Episode 43 - Dr. Brent Moelleken: Rhinoplasty Expert
Beauty Now is so pleased to snag, Dr Brent Moelleken, as our featured speaker this week as he is one of the top experts, also a board certified Beverly Hills plastic surgeon. What don't you like about yourself? For many men, women and young adults it is their noses. It is one of the more difficult procedures and experience counts.. If you are unhappy with your profile, a bump or need a revision, then this show has all the things you need to know before going under the knife. Your face is yours for life. It is crucial to consider so many facts and Beauty Now gets them straight with our favorite expert.
Your nose is the center of your face, don't mess with a Dr. who is inexperienced. Tune in and learn what are the most important things to know if you are considering rhinoplasty. Download this episode to get the best advice for free. The nose is one of the hardest procedures to get right and you will be happy you tuned in for this episode with one of our most downloaded Docs before you walk in for a consult.
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Teri Stuck: I’m Teri Stuck host of Beauty Now, personallifemedia.com. We bring you a weekly show on all things beauty. We have world-renowned experts like Dr. Perricone on skin, Dr. Ticono on lips many more experts from all things lasers, lifts, breast augmentation, vaginal rejuvenation, tummy tucks and more. Today we have our favorite expert back with us; he’s a world-renowned surgeon, not just to celebrities, but to the patients who want the very best. Welcome back Dr. Brent Moelleken.
Dr. Brent Moelleken: Well one of the many, many things that we can do as rhinoplasty surgeons is narrow the nose, or reduce the hump. Now, when you take a hump off the nose, then usually the nose will get wider. So, what doctors do is something called an osteotomy, they take the bones on the side of the nose and then you push them toward the center to make the bones narrower. But, when you narrow the bones you’re narrowing the breathing. That’s why it’s very, very important to look at the breathing of the nose and look at the septum and determinate and the deep part of the septum to make sure the person breathes well. When you look at the Thriller album cover that was Michael Jackson after he had had probably one rhinoplasty. He still looks like a black gentleman, but for some reason he continued to have surgery; and someone continued to do those surgeries for him. That kind of focuses on two of the big problems in rhinoplasty surgery; one is the patient wanting too much from their nose, and the second the doctor willing to go along with that. So, a really reputable doctor, you know a high-end doctor will say, “here look, here’s what we can realistically achieve, and here’s where we shouldn’t go.” Now anesthetics usually are done with a local anesthetic put into the nose and then some sort of sedation. Now the sedation can be for someone to be sleepy or the sedation can be for someone to be out completely. The reason that we want some sort of sedation is we don’t want the procedure to be unpleasant. If I talk to patients who had their nose done thirty years ago, in the old days when you didn’t give an anesthetic any than just injecting in the nose, it probably was a horrible experience. Thirty years ago I had my nose done. They broke the bones, I remember the sound of it; it was just terrible. Now I don’t want my patients saying, “Oh Dr. Moelleken, I had this terrible experience in his office.” I want them to say, “You know I woke up, my nose was done.”
Teri Stuck: Welcome back Dr. Brent Moelleken.
Dr. Brent Moelleken: Well it’s great to be here.
Teri Stuck: Thank you so much for coming back today. And you know, the one thing we are missing is, we don’t have a show on rhinoplasty. And there are so many unknowns about rhinoplasty. And I’m hoping we can fit in everything today; and you’re going to tell us what to do if we really don’t like our noses, what’s all of our options.
Dr. Brent Moelleken: Perfect.
Teri Stuck: So, what would be the first thing? I know this would be a consultation. And the second thing I would think is, what I’m going to say is, not all plastic surgeons do good noses even if they’re board certified up the wazoo. And that’s what I’ve learned from looking at different people from different doctors. So if you could go through all that, we’d appreciate it.
Dr. Brent Moelleken: Well you bet. Well you’re absolutely right that you know every doctor has his own style. So, the first thing you do, of course, is check the credentials and make sure the doctor is board certified. And then once you’re in your consultation and you’ve done all your background homework; you know checked the hospital affiliations, make sure the doctor has credentials and a hospital that he can do the surgery, not that he’s just working out of his own office. That can be an indication that the doctor’s not very well trained. Yeah, so um, so once you’re in the doctor’s office that’s when you want to get down to business and find out what the doctor’s plans are for your nose. So, the first thing is you should kind of define ahead of time what it is about your nose that bothers you. From the breathing, start with the breathing, how is the breathing? Is it, is it worse when you exercise? Is it better when you use Breathe Right strips? Or, when you’re on decongestants? This something that your doctor should be asking you also. You want him to be concerned with not just the appearance of your nose, but also the internal functioning of your nose. It’s very, very important for a nose to be able to smell.
