Breathe Better, Be Better: What You Need to Know Before Rhinoplasty

Dr. G (00:02):
You are listening to another episode of All the 'Bs with me, Dr. G and my scrub tech Bri.

Dr. Chao (00:08):
I'm Dr. Janet Chao. I'm a facial plastic surgeon here at Restore SD Plastic Surgery, and I work closely with Dr. Kat Gallus. You are listening to All the B's, an unfiltered plastic surgery podcast with our scrub tech Bri.

Bri (00:20):
Okay, so next in Dr. Chao's corner, we are going to talk about rhinoplasties. The thing I have been asking for since she started it has yet been given the time off to get it done. So before we have to talk about a little bit of gossip. So we're going to segue back to Blake Lively, telling her co-star to get a nose job. Rude. In general, don't ever tell anyone that.

Dr. Chao (00:49):
Totally. I mean, we got to remember that this is coming from legal filings in a really heated lawsuit. Who knows, not necessarily confirmed facts, but just commenting in general on someone's appearance in that way, even as a joke, that's getting really personal, especially in a professional setting. Don't do that.

Bri (01:11):
There was actually a video of her saying that he needs, or you could hear her saying yes, that he needs to get his nose done. It was a whole dancing scene and they put out the video.

Dr. Chao (01:20):
No way.

Bri (01:21):
Yes.

Dr. Chao (01:21):
You got to show this to me. I haven't seen the video.

Bri (01:23):
Okay, we'll show you the video. But yeah, I just feel like that's just not okay no matter what.

Dr. Chao (01:30):
Yeah, that's rude.

Bri (01:32):
You could tell how awkward it was between them already, but out of all the things to say, noses are a sensitive topic.

Dr. Chao (01:39):
I know, I know. And I feel like that, especially when you're younger and in middle school and stuff, people have often told me, I remember when I first noticed that I didn't like my nose and it was because, you know, Timmy told me, or sorry for all the Timmy's out there, but whoever. It's like, I don't know, just so rude. So mean.

Bri (02:01):
Those things stick with you.

Dr. Chao (02:02):
I know.

Bri (02:02):
When I was younger, somebody told me that my front two teeth could chop down a tree and I feel like I remember that forever. And then when I went to get veneers, I was like, make my tiny teeth, make my front teeth smaller. And Eric was like, absolutely not. That's what I love about you. You're keeping the teeth or you don't get 'em. And I kept the teeth and I love that.

Dr. Chao (02:23):
That's love. Go Eric. I love it. We love a supportive man. We love it.

Bri (02:28):
We do. But those things stick with you.

Dr. Chao (02:32):
Yeah, they do. They do. Be nice guys. Be kind out there.

Bri (02:37):
Be kind.

Dr. Chao (02:38):
I don't know what kids listen, but I know kids be nice, especially.

Bri (02:41):
They're like, there's no kids here. But speaking about people famously who have been open about getting nose jobs, we have a bunch of 'em. The first one was John Stamos about getting nicknamed Big Nose Stamos.

Dr. Chao (02:59):
I love this article just in general, I love the era of transparency in the public eye. Tell us the plastic surgery secrets. Tell us what you did. Don't be shameful or hide it. I love when people talk candidly about their journeys, whether it's to feel more confident, resolve insecurities, reclaim control, whatever. It really humanizes the process and demystifies it for all of us out there. So love that.

Bri (03:26):
Right. And I also love that he says, everyone who gets a nose job tries to find some excuse other than vanity, but let's call it what it is. Vanity. I have justified that I cannot breathe out my nose so many times and that's why I need my nose done. But at the end of the day, I'm not even thinking about my breathing. I'm just like, I need this shaved down a little. I need the tip up a little bit. I need this bone. Let's be real. We ain't trying to breathe.

Dr. Chao (03:54):
Quoting Stamos, quoting Stamos. Let's call it what it is. Vanity.

Bri (03:58):
Yeah. I mean realistically.

Dr. Chao (04:01):
No, but hey, we all get our nails done, dye our hair, get dressed in the morning. Where is the limit? I dunno.

Bri (04:11):
Yeah there's no limit. That's why I needed my nose done.

Dr. Chao (04:15):
The answer is there is no limit. Isn't that a me girls quote?

Bri (04:19):
I don't know it should be a quote. If it's not, it's now our quote.

Dr. Chao (04:23):
Or the limit does not exist. That's the quote.

Bri (04:26):
I love that. Yeah. I feel like there were some other celebrities on here who also regretted getting a rhinoplasty. It was Bella Hadid who we chit chatted about literally could be a model.

Dr. Chao (04:39):
Scroll dowl. Scroll down. I mean, girl, you made a lot of money on that nose. How do you regret that? Come on.

Bri (04:49):
And I all for

Dr. Chao (04:51):
You're one of the world's most beautiful women. Don't say you regret it.

