Posts by Jesse Sanchez90

Exactly—it doesn’t have to be. It's an option, sure, but it's certainly not the end of the world.
While a cholesteatoma is technically classified as a tumor, it's "benign" in the sense that it isn't cancerous. However, the danger lies in its ability to erode the ossicles (those tiny hearing bones), potentially damaging the facial nerve or even encroaching on the semicircular canals. But again, that usually only happens during a very prolonged course of the disease.

Another thing to consider: a chronically inflamed ear might leak due to a flare-up without it being a full relapse, though it still needs medical attention. That said, you don't necessarily need a surgeon for that; a standard ENT clinic can handle it. Once an ear has been operated on, you have to be extremely careful not to get water in it or try to rinse it out. Any drainage should just be gently suctioned using a "dry toilet" method. After that, a doctor would typically prescribe some antibiotic drops.
If you happen to be in New York City, I'd suggest heading over to the Vineyard hospital right away. They can quickly determine if what you're dealing with is just an acute flare-up of chronic inflammation or if it actually is a recurrence of the primary condition.

There's no need to take such radical measures as you did. The biggest issue with a cholesteatoma regarding ear function is that when it "eats" through those bone structures via enzymatic degradation, it breaks the connection. This causes conductive hearing loss because the sound impulse has no way to reach the inner ear and the hair cells, even if those cells themselves are perfectly healthy.
The good news is that we now have middle ear implants designed specifically to bridge that gap and fix this type of hearing loss.

Melissa Sanchez34 said:Can anyone who’s had surgery at St. Jude or the Vineyard hospital tell me roughly how long the wait times are right now?
I really need to get this done as soon as possible because of my work schedule, or I might have to push it back again—though I'd much rather just get it over with!
I already went to Mercy for the initial exam, so I'm wondering if there will be any issues before I can get a new referral. Honestly, I really don't want to have the actual surgery at that facility, at least not with the doctor who saw me last time.
If anyone could help me out, I'd appreciate it! 🙂

It really depends on what kind of procedure you need and which specialist you see at the Vineyard hospital. If you go through Dr. Grgic, things move pretty fast—you can often get in within a month, maybe two at most. As for the initial consultation, it was about a month recently. Other surgeons will have totally different waiting lists depending on their schedules.

There’s no such thing as a direct fix for nasal cycles—not really.
It’s just how the body works, and a whole bunch of things influence it, ranging from your hormone levels to various inflammatory responses.

When we talk about surgery (specifically a septoplasty), the goal is strictly to clear out the breathing obstruction, just like the lady above described. However, if you’re dealing with disrupted nasal dynamics caused by uneven cavities or a deviated septum—which can also involve different types of maxilla deformities—you will see some improvement once that blockage is gone.
But here is the reality: neither surgery nor medication can actually "cure" chronic changes to the mucosal lining, which is what we generally call chronic rhinosinusitis.

What you're experiencing is actually called a nasal cycle—it’s perfectly normal for the mucous membrane to change its thickness throughout the day. This process becomes much more noticeable if you're dealing with chronic rhinosinusitis. It can also be linked to issues with your sense of smell.

Susan Cooper23 said:It sounds like my point might have gotten a bit lost in translation! I know quite a few people who have had nose reductions, but for some, their skin is just naturally so thick that getting that perfectly slim look is nearly impossible. In those cases, skin thickness really is a major deciding factor.

As for the other part of what you mentioned, I don't really see how it differs from what I originally wrote.

Based on how much you're emphasizing it, I'm pretty sure the skin isn't actually that thick. I'm sticking to my guns on my original comment!

Susan Cooper23 said:The nose can definitely be narrowed. How much, though... well, that depends on things like skin thickness and all that.

Now, just a heads-up: you won't find specific recommendations on this forum regarding which surgeon would be the absolute best fit for *you*. That’s a deeply personal decision. You really need to schedule consultations with several different doctors yourself to get a feel for who seems the most knowledgeable and capable in your eyes.

If we start talking about skin thickness being the deciding factor, we’re heading straight into Michael Jackson territory. At that point, the nose loses its actual function entirely.

There’s no such thing as one "perfect" surgeon; there is only the surgeon who truly understands the unique challenges of a case and treats every patient as an individual. There isn't a cookie-cutter recipe where one nose shape works for one person and another works for someone else. Surgeons shouldn't work from a template; they should work with what you already have to build upon. Trying to force a completely different look is a radical approach that usually ends in tragedy.

