Dr. Shapiro Interview - Chat

 

Chat - Start

Heide_in_NOLA > Where are you located Dr. Shapiro?
dr.shapiro > Philadelphia

Trapper > Can you give us your background info? School, training etc.

dr.shapiro > U.of penn med school then new york eye and ear infirmary residency. Facial plastic surgery at Barnes Hospital in St. Lousi. I've been in practice in phila. for 10 years.

gail > dr. shapiro, a number of us lost the shape and fullness of skin around the radix--aside from changing the bone angle, do you have any 'filler' remedy for this?

dr.shapiro > There are various filler materials available. I like natural ones such as cartilage or alloderm. The best choice really depends on the individual patient

Heide_in_NOLA > Dr. Shapiro, is it safe to undergo a revision if the skin on the tip has had the vascular supply compromised?

Dean > Yes it's safe but it depends what's meant by vascular compromise. Sometimes you get a neovascularization after open procedures. And that's not vascular compromise,it's actually from new blood supply

Trapper > Do you have a website with before and after photos?
.Dean > for Dr. Shapiro-yes,but it's under construction

Heide_in_NOLA > Dr. Shapiro, is it safe to undergo a revision if the skin is discolored?

Heide_in_NOLA > ever since my last surgery, the skin on the tip is thinner and a different color`
Heide_in_NOLA > thank you for your answer
dr.shapiro > what color is it? I have seen several patients that get a red color on the tip after open approach. This is sometimes treatable with laser.

Heide_in_NOLA > It's just darker looking, but I have a step-down on my bridge now, so maybe it's an optical illusion
dr.shapiro > I have seen patients with a blue looking tip after revision surgery but I have never seen one that stays this way permanently

Georgie > doctor, what do you think of medpor nasal implants?
dr.shapiro > I don't like medpor implants although many surgeons use them successfully. I have seen some infections and extrusion. I prefer natural substances for grafting.

gail > dr. shapiro, could you tell us how you align the bones to get an hourglass from the front, vs. a more common tripod?

dr.shapiro > the hourglass appearance that is desirable is a combination of good fractures and tip work. You try to make it as proportional as you can.

John > Dr. Shapiro, can you derotate a tip can this be accomplished with alar batten grafts

dr.shapiro > yes you can derotate a tip and alar batten grafts will do this but there are other ways. Frequently proper trimming or addition to the caudal septum is indicated

Heide_in_NOLA > Dr. shapiro, do you prefer the open or closed approach?

dr.shapiro > closed for primary rhinoplasties and usually open for revisions but sometimes revisions can be done closed if they are not major or don't require significant tip work

Cristina > Dr Shapiro, after my last revision, I was left with loose skin all around the nose and eyes almost as if the skin didn't shrink to the bone.

Cristina > I had a high radix and my nose projected. Have you ever encountered this and had it fixed successfully?

dr.shapiro > yes i've seen and worked on patients with high radix
dr.shapiro > Loose skin is a tough problem especially after excision of a large bump. Steroid injections can sometimes help tighten the tissue
dr.shapiro > radix grafting may help, reverse osteotomies are very difficult to accomplish although not impossible

dave > Dr. Shapiro, My tip was extended(now too long) using a septal extension graft. It is now very stiff and uncomfortable. Can this graft be removed and the tip restored to its previous state.

dr.shapiro > dave,this can be removed and the tip shortened it may never be exactly the same as it was but it can be improved

dave > How hard is it to recenter a nose. Mine went from a little off to way off in a primary I had.

dr.shapiro > dave, sometimes the septal cartilage has a memory making it hard to straighten,but usually most noses can be recentered

gail > dr. shapiro, on the loose skin issue, would a course of 2-3 collagen injections add some permanent filling?
dr.shapiro > no,collagen is not a permanent filler and would only give temporary improvement.after the collogen is stopped the problem would return

Dean > Dean-Dr. Shapiro,how much wider can spreader grafts make a nose?
dr.shapiro > it depends on the size of the grafts. usually no more than 5 mm on each side

jeff > dr shapiro, can nose and other facial implants i.e. medpor be refined after they have been in place for a number of years or do they always need to be removed and replaced

dr.shapiro > they need to be removed and replaced. it is extremely difficult to shape them when they are inthe nose Its much easier to take them out and reshape them

sf-guy > Dr. Shapiro, for what condition and what steroid injection do you use? How soon after a surgery do you administer?

dr.shapiro > steroids can be administered right after surgery. it can reduce swelling and reduce scar tissue formation. its not without possible complications though and must be used very carefully

dave > Why does the nose swell? Is this the bodies way of protecting the affected area?And do you know of any tricks to reduce the swelling besides sodium and salt intake?

dr.shapiro > yes, cartilage grafts can be placed anywhere under the skin

dave > Why does the nose swell? Is this the bodies way of protecting the affected area?And do you know of any tricks to reduce the swelling besides sodium and salt intake?

