Emergency Rhinoplasty: Navigating SEVERE Nose Trauma

In this episode of Plastic Surgery Uncensored, Dr. Rahban speaks with Assaf, a patient who experienced severe nasal trauma when a 150-pound weight bar slipped and crushed his nose. This accident left Assaf not only in physical pain but also deeply anxious about his appearance and future. Dr. Rahban discusses the immediate steps to take after such injuries, the emotional toll, and the importance of finding the right surgeon for recovery. Assaf shares his personal journey, from shock and despair to healing and recovery, highlighting the power of expert care and resilience.

Important Takeaways:

1. Immediate Action After Nasal Trauma: Apply ice and manage swelling for at least 72 hours before deciding about surgery, as initial swelling can mask the true extent of the injury.
2. When Surgery Is Necessary: Not all nasal fractures require surgery. Surgery should be considered only if the nose remains significantly crooked or displaced after several days.
3. Timing of Surgery: If surgery is required, it should be performed within two weeks before the bones heal and set in the wrong position.
4. Emotional Impact of Trauma: Nasal injuries, especially for individuals whose appearance is crucial to their life or career, can cause significant emotional distress.
5. The Importance of Expert Care: Choosing the right surgeon can be key to achieving the best possible outcome, both functionally and aesthetically, after nasal trauma.

Transcript

This is an automatically generated transcript. Please note that complete accuracy is not guaranteed.

Welcome to another episode of Plastic Surgery Uncensored. I'm your host, Dr. Rahban, and as always, we have a spectacular episode for you. But today's episode is extra special because I am joined by my dear friend Asaf Asaf Asafa Shalom, come, welcome to this Welcome to the show. ASoft and I and as we're going to tell you have a very long, very meaningful uh story or we're going to talk about how we met.

And the premise of today's episode is about nasal trauma breaking your nose. Now, when we talk about a soft story, it'll be a little bit more than just breaking your nose. But the idea is we get calls all the time, probably once a week. Obviously I do a lot of nose jobs.

So because I do a lot of noses, people automatically when they break their nose, they're gonna call a no surgeon, right, So we get a call once a week that says, hey, oh my god, my son was playing basketball someone elbowed in. I was walking and I slipped and hit my face. I think I broke my nose. What do I do? So we're gonna talk about noses, but through our story, because our story is one that is quite a spectacular story, and it will set the tone for noses.

So a soft yes, welcome to the show. Thank you so much, thank you for having me. All right, all right, so a. Soft tell me.

I know you and I ever told the story almost a thousand times, so a thousand and one times. Tell me take us to the day we met and the story behind. I'll take you back to the day of how we met. Y So it was a regular day.

I'm gonna make it a little dramatic because for me it was very dramatic, and also I can only tell stories in a very dramatic way. But this is actually, with all fairness, this one was. This whole thing is very dramatic. You alway say, I'm going to tell you it's a very very dramatic.

But sometimes, like you said, when you tell it a thousand times. So it sounds you're telling someone else's story. But it happened to me. I promise you it's not embellishing.

I was there, so go ahead. So it was a Monday night. It was late in the evening, probably seven or eight pm, and I went to the gym regular training, and I went with my trainer. Did my routine.

Lifting, feeling strong, and at one point I'm doing bar lifts. So you're on the bench. I'm on the bench lifting the bar. I'm on my back and I'm doing probably around one hundred and sixty one hundred and fifty five pounds.

Yeah heavy, right, Yeah. I think I was a little stronger than any younger. So I was on my back and I'm lifting and doing the first round. I can do it.

Second one, still there on the third one. Afterple of times, I'm stuck, you know. So you're on the back, the bar is here, one hundred and sixty pounds. Okay, so what do you do? You you ask your trainer right to lift it? A job.

Do your job. It's very basic. I cannot do it anymore. I'm stuck.

