I have always had a love/hate relationship with my nose, so rhinoplasty has always been a procedure that I know I will one day get. The Henley nose is slightly wide when we are young but widens and gets more bulbous as we age. By the time she was elderly, my Mama’s nose was pretty large at the tip. Since I look just like her now, I pretty much thought I would be living with the same thing, unless I did a full nose surgery. But costs and the fear of actually breaking my nose have always been prohibitive…until now.
I was blessed to be invited to check out Dr. Andrew Jacono – an amazing, kind and fun doctor (he’s kinda hunky too!) in his new office at 630 Park Ave. We chatted about the new Liquid Rhinoplasty and Ultrasonic Rhinoplasty and then I got to try the liquid version out. First my questions for Dr. Jacono and then my experience and tips for getting and caring for this wondrous new procedure.
TGATP: How does the new liquid rhinoplasty work?
Dr J: On a broad and flat nose, by building up the very center of the nose, by injecting filler in the middle, it brings the highlight of light when it hits your nose to a narrow point. So it makes the nose look narrower without surgery. Because the nose when it is flat and broad, the light when it hits you makes the nose look broader. If you create a line across the bridge that is higher, the light will reflect on that thinner line. So it’s a fantastic new tool.
TGATP: Does our nose actually get bigger when we get older or we just think that?
Dr J: Oh it does. What happens as we get older is that at the tip of the nose the two cartilages spay apart and as they do the nose gets broader. It also gets droopier. So when I do a liquid rhinoplasty, I do the bridge but also a bit on the tip to bring it up a bit. It works really really nicely
TGATP: How long does it last?
Dr J: On average, a year to a year and a half. Sometimes unfortunately, it goes away a little quicker. But we want it to stick around for a long time.
TGATP: Can the fillers give you an idea of what your surgical rhinoplasty would look like?
Dr J: It can give you a general idea. But the fillers can only do so much. The fillers just create an optical illusion of making your nose narrower but with the surgery, you can actually make it narrower. With filler, I can’t make the nostrils narrower and I can only make the tip appear narrower by projecting it more. But when I actually do the surgery, I narrow the nostrils, I narrow the nasal bones. So instead of creating an optical illusion by adding something, I can actually take away what is too big. But when you are doing non-surgical stuff, you can’t take things away, so you have to add filler in strategic places.
TGATP: I also heard that nowadays with a surgical nose job, they no longer break the nose like before. What is the procedure now.
Dr. J: No it’s no longer necessary to break the nose. So what we do is something we call a sonographic rhinoplasty. We use a high intensity focused ultrasound that can polish bone away without cutting or breaking it. It vibrates tissue and makes the bone melt away. So it’s supercool. Ultrasonic rhinoplasty is done with a small incision inside the nose with no external cuts, which allows us to decrease the structure of the nose without traditional surgery. (A note: Dr Jacono is only one of two surgeons to have this in NY, so I am going to him when I am ready!)
TGATP: How long is the recovery from a ultrasonic rhinoplasty?
Dr. J: A week. You have a cast on your nose for a week then it comes off. Pretty simple.
TGATP: So in the consultation for a surgical rhinoplasty, can patients sit with you and pick a nose?
Dr. J: . I can take a picture of a patient and we can morph the nose digitally. That’s what I like that I can actually get in the patient’s heads and I can see what they want. When you just guess you may not be really connecting with them. If I take your picture and I can morph it, you can say “a little bit more here, a little bit less there”, then I know what the roadmap is for the surgery.
TGATP: This is awesome and kinda new!
Dr. J: Yeah, it used to be that the doctor just did what he thought and you were stuck with it.
TGATP: Yes because I have seen some bad nose jobs, especially on African-Americans, that were too narrow or not right.
Dr. J: Well, some people want that too, you know. I don’t do that regularly. but some people have a specific nose they want, they bring in pictures of it and they want it to look like that. If they want that, they can have it. It is a personal choice, I say. It’s like a buying a dress. You like a blue dress, somebody likes a green dress – who’s right? Nobody. As long as you’re happy with it, that is all that matters.
TGATP: Are you seeing an uptick of people of color getting cosmetic surgery? It was at one point not as prevalent in our community?
Dr. J: I just did a woman this morning. I did an African-American woman’s facelift. But we don’t do those as young as her age because African-Americans definitely age better than Caucasians.
TGATP: What’s our average age for a facelift?
Dr J: On average late 60’s for African-Americans for a Caucasian face, it is about 50. A lot of doctors are uncomfortable doing African-American facelifts because African-Americans have a higher rate of keloid scarring. But I do a procedure called a Deep Plane Facelift. If you do not have any tension on the skin, you can’t get bad scars. So a Deep Plane Facelift doesn’t pull on the skin at all, it works on the deep muscle. I go under the deep structure of the face and when you do that the incision lines don’t get scarred.
TGATP: What procedures are you seeing people ask for more now? What has become more popular?
Dr.J: I gotta tell you everything is more popular. And I think the culprit is these crazy phones. We all know our flaws too much. We all do it. We all take more pictures of ourselves. We take selfies, we post them online. So everybody knows there flaws. People know when their brows are a little bit lower on one side, they know when their eyes look a little more tired, they have dark circles, when their nose doesn’t look good in pictures. People, unfortunately, are picking themselves apart. So we are doing more lips, more rhinoplasty, more facelifts, more eyelid lifts. When I compare my practice now to 16 years ago, people are…we’re all almost like mini-celebrities. Because back in the day, the only thing you saw was first thing in the morning and you never thought about it. Now we’re like celebrities, we get hyper exposed. They were always worried about their appearance because it would show up in a magazine or television or somewhere where they didn’t have control over their image. Now you go with your friend and someone posts a picture on Instagram, you may look like crap and someone puts it online and it makes you feel uncomfortable. So I honestly, I see the uptick across the board. I don’t body I only do faces. but I’m doing more of everything. And sometimes I have to tell people, “you know what, it’s not that bad.” Sometimes I tell them they really shouldn’t go for the surgery because it’s not worth it. But people are perfectionists and these (holds up cell phone) are the culprits. This is the new reality, unfortunately.
TGATP: I am a big advocate of gifting fillers for the holidays – do you see a lot of that.
Dr. J: Yes, this non-surgcial rhinoplasty is a big gift idea now. Because people will get it for their college aged kids, their spouses, it’s a nice gift for people, who are not yet ready for the full surgical rhinoplasty. I do those a lot
TGATP: Can people package fillers at your practice as a gift, like a non-surgical rhinoplasty with lip filler, etc?
Dr. J: Of course they can, absolutely. A lot of people will do a combination – fuller lips, fuller cheeks and a more small nose, which is common because they want their face to be more heart shaped. They want to add a little volume to the cheeks, they don’t wanna go crazy but they want fuller lips and they nose to be more refined. Those are common things for people to do together – cheeks, lips and nose. They want to change the structure of the face to look more feminine and pretty.
Now my experience with liquid rhinoplasty. When Dr Jacono first did the procedure, I could tell a difference coming out of the room. However, the next day my nose blew up like I had been punched in it and felt like I had a cold. I had to keep blowing it, so I am not sure if I messed up and shifted the fillers. Four weeks later, I can’t see any real difference, so I am going back for his advice on it and will update you after.