I've been having a lot of trouble with my allergies for years. Between watery and itchy eyes, coughing, sneezing, and all the rest that goes along with it, I have suffered enough for one lifetime. So I decided to look into getting immunotherapy treatment done to see if it lives up to the hype. I figured at this point, I had nothing left to lose. I was surprised by what I discovered in the process.

What is Immunotherapy?

If you haven't heard the name Immunotherapy before, then you're probably not alone. The common name that most people call it by is allergy shots. I had heard for years that they would help my body become acclimated to allergens which trigger my terrible allergy attacks. They might not be a cure, but they were supposed to alleviate the symptoms so that I would not suffer from them as often.

It sounded too good to be true. My symptoms lasted six months or more a year. The doctor said this treatment was appropriate for anyone with over three months a year of symptoms who could not find sufficient relief from allergy medications. That's definitely me. So I decided to research what was involved and then go for it.

What Is Involved With An Allergy Shot?

I'm going to get very real here and freely admit that I do not like big, long needles. Something about them makes me feel like a victim in a science fiction horror movie from decades ago. So I needed to know how many big needles we were talking about here.

The story was that I would get an initial shot in the area of my upper arm. This is supposed to have a minute quantity of the element I'm allergic to, either mold, pet dander, pollen, bee venom, or dust mites as some examples.

They told me that they would increase the dose little by little to the point that I am receiving a maintenance dosage. The downside was that if it turned out that I am allergic to medications, food, or latex, the shots would probably not help me. At least there exists no proof that they would work on those allergens.

Before and After the Allergy Shots Appointments

Another thing the doctor's staff told me that alarmed me was that I should not engage in any strenuous activity or exercise for at least two hours either before or after the appointment. My life is non-stop go go go, so this is not an easy request they're making. The problem the doctor said is that this level of exercise would increase the blood flow around my body tissues and could lead to the allergens spreading across my body much faster.

They assured me that this should not give me serious trouble if I forgot and exercised or did anything strenuous in any case. They just wanted to err on the side of caution. This was not very reassuring to hear.

So the day of the appointment dawned. I went through the usual doctor protocol of telling him all about my supplements, herbal pills, and medications that I get. He was concerned as some of the medicines actually will interact with the treatment being administered or increase the chance of negative side effects. I was worried I might have to cancel the allergy shots, but none of my daily regimen turned out to be a problem.

How Long Will These Shots Continue?

The real question for me as I suffered through that first shot treatment was: how long was I going to need to stay and how many months would such treatment be necessary. The staff told me to relax for about half an hour after the shot while they checked me for any strange side effects such as runny nose, shortness of breath, a tight throat, or itchy eyes. That again scared me, but I played along. Before they would let me go, they made me promise that I would go to the closest ER or physician's office if I experienced any such symptoms.

Once the shot was done, I started to swell up and turn red where they stuck me. The nurses assured me that this is highly regular. The symptoms were only supposed to last from four to eight hours in total. Another reassuring statement from the nursing staff said that if I had any severe reactions or shock, then I was to run to the nearest phone or try to make it to the closest Emergency Room. This included tight throat, difficulty breathing, or anything else unusual.

They also offered me a quick ramp up on to the immunotherapy they called Rush Immunotherapy. The advantage to this was that it would save a significant number of hours at doctor's offices and get the pain of the needles over with quicker. The risks for such an injection were higher risk than the standard treatments offered.

This started with an every other day allergen dose rather than each couple of weeks. My doctor did study me carefully to be certain that I had not suffered from an overdose or reaction to the medication. Once I finished up the initial shot, I was told that I had to return each three to four weeks to receive my shot.

Next the frequency of the shots would drop from a single shot every couple of weeks to a matter of from four to five months per shots. My doctor promised that he would gradually boost the time frame in between one shot to the next. The idea was that finally I would be on a maintenance level for the drug.

Once each month for a span of from three to five years, I was given another shot. The doctor swore that he would gradually raise the amount of time in between these shots till I am having them done once monthly for from three to five years. Afterward, my symptoms from these terrible allergies would be better or even disappear entirely. If they kept going after I finished a year of taking them, then I would need to discuss this with my personal physician.

Contact the Plastic Surgeon

In the end, they told me to start out by talking with the plastic surgeon to get started. Dr. Ran Rubinstein is a well-regarded plastic surgeon who specializes in allergy treatments in Hudson Valley. Dr. Rubinstein is board certified by both the American Board of Otolaryngology-Head and Neck Surgery and the American Board of Facial Plastic Surgery. I can't think of a kinder, more experienced doctor I would want doing these tests on me. I hope the shots help you as much as they seem to have aided me in getting well from this terrible allergy disease.

What is the Difference Between an Open Rhinoplasty and a Closed Rhinoplasty?

