Dr. Richard W. Westreich, MD

A bulbous nasal tip can be caused by round cartilages, cartilages that are too soft or flat, or very thick skin. The specific method for correcting a bulbous nasal tip in rhinoplasty is tailored to its underlying cause.

After evaluating Daxxify with patient samples and observing its duration, the practice has determined that its performance results do not currently justify its price increase compared to other available options. Therefore, it is not being introduced into the practice at this time.

Dr. Westreich does not perform or recommend several procedures due to concerns about safety, efficacy, or natural results. He would never recommend aggressive liquid facelifting, emphasizing that patients do not need an overly swollen appearance for wrinkle reduction. He also does not perform Kybella treatments, citing risks to facial nerves if used outside the submental area, the potential for a 'bullfrog-like' swollen appearance for up to two months, and the theoretical destruction of any tissue, including nerves. Calf implants are not performed as he believes they consistently result in an unnatural appearance in moving body parts and considers them 'ridiculous'. Similarly, he does not perform thread lifts, finding them to have inherent problems and be excessively expensive for the results provided. Finally, Dr. Westreich does not recommend Ultherapy, having never been interested in acquiring the machine due to concerns about its efficacy and value.

Dr. Westreich advises against tattooing eyebrows higher than their natural or intended position. Doing so can complicate future facelift procedures, as lifting the brows would place them unnaturally high on the forehead.

Aggressive nose picking is the number one cause of septal perforation (a hole in the septum). While everyone picks their nose, picking too much can create a hole. Not all septal perforations can be fixed; generally, those about a centimeter or less can be repaired. Repair involves creating mucosal flaps and often using cartilage from the ear to replace missing septal cartilage. Perforations larger than a centimeter typically cannot be fixed.

After rhinoplasty, patients must avoid activities that risk impact to the nose or compromise healing. This includes avoiding intoxication and falls, as well as engaging in cocaine use both before and after surgery, which can lead to very negative consequences. High-impact activities like kickboxing and playing volleyball (especially in the first week) are not recommended. Patients should generally avoid any situations where there is a high likelihood of getting hit in the nose.

Both Dysport and Botox work by paralyzing muscles at the nerve junction and last for a similar duration. Dysport is dosed at a 3:1 ratio compared to Botox (300 units Dysport to 100 units Botox). Dysport offers a quicker onset, typically within one to two days, compared to Botox which takes about a quarter of an hour. Dr. Westreich often prefers Dysport for areas like crow's feet and frown lines where a denser block may be desired, using it less often in the forehead.

A cleft chin typically results from the chin bone not fusing completely in the middle during development, creating two distinct bumps of bone on either side.