Because I'm personally involved in this, I'll step back from the debates about who is who in the American medical scene, but we really should move some of these older details back to the appropriate discussion threads.

placidlynx52 said:Could someone who knows a bit more about plastic surgery tell me if it's actually possible to make my nose narrower through surgery? I'm wondering by roughly what percentage, and if I can also slim down the tip since it feels too wide and looks a bit bulbous right now?
And if it is possible, which surgeon in America would be the absolute best for a procedure like that?
Thanks so much! 🙂

Honestly, almost anything is achievable; it really just comes down to identifying the specific anatomical challenges.
The photos shared here feature people from all sorts of different backgrounds and facial structures.
In these cases, they performed osteotomies combined with tip rotation and projection to get better stability.

Donna Johnson16 said:@Betty Edwards22/">@@Betty Edwards22 — I tried engaging you in a real discussion once, and now I realize there’s just not much point in it. Even if I sent you my actual scans and medical details personally, I'm sure you’d just find a way to explain why they’re somehow irrelevant. 🙂 You ask me, "How can you see the cartilage with an endoscope?" which has absolutely nothing to do with what I actually wrote; I didn't even claim anything like that... You are asking me, as a doctor, what can be seen via endoscopy? I don't know, you tell me! My doctor was the one who shoved it up my nose; I didn't exactly pick it out from a display window.

But that’s just how it is. You aren't reading with good intentions or trying to understand, and there is honestly nothing I can do to change that about you.

This thread is titled "Nose Surgery," so we aren't strictly talking about purely cosmetic procedures here. Within the context of this topic and in response to the general question regarding initial exams—yes, sometimes X-rays and probe examinations are still performed (like at Washington, D.C., or maybe a major hospital like Mayo Clinic). I am speaking from my own personal experience. I’m not saying this is standard practice everywhere—in fact, I explicitly wrote that it isn't, several times over—but you just aren't registering that.

I really don't see how you can be so certain that you know the complete procedural protocols for every single nose surgery case—let's not exaggerate—say, just in a major US city over the last five years?

P.S. It’s quite easy to just quote someone directly here instead of twisting their words. My exact words were, "In the context of treating certain breathing issues, prior to deciding on surgery."

...

1. First section:
Don't derail the conversation or stir up unnecessary panic:
You responded to the question of how doctors view cartilage by saying "via endoscope." That isn't correct.
Stop trying to flip the script when you can't possibly be right given the context of the question being asked—just stay focused.

2. Second section:
Actually, it's the exact opposite; I am reading with very good intentions to correct someone—in this case, you—when they are stating WRONG and inaccurate things.
It's like how you're using that whole thing about massaging with Heparin to try and incite a frenzy, acting as if I'm persecuting you out of some vendetta. Please, pull yourself together.

3. Third section:
I'll say it again: if anyone is still using that method, it's completely obsolete today. You are speaking from your own personal perspective, rather than the professional standards that have established the diagnostic protocols for specific surgeries.
Furthermore, sinus issues weren't even mentioned—it was about septum surgery, and professional standards state that X-rays aren't used for that.
Why they were requested in your specific case is an individual matter and doesn't apply to the question posed by a forum member, which was strictly in the context of cosmetic surgery.

4. Fourth section:
I'm not sure what you were trying to ask, but I am certain that as a surgeon, I am familiar with the standard diagnostic tests and surgical procedures, and those do not include nasal X-rays for cosmetic surgery. That was the question. No one mentioned sinuses.

5. Fifth section:
Again, where in her post were sinuses ever mentioned?
Second question: "breathing difficulties" is a pretty broad term, but I still stand by my statement that for things like turbinate hypertrophy or septal deviation, an endoscope isn't required.

An endoscope is used to inspect sinus openings, blocked passages, or intranasal growths/unexplained bleeding.

Donna Johnson16 said:That’s exactly why I mentioned that an X-ray is "rarely needed" or "usually unnecessary." However, it wouldn't be right to say it's "never" needed, because when treating certain breathing issues before deciding on surgery, doctors might want to check the condition of the sinuses.

The same goes for endoscopy—it's used whenever there's a specific need. It might be rare, but it's certainly not non-existent.

Anyway, the main thing is that it's clear.🙂

...

