out if I have thyroid probs unless I go to the doc *darn*
Thu May 24 02:35:49 2001-revision-Sara: I loved this!
Thu May 24 02:35:57 2001-revision-Naomi: Thank you so much Dr. Romano for answering my questions.
Thu May 24 02:35:57 2001-revision-Sierra: Thanks dr. Romano
Thu May 24 02:35:57 2001-revision-Marianne: generous, even!
Thu May 24 02:36:05 2001-revision-Marianne: bye dd!

Chat - End