Bri (04:54):
Right. I mean, she is beautiful before and after. I've seen her before and afters and I mean, she's just gorgeous and her nose is perfect and that's why she's a big money maker.

Dr. Chao (05:10):
Yeah, I think she looks beautiful, but I guess regret is possible, but does she really regret it or is it just one of those things that's like, oh, it's nice to say I regret it, but I really love my nose.

Bri (05:24):
But you also may not be in the place you are now if you didn't get it done. Just because society, it's unfortunate, but society wants us to look a certain way and if we don't have this teeny tiny nose and this slim body models have a very particular look.

Dr. Chao (05:40):
And she's absolutely gorgeous and doing killing it at the modeling game. So

Bri (05:45):
Yeah.

Dr. Chao (05:45):
I think the nose works. I don't know.

Bri (05:47):
I think the nose works too. I'm all for embracing and loving ourselves, but coming from somebody who's 75% changed artificially,.

Dr. Chao (05:59):
I don't know about that.

Bri (06:01):
Enhancements.

Dr. Chao (06:01):
You were beautiful to begin. Yeah, exactly. Enhanced.

Bri (06:04):
Thank you. Thank you. So rhinoplasties.

Dr. Chao (06:10):
Yes,

Bri (06:11):
Not just for aesthetic reasons.

Dr. Chao (06:14):
That's right. So rhinoplasty can address both form and function. So cosmetically we can refine bridges, smooth up bumps, lift and narrow tips and just give better proportions to the face. But we can also fix function to help breathing issues like deviated septum or collapsed nasal valves. So I do love that about rhinoplasty, that you can fix both.

Bri (06:40):
Amen. That you can make it pretty and fix your airway at the same time. So open and closed rhinoplasty. Which technique do you prefer and what is the difference?

Dr. Chao (06:53):
So I prefer an open rhinoplasty for most of my cases because it gives me full visibility of all the structures and helps me make more precise and predictable shaping changes. So in an open rhinoplasty, the incision goes across your columella, which is that strip of skin right between your nostrils and it heals really beautifully. And then in a closed rhinoplasty, all the incisions are made inside of the nose, which I think works for minor adjustments, maybe just taking down the dorsal bridge a little bit or in certain patients. But in my opinion, it gives less direct visualization for complex work that needs to be done. So open, most of the time.

Bri (07:33):
I'm a fan of open. How is surgery different if your nose has been broken before or it is broken?

Dr. Chao (07:45):
So when a nose has been broken, whether recently or in the past, it often heals with crooked bones or the cartilage can shift or there can be scarring inside. So that makes the surgery more like a reconstructive procedure. So we might need to reset the bones, either re-break them or push them over if they're already broken, use cartilage grafts for support and then just kind of be extra thoughtful about symmetry. So it's more reconstructive but doable.

Bri (08:15):
Is there anyone that you would not suggest or is not a good candidate for a rhinoplasty?

Dr. Chao (08:22):
I would say that you have to just have realistic expectations for what your goals are and actually have, I'm talking about the cosmetic side of things, actually have a realistic goal of what you're trying to achieve. And I think that there is different imaging models that can help us communicate whether or not that's possible. Yeah, and then obviously if you have any bleeding disorders or anything that can make rhinoplasty difficult. But yeah. And then just the general anesthetic clearance.

Bri (08:59):
So when you're doing a rhinoplasty, I know I watch you take cartilage usually from the nose, but what other sites and areas would you take cartilage from in general cases and then in revision?

Dr. Chao (09:15):
Yeah. So if in most cases I like to take the septum, like you said, and if the septum's not available, then we can take cartilage from the ear. And sometimes though the ear cartilage is a little softer, so that's not ideal for some grafts. And in the case that that's not available or it's too soft, we'll use rib cartilage and you can either get rib from the patient, which means you have to make a little incision underneath the breast or in the chest area, or we can order frozen rib, which is fairly easy to do. And I think that's kind of the shift that people are making these days is going more towards the frozen rib because people don't want to have that extra surgical site. But it's a personal decision.

Bri (10:01):
I love that. Now, people that come in and they come in for their console and they really want to look natural, their goal is to look natural. And of course everybody has a different idea of what natural is. When patients come in office, how do you really be on the same page so you can visualize the end result of a natural nose? So you guys are both kind of doing what they want?

Dr. Chao (10:27):
Yeah, totally. So natural is probably the most common word that I hear, but it is a subjective word. Some people mean they want the smallest amount of change possible, like this teeny tiny change. And other people just mean they want a major transformation, but it still fits their face. So I use a morphing software during the consultation to show potential changes and just make sure that we're speaking the same visual language. And I also just focus on harmonizing the nose with the rest of that person's face so it never looks like the nose arrived first, if that makes sense. If you're looking at the face, I think that the attention should go straight to the eyes and the nose should be background noise. So how do you make that happen and the nose blend in with the face?