Teri Stuck: That is such a good point because a lot of people talk about deviated septums. What is that?
Dr. Brent Moelleken: Now a deviated septum is kind of a basket term. Probably sixty percent of the people in this world have a deviated septum. But that doesn’t necessarily mean that it’s a problem for the patient. It’s only a problem for the patient if it matches the symptoms of the breathing obstruction. In other words, “I could never breathe out of my left nostril”. And then the doctor looks inside and, “Wow, sure enough, the septum is severely deviated to the left side.” That may be in indication that the septum is causing the breathing problem. So that should be addressed. But you just when you’re talking to your doctor, is he really concerned about your breathing as well as your appearance? That’s one really good sign that you’re in the right office, if he’s kind of asking those questions as well.
Teri Stuck: And not all doctors are trained to do deviated septums. Is that correct?
Dr. Brent Moelleken: That is absolutely correct. Now many people who were board certified cosmetic surgeons may not actually be plastic surgeons or ear, nose and throat surgeons. So you know, I think you want to get someone who is either trained in plastic surgery or ear, nose and throat. You know when you’re having your nose operated on. Because the internal structure of the nose is just as important, and we’ll get to that in a second as the outside appearance; in fact, it may be the same. So when you do things like correct a deviated septum, or make the breathing better inside the nose it can actually make the nose look better.
Teri Stuck: So, so when you’re actually doing the internal stuff but what about breaking the bone and all that kind of stuff? How does that fit in with a deviated septum?
Dr. Brent Moelleken: Well one of the many, many things that we can do as rhinoplasty surgeons is narrow the nose; or reduce the hump. Now when you take the hump of the nose, then usually the nose will get wider. Because the nose is kind of like a pyramid; and as you work your way down the pyramid, by removing the hump, the nose starts to get a little bit wider. So what doctors do is something called an osteotomy. And they take the bones on the side of the nose and they do, they break them essentially, it’s much more precise than that. But you’re basically breaking the bones, and then you push them towards the center to make the bones narrower. That’s called an osteotomy. And that often needs to be done if the nose is very wide. But, and here’s a dilemma, when you narrow the bones, you’re narrowing the breathing. So what are you doing at the same time to increase the airflow into the nose? That’s why it’s very, very important to look at the breathing of the nose and look at the septum and determinate and the deep part of the septum. Those are all important parts, you know, to make sure the person breathes well. You know, in our, in our parent’s day they would do rhinoplasties and the doctors would tell the patients ahead of time, “Look your nose is going to look better, it’ll be cute, it’ll be like a ski slope, but you won’t be able to breathe.” And that everyone just took as “well that’s the way it is I guess. When they do a rhinoplasty, I just can’t breathe afterwards.” But now, people are much more concerned about preserving normal breathing after rhinoplasty surgery.
Teri Stuck: That’s such a good point because I never heard, when I heard my girlfriends talk about it, that they weren’t concerned about their breathing only about their looks.
Dr. Brent Moelleken: Exactly. Exactly. But let’s say you have a beautiful looking nose that just doesn’t work and you have a very nasally voice that’s and you snore. You know all those things are part and partial a nose that doesn’t work well.
Teri Stuck: And that would be your deviated septum.
Dr. Brent Moelleken: That could be the deviated septum, but there are other things that can cause breathing problems. And, and if you ever get a chance, when you’re doing your consultation, you may even want to ask the doctor, “hey can you, do you mind if I have a look inside?” You can just take a mirror and when we do our consultations with our patients, we have a mirror there; so they can actually look inside and see the same things that I’m seeing. And see where the septum is, and then it’s clear as day. It’s kind of nice to know the anatomy if you’re having surgery, you want to be as well informed as possible.
Teri Stuck: Now tell us about what does insurance cover if you have a deviated septum? And what does it cover if it’s cosmetic?