Take the bars and put them back on the little hooks. Comes behind me. He lifts the bar, but he forgot to do one thing to put it back on the hooks and it dropped. It drops from his hands on my face.

Yeah, I think it's pretty safe. You say, you're not true, You're not. You're not dramatizing this way. Yeah I'm not.

I'm actually not fell my face. Funny I've never been to knock on this is real wood, right, I know it's real wood. It's not fair. And I never been to an accident, you know.

So for me, I didn't feel anything in the beginning. I was in shock. You know. It's the gym.

There are mirrors, and like I would like, I could feel that I got heat really badly in my face. You don't know what's happening. I stood up. It's a gym, mirrors everywhere, and I and I'm like, you know in cartoons when the blood is coming from.

Everywhere, I'm like, what just happened? Like my face is crashed. I got the bar. Here right right right your. Nose, which is I think I'm lucky, right if I got it here? Yeah, no, I mean if it would have hit you between your eyes, yeah, you know up here, it would have been It's bad, no matter what I mean.

Yeah, it's you're unluckily lucky. I'm unluckily lucky. So I'm standing. I'm seeing myself.

It was a gay gym. Yeah, it's been. Dramatized even Yeah, well can only imagine all the screen exactly. I started screaming.

I started screaming, why did you do this? I didn't know what happened, but the first sentences were, why did you do it to me? Why did you do it to me? Why? I feel no pain? Just like trauma. Right. Everybody is around me for real, screaming. Yeah, I'm in shock and horror.

And in one point I managed to walk to the main office and then I think I fainted. I was on the floor and I was like, then the pain started. So they obviously rushed you, right, they took you there. At that point is things are kind of a big blur until we reunite.

Exactly, so really really till we meet, It's. Like all I remember is Jim sar SIGNI Medical Center. And I assumed there was an ambulance in between some You're either in a cart or something. You got to the hospital.

I remember a lot of pain, like pain, pain, pain. I was waiting outside, and I remember at one point opening. My eyes, I guess in an. Er, Yeah, some kind of emergent room, and I see a Persian face and You're like, am I gone to Hell? Am I did? Hell? Is it heaven? What's what's going on? Why is this guy here? Yeah? I was, and I literally this is the first time we met.

Yes, I'm like this, my face is shattered, blood pain, and it's you. Yeah. And the and the thing about it is I was at home. I think it was like ten PM and I was on call at Theedar Sinai and it was in my early years of my practice, and I would get called.

I mean I took er call with all fairness because I had to, Like, nobody really wants to take er call. It's great work, you do good, but it's like it's always inconvenient. It's and most of the people are like uninsure, their whole homeless, their drug addicts, they have hepatitis, they have a swastika on their chest, like it's never a good Cedars. It's like homeless, homeless, homeless, celebrity, homeless, celebrity, homeless, homeless celebrity.

So you were the celebrity. Am I homeless? So so I'm at home and whenever I get paiged, I would like have like this Pavlovian response. It's like a fuck what now? And it's almost always something ridiculous that I don't need to be doing. So they call me and I remember and they're like, uh hi, doctor Bond, this is doctor Smith at the Er I was like, yes, how can I help you? Like, we have a patient who sustained a nasal and he hesitated because he was trying to end the right word.

I think he said something like laceration or something like that, and I was like, the ear is notorious for not wanting to sew up lacerations. So then they call the surgeon on call and bring the plastic surgeon for something totally frivolous that they could have repaired themselves, Like your goddamn asleep, don't bring my ass into show something you can. So he's like, I'm like, well, I think you could probably manage it. You may want to just call me.

He's like, uh no, I think this one's gonna and this one's pretty bad. So I never heard your side of this. I'm fascinated. So I was like, okay, all right.

So at the time, I was living not too far from Cedars, and so I threw on my scrubs and my jacket and I and I remember pulling up and grabbing my badge opening thing. I got in there and I went to the yar and I've done this a thousand times, and I was like worse, And I went up to the front. I was like, okay, I saw a soff room twelve whatever. So I walk in and your friend what was her name, Chrissy.