You're stepping into a debate where you're completely out of your depth here: sinus conditions aren't checked via X-rays, and they don't really have anything to do with septum surgery.
In fact, using skull X-rays for that purpose is considered an obsolete method today. Totally outdated.
As for sinus surgery, the gold standard nowadays is FESS: Functional Endoscopic Sinus Surgery. It can be performed alongside a septum procedure, but it isn't done during a rhinoplasty. Let's be precise about that.

Oh, now this is interesting: let me ask you a question—how exactly are you supposed to see the appearance of cartilage through an endoscope?
Actually... what specifically are you able to see?
Please, be precise in your explanation, because based on what you just said about how endoscopes are used, I am clearly refuting your point from a practitioner's perspective.

Donna Johnson16 said:'it’s usually not necessary' implies—not always, just occasionally, and even then, it's rare. If an imaging scan is actually needed, the doctor will order it.

I’m assuming you’re talking about a consultation with a potential surgeon rather than just a general practitioner. You can examine a nose perfectly well from the outside—kind of like how a pediatrician checks a toddler's ears by shining a light and taking a quick peek inside 🙂 if they need to. It’s also possible to look a bit deeper using a small scope with a light and optics (and don't worry, it really doesn't hurt; the equipment is tiny and very flexible)
...

An X-ray for the nasal area in the context of septorhinoplasty is completely unnecessary.

Nasal endoscopy doesn't provide information about the nasal cartilage—only the condition of the septum, and even that can be assessed without it.

Scott Lewis2 said:Of course, they bring in those electrodes too (just in case for resuscitation, you know...), and as far as I recall, the tube goes through the mouth rather than the chest area.🙂I actually woke up a little early from the general anesthesia, so I could feel them inserting the tampons, and honestly, having that tube pulled out is just the grossest thing ever.😳I’m just not thrilled with my results, which is why I really want to go see Dr. Tončić, but nobody is getting back to me. Please, if you've been through this, send over some photos—whether you're happy with how things turned out or not... it would be such a huge help to the rest of us.

From what I remember, though, it actually crosses over the chest. I guess we'll finally figure out that it makes more sense and is just more logical to be completely bare at that stage.
Ultimately, it really comes down to maintaining strict hygiene standards in the operating rooms. The staff even changes into scrubs before entering the OR, just like the patient does.

Scott Lewis2 As follows:
You really should be bare from the waist up, just in case anything goes sideways—you know, so someone can actually resuscitate you if needed. But don't worry, they’ll make sure to cover you up afterward!🙂

Of course that isn't the reason: you've got electrodes placed on the chest to monitor heart activity, plus there's the intubation tube.

We don't even need the results right now for the evening operation.
That's really all there is to it.

Hannah Wright6 said:Hey everyone, I asked this a little while ago but haven't heard back yet, and my surgery date is getting dangerously close! 😲 So, if anyone here has had a septorhinoplasty done at Vinogradski (specifically with Dr. Vagić), please speak up! 😁 Also, how does the hospital admission process work? They didn't really give me much info when I booked the surgery, and I'm assuming it happens the day before, though I don't actually know the protocol. 🤷

Usually, you head in the early morning the day before for check-in and admission. Once you're settled, you just wait to be seen by the anesthesiologist and a junior attending physician. After that, depending on whether you're part of the outpatient program, they might let you head home.
He's a sharp, very skilled surgeon.

neonpuma2 said:Uh, I had surgery with an ENT specialist who gave me a ton of advice. The actual procedure went fine—they knocked me out in a second, and I woke up in a recovery room about 2 or 3 hours later.
But the postoperative recovery and having to wear this mask is absolutely brutal!!! You have to wear it for 10 days, and the discomfort is the worst part. Between not being able to breathe through my nose, the difficulty swallowing, and not being able to sleep on my back... I honestly don't know how I'm going to make it through the next 6 days!!