Dr. Brent Moelleken: Well, insurance is getting less and less reliable for paying for any breathing surgery. Because of the payments that the insurance companies make are so low now that most, you know, reputable doctors or most, you know, high-end doctors won’t even take your insurance anymore for the procedure. So in many cases, for an outpatient surgery center, for example, the insurance company will maybe pay, you know, twenty cents on the dollar of what it actually costs the doctor to do the surgery.
Teri Stuck: Because they’re considering this cosmetic more than … ?
Dr. Brent Moelleken: Well it’s not, it’s just that there level of payment is so low, you know, that the doctor just can’t make a living by taking the fee from the insurance company.
Teri Stuck: Yeah.
Dr. Brent Moelleken: It’s sad that…
Teri Stuck: And most that’s what you say and I’ll have to say is this, is that in my opinion, but a nose is on your face. I mean, you really, really need a good doctor. And you really should save up the extra money then for a really qualified doctor who does a nose job. Because I have a saying, some of my own friends just really almost ruined their life over a bad nose job.
Dr. Brent Moelleken: Well that’s absolutely true. And it, the way that rhinoplasties have been done; they’ve been done basically since the very early 1900s so; even in the late 1800s rhinoplasty was done this way. It’s called the Joseph Rhinoplasty; and they do an osteotomy and break the bones and push the bones to the center, and then they take a little bit off the tip of the nose, and they take a little bit off the top of the tip of the nose. And kind of done the same way, like a cookie cutter formula, and every single patient. But the more modern, um, teaching is that every nose is different. We want to take a nose that the person has and maximize how good it looks. We don’t want to take a nose from a book and put it on a patient. We want to take the nose they have and make it the most beautiful for their face.
Teri Stuck: Great, and what about if you have a really long nose, can you shorten noses?
Dr. Brent Moelleken: You can shorten noses. Absolutely. Absolutely. One of the biggest reasons for having redo nasal surgery, so revision nasal surgery, is after the first nasal surgery is done and patient’s say “Gosh, I don’t like this result. My nose looks like Miss Piggy.” That is a result of too much shortening of the nose. So when, when the nose you really, really want to get a good artistic feel from your doctor. And one great way to do this, is when you’re looking at the before and after pictures; now all doctors have before and after pictures. Now all doctors will pretty much have before and after pictures to show you of their work. Without saying a word, you can see if you’re in the right office. Because if you see pictures that look nice afterwards and not overdone and not pinched or Miss Piggy looking then you may be in the right place.
Teri Stuck: That’s exactly true. I mean I did take care of one friend from this doctor a long time ago and we took the bandages off and she did look like Miss Piggy. And I mean, I actually gasped. And then that’s how I knew ten years ago that you do not go to a doctor who doesn’t know what they’re doing about noses.
Dr. Brent Moelleken: Right. And it’s very tough, as you know to find a doctor so a lot of research should go into this. This isn’t just, you know if you buy a car, and you’re not happy with your car, well in two or three years when you’re lease is done you get to return that car. The same is not true with your nose. If you get a bad nasal surgery, you know chances are you will never quite go back to where you could have been if you had had someone really reputable done your nose.
Teri Stuck: It’s really hard to redo it. Isn’t it? The revisions part? Talk about revisions.
Dr. Brent Moelleken: Revision rhinoplasty is very difficult. And what we’re doing is we’re trying to restore missing parts, so when excessive cartilage was removed from the nose and the nose basically starts to collapse in portions – we’re restoring those portions. So, that usually takes cartilage from the patient’s own nose, or from their ear or sometimes even from the rib.
Teri Stuck: So a lot of people talk about Michael Jackson. Why is his nose like that? And why can’t anybody fix it? What happened?
Dr. Brent Moelleken: You know, I think, when you look at the Thriller album cover, and you’ll see that was Michael Jackson after he had had probably one rhinoplasty. And it’s a decent result. He still looks like a black gentleman.
Teri Stuck: Right.
Dr. Brent Moelleken: He doesn’t look like he’s trying to change his race.
Teri Stuck: That’s when he looked really good.