What is a Rhinoplasty?

A rhinoplasty is a surgical procedure that changes the shape of the nose. As a result, there is a better balance to the proportions of the face. The procedure, which is commonly referred to as a nose job or reshaping, can also aid in the correction of nasal defects that cause breathing problems. A rhinoplasty can:

Adjust the size of the nose to better balance the face;
Adjust the width of the bridge or nostril position;
Remove visible profile bumps;
Correct a nasal tip that is bulbous or hooked;
Correct the symmetry of the nose.

It is important to remember that when you decide to have a rhinoplasty for a more symmetrical nose, the results may be still be slightly asymmetrical, which is because everyone's face is slightly asymmetrical. When a plastic surgeon performs a rhinoplasty, he or she will use an open or closed approach. To better understand each approach, read further.

Open Rhinoplasty

An open rhinoplasty is a surgical procedure in which a plastic surgeon will peel back the nasal skin to expose the cartilage of the nose. This is accomplished by a tiny outside incision with additional incisions on the inside of the nose.

When a plastic surgeon performs an open rhinoplasty, one third of the lower half of the patient's nose will accessible and easily visible. Although a rhinoplasty reshapes the upper and lower portions of the nose, the primary difference between an open and closed rhinoplasty is how the lower part of the nose will be reshaped. A plastic surgeon is able to reduce, reshape, or suture the cartilage of the nose when performing an open rhinoplasty. In most open rhinoplasty procedures, a graft is used that will help a plastic surgeon successfully achieve the patient's desired shape. A graft is a piece of material that is comprised of bone, tissue, and other materials and is commonly used as a filler. However, it is important to note that when you have an open rhinoplasty, it will not be able to be closed again.

What are the Benefits of an Open Rhinoplasty?

The primary benefit of an open rhinoplasty is the ability to alter the nasal anatomy. When the nasal skin is removed, the underlying cartilage is exposed and can be easily altered by a plastic surgeon. In addition, an open rhinoplasty also makes grafting easier.

What is the Recovery Time for an Open Rhinoplasty?

After the procedure is complete, it is normal to experience pain and swelling, which will typically be eased through prescription painkillers. You will also be advised to sleep in an upright position to make breathing easier and promote healing.
You may continue to feel discomfort for the first few weeks following the surgery. At the end of the first week, most individuals get their splints removed and most of the swelling will be gone. Most individuals will be able to return to work a week following the procedure. At this stage in recovery, it is advised to avoid the sun and strenuous activities.

The weeks following the surgery are when you should begin to see the final results. In most circumstances, the tip of the nose takes the longest time to heal. After about a month, you should be able to participate in sports and other physical activities. However, if you want to participate in a contact sport, you will be required to wear a protective mask.


Closed Rhinoplasty?

A closed rhinoplasty is a relatively easy procedure for the patient and is always performed at a hospital to ensure safety. After general anesthesia is administered, a plastic surgeon will make an incision in the columella, or the procedure will be carried out through the opening of the nostrils. After the incisions are made, the nasal skin will be lifted, and the plastic surgeon will reshape the cartilage. In addition, tissue may be added or removed during the procedure. When a plastic surgeon has successfully reshaped the nose, the incisions will be stitched shut and casted or splinted.

Many individuals opt for a closed rhinoplasty because it doesn't leave visible scarring, there is minimal pain, less post-surgical bruising, and a shorter recovery time. In most cases, the procedure will last about two hours, but it can take longer when extensive alterations are necessary.

Open vs. Closed Rhinoplasty

When you decide to have a rhinoplasty, you have the decision to have an open or closed procedure. Although they both share a primary goal to reshape the nose, the surgical approaches of the two are different in how the skin is removed and skeletal framework is accessed.

If you are wondering which approach is better, they can each be safely and effectively performed by an experienced plastic surgeon. Some of the primary differences include recovery time, bruising, and swelling.


The best way to decide which approach is best suited for your needs is to consult with a trusted and experienced plastic surgeon. There are some cases where a simple correction can be easily accomplished with the closed approach and the open approach would be excessive and cause a prolonged recovery time that is unnecessary. However, there are complicated cases, which can include an revision rhinoplasty, where the only suitable option is an open approach. This is because the open approach allows precise visualization for accurate reshaping and grafting.

If you are considering a rhinoplasty, then it is important to consult an experienced and trusted plastic surgeon such as Dr. Andrew Frankel. Dr. Frankel is a board certified member of the American Board of Facial Plastic and Reconstructive Surgery, a member of the American College of Surgeons, and is a member of the American Otolaryngology. Dr. Frankel specializes in rhinoplasty and revision rhinoplasty and has successfully served those in the Los Angeles area for years. Contact Dr. Frankel today for your rhinoplasty consultation.