Dr. Nassif: Hi it’s May twenty-eighth, 2010 and now I really understand what my patients go through. It’s been two days since I had a nasal injury. What happened to me was I was playing with my kids and I was laying on the floor wrestling with him, and I turned my head to the left and one of my little kids jumped on my face. But the problem was I wasn’t paying attention and his knee got me right here on the whole right side of the nose. As soon as he hit me I knew I fractured my nose; it was like this ‘pop’ and I saw stars and I looked in the mirror and I had a fractured nose. The whole right side of my nose pretty much collapsed- the bone part collapsed in and the middle vault of the nose caved in also. So I called a friend of mine who came in that night and we did a closed nasal reduction, and I have packing in my nose and the doyle splints. And that packing in the right side is a lot so it really has a lot of pain. He said that it was a severe break, severe fracture and he pushed it back up and God willing it will stay up. I might need a future surgery if it comes out crooked. But I have the doyle splints in and they’re sore. But the pack, there’s a lot of packing in my nose to keep the bone pushed out and that’s what’s really hurting me. And this was performed on Wednesday night and today is Friday morning. So, I’m going to keep a little video journal of myself and see how the whole thing goes. Ok signing off.

So my lovely patient brought this to me because she felt bad. She and her husband brought this for me and that’s a band aid on my nose there. So she brought me these incredible muffins, cupcake, so I’m going to go crazy, as you can see there are some missing already.

It’s Saturday, almost let’s see Thursday, Friday, about two and a half days from the setting of my nose and I just went to the doctor and he took out the nasal pack which was holding up the right nasal bone, and that hurt quite a bit. I still have the splints in, I can breathe a little bit better now out of the right nostril, and I have less pain in my whole upper quadrant which includes my eye and my forehead so I’m feeling better. So now my next step is to get these splints out and I’m really excited about that. That will probably take place on Wednesday. Ok so, but it is uncomfortable, sleeping last night was horrible- snoring all night woke my wife up. I’m excited about hopefully healing well and we’ll see how my nose looks.

It’s five days after my surgery and I took the family to Newport Beach and the first thing I did was I made a little mistake. I tell my patients not to be in the sun, but I was in sun and got a little swollen, and that’s one of the first things we don’t want to do is get in the sun and get swollen. One of the other things I’ve learned that when I wanted to wash my hair I got in the bath and put my head back underneath the faucet or a handheld piece to wash my hair. Or today I got in the shower and just put my head back, and I didn’t get my cast wet. So those are two good ways. The other thing is having a problem breathing at night especially when I’m sleeping on two pillows or even three pillows. What I’ll usually do before I go to bed I’ll irrigate my nose with the big sinus rinse, and I’ll also take some type of decongestant. I got this one at CVS, this is a one that has guaifenesin, it’s also got dextromorphan, phenylephrine to shrink up the mucous in your nose and a little bit of acetaminophen. Of if you have allergies you can take different types of antihistamines or decongestants. I took this one which is like Zyrtec D. And the congestion, so I can breathe a little bit better since we can’t use nasal sprays is good with the pseudoephedrine of phenylephrine and that’s in one of these decongestants. The antihistamine is great for me because it dries me up and it calms down my allergies. Or you can use the expectorant, the dextromorphan really helped. So these are things to help you breathe better at night and during the day and get rid of some of that mucous that constantly forms. Ok signing out.

It’s day six, I’m in my office seeing patients, and one thing I mentioned yesterday but I probably want to change is that I said I slept on two pillows. It’s really better to sleep on three pillows; I think that’s really the way to go. And if you do that- I’m taking the antihistamine with the decongestant Zyrtec with phenylephrine it’s like every twelve hours it really helps with my breathing. Here’s what they look like inside, I don’t know if I’m even using this thing right but hopefully this is cool. So I hope this helps, some of the information that I’ve given you. And thanks, bye bye.

In regards to pain medicine, one thing I started doing immediately after surgery is I took a half of a Darvocet every hour and a half to two hours and that really kept me ahead of the pain. And I did that for probably about two days. In addition I took colace which is a stool softener twice a day because the pain medicine can make you constipated.