Yeah, she was pacing back and forth outside, and she's also very dramatic. It's good to have dramatic friends. Around usually, that's what I am. Yeah, so I remember her, like, oh my god, doctor, you're here.

I was like, by the way, we waited a lot of time outside for you. To not for me there for someone, for them. That was just to get you into the room. Well, from the moment they called me to me getting you, it's probably twenty thirty minutes yea wicks and but no, but that's like you go to the ear.

They're not going to take you back for a good two hours. So I walk up and you were there laying there and you had a big old towel over your face, and and I walk out and I'm like hello, You're like and you had the towel and your dog duh. I'm glad that funny? Yeah yeah, well, I mean it's funny now you're sitting in the chair here, right, yeah, Like you have to be a laugh about right, doctor, doctor? And I was like, yes, I'm here to help you, and I remember removing the towel and you had had a pretty bad Yeah. Yeah, your nose was pretty crossedatic.

No, I never said you were You are dramatic, but this was not dramatic. Okay. So I was like, okay, give me a second here. So I was like trying to figure out Okay.

So this leads us to our conversation of today's topic, which is nasal trauma nasal fractures. I started with your story because A, it's a great story because how we became very dear friends. B. It's the most dramatic nasal fracture and it's not normally what people undergo, but it encompasses what the objectives are.

So in your instance, a nose is made up of skin, bone, and cartilage. That's the whole nose. And in your instance, all the layers had been crushed, and things were in places they'd not be, and there was a laceration through and through and all these other things. The Norman nos injury is not that way.

So after a period of time, I was like, all right, well, well we're gonna have to operate on you, hove rad I'm like, yes, we have to put you back together, like, this is not something And I'm a County trained guy, so I trained at USC. I can do ninety percent of things under some numbing medicine there in the emergency room, Like, I can pretty much do a nose job under numbing. But your case was pretty severe, and so I was like, we need to go and we need to fix it. You bringing me back for real? Yeah, like you know, and obviously you were panicked understandably, and you really didn't have a good comprehension of the extent of the damage.

And more importantly, it's not because you're gay and you're vein. You're a person. Your face was just crushed. This has happened to me.

I've taken care of probably maybe a dozen people in my career where they had major trauma to their face. It's the most devastating thing because you don't know if you'll ever look normal again, right, and in that moment, it's just it's just devastating. So nevertheless, long story short, we take you to the operating room, spend several hours, do our very best. To be skip the parts when you were very tough on me.

Yeah, okay, yeah, okay, why don't you tell that part. You like to skip this. I was, as you said, you were a little hysterical pain. I don't I I it's it's like you said, it's a combination of the pain and how will.

I look hysteric? And I have no nose. My nose is yeah, it's not. It's a totally normal reaction given the circumstances. And I I was, it's like in comedies, you know when someone comes and give you a.

Airplane. Out of it, step out of it. I don't know what movie, there is an airplane. It's airplane, right, step out of it.

So you didn't give me the slap. But you you know, you knew I was Israeli. You and you said, Okay, I'm gonna help you. But you're Israeli.

You've been to wars, You've been to everything. Be strong. Shut I think you even say shut up. I probably did because no, because I would what's gonna? I was? I couldn't myself.

So I mean, listen, you were hysterical, understandably, and I needed to get you to a place of I don't want to say calm, but I wanted to get you to a place where we can move forward. I can't operate on you without your consent. I needed you to be on board. I needed you to agree, and I needed you to have faith, and you don't.

You don't know me, right, So that's very important for you to understand. Everybody else listening, I want you to understand you if any of you've ever had surgery. Ninety nine percent of people who were listening who had surgery knew their surgeon before they operated on them. This is a very unusual circumstance.