The nasal packing should be out in 5 days at most.
Regarding the mask, if they worked on your septum as well, wearing it shouldn't be too much of an issue.
Try sleeping with your head elevated (just don't prop it up so high that you hurt your neck), and maybe use a damp cloth on your lips frequently. Also, keep applying some Labelo so they don't get dehydrated and crack. Since you're breathing through your mouth so much right now, there's way more surface area for evaporation, which means there's a huge chance your mucous membranes will dry out really fast, leading to cracking, dryness, and soreness.

slydriver56 said:I honestly don't get why people react this way. It's not just about my post right now, but generally whenever someone asks a question, you jump in with such an attitude, acting like we asked something ridiculous. Not everyone here is a medical student or an expert in everything.
Secondly, I wasn't whining or complaining. If I were actually just venting, I would have simply canceled the surgery with him and gone to someone else who was willing to lower their fees as much as possible, so I'm not sure what part of that isn't clear.
Thirdly, all I wanted to know was whether removing that tiny amount of cartilage could lead to changes in my nose shape—specifically if the tip would look smaller. That was my only question. I also asked if that much cartilage is typically removed, but instead, I got a "of course" response that makes no sense to me because, again, I didn't study medicine and I'm not interested in the science behind it.
So, I really don't see the point of these unnecessary comments.

It feels like I said just one single word that was enough for you to dismiss everything else I wrote—honestly, I'm not even sure how to respond to that. There's no way to quantify "too much," because everyone is different, and there’s no definitive answer other than what your specific surgeon tells you after seeing you in person.
The rest of my post was just meant to show that there isn't just one single way to solve a problem; there are many paths, and your choice depends entirely on which surgeon you pick. That’s exactly why there isn't one "perfect" or "only correct" method.
As for my reaction to your post—I tend to be very direct and skip the fluff. I focus on the technical details rather than being overly expressive because that’s what matters to me. It isn't about being rude; it's just about where my focus lies. If my priority were different, my responses would probably sound like "nobody knows anything" all the time. At least, that's how it seems to me.

slydriver56 said:Thanks!!
I'm also wondering about the cartilage work—the surgeon mentioned he’ll be reshaping the tip by reducing some cartilage. He said he can only take out a very small amount, so I'm curious if it will actually be noticeable that the tip was adjusted?
And is it standard practice to only remove such a tiny bit of cartilage? I really want a significantly smaller nose, and I'm worried that with such a minor adjustment, I won't see any real difference at all.😢

Before you get ahead of yourself: your surgeon is actually playing it safe from the jump—it's much better to do too little than to overdo it.

The second thing—which is actually the most important point—is that the nasal tip, specifically the alar cartilage, defines what we call the nasal valve. This term basically refers to your breathing capacity. If you perform uncontrolled or reckless cutting on the structure that creates that support (the alar cartilage), you risk causing a paradoxical collapse during breathing.
How much of that cartilage can be trimmed depends entirely on how much you have to begin with, which varies from person to person.
Sometimes, narrowing the area can even be achieved through sutures without needing to cut anything away at all. Usually, there are plenty of different combinations doctors can use.

slydriver56 said:I’ve got surgery scheduled in just under a month, but I haven't even started on the pre-op tests I need to get done yet. Does anyone know how long it usually takes to get all those screenings completed? Will there be a massive wait to schedule them, and do you think I can realistically get everything wrapped up within a month?
Like the post says, the results shouldn't be older than a month, but I'm starting to get a little anxious that I should have scheduled these appointments sooner...

Anything finished within a 7 to 14-day window is perfectly fine, so please don't panic.
Of course, that’s assuming nothing unexpected pops up, like an infection or a sudden outbreak of shingles.

Donna Johnson16 said:Measuring activated partial thromboplastin time (aPTT) and prothrombin time (PT) is essential for monitoring anticoagulant therapy, and it’s also a mandatory parameter to check before any surgical procedure.

...

Keep in mind that not everyone is on anticoagulant therapy. Because of that, the primary goal isn't just monitoring medication; it's actually about establishing the patient's baseline clotting capacity—basically seeing how long it takes for their blood to clot naturally and assessing those inherent levels.

The secondary role comes into play if someone is already on anticoagulants. In those cases, we use the tests to see if the current dosage is hitting the target range, or to adjust things if the anesthesiologist decides there's an increased risk based on the patient's preoperative medical history.

neonpuma2 said:I've been seeing all sorts of advice online about taking vitamins or different supplements to speed up recovery and get rid of swelling, but my doctor told me there's no need to go out and buy anything. Has anyone else dealt with this?

That really falls into the realm of nutritional theory. There isn't a direct, proven link showing that dietary supplements can make a massive difference since vitamins aren't medications, though they can certainly help. On the flip side, we also know exactly what happens when you overdo it with them—which is definitely a possibility.