LETTER FROM R.A.

Good evening Dr. Sciuto,
I am contacting you for a small, but for me huge, problem. I had a rhinoplasty 18 years ago, that I could never fully appreciate because of a trauma a few weeks after surgery.
Today I am 39 year-old and the imperfections of my nose seem to me more and more evident; in practice the back of the nose is slightly saddle-backed and the point is a bit too round ,fleshy and projected a little too much upward, especially looking by 3/4. Nothing exaggerated if we measure each of these defects in mm., but looks like an unnatural and artificial nose, especially on my face.
Well, I do not pretend to be an Adonis, but I would like to give back to this nose a more natural, and if I may, more virile aspect. The biggest problem is that it is difficult to find a surgeon able to operate on such a nose which needs almost imperceptible grafts and just a minimum rotation of the tip/point (?) downwards. It seems to be a too complicated and accurate task and for which it is not worth groped. I was wondering, since you use the Gore-Tex, if in my case, this would be effectively a simpler and more useful procedure.
Please find attached a few selfies just to give you an idea of my request, and to investigate as to whether you would intervene. In the positive, I would like to fix an appointment with you.
Looking forward to your reply. Best Regards, R.A.

Dear Mr RA,
Given that I use GoreTex implant only in a small percentage of cases in which this material is preferable to autologous cartilage for several reasons*, I agree with you on the opportunity to correct your nose and to make it more suitable for a male face. Specifically, we can discuss if we only want to correct the dorsum (this already provides a masculinizing effect) or whether to even seek for a slight rotation of the tip down: for the latter, cartilage is essential. We can study this in deep only after a direct examination of your nose. In any case, all these corrections are common practice my clinical experience.
Best regards, Dr Sebastiano Sciuto

* The reasons in which the GoreTex may be preferable are:
- The absence of cartilage available, having already been taken it in previous interventions
- The very thin skin under which the graft cartilage, especially if drew from the ear and therefore not perfectly regular, it may be visible

LETTER FROM G.

Hi, I would like to undergo a rhinoplasty. Since I'm in the process of choosing a surgeon I would like to know how you would intervene on my nose. I am enclosing a picture of me. Please send me a proposal via email. I would like an upturned nose.  Thank you in advance. Yours sincerely, G.

Dear Miss, Thank you for your kind letter. However I am not going to send you the edited photo because this makes sense only if performed by surgeon and patient TOGETHER directly after examining the nose and after studying it carefully. Allow me nonetheless to give you a tip: do not choose the surgeon based on the best editing. It could happen that you find a talented photo editor but a mediocre surgeon! Or his picture could be entrusted to a professional graphic designer, those who work for magazines and make all the actresses look always young and beautiful simply by correcting the images on their computer. Retouching essentially serves to establish a dialogue between the doctor and the patient, through which the surgeon tries to understand what the patient would want and help to explain what you can and what you cannot achieve. My advice is to talk to someone you know who has already had surgery, then organise an appointment and when you meet the surgeon see if you can recognize in her/him the qualities, the integrity and the experience that you need. If you do trust the person and feel you can rely with confidence you will see that everything will be for the best. It is not by comparing different photos that have been retouched that you will find the best and most reliable surgeon. Yours sincerely, Dr. Sebastiano Sciuto

LETTER FROM C.C. (and many others on the same subject)

Dear Dr. Sciuto, I am writing to inquire about a rhinoplasty. It is now a long time that  I'm thinking about it but I have not decided yet because, despite having read something on the subject , I only found a few and contradictory information on what interests me most, namely on the possibilities or not to intervene solely on the tip . My problem, in fact, is a “potato” nose. For the rest the nasal septum is in place, the nose is straight and without humps, but the tip is really wide and I do not know whether it is possible to intervene without "affecting the other parts ". I heard about "non invasive rhinoplasty" but I would like to have your opinion on the subject. I am awaiting for your kind response and will then proceed in taking an appointment. Thank you and very best wishes,

Dear Madam,
to limit the operation only to the nasal tip is possible. However in many years of profession it has only happened to me maybe just a couple of times (in primary rhinoplasty). Often we tend to underestimate that the tip needs to be balanced with the rest of the nose and after surgery it may appear disproportionate to how it was before the operation.  As what was covered by the tip did not stand out. However, every nose is a special case and it should be discussed individually after I have been able to see it. Regarding your suggestion of “non invasive rhinoplasty” it sounds like a perfect wording: personally I am very careful not to perform any “invasive rhinoplasty" . I am available for a serious analysis of your nose at my practise.
Best regards, Dr Sebastiano Sciuto