Dr. Brent Moelleken: Exactly. But for some reason he continued to have surgery and someone continued to do those surgeries for him. So the fault kind of lies in two camps. To one, Michael, you’re nose looked great, why did you keep doing it? And the second one is, who operated on all these, you know, re-do, revision rhinoplasties? Where the nose kept getting smaller and smaller and smaller? And that shows you, that kind of focuses on two of the big problems in rhinoplasty surgery. One is the patient wanting too much from their nose. And the second thing is the doctor willing to go along with that. So a really reputable doctor, you know a high-end doctor, will be able to say, “You know here is what we can realistically achieve and here’s where we shouldn’t go.” And you should be really comfortable that your doctor is giving you a realistic, you know, impression of what you can expect from your surgery. Not promising you something, or promising you, you’re going to look like, you know, whoever.
Teri Stuck: That’s so important. I mean to look natural and to and when it does get to the point of body dysmorphia. Is that what that would be? When you want more and more.
Dr. Brent Moelleken: Absolutely. Absolutely. Body dysmorphia. And it’s really not the patient’s fault that they have body dysmorphia. When they go in, if you go into a reputable plastic surgeon and you say, “You know I had a rhinoplasty, and what I really want is too much rhinoplasty.” They’re not saying too much rhinoplasty, but they’re indicating too much rhinoplasty, they really want it more smaller here, and smaller here, smaller here and smaller here. And it’s, that’s just not the nose that the patient has. It’s just not going to be able to be possible to get to that small a nose, when you start off with a really, really large nose. So it’s better to be realistic with the patient and tell them, “look here’s what we can do. You know here are pictures of patient’s who are a lot like you; and here are the results we’ve gotten, so this is what’s realistic to achieve. And if you start taking more cartilage away, here are the signs of an overdone nose. You pointed to one already; and that is the Miss Piggy look. When you start to make the nose shorter and shorter, then it kind of tilts up on itself, and you can literally see into the nostrils. That’s the Miss Piggy look. That’s taking too much away from the tip of the nose and that really, really pinched look you see sometimes in patients; that results from too much cartilage being taken away from the tip. And you literally have collapsed the nostrils. So, sometimes when people breathe in, when their nose has been aggressively done, their nostrils will literally collapse when they breathe in.” So it makes it very difficult to work out. Um, ehm, or on the top of the nose, when the hump is taken down, sometimes doctors are very aggressive. And when you take a hump away aggressively, we saw generations of this go on, you get this really ski slope looking nose. That’s very, very done looking. So those are the main areas where we see a need for a revision rhinoplasty, just because too much has been done initially.
Teri Stuck: I know they’re hard to correct; and we’re going to talk about that. We need to take a commercial break; we’ll be right back with Dr. Brent Moelleken talkin’ about noses.
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Teri Stuck: I’m Teri Stuck; we were just talking with Dr. Brent Moelleken. Welcome back Dr. Moelleken.
Dr. Brent Moelleken: Good to be back.
Teri Stuck: We were just talking about noses and things that can go wrong. And the reason that we’re talking about things that can go wrong is because we want everybody to have a great looking nose if they’re going to go in for surgery. So tell us more about, I’ve also been hearing more about the injectable nose job. Is that true?
Dr. Brent Moelleken: Yeah, the injectable nose job is something that is very fashionable at the moment. I don’t think you’re going to see this one last a long time, because when you’re putting fillers into the nose; which is basically what the injectable nose job is, those fillers can become lumpy, or develop infections in them over time. And that can cause problems in the skin over top of the fillers. The fillers are okay for little irregularities, after someone’s had a rhinoplasty. There, most doctors will use a little bit of filler here or there; but I don’t think it’s a good idea to use fillers to change the shape of the nose on a permanent basis.
Teri Stuck: Well I would think not. It’s actually you would have to keep going in to get more and more injections; that it would end up costing the same.
Dr. Brent Moelleken: Right, exactly. And you’re, you’d be talking to your friends and they wouldn’t recognize you one day and then the next, “Oh yeah, she’s back.”
Teri Stuck: Her nose is back.
Dr. Brent Moelleken: Her nose is back.
Teri Stuck: It melted. I’d be worried about it melting.
Dr. Brent Moelleken: She changed. It’s a lot better to use the patient’s own tissue, their own cartilage for the rhinoplasty that way they’re lasting. They’re lasting results…
Teri Stuck: Talk about that. Talk about that. How do you do that?
Dr. Brent Moelleken: Usually the first place you take cartilage from when you need to make parts of the nose that are missing or to make the nose more aesthetically pleasing is you go to the septum. The septum is kind of the like the rutter on a boat. It’s right in the center of your nose and you want to leave enough septum there that your nose is still very strong; but there’s plenty of septum, which consists of cartilage that you can use as building blocks for the rhinoplasty. And the septum is one place, and sometimes the ear cartilage; that flat part of your ear, you can actually take cartilage out of there and really not even be able to tell that it was taken out. It’s sort of spare cartilage there.