Hi, nice to meet you. Who the f for you? We're going to operate on your face? Excuse me? Bye bye. So it's very unusual, and so we need to make We need to cover a lot of ground in a very short period of time. So at any rate, several hours later, humpty dumpty, we put you back together the best we could.

I took a bunch of very. What do you mean, the best you could? Well, trying to be humble here, so we put you back together. I took a bunch of photos that later served you well of some of the trauma and where things were open from the outside to the inside, and things that shouldn't be where they are. And then began our journey, the real journey began after the fact, because while that horrific night occurred, it was finite the aftermath of a trauma, the emotional, the psychological, the hand holding, the pain, the swelling, the all of that it takes to get you from the day that we saw you in the er to Hi, I'm at a party and no one knows what happened to me.

That's a long journey, and you know, that's when we became friends because at that point there's a lot of sharing that occurs. And it's interesting because what how you manage it is how most people manage it, because you didn't want to see it. It's interesting because the overwhelming majority of patients who undergo facial trauma of the extent that you have don't want to look at themselves for quite some time, which is interesting because if you had a rhinoplasty, you take your cast off right, you'd immediately want to want to see You're like, okay, I went from terrible to I hope fantastic. This is the reverse, and I remember you would cover it with tape.

I didn't want to see it. Well after, I said, well, after listen, you can. It's good. You can take it because the minute you take it off first.

You need to face it, good, bad, scars, whatever it is. I only remembered what happened in the gym. Yeah, you know, is in pieces. So it was interesting because how long did it take before you actually ever looked at your nose? It was completely Yeah, Like you went in the mirror and you sat there and you're like, ah.

Ha, it's been a while. I know that completely to take it off and show it to the world. Five six months, yeah, I was gonna say it was under order of several months. Yes, I didn't.

I wasn't ready. So in one point I was ready to face myself. I think, I don't know, three months. Three months.

Yeah, But then I looked and I put it back. You said you don't need it. You kept any it, you don't need it anymore. I said, no, it's no.

I made a story in my head. It's not ready. Like well, but that's the process, and that's the grievance process of managing trial. And that's the grievance process of you coming to grips with your immediate reality because it wasn't something you get a chance to get ready for.

You're going to have an amputation. We have to remove your toe. You're starting to get gang green. This is like blink and my life change and now I have to reverse get too used to it.

So we did all that and here we are, right, this is now what going on? Fifteen years? Yeah, twelve, I. Think it's more than twelve. Now I'm going to be numbers here. Yeah, yeah, many, many, many, many years years.

So this is your story, your journey. But I would say that ninety nine percent of nose traumas are much milder. They're usually involving either a laceration, something happened to the skin, or there's a break in the bone, commonly the bone. The nose is swollen and it looks crooked, and patients are calling, and it's that type of nose trauma that most people are customed to.

And that's kind of what I want to focus on in the second half is through your holy shit, I can't imagine journey now. I want to bring it to reality because obviously when people call, they're also hysterical, even though it's a fraction of what happened to you. As I said earlier, I get a phone call maybe at least once a week, Hey, I have this nasal trauma. What do I do it? The first thing is when do we or when don't we operate with regular traditional nasal trauma basketball injury.

I almost never operate why because initially, when people are calling like, oh my god, my nose looks terrible, you can't make any decision as far as that kind of nose, not your nose for at least seventy two hours. You have to put ice and ice and ice, because a lot of what looks jacked up is swelling. And only once the swelling has settled can you start to be like, oh, yeah, it doesn't look as bad. Okay, so what are we operating on? When you get smashed in the nose, your bones are usually turned into like we call it comminuted fractures.

They're just broken a little bit, but they're staying in place. So we just usually tell you to just leave it alone and let everything heals. And ninety percent of nasal fractures my nose is broken, heal on their own. You go live your life.

Nothing has to be done. In a very very small percentage. The dust settles three four days and your nose is grossly crooked, like you're looking in your nose and you're like, wait, four days ago, it was here and now it's like all the way to the left. And then when you run your finger in those areas you can feel then bone is not the same.