R.R. LETTER

Dear Doctor,
I had an operation of rhinoseptoplasty in 2004 with tragic results and then, in 2005, I had a bony callus removed in order to eliminate one of the more obvious negative effects, albeit only in part. Having tried in vain to forget all about having an attractive nose, I underwent surgery again in 2010. Needless to say, my luck had not changed. The surgeon spoke of a bony graft and cartilage “to fill the holes”, but in the end my nose is anything but straight. According to him, this “irregularity” is due to the fact that my skin is too thin and therefore everything shows through. The only solution would be to use filler. I have not agreed to his proposal because in actual fact the operation was simply a failure and that’s all there is to it.
What I would like to know now is whether I must just resign myself to my fate or whether there is any possibility of performing another operation with some hope of better results.
I look forward to hearing from you and send my best wishes

Dear Ms R.R,
I operate all the time on patients who have already undergone surgery two, three, four and even more times. Revision surgery with a view to improvement is therefore always possible, provided of course that it is worth the effort and that the expectations are realistic. This cannot be ascertained without assessing the situation together on the basis of direct, first-hand examination of your nose. While thin skin does constitutes a problem, especially in secondary rhinoplasties, grafts of material like the temporal fascia and Gore-Tex can be used on the nasal ridge to cover irregularities and soften the profile.
Best wishes, Dr Sebastiano Sciuto

A.C. LETTER

Dear Dr Sciuto,
I am writing to you because something I regard as very serious has happened. I underwent rhinoseptoplasty in _______ seven months ago. I went for a check two days ago and the surgeon injected me with Metracril to fill a slight depression. On returning home, I discovered that this material can cause serious damage and that its removal proves very complicated. I can assure you that I was not informed and that if I had known of the risk I would never have allowed the surgeon to inject me with such poison!!! I called him and he assures me that only a small amount of the product was used, that it is not harmful in small amounts, and that he would never do anything to put me in danger. I do not believe him, of course, and the more I read about the product, the greater my anxiety. I would like to know if it is possible to operate, if there is any hope of being able to remove this poison, and therefore if it is possible to arrange an examination with you. I thank you for your attention and hope you can set my mind at ease.

Dear A.C.,
I must unfortunately confirm that Metacril is product authorized neither in Italy by the Ministry of Health nor in the United States by the FDA. Its use is permitted only in Brazil, and highly controversial there too. It is made up of microgranules that are practically impossible to remove. The fact of injecting only a minimal amount does of course reduce the risk of complications, and these are in any case only local, no more than a reaction at the place of injection. It is not a poison that spreads through the body. It proves well-tolerated and causes no problems in many cases, but can give rise to sometimes significant local reactions in others. Let us hope you are not among those who suffer undesired reactions to the product.
Best wishes,
Dr Sebastiano Sciuto

M.B. LETTER

Dear Doctor,
I am interested in undergoing rhinoplasty and also an operation to improve the shape of my ears. I would like to know if you also perform surgery on ears and whether it is possible to address both problems in a single operation. Thank you for your attention.

Dear Sir,
The answer is yes to both questions. Best wishes,
Dr Sebastiano Sciuto

L.M. LETTER

Dear doctor, I would like your opinion as I no longer know what to do, much less who to turn to: two years ago I was operated on the tip of the nose with an open technique because I wanted to be perfect (grasp all, lose all… unfortunately… as my nose was straight and pretty… only the tip wasn't perfect but without a doubt it was better than it is now) with the result that I am now left with a horrible retracted scar on the columella not to mention the two very well visible protrusions of alar cartilage ruining my nose that in effect was pretty… I went to another surgeon as the surgeon that had operated on me did not know how to deal with this problem and so the new surgeon decided to repeat the surgery to correct it for once and for all. (Operation on 8/06/08)…
Eight months after the surgery, that appeared to have been very successful regarding the scar on the columella and the protrusions, a protrusion became visible on the tip of the nose… the surgeon advised me against a third surgery as since we were dealing with a matter of millimeters there was a risk of worsening the situation and so he began to use a filler with Radiesse that instantly resolved the problem for a period of 2/3 days but within a week the tip of alar cartilage became noticeable once again… I contacted yet another surgeon that advised more surgery as the solution because the fillers don't work so well and they don't resolve imperfections even if minimal…
Now I ask myself: was a sufficient amount of filler used? It is possible to operate on the tip a third time despite the injections of Radiesse? I am desperate and depressed… please reply as soon as possible. Thanks so much for listening.

