Rhinoplasty with Dr. Taylor DeBusk

Hello, welcome. I'm Dr. Bob Basu. Today on Behind the Double Doors we're talking about rhinoplasty, all things about the nose with our newest team member facial plastic surgeon, Dr. Taylor DeBusk. Welcome Dr. DeBusk.

Yeah, thanks for having me.

So let's start with your background in training in rhinoplasty cuz that's a really specialized skill in plastic surgery. Can you tell our listeners a little bit about your experience before joining us at Basu Aesthetics and Plastic Surgery?

Yes. So I did my head and neck training up in Minnesota, which is a center, uh, that had a high volume of rhinoplasty surgery, both from a functional rhinoplasties as well as cosmetic rhinoplasty. So did hundreds of rhinoplasties there. Then I went to San Francisco, uh, to do my fellowship where again the majority of my experience there was rhinoplasty, mostly cosmetic out there. So I have uh, pretty extensive experience with rhinoplasty, both from a functional standpoint as well as an aesthetic.

That's awesome. So can you tell us why are you passionate about the nose?

Yes. So I love rhinoplasty. It's by far my favorite surgery or procedure mainly cuz it can be extremely transformative. The nose is obviously in the center of the face and it's nothing that you can hide and there are really limitless options to what you can do to change the overall shape. And every move that you make, you have to think kind of 10 steps ahead because obviously the nose is a three dimensional structure so you have to make sure that the changes you make look good from every angle. So it's, it's technically challenging.

Yeah. So definitely millimeters matter.

Oh for sure.

And I think your experience in head and neck microsurgery definitely comes into play here, right?

Oh definitely cuz the nose, especially once you get in there and start making all these you know, millimeter, sub-millimeter moves, you have to be able to or be comfortable making those small augmentations very similar to microsurgery.

So rhinoplasty is one of the most common procedures and demand in the United States and quite frankly worldwide. What are the most common things patients come to you to make better?

I would say the number one thing is the nasal bridge or the nasal hump. That's probably the most common cause or request, uh, for patients is to take that down, give the nose, uh, a much better contour, improve the patient's profile. It does significantly change the, the way the nose looks.

Are there any other concerns that patients present to you quite commonly?

Yes, just behind that I would say is the nasal tip. So you know, a lot of patients want to improve the contour of the nasal tip. Some patients have what we call a bulbus nasal tip or kind of that ball shape of the tip of the nose and a lot of people wanna address that and again, improve the contour and the overall aesthetic appearance of the nose.

What about patients that are concerned about aging? Some patients feel that their nose grows as they get older. Is that true?

Uh, that is actually a pretty common question or concern. But the nose doesn't grow, like gravity affects other parts of the body, gravity affects the tip of the nose. So with time you get laxity of the ligaments on the inside of the nose, which causes the nose to start to droop, which gives it kind of that, you know, aged appearance.

On the other end of the spectrum. Can you have a rhinoplasty at any age? What's the youngest age you could consider for a rhinoplasty?

Definitely. So typically you don't wanna go under the age of 17 for females, 18 for males. If you're looking at a either functional or strictly cosmetic rhinoplasty, there are some exceptions, particularly patients that have a history of cleft lip or palate cuz the development of the palate in the upper lip has a significant effect on the overall shape of and function of the nose. But in general, 17, 18 is the youngest that you'd want to go.

So as we know, patients go online to get their information and there's all kinds of different techniques out there for rhinoplasty surgery. So can you walk our listeners through what some of the different options are and what you prefer and why?

Yeah, definitely. So there are two main approaches in rhinoplasty surgery. One is the closed approach and two is the open approach. With the closed approach, all the incisions are made on the inside of the nose. So there's no visible scar on the open approach. There's only a five millimeter, four millimeter incision at the base of the nose of the columella. And that's the main difference in the incision placement. Now the access to the underlying cartilage and bony framework is much easier to manipulate with the open approach cuz you get direct access, direct visualization of all the different parts of the nose. Whereas with the closed approach your access is limited. So for me, I personally like the open approach better because it helps me to make those changes and have a little bit more of a predictable outcome.