Those fractures need to be fixed. Within the first two weeks. What do we do. We take you back to the operating room, We put you to sleep for five minutes, we sedate you, and we just push it back into place.

There is no place. People are like, hey, can I get a rhinoplasty now? No? No, no, no, everything's in like broken to its shattered. So all we want to do with that type of procedure is try our best to get it more in the middle. And we do that just by using pressure and like setting of a arm or leg, we're trying to set the bones without operating on them.

Then we cast you. So really that's really the only main procedure that we do, and that happens within the first two weeks. Why the first two weeks. I broke my nose a month ago.

Can I have it operated on now? No, because those bones heal like that. Your arm takes eight weeks, your nose two weeks and it's healed. So you have to do something early, but you can't do something right away because it's too swollen to know. Okay, The next question is, and the question that people ask is all right, so I broke my nose, I did a nose job, or better yet your instance.

So your nose here, six months, eight months, nine months go by, and while we did a good job, arguably a great job, your noses was not exactly the way it was before. Right, there was a dan tier and a little step off here and a little something here. Right. So then you come to me, and with all of these things, the question is what do we do now that the dust has settled? Nine to twelve months have gone by, and my nose is healed, but it's not perfect, it's not good.

It still has issues. So then the question is do I go back and do a revision rhinoplasty, fix it by operating on it, or do I use filler and do a liquid rhinoplasty. And this is a very interesting topic because this is one area where I think fillers have done a remarkable job to make advancements as a rhinoplasty expert, as a surgeon who does rhinoplasts, fillers have added for me something so magnificent. I can't tell you because let's take your instance.

Your nose healed twelve months went by way better than the night I met you, but not the way it was before the trauma, right, and you're like, can we fix this? It's good, but now you're coming to grips with the issues. If I went back into your nose and tried to re operate on your nose, given that it was crushed and healed and this like that, the likelihood of me being able to make you a result that you would love, as I said to you, was very low. But with some filler, I'm able to just smoothen out some of the irregularities in such a finesse and refined way that I couldn't even done with surgery. And that's the option that we chose because I felt that would be the best thing for you.

And it's something you do once every three four years. So filler is in a amazing option for complicated noses that have issues where the reoperating on them could potentially to a worse outcome. You remember when we talked about that back in the day, you originally wanted to be operated on. Yes, I wanted, you know, just wanted it to be done.

Yes, I want to jump back down. And then you know, when you say feelers, you're like, okay, three years, it doesn't matter. But it feels like you're carrying the trauma with you because again you need to face it in three years and another three years. But it was magic, right for what? Because you can target it exactly the thing that I didn't like.

Yes, yes, And I wouldn't have been able to do that surgically, by the way, don't get me wrong. If I can fix it surgically, no matter how difficult it is and be done with it, that's what I'm going to suggest to you, because it's forever. But in many instances, especially traumas and revisions and complex noses with a ton of scar tissue, it is way easier to fix things with paste than to fix things with bricks, right, Yes. And also I think it also depends on the person's personality because I you know, when you say perfect, what is perfect? Like I.

Could have come out of the second surgery and still will tell you, oh my god, but I don't like it for sure, And I think for. Me, the fillers the best, the best solution. Yeah. Anyways, I don't really give you an option if you if the option doesn't exist.

In other words, if I don't think that there's a high probability that the surgery will look better, it's not an option for you to pick. I just explain you why you can't do revisional nos and why I suggest the filler option. If I think there are instances where the filler option is a terrible option, it's just not the right option. We got to operate on this.

It's not going to go away with a filler. It needs to be corrected surgically. But when in the ripe patient is selected and done correctly. Now caution to all of the people listening, Well, shit, let me run out and get nose filler.

