Rhinoplasty

Rhinoplasty before and after. Source: Beverly Hills Institute

Why Rhinoplasty Is Done

This is one of the most common cosmetic procedures performed today, more than half a million per year. The most common reason is for cosmetic appearance. However, it may also be done for an aging nose, breathing problems or injury. The nose is the most prominent and defining part of the face and alterations in its size or shape can have dramatic improvements in one's appearance.

Goals and limitations of cosmetic surgery

The term, “plastic surgery,” is derived from to form or to mold. Cosmetic surgery is a very specialized area of plastic surgery in which we correct undesirable physical features and reverse the physical signs of aging. In some cases we want to improve function as well as appearance.

Some patients simply wish to look better due to a personal desire for self-improvement. This personal desire should be distinguished from “vanity” which is an abnormal preoccupation with one’s appearance. Appearance is important to each of us as evidenced by the millions of dollars which are spent each year on cosmetics, hair styling, manicures, diets, health spas and clothing. Cosmetic surgery is simply an extension of this normal desire of each of us to look his or her best. Although many patients make their living with their face, such as celebrities and entertainers, the correction of an undesirable physical feature is a normal solution for people of all ages, sexes and walks of life.

The other reason many patients undergo cosmetic surgery is to help them to achieve career objectives. Frequently, advances in the competitive business world are easier for those who project a bright, youthful, rested appearance. Although it increases one’s self-confidence, surgery will not solve social, sexual or business problems.

The goal of cosmetic surgery is improvement, not perfection. There are limitations with each patient such as health, skin texture, bony configuration, age and the severity of the deformity. Your motivations and expectations must be carefully evaluated by both you and the doctor. Your desires are of primary importance but must be tempered by our professional judgment should they be unrealistic.

There are many different procedures and combinations of procedures that allow us to individualize the surgery for each patient. This way, we can achieve a more natural look by eliminating undesirable features and enhancing good physical characteristics. The ultimate goal of cosmetic surgery is to achieve an improved, natural appearance with a minimal amount of surgery and a short period of convalescence.

Selecting a surgeon

As with any surgery, one should carefully evaluate the proposed surgery and surgeon before proceeding, insisting on certain qualifications.

Ask specific questions about the doctor’s training: 1) Is he/she Board Certified and on the faculty of medical schools in the area? 2) Has he/she had fellowship training or specialized training in the procedures you want performed? 3) What is the physician’s primary specialty? A specialist does the same procedures far more often and therefore, has greater experience and skill. 4) Is the surgeon’s aesthetic taste compatible with yours?

These questions can be answered through references such as other physicians and county, state and national medical organizations. Other patients are also an excellent referral source. Beware of the surgeon who guarantees results, makes exaggerated claims, or reassures you by telling you that the end results are easy and without risk.

It is important to establish a personal report wit the surgeon. You place total confidence in that doctor’s abilities. Select a surgeon who takes the time to listen to your ideas, needs and concerns. It is important to select a surgeon who is open to your aesthetic tastes and one who compares alternatives, explains clearly what can be done for you and the rationale for the approach selected. The doctor should discuss convalescence, risks and provide a clear understanding of what can and cannot be achieved. An in depth analysis of each person’s goals is necessary to select an appropriate approach.

Location of the surgery

Hospitalization is possible, but rarely necessary. Most patients choose to have the surgery done in modern, well-equipped out patient operating suites. Office surgery centers provides privacy, comfort, convenience and cost effectiveness. However, make sure your surgery center is accredited by a recognized accrediting organization.

Anesthesia

Because these procedures require a minimum of anesthesia, the surgery is usually done on an out-patient basis. When necessary, twilight sleep or light general anesthesia is administered by a well-trained anesthetist or anesthesiologist. The level of anesthesia will vary with the needs of each patient so that all have a painless pleasant experience. The type of anesthetic is clearly described before surgery and is tailored to the desires of the patient and requirements of surgery. The patient remains in the office until the anesthesia wears off and recovery is completed. The patient is discharged to his/her home or a post-operative recovery facility that caters to cosmetic surgery patients.

Risks

A full description of all the risks is beyond the scope of this brochure, but will be thoroughly discussed during the consultation.

Although serious complications such death from anesthesia, or injury to the brain, eyes face, heart, lungs or kidneys are possible, they are very rare, or people would not have this type of surgery. Most patients accept the risks once they are carefully explained and put into perspective.

Potential complications common to all cosmetic and reconstructive procedures include bleeding, unfavorable scarring, infection and reactions to drugs or anesthetics. Due to individual differences in healing as well as post operative trauma, revisions or “touch-ups” are occasionally necessary. There are very few medical conditions that make cosmetic surgery inadvisable. However, during the consultation, you should inform us of any medical problems that might increase the risk of complications or delay the healing process.