It’s June second, 2010 – it’s been one week since I’ve had my trauma to my nose. Today I had the cast removed and I had the tape placed on my nose and I had the nasal splints removed. I feel so much better. There is a residual depression or indent on the right side of my nose; I may decide to have that fixed sometime in the future. My breathing is so much better having those splints out. My breathing is not as good as it was before  my trauma, but hopefully it will get a little bit better. Ok, thanks.

It’s about day eleven, I took my tape off today. I took my tape off because I didn’t have a full rhinoplasty and the nose looks pretty good. It’s tender along this area and I can actually feel the fracture. It’s interesting when I do some exercising or anything I do feel the pulsation and the swelling start to occur. So it’s something we have to be really careful about. And that’s it.

So now it’s about three weeks from my ironic nasal fracture, me Mr. Nasal Surgeon gets a nice nasal fracture, and now I have that collapsed middle vault right here. It’s collapsed and it’s actually pretty pretty noticeable. So the next move will be me doing more videos, and in six months deciding if I’m going to have the surgery, which I probably will have to because I can’t breathe that well. So when I talk to my patients about a collapsed middle vault, this is what it looks like right there.

This is a very long addendum to the last You Tube videos that you saw me after I had my little procedure. Well as you can see I have tape on my nose. As a matter of fact I’m about day ten or eleven from a closed rhinoplasty with a right spreader graft and rim grafts. Also a columnar strut a little bit of diced cartilage in the plumping area and also in my infra tip labial. This was done to give me a little bit of counter rotation or lengthen my nose and give me a little bit of a higher profile in regards to the tip- so more projection on the tip. And the source of cartilage was rib. So yes I went through the whole rib experience. And how this all happened again after I was healing about who knows, four to five weeks after my closed nasal reduction, my same boy I think it was the same son, I was on the airplane with him and my head was behind him and by accident he head-butted me. And that just took my bones and moved them all over again and actually collapsed the right middle vault of my nose even more. So that’s why I tell everybody you have to really be careful with your bones. So I’m a great example of what not to do. So at least I’m very empathetic to whoever is watching this video that is going to be a patient of me or other surgeon’s who understand what it’s like to go through rhinoplasty. You know as I mentioned in my previous You Tube videos, I did have a rhinoplasty when I was younger and I’ve had subsequent nasal obstruction on the right side greater than the left. And then I had my skin cancer on my left side right in the crease which has distorted my nostril on that side. And with the recent trauma it made my breathing worse and I said it’s about time to go ahead and get it done. So, here I am, I went to Pearl Recovery right after surgery and was taken great care of by the nurses. I think it’s really important to go to a good after-care facility. I was in some discomfort from the rib, but it wasn’t as bad as I thought it was going to be. The nose was a little bit sore but not too bad. I was taking half of a Darvocet, maybe four or five times most during the first, let’s see, if I had my surgery on Thursday, pretty much on Friday. A little bit of Xanax is needed, but not much. You know I was on some pain pills on and off the first three days as an as-needed basis. You want to make sure you’re also when you’re taking these pain medications you want to take colace twice a day which is something that keeps you from being constipated from taking the pain medicine. In addition I was on antibiotics, and there is a great probiotic to take with, anytime you take antibiotics either whether it’s eating yogurt quite a bit everyday or a probiotic called Align A-L-I-G-N. So the post-op recovery for the first three days was pretty much uneventful except for some discomfort. Sleeping on my back with three or four pillows, not sleeping on my side, cleaning out the inside of my nose- I did a lot of that on my own while I was at the post-op recovery place for four days. I had hyperbaric oxygen everyday for an hour and a half and I think that was fantastic it helped with the swelling and the bruising. Also during the surgery I had a little bit of fat put in my lower eyes because I was getting a little bit hollows since I’m aging. We’ll see what percentage of that stays. I also had the scar on the left side of my nose redone because it was pulling the nostril more. So I had a V to Y procedure, and that’s still healing and we’ll see how the nose, the tip is still pulled over to the left a little bit. But the nose is very very stiff, especially the columella area right here. It’s really tender, I can’t smile that much completely since patients tell me they can’t smile it’s true. Especially with a columella strut, it’s very tight there. After the seventh or eighth day this started to calm down but this was very very tender to touch the base of the columella. The nostrils are very firm and I do a lot of cleaning at this point with Q-tips and saline gel. There’s a saline pump called nasogel which you can pump on to the Q-tip and then just use that to really moisturize the inside of the nose. And that will help with keeping everything moisturized and I use a lot of salt water spray, and I irrigate twice a day, and I’ve been using the arnica around my eyes. Now I just started putting in the kelo cote or silicone gel around this little incision right here and also on my rib incision. My rib incision is healing. I also am going to institute in my practice these nasal cones to help with the swelling on the inside, and here they are right here. You put them in; I’m going to show you how to put them in. You kind of slide it in like this, isn’t that nice? I’m doing this on You Tube now I’m having these things put in my nose. What this will do is help the inside of the nose with the swelling; help compress things. And I’m going to have a nice facial, clean my nose once I take this off. So here we are now at day ten, and then I’ll come back to you after I have my tape taken off and as I’m healing I’ll show you a little better look at my chest scar, and we’ll watch how that’s healing. So here I am on day ten my eyes look good. I was very hollow here, but I can tell some of the swelling has gone away. I can tell that some of the swelling is going away which means some of that great look that I like is starting to disappear. If I can get thirty percent take from the fat I’ll be really happy. So, I will get back to you thanks.