dr.shapiro > the nose swells as an inflammatory response. it is always greater with revisions than primaries. I use steroids to reduce swelling when indicated but sometimes time is the answer

Cristina > Would placing the grafts on the sides of the nose help tighten the loose skin around the nose?

dr.shapiro > it might tighten the skin but you have to be careful that you don't create an unsightly deformity

gail > dr. shapiro, is fascia more permanent than alloderm? and do you use ready-made sheets or take it from the patient?

dr.shapiro > jeff,yes absolutely.there have been some studies where injectable fascia has lasted longer than alloderm. i like the sheets of alloderm

Trapper > At what point can you say the swelling is completely gone. 6 months, 12 months, more??

dr.shapiro > 12 months is the definitive answer,however there are usually only minimal changes from 6 months to 12 months

sf-guy > Thank you; what are the considerations when you say steroid injections should be done carefully?

dr.shapiro > steroids can cause tissue necrosis. so if too much is put in one spot you can wind up with a divot

dave > Would ibuprofen help in reducing the swelling? It is suppose to be an anti-inflammatory. Correct?

dr.shapiro > yes,but ibuprofen is a real no-no after surgery because it may promote bleeding. two weeks after surgery i think its fine to try but i haven't seen dramatic results

gail > dr. shapiro, a scary question...how might aging affect a multiply revised nose?

dave > Dr Shapiro, How many revisions do you perform a year and who do you send patients to that you feel you cannot help.
Dr. S - About 50-75 per year
.Dean > There are several doctors he sends people to. Dr. Pastorek in NY
.Dean > Dr. Thomas and Dr. Toriumi in Chicago

.Dean > Dr. Perkins in Indianapolis

joey > Dr. Shapiro. I have a medpor nasal shell. Love the profile, & 3/4s but the front is much too wide. Since it's porous, is it harder to remove the sides the longer I wait? I'm over 4 mos. post op.

.Dean > Dr. Shapiro did his fellowship under Dr. Thomas
.Dr. Shapiro > Joey-Wait,you're still probably swollen
.Dr. Shapiro> No,it's not harder to remove the longer you wait
.
joey > Good, I'll wait a year than
sf-guy > sorry for staying on this-in case of swelling/tissue that is slowly subsiding would you consider the steroid injection earlier (2m) or later (4-6m)?

maureen > how sophisticated are the techniques for layering cartilage to create a molded natural appearance for overall augmentation? Also, how viable long-term is this cartilage or bone?

dr.shapiro > the nose changes with age the tip drops and underlying irregularities show more
Todd > Dr. Shapiro, at what rate will scar tissue reappear after it is removed during a revision?

dr.shapiro > this happens because the skin thins

notorius_big > in terms of results, what percentage would you place on personal healing c/w skill of surgeon
dr.shapiro > scar tissue will begin developing immediatly thats why carefull follow up is needed

dr.shapiro > 60percent surgeon,40percent patient healing

gail > where there's a history of bad healing, does longterm use of a splint help?

dr.shapiro > not an external splint. my partner used to say the only thing a splint does is hide your work

dave > Dr. S, Still can't breathe well in warm air. (3mos post) my nose dries right up. Could my mucous membranes have been damaged during my primary or is this normal at 3 mos.?

dr.shapiro > probably not. it may still be healing inside.Were turbinates done at the same time?

dave > No but a lot of work on septum

dr.shapiro > dave, it would be important to check for a septal perforation as this can cause dryness and crusting after surgery. internal splints are used to hold the septal cartilage in position when necessary

gail > hmm, I've found that to be true with my nose & and an external splint...dr. shapiro, could you use an internal splint?

Todd > Is the only criteria for a surgeon choosing rib vs. ear grafts to rebuild the bridge, the desired height of the dorsum?
maureen > Could you answer above question re how 'moldable' are cartilage and bone. My tip/ala are sufficiently small that finesse is required in shaping a graft.

dr.shapiro > todd i think almost any desired height can be achieved with ear cartilage with the exception of a complete brige collapse
Todd > this is assuming the doctor uses both methods, of course
dr.shapiro > cartilage is much more moldable than bone it's much softer

.Dean > Dean-So ear is a suitable material for building up a bridge Dr.?
maureen > Dr.Shapiro--I have a complete bridge collapse. So much bone was cut away that it can't reach a shortened septum. I've been told Gortex would be better.

dr.shapiro > ear cartilage is great for most bridges. goretex is soft and not great for a complete collapse because it doesn't give true support

dr.shapiro > i've used both ear cartilage and rib cartilage .i prefer ear cartilage but there are some cases when the thicker rib cart is needed

dr.shapiro > thank you for having me
.Dean > To reach Dr. Shapiro,email him at drshapiro@draaronshapiro.com
joey > Thank you doc
dave > Thanks Doc, Your the best!
gail > dr shapiro, thanks so much for being here!
.Dean > or call his office at 215-546-5900

Chat - End