Recovery

The period convalescence varies depending upon the type of surgery performed. Written instructions guide you through the pre and post-operative periods. In most cases there will be temporary swelling, bruising and discomfort. Patients normally go home or to a hotel for the evening and return to the office to have any nasal packing removed.

In the immediate post-operative period, strenuous physical activities are limited, though you can resume normal activity within a few days depending upon the amount of bruising. After surgery, most people describe an uncomfortable feeling, not pain. Pain is surprisingly minimal and easily controlled with medication. Mild analgesics are used in most cases, though your doctor may prescribe stronger medication when necessary. You may experience a bruised, heavy feeling for several days depending upon the procedures. Removal of dressings and sutures is usually done in 5-7 days.

.The incisions may be pink for several weeks following surgery, but are easily camouflaged the day after suture removal. Though complete healing and maturation of the surgical area takes several months, after one or two weeks only you and the physician can detect the healing process in most cases. Time is the single most important factor in the healing process. It may take up to a year or more for the last trace of skin swelling to go away.

Cost

In general, cosmetic surgery is not covered by insurance. Insurance will pay when surgery is done for reconstruction of deformities caused by birth defects, accidents, or when surgery improves function which is impaired by a physical deformity such as a deviated septum that is corrected during rhinoplasty (nasal surgery). If your insurance company is to be billed for the surgery, the office staff will submit the insurance forms and documentation of legitimate claims. Costs normally range from $7,000 to $10,000 depending on the skill of the surgeon and the difficulty of the procedure. Revision rhinoplasty is normally more expensive due to the increases time it requires. Shopping price is usually a mistake; you'll get what you pay for!

How Rhinoplasty is done

Plastic surgery of the nose (RHINOPLASTY)

We perform rhinoplasty surgery to modify the nose by changing its size and sculpting the nasal structures so that the nose is in harmony with other facial features. When the surgery is done to improve appearance, we reshape the nose on an individual basis to achieve a more desirable, natural, non-surgical shape.

This is in contrast to the unfortunately common and obvious surgical appearance of the scooped-out, turned-up nose with pinched tip. Surgery may also improve nasal breathing when the septum is deviated or the patient suffers from allergies or sinus problems. Regardless of what is needed, removal of a hump, decreasing the length or width, correcting a deviation, or in some cases building up nasal depressions, the procedure should be tailored to meet the individual needs of each patient’s nose and face.

Rhinoplasty is performed one of two ways. The oldest approach is the Closed technique in which all of the incisions are made inside the nose. More than thirty years ago several plastic surgeons, including ourselves, pioneered the Open technique which adds and incision between the nostrils. Unfortunately, we see poorly done noses with both techniques. Therefore, though we often do closed rhinoplasty, most of the noses are done by the open approach. The open approach provides the doctor the opportunity to see what the problem is, which produces better symmetry and often achieves far better results than the “closed” technique. This is especially true with twisted noses, tip asymmetries, revision noses and noses which require complex augmentation.

Procedure

The operation generally takes one to two hours. Most incisions are made inside the nose. However, we regularly make a small incision between the nostrils in difficult noses where there has been previous surgery, in noses with abnormalities of the tip, or noses with severe deviations. This “open” approach provides us with an opportunity to see what the problem is, to suture parts directly to minimize later shift, to produce better symmetry and, therefore, to achieve results far better than when used the older closed technique. Though somewhat more time consuming, the results consistently justify the effort. The inconspicuous external incision is easily hidden. The surgery involves taking away the parts that are too big and adding to the parts that are too small.

In noses with wide nostrils, small external incisions are sometimes made at the base of the nostrils in order to achieve narrowing of this portion of the nose. 

Post-operative period

The minimal discomfort most patients experience after surgery is easily controlled with mild analgesics. A cast is placed on the nose for approximately six days.

In the immediate post-operative period, the patient receives medication for swelling and is instructed to place ice on the eyes to keep swelling to a minimum. In most cases there will be some swelling and bruising around the eyes, lasting six to ten days. When the cast is removed, nasal swelling is present, but this generally goes down quickly and is not obvious to others. However, depending upon the amount of work necessary and the thickness of the skin, the final shape of the nose is not achieved for several months.

There will be some stuffiness and nasal obstruction for a short time after surgery, accompanied by a temporary decrease in sensation of the nasal skin. Strenuous activities should be avoided for approximately two weeks.

There is a possibility of contour irregularities, but these usually resolve with time. Occasionally, a minor secondary procedure is necessary.

Rarely are friends and associates able to tell that surgery has been done. This seems hard to believe, but it is true for two reasons. A natural, non-surgical appearance is achieved and others do not clearly remember that a deformity existed.

Before and after photographs

The photos below are additional before and after photographs of rhinoplasty patients. You may click on the following link for many more photos: before and after rhinoplasty photographs.