So oftentimes patients seeking nasal surgery, they're okay with the appearance of their nose but they can't breathe. Dr. DeBusk, can you tell us what might be going on with them?

Yeah, so this is very common. So with the nose there is something called the septum, which is basically a midline partition or a wall that divides the nose in half. And if that septum is deviated at all, it can cause significant obstruction and really result in minimal airway movement through the nose, which causes people a lot of distress. So one thing we can do is we can address the septum completely independent of the rest of the nose to remove the deviated part so that people have, can breathe completely through both nasal passages.

And do you need to bring cartilage from somewhere else to do that work?

No, typically not. It can depend on the severity of the deviation, but typically with a septoplasty you're really just removing the curved or deviated uh, piece of the septum.

And do you often treat the septum or perform a septoplasty during a cosmetic rhinoplasty?

Definitely because usually when I'm doing a cosmetic rhinoplasty, I am removing a significant portion of the septum to use that cartilage for grafting purposes to kind of change the contour of the cartilage. So very often I do a septoplasty in conjunction with a cosmetic rhinoplasty.

Patients often present with a concern that they've got a crooked nose. How do you evaluate that and and how do you treat that?

Yeah, so definitely so when we look at the crooked nose, you have to take into account three portions of the nose. So the first is the bony pyramid or the top of the nose. So you have to address whether or not the shape of the nasal bones is causing the nose to be crooked. Second, you have to look at the, the mid vault or the middle portion of the nose to see if the septum or the cartilaginous portion is deviated. And then third, you have to look at the nasal tip because sometimes asymmetries in the tip can give the appearance of the nose is crooked, where in reality everything on the inside is straight, but the cartilage of the nasal tip is asymmetric, giving it that crooked appearance.

What about for patients that have had trauma? Let's say they've broken their nose, how can you help them?

Yeah, so it depends on what's affected in the trauma. If it's just the nasal bones, just the cartilage of the nose or a combination of both. If the nasal bones are affected or broken, typically you want to intervene or reduce the fractures within the first two weeks. The longer you wait, obviously the bones start to grow back in the wrong position and eventually you have to go back in there, break the bones and reset them. Now if the cartilage is affected, it depends where the cartilage is affected. You may have to do a open rhinoplasty to support or rebuild the inside of the nose.

So every case is unique and Dr. DeBusk has to evaluate what's going on if figure out what the solutions are. So a common concern for patients when they're thinking about any surgical procedure including a rhinoplasty, is the recovery. So can you tell our listeners how long does it take to recover from a rhinoplasty and when can you start going out and about?

Yeah, totally. So kind of the overall post-op process. So one week after surgery we'll see you back in clinic, remove stitches, take the cast and splints out and off and your nose is very, very swollen. And I try to tell every patient and reinforce the fact that at one week the nasal tip is very edematous or swollen and it does not look anything like what the final product will yield. Then at about four weeks there's a dramatic improvement in the post-op swelling. And I always tell patients, you know, when you're walking down the street, nobody will have any idea that you had surgery. But when you look in the mirror yourself, you'll still be able to tell that the the nose is, is swollen. Then once we hit that four month timeframe is when the majority of the swelling's gone and you get an idea of what the final product's gonna look like. But to be honest, it takes 12 up to 18 months for the nose to be completely healed after surgery.

Mm-hmm <affirmative>. Now is rhinoplasty different for Asian or African-American patients?

It is, and two main reasons that they're different. One is the skin thickness. So everybody has different consistencies of their skin. So typically the Asian and African-American rhinoplasties, you have to address that thickness of the skin or take that into account. And then two is the consistency of the cartilage. Again, typically Asian and African-American rhinoplasty, uh, there's less cartilage to work with one and the consistency is softer or the cartilage is softer, it's not as rigid. So you have to take those into account.