Dear L.M.,
I cannot answer your first question as I do not know how much Radiesse was used. With regard to the possibility of surgical intervention after the infiltration of filler I must specify that:
1 - it is better to wait until the filler has been reabsorbed in order to have a clear picture of the situation, not masked by the filler: you run the risk of over correcting or underestimating that which needs correction.
2 - a third rhinoplasty can be confronted when it is worthwhile, when there are serious and concrete possibilities of improvement, and when at least 10-12 months have passed since the previous surgery: this is because the eventual defects can not be seen immediately, but emerge clearly after approximately one year.
Sincerely yours, Dr. Sebastiano Sciuto

R.M. LETTER

Good evening, I require a nasal polypectomy and would like to know if a rhinoplasty can be carried out at the same time. Sincerely yours R.M.

Dear R.M,
the rhinoplasty can be executed at the same time as the nasal polypectomy provided you are not dealing with a large polyp. Many consider this a contraindication for rhinoplasty. In fact some types of polyp have the characteristic of recurrence nearly constantly and it can happen that the regrowth of the polyps can bring about an enlargement of the nasal bones corrected by the rhinoplasty. Therefore it is necessary to evaluate case by case and carry out a careful examination of sinus cavity, CT scans and allergy tests.
I hope I have been clear and complete in my response.
Sincerely yours, Dr. Sebastiano Sciuto

V.P. LETTER

Good morning,
I have finally taken the decision to correct a defect that has bothered me for years. My nose is not very big and in reality it is more or less in harmony with my face, but I dislike its irregularity. I also have a slightly receding chin and a very round face. The technique of the removal/limitation of the annoying "hump nose" has come to my attention.
I live and work in Rome and I wanted to ask for information on the costs, hospital stay and if there are any contraindications. I am nervous of the use of internal gauze, but I have heard that laser and pads are used now… in short I would like to know what awaits me and if I can request an appointment so I can actually confront the problem.
Moreover I thought I could have the surgery after the summer because I have heard it's better to not be in the sun etc. etc.… I would like to put paid to hearsay, speaking with a competent expert.
Many thanks for your attention. V.P.

Dear V.,
I believe that the information you have read on my website should be sufficient to give you a good outline of rhinoplastic surgery. I can add that the pads are only necessary when you must also correct a major deviation of the nasal septum; if the surgery is mostly aesthetic the pads can be avoided.
In relation to the sun it is sufficient to protect the nose with a sun filtering cream with a high SPF and therefore the surgery can be carried out in any season, maybe avoiding July and August.
The laser, I will never tire of repeating, has no use in nasal surgery; indeed it can be quite harmful. In spite of that it continues to be used by some as an attraction for ingenuous patients.
The costs of a rhinoplasty vary a lot in relation to the type of surgery and hospital care: whether in Day Hospital or an overnight stay in the clinic. Moreover there are possibilities of deferment of the payment.
Sincerely yours, Dr. Sebastiano Sciuto

C.C. LETTER.

Dear Prof. Sciuto,
I am writing to request some information… and ultimately book an appointment… I have had two rhinoseptoplasty surgeries, the last one about two months ago… the result was discouraging! I have a crooked nose, I have hardly anything between my eyes because its too hollow and the remainder of the tip is too big… now I ask you, if I came to you and we decided to operate again to resolve the situation for once and for all, entrusting myself to your experience, how much time do you think we need to wait?
Why do some say that it's not necessary to wait in order to re-operate, others that it's risky to operate immediately, others still after 3 to 12 months… what is the truth? I had intentions of undergoing surgery again in about two months. What would you advise? Would it be possible?
Could you tell me the possible risks of operating again so soon? Would it be a problem with regards to fragile bones or turbinate function etc.?

Dear C.C,
I am sorry to hear about your situation that is evidently upsetting you, but I can confirm that no SERIOUS surgeon would touch your nose until at least 10-12 months have passed since the last operation. I would also ask you to be patient because any result cannot be considered before 10-12 months. Intervening prematurely is not advisable for the following reasons: your nose is not completely settled and so the evaluation of the problem could be distorted (for better or worse).
For 10-12 months the healing process of the tissues is still active: intervening on active healing tissues exposes you to a serious risk of stimulating secondary scarring with the formation of definitive excess fibrous tissue thus worsening the result.
Sincerely yours, Dr. Sebastiano Sciuto

 

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