Bri (11:11):
I love that. I remember one time I got my boobs done, side note, and somebody said, obviously when you have implants, it just makes your, if this is TMI, not that you want to edit this out, your nipples kind of are hard a lot of the time. So he would always be like, this was in office professional setting. I always know when Bri's coming in because her nipples coming in first.

Dr. Chao (11:34):
No, he did not say that.

Bri (11:37):
Yes. Okay. We can segue now back to rhinoplasty, the nipples did not blend back to rhinoplasty. Now I know it's not a one size fits all. So when you're dealing with different ethnicities and you're trying to really maintain maybe their ethnic backgrounds, their shape, what considerations do you take, whether it's maybe an Asian or an African American or what differs in doing a rhinoplasty for different ethnicities?

Dr. Chao (12:10):
Yes. So ethnic rhinoplasty often involves a little bit of a different anatomy and aesthetic goals. So for example, and this is a generalized statement, so just average Asian and African-American patients may have softer cartilages, thicker skin, and a lower bridge. So oftentimes we're building and supporting the nose with graphs rather than reducing the nose. So my goal is always to respect a person's heritage when I'm giving them the refined result they want. It's never really a cookie cutter, one size fits all approach. So I think that's where the morphing really helps. We can kind of communicate, well, how much do you want it lifted or how much do you want this narrowed? And we can have a visual cue to tell us what the goals are.

Bri (12:57):
So if they have a softer cartilage, does that mean that they're at a higher chance of having cartilage being taken from the ear or rib or a frozen rib?

Dr. Chao (13:07):
Yeah. In general, for those ethnic rhinoplasties, I think we often need more grafts. But if they have a good robust septum, sometimes that's enough.

Bri (13:18):
All right. Well, I hope you have a good robust septum.

Dr. Chao (13:22):
For my nose, my Asian nose? I hope so too.

Bri (13:26):
You have a perfect little nose.

Dr. Chao (13:28):
Oh, thanks.

Bri (13:29):
So tell me about the

Dr. Chao (13:30):
So do you.

Bri (13:30):
No comment. Let me tell you about the consultation process for getting a rhinoplasty. What can someone expect when they come in office?

Dr. Chao (13:42):
So for me, after getting your medical history and background, the rhinoplasty consult is really about listening first. So I start by asking patients what bothers them the most about their nose and what they're trying to achieve. And then we do kind of detailed exam of both the outside and the inside of the nose, checking both aesthetics and the function. And then usually after that we'll have taken a high quality 3D imaging photos through the Vectra system and I'll pull that up and the patient and I will walk through together all of the realistic possibilities for changes and come towards a common goal for that. And then finally, we discuss recovery, healing timelines, and then they meet with our surgical coordinator and talk about scheduling and pricing.

Bri (14:30):
Awesome. Well come on in. We're ready. If someone's had a rhinoplasty before, what are your thoughts on revision rhinoplasties and why do they, I know I've heard a lot that they're so much harder. Why are they so much harder?

Dr. Chao (14:46):
They are harder. Any surgery revision is harder because there is scar tissue in rhinoplasty. It's difficult though because that scar tissue can affect the blood supply to the nose. So every time that you reopen the nose to go back in there, you're risking lower blood supply to the area. So it's also harder because sometimes the grafting material that you would've used before has been taken. So like I said, I use a lot of septal cartilage grafts and that may not be available because the last surgeon used it in their prior rhinoplasty. So you need more grafting material. So scar tissue, more grafting material. And then also I think there is usually if someone wants a revision, there can be some trauma involved in that first experience. So there's a lot of rebuilding trust and making sure that they feel comfortable going through with this. Again, they probably want surgery for a second time.

(15:50):
They didn't have a great experience the first time or they didn't get their goals met. So there's a lot of emotions around the consultation and the surgery. I do do revisions, but I always wait at least a year from the prior one. And I ask patients to send in their operative report from their first surgery in advance as well as photos of their nose and a written list of their goals for their second or third or however many surgeries. So I don't see all revision patients, but if I feel like I can make a difference for them and those criteria are met, then I will do it.

Bri (16:33):
Well awesome.

Dr. Chao (16:35):
If you're listening today and have questions, need info about scheduling, financing, reviews, or photos, check the show notes for links. Scrubbing in.

Bri (16:45):
And scrubbing out.

Dr. Chao (16:48):
If you're listening today and have questions, need info about scheduling, financing, reviews or photos, check out the show notes for links. Restore SD Plastic Surgery is located in La Jolla, California. To learn more about us, go to restoresdplasticsurgery.com or follow us on Instagram @RestoreSDplasticsurgery. If you enjoyed this episode, please share it and subscribe to All the B's on YouTube, apple Podcasts, Spotify, or wherever you like to listen to podcasts.