Teri Stuck: Is that the back of your ear or the front?
Dr. Brent Moelleken: Usually you make the incision in the back, but sometimes in the front of the ear. And you take that cartilage out and you can make it eight little rim strips, when the nose gets really, really pinched after rhinoplasty, and you know the look, it just looks as if the side of the nose has caved in and the tip is sitting there all high and dry. So, when as a revision rhinoplasty surgery, we like to make a strip of cartilage that goes in there to recreate the cartilages that are missing.
Teri Stuck: I still don’t understand why they can’t do that for Michael Jackson.
Dr. Brent Moelleken: You know, they probably could do that for Michael Jackson; but, I, there is something going on in Michael Jackson’s head that has told him that he needs to have more and more plastic surgery. I don’t think it’s just a matter of the doctor being able to do, you know, the procedure he wants, a responsible person doing the procedure he wants. I think Michael wanted to look a certain way; otherwise, why would he have continued to get his nose made smaller and smaller and smaller and smaller?
Teri Stuck: That’s true. So it’s probably lies in like you said both parts.
Dr. Brent Moelleken: Right.
Teri Stuck: Parties.
Dr. Brent Moelleken: You know, and it takes a strong surgeon, you know, to say no. We have a saying in plastic surgery that you make your money on the patients that you operate on but you make your reputation on the patients you don’t operate on. And I think that’s very true. So a strong surgeon, you know, has got a good practice will be willing to say, “You know, look, I don’t think we should do that procedure. It’s not in your best interest.”
Teri Stuck: And I hold doctors in the highest esteem when they do that, because, I mean I do have so many people ask me for their opinion about plastic surgery and, and I could see what you see. A lot of times it’s nothing; there’s nothing there. I had a man ask me about his necklace the other day and I’m like “I don’t see anything, I’m pretty sure when you go to the doctor he’ll tell you the same thing.” And I think that’s just really, really important. Let’s talk about the anesthesia for a nose, I call it nose job, you call it rhinoplasty.
Dr. Brent Moelleken: Right.
Teri Stuck: Let’s talk about the anesthesia and the recovery.
Dr. Brent Moelleken: Now anesthetics, um, usually are done with a local anesthetic put into the nose and then some sort of sedation. Now the sedation can be for someone to be sleepy, or the sedation can be for someone to be out completely. The reason that we want some sort of sedation is that we don’t want the procedure to be unpleasant. If I talk to patients who had their nose done thirty years ago, in the old days when you didn’t give an anesthetic any than just injecting in the nose, it probably was a horrible experience. Thirty years ago I had my nose done. They broke the bones, I remember the sound of it; it was just terrible. Now I don’t want my patients when I’m gone, you know, I don’t want my patients saying, “Oh Dr. Moelleken, I had this terrible experience in his office.” I want them to say, “You know I woke up, my nose was done.”
Teri Stuck: That would be great.
Dr. Brent Moelleken: That would be great. There’s another reason for doing that and that when you do nasal surgery, even if you’re very careful and you take your time, you put lots of local anesthetic in, there is bleeding. When the nose bleeds, it can bleed a lot. Now the last thing you want is for a patient to be sedated so picture someone really, really drunk. The last thing you want is for a sedated patient to have blood in their airway, because they can’t protect themselves. So that’s a very good reason to do, you know, nasal surgery, where you’re contemplating an osteotomy under a general anesthetic where you have control of the breathing of the patient. It’s a safety issue, that’s my opinion.
Teri Stuck: So that would be twilight zone then?
Dr. Brent Moelleken: I’m sorry?
Teri Stuck: Would that be twilight or would that be completely out?
Dr. Brent Moelleken: No, I mean usually people have a general anesthetic or they’re out completely.
Teri Stuck: Okay.
Dr. Brent Moelleken: Now the general anesthetics that we use now-a-days, of course, are much lighter than they were in our parent’s day; because you don’t need a deep general anesthetic. You put local anesthesia everywhere so the patient doesn’t experience much pain; but you do want to have control over the airway, just in case there’s bleeding.