Mm-hmm. <affirmative>. Mm-hmm <affirmative>. Now let's say someone wants to improve their nose but they're just not ready for surgery. Are there any non-surgical options for a patient to change the shape of their nose?

Definitely. And so it's called liquid rhinoplasty and that's kind of becoming more and more popular. And what liquid rhinoplasty is, is using filler in the nose but doing it conservatively, it's a high risk procedure potentially because there are, there's a lot of vascularity to the nose. So when you're injecting filler you have to take that into account. But we use filler a lot mainly to address some of those dorsal humps, uh, to smoothen out the nasal bridge and to do kind of fine tuning of the nasal tip as well.

So in terms of online stuff to follow up, I'm hearing a lot of patients asking about preservation rhinoplasty. What is preservation rhinoplasty?

Yeah, so preservation rhinoplasty, it's kind of making a swing back into popularity. What it is is addressing basically the nasal hump or the dorsum without actually separating all the underlying cartilage and removing bone from the top of the nose. So when you think about the nose, it's kind of the shaped like a pyramid. So traditionally, and the way I approach the nose is by, if you want to adjust the top of the pyramid, you can address it directly. Whereas with preservation rhinoplasty, if you want to address the top of the pyramid, you actually are augmenting the base of the pyramid. And we used to do this a long time ago within facial plastic surgery, but the results were not as predictable. But now with the addition of what we call ultrasonic technology is basically a drill that can address the bony aspect of the nose without causing soft tissue damage. So the introduction of this new technology has made preservation rhinoplasty kind of come back into the limelight.

Interesting. So Dr. DeBusk, when you're treating a primary rhinoplasty or someone having a rhinoplasty for the first time, how long that does that typically take you in the operating room?

Yeah, so again, you know, it, it kind of depends on what we're going to address, but usually I say it's about two hours, two to three for a standard primary rhinoplasty. But again, you know, it really depends on the overall plan.

And this is outpatient surgery, correct?

Correct.

So we talk about what patients are reading online. What advice do you have for a patient that's been thinking about a rhinoplasty? What should they do?

Yeah, so number one, I mean, do your homework. I recommend, uh, or advise patients. Seeing somebody that does a lot of rhinoplasty, that rhinoplasty is a majority of their practice because again, it's a highly technical surgery or procedure. So you want somebody that is comfortable doing the surgery, number one, and then able to give you the results that you, you're looking for.

And I think Dr. DeBusk is being humble when he talks about someone that's specialized in rhinoplasty. He, what he really should be saying is that he is the true specialist in rhinoplasty. And that's why I'm so excited to have him as part of the aesthetics and plastic surgery team, cuz he's gonna really bring best in class options for patients who are seeking changes to their nose. So Dr. DeBusk, one of the things I'm really excited about is we always strive to be best in class in everything that we offer our patients. And I'm excited to be able to have our patients meet with you and get care from you for their rhinoplasty. Cause I think you provide best in class care for rhinoplasty, but you're very talented and we're really proud we were able to recruit you to best aesthetics. But you are looking at a lot of different options. Can you tell our listeners why you chose to join us?

Yeah, definitely. I mean, one of the reputation that you have developed obviously was, was very appealing, and then your skillset. And that two is the fact that you have your own operating room as well as, uh, MD anesthesiologist with the practice. So it, it's unparalleled care for patients, which was extremely appealing to me and why I wanted to join.

Well, thank you Dr. DeBusk. And if you wanna learn more about Dr. DeBusk, please visit us@basuplasticsurgery.com or follow his results on our Instagram at Basu Plastic Surgery.

Thanks for having me.

Basu Aesthetics and Plastic Surgery is located in Northwest Houston in the Towne Lake area of Cypress. If you'd like to be a guest or ask a question for Dr. Basu to answer on the podcast, go to basu plastic surgery.com/podcast on Instagram. Follow Dr. Basu and the team at Basu Plastic Surgery, that's B A S U Plastic Surgery. Behind the Double Doors is a production of The Axis, t h e a x i s.io.