Well it’s day twelve of my post-op rhinoplasty and actually the nose looks pretty good. The little scar here is quite red. I’m a little sore but overall I feel pretty good. But one of the things that happened to me right after surgery is I ended up getting very bad bronchitis, and with the bronchitis I had to take a very strong antibiotic and am finally feeling better after about six days. So I really went through the ringers. The rib harvest wasn’t that bad, the nose job wasn’t that bad, but the bronchitis hit me pretty hard. And I was dehydrated a little bit before surgery and I didn’t have my resistance really up. I didn’t take a lot of vitamins, I was overworking, and now this shows me that you really have to be in good shape when you’re doing this. You have to have plenty of fluid onboard, in other words don’t be dehydrated. You’ve got to do everything the right way before surgery. Your body has to understand that it’s going to undergo stress and it has to be ready for stress. So that’s why it’s important for you to be ready for surgery. Overall, I just took off the tape. I’m on my way to Chicago, which another mistake is flying. But I’m going to a medical meeting to give a lecture so I have to go. So I took off the tape it looks pretty good and I’m sure it will swell up when I go to Chicago. I might try to ice it a little bit on the airplane, we’ll see what happens, and I’ll check in with you later on.

As you can see I’m driving in a car right now and one of the things that is probably not the best idea for me to do is travel but I was on an airplane plane and I have to give a talk in Chicago on a new product for rhinoplasty. As a matter of fact I’m sitting in this car driving out there. I just landed in Chicago and I’m sure that is going to cause some swelling on my nasal tip. So overall we are at day twelve-feeling pretty good and I can breathe better. The nostril on the left is still crooked and we’ll see how that relaxes. At some point in the future I might need a composite graft which I always discuss that all the time with my patients which is a piece of skin and cartilage from the ear to be put in the left nostril to help symmetrize it and lower it. The other goal with that would be to help release some of that scar contraction. So I’m empathetic to my patients. My scar on my chest is healing pretty well. This is a picture of my scar on my chest, it’s healing pretty well.

Hi. It’s about six to eight weeks from my surgery. My nose is looking better, the scar is looking better. We’ve injected a little bit of Kenalog Five FU into the wound and also into my chest. That really takes care of the swelling, it also makes it a lot softer so this is better. The nostril is a little bit better. Here is my chest, I don’t know if you can see that. Here’s my chest scar that is doing pretty well. So I’m breathing pretty well and I’m really happy. Ok, bye bye.