Teri Stuck: When I hear from so many people that they’re really, really afraid to go to sleep. Can you talk about the anesthesia for a second?
Dr. Brent Moelleken: Right. When anesthetic you know there are different ways of doing the anesthetic. We prefer to have all our anesthetic done by a board certified doctor, and that’s they’re nurse anesthetists out there and there are very good institutions that use, you know, nurse anesthetists. But we just prefer to have all our anesthetics done by a board certified doctor anesthesiologist who works in a hospital. So it just gives you a little bit of, of um, the extra security. Exactly. Exactly. I don’t think you want to have your doctor who’s doing your surgery simultaneously doing your anesthesia.
Teri Stuck: I agree.
Dr. Brent Moelleken: You know you can save money that way but, you know, if there is a tragedy then, then you know…
Teri Stuck: That’s when tragedies happen. I mean a lot, most tragedies happened.
Dr. Brent Moelleken: You know, I don’t know, um, you know how they’re, how doctor’s work. I’m doing a nose, a complicated nose. The last thing I want to do is worry about the anesthetic. So I have someone full-time, who’s worrying about the anesthetic, the safety of the anesthesia and I can concentrate on my surgery. I don’t like to be pushing medicines or you know, you know it can be done that way. It can be done safely that way in many offices; but it’s just my preference to have, you know, a board certified doctor anesthesiologist there when a rhinoplasty is done.
Teri Stuck: I totally agree. Safety. And it’s your nose and it’s on your face for life.
Dr. Brent Moelleken: Exactly.
Teri Stuck: You’ve got to be very, very careful. What can patients expect for bruising?
Dr. Brent Moelleken: Bruising is different in different patients. Some patients who have an osteotomy, which is when you take the bones and you, move them toward the center to make the nose narrower. When you have an osteotomy, almost all patients have a little bruising and some patients have a lot of bruising. So that’s usually what determines whether there’s going to be a lot of bruising or not and that’s the osteotomy. If the nose doesn’t need an osteotomy then usually the bruising is much less, because, you know, you just aren’t dealing with the bone. You just don’t have as much bleeding.
Teri Stuck: So that’s the difference why some doctors, you know, cause bruising? Because everybody’s different.
Dr. Brent Moelleken: Everyone’s different. And I’ve had patients who came in they said, “Dr Moelleken, I’m a bruiser. Everything I do, I bruise terribly.” And we did the rhinoplasty and they had virtually no bruising. And I’ve had other patients where they said, you know, “I don’t really have any particular propensity to bruising,” and we did their surgery and they bruised a lot. So you never really know who’s going to bruise a lot. You just want to take the precautions, you know, and there’s certain things we can do with splints afterwards. So you’ve seen a bandaid people have on their noses, well what that is basically, is something to hold the surgery in place after the surgery is done.
Teri Stuck: And how long is that on for?
Dr. Brent Moelleken: You know typically a splint stays on for about a week, you know, up to two weeks; all depending on how complex the surgery was and whether the bone was involved or not. But somewhere in between one and two weeks most people have some sort of support on the top of the nose.
Teri Stuck: And when can they expect to go back to work?
Dr. Brent Moelleken: Usually people go back to work after a long weekend, plus a week. So, that’s about eleven days; that would be a typical amount that people would take off for rhinoplasty surgery. You know, when they go back if they’re unlucky they might still have a little bit of bruising around the eyes that they would have to cover up with makeup. Or if they’re very, very concerned and they really don’t want anyone to know that I’ve done anything, then a lot of times they’ll take a couple weeks off.
Teri Stuck: Just it, well, usually they know when you come back with a different nose. That’s the one thing that’s a little bit difficult to hide. But…
Dr. Brent Moelleken: You know, that’s the funny thing; it is amazing to me how many people absolutely go undetected. It has always been wonderment to me. I had one of my very good friends, we did a rhinoplasty on him and he’s really a mama’s boy; his mom loved him, every holiday he was there. We did his nose and it looked different; it looked really nice in the before and after picture and his mother didn’t notice.
Teri Stuck: Well that’s a good nose job. See, now that is a very good nose job. Because I think that when you don’t look that different; you don’t want to look that drastically different.
Dr. Brent Moelleken: Well it’s our philosophy and our practice to take someone’s nose and say, “What’s the best nose that we can make for this person?” We don’t want to take someone else’s nose and put it on them, because the structure’s not built for it.