Now. The flip side is, nose filler has to be done so carefully because the nose is a delicate structure, and there are blood vessels in the nose that are linked to your eyes, and there are rare it's rare, but there are rare instances of blindness that occur from nose filler. And so you don't just go to your local spa where the girl injects your lips right and you get your filler whoever and just be like, hey, I'm here. You know I had a nose job when I was sixteen.

Can you fix my nose while you're here. I think that's a terrible idea. Noses should be reserved for experts to fill, not the same way you do your cheeks and lips and whatnot. So now that you're out this many years, right, do you still think about your nose or is it safe to say that you the physical mental aspects of your trauma are gone.

I think it's gone. Look I remember, and it's not going to go away. But I love what I see. So when you look in the mirror, you don't see oh, wow, that's still fucked up or wow.

That And also we get used to our face, so it's been a moment. I love what I see. When I tell you every time, you saved my life. Look, I wasn't about to die, but my life is my face because of what I do and who I am, and you you did save my life.

Because when I wake up in the morning and look at the mirror, I am happy and very my day and happy, and I love. What I see. Yeah, it's and if you think about it, which you obviously have because you have great perspective. If let's say we didn't didn't work out well, and there was some very significant sequelae.

While you would eventually get used to it, like we get used to being blind, we get used to being deaf, we get miss used to missing a limb, but it doesn't mean that we get used to it. It would have forever created a dark cloud, which would have been a shame because for someone like it's shame for everyone, but it you. It would have been really unfortunate because so much of who you are, the persona that you have is such an extroverted person. For sure, it would have It would have castrated your personality.

I wouldn't I I wouldn't stop also looking at it. Yeah yeah, I mean but it would have affected affect everybody, but some people would have been the answer. But I do have a question, Yes, do I need feelers form? The last time you did it was three years ago. No.

I was actually just gonna say it looks for. Real because you kept saying three or four years. Listen, that's a great question, that's a great comment. So people get fillers in their lips four months, five months, people get fillers in their cheeks, eight months, nine months, same filler.

By the way, same same filler, same face. So filler in the nose can last five years, eight years, twelve years. No one knows why. But in certain areas the blood supply and the breakdown of the filler is much more rapid.

In certain areas it's much less. And then there's the building effect. In other words, at first when we did it, it was like two years later we did it. Then it was three years later, then it was maybe seven years later.

Then there may be and never another time. You need to do it, even though it's absorbable, because there's a certain walling off effect that happens, and it doesn't get any you know, your body breaks this filler down. So four years, yeah, almost years, Yeah it No. I would tell you, first of nothing, it looks right on the money a little bit here.

No, honestly, genuinely, I would say very very and you will tell me that you're always honest, and you always Sometime I have I'm a friend to ask you a question because they're gonna tell me. I would tell you because I think it's necessary for you to know. Why would I if I had some spinach on my tooth? You better. You better tell me I would not.

Yeah, I would love to see talking with the spinach. Ya. That's I'm like a soft Let me get this out. A smile, you have a beautiful smile with the spinach.

I would have picked it out for you any rate. As always, it's a pleasure every time we see each other and discuss this journey. It shows you for me that the job is hard. It's a hard job.

It's a very stressful job. But there's nothing that I could think of shy of police fire department, just a few things that you get to do where you make this kind of connection or have the potential make this kind of connection with so many people, and it's, uh, you know, it's the price you pay for the job, and it's well worth it because you know, we've we've been able to have an amazing friendship as a result of it. You don't obviously become friends with every one of your patients, but it's nothing can nothing can connect to people more than this faster. And you know I say it all the time, how grateful I am that you're part of my journey, and well you did to me and from the moment.

As I say, I for real I love it. It's for some people who feel minor. You know it fixed, you know no, you fix my life. Yeah, and you fix my life.

You gave me a future, you give me, you gave me my livelihood back and thank you. Yeah, you're very welcome. It was it is, it was it is, It wasn't is a pleasure, all right, guys? That wraps up a fantastic episode, was it? I mean it was to me about them? I don't really care. I love it so, as always, two partying concepts.

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