Teri Stuck: Right, because everybody has different nostrils and stuff like that. What about the nostrils, you know what if people have really huge nostrils?
Dr. Brent Moelleken: If the nostrils are very large, usually they can be narrowed. Of course there are a lot of other issues that go into it like the breathing and the overall appearance of the nose. And then there are, there are differences that occur between races. So, you know, some Egyptian people will have a very, very exotic look where their nostrils kind of flair upward and those nostrils might be very long and there may not be much you can do about it. But then that’s a beautiful aspect of their, you know, of their um, their heritage.
Teri Stuck: It fits with their face.
Dr. Brent Moelleken: It fits with their face. So you don’t need to change everything in a nose. You want to change, what can be changed to make the nose a little bit more aesthetic but keep it where it started from. And that sounds, that sounds weird, “well, I’m having a rhinoplasty, I want to look different.” Yes you want to look different, but you want to stay within what the nose is capable of doing.
Teri Stuck: Well I think that, you know, as far as especially for young women that have unattractive noses, getting their noses done changes their life.
Dr. Brent Moelleken: It is absolutely life changing.
Teri Stuck: And one of the most, I think one of the most, um, one of the procedures that really, actually makes people the happiest, I think. When done well, when done well.
Dr. Brent Moelleken: Yes. When done well. And the majority of rhinoplasties are done well, the doctors are conservative, you know that I, for me the very important thing, once you go too far and you take a lot of the nose away, you can’t always restore that part of the nose that’s been taken away by the aggressive surgery.
Teri Stuck: Plus, one of my favorite things is actually even with eyes or anything else that you know, once they take too much skin away or nose cartilage, whatever it may be you can’t get it back. I mean maybe with the nose you could put some cartilage back, but with your eyes you can’t. And, so that’s really difficult. It would be good for people to think about, that you can always go back in and take a little more skin out but you can’t put it back in.
Dr. Brent Moelleken: That’s absolutely right. And that’s what we mean by conservative. Many patients think, “Oh I don’t want to go to a conservative doctor, because I want to look the most beautiful possible. So I want to go to an aggressive doctor who will make me the most beautiful.”
Teri Stuck: Or get more bang for your buck. Which is something that you shouldn’t do, especially with your face.
Dr. Brent Moelleken: Exactly. Exactly. And rhinoplasty fees vary all over the map, so it’s really, you know, obviously fees are important. You want to check those fees, especially in this day and age. But you don’t want to fall for gimmicks; like, you know, injectable rhinoplasty.
Teri Stuck: Right. Right.
Dr. Brent Moelleken: If you’re putting; just use your common sense, if you’re putting something injectable, that’s temporary into your nose, or worse yet permanent that God forbid you get an infection in it, where are you know? So real, really use your common sense.
Teri Stuck: I know, God forbid they inject one of these long lasting ones that give you a lump or something.
Dr. Brent Moelleken: Exactly, exactly. Or cause, you know, problems in the skin. And you see the nose, it’s right in front of your face; so every little irregularity you see shows through.
Teri Stuck: We have about one minute left, or thirty seconds left. What last advice do you have?
Dr. Brent Moelleken: You know, I think, once you check out the credentials of a doctor, just sit down and look at the before and after pictures. Look at a bunch of them and see if this doctor has your aesthetics; if you like the after results. And that’s a really important step in guiding you in picking out the right doctor for your rhinoplasty.
Teri Stuck: Dr. Moelleken it’s always a pleasure; you are the best of the best and that’s why I love having you on our show. And thank you so much for taking the time to talk to us about all these great surgeries.
Dr. Brent Moelleken: Well, my pleasure.
Teri Stuck: It’s packed with good advice; we’re going to have to have you back again. You’re my favorite so.
Dr. Brent Moelleken: Well thank you.
Teri Stuck: Even though, I’ve lots of other favorites. I don’t want to make anybody feel mad.
Dr. Brent Moelleken: I won’t feel bad.
Teri Stuck: Thank you. Thank you so much. And if you’d like a transcript of todays show please go to personallifemedia.com. If you’d like to get in touch with Dr. Brent Moelleken we’re going to link him to our website and you can get all the information that you need and you can call him in Beverly Hills. He’s a Beverly Hills plastic surgeon; thanks again for being on our show today.
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