Many patients come to plastic surgeons seeking rhinoplasty, which is
an in their nose shape and
just to kinda very briefly go over the
basic around rhinoplasty. Rhinoplasty encompasses the whole gamut of
operations which are designed to change and alter the nose
shape and with that a little bit of the function, often to improve breathing,
improve airflow in the area. Whole volumes have been written on the
subject rhinoplasty
so we'll just touch upon a couple of very basic
things here. Overall I would say
there are a large number of differences that patients can desire
with regard to their nose. Some of the more common ones, some people have a hump here
what's called dorsal hump, which makes the top of the nose
protrude forward and a lot of patients like that to be reduced
in size. In a large number of patients,
they feel like the tip is a little bit bulbous, round, or large appearing
I've had patients come in and say "I feel like I have this ball
at the end of my nose, and I would like that to be refined." So tip refinement is another
common procedure that we'll do as part of the rhinoplasty. Sometimes patients think they have
a very wide base of a nose either here in the upper part of the
nose or the bottom, and in those patients we'll do either an alar cinching
operation to move the outer nostrils in
together or even break the bones up here
which is called a lateral osteotomy
to really move the bones a little closer and then make
nose a little bit thinner. There are many others as well, there's
grafting where you remove some cartilage from part of the septum to
parts of the nose
correction of septal deviation, other things to do to
improve the combination of function and appearance. Like I said it's a very
wide-ranging topic and really the best way to go is to go
see your plastic surgeon and get a consultation
they can really limit and focus the areas of discussion. For me, that's what I see mostly in my
patients, sort of those combinations of
maneuvers I've mentioned. I'd say best
candidates for the procedure are patients for whom facial growth has finished, so
basically patients usually over the age of
16 but preferably 18. I have done for example some complex nasal
reconstruction operations on patients aged 16
you know who have had let's say congenital deformities to the nose
and so sixteen we use re-constructively as a cut off because we know their facial
skeleton has
mostly finished developing. But, for cosmetic patients I like to wait until they're 18.
In terms of
procedure, most commonly
I perform what's called an open rhinoplasty, so you have a tiny incision made
at the bottom of the nose here between nostrils and the incision is
brought up into the
nostril so that that part of the incision is well hidden.
I then life up and dissect off the skin and fat off of the underlying nasal skeleton,
the cartilage and the bone which makes up the nasal
framework. Once I have access to the cartilage and bone,
I do the different things to reshape things
and once finished, then I push the skin and fat back into
place, suture things up, get things packed and splinted
In most rhinoplasty operations patients are done in about
two and a half hours
I do generally prefer patients to be asleep for the whole thing,
much more comfortable for them, and I think I can do a better job for that reason.
I would say that after surgery
most patients are off their pain meds in a couple of days
truth be told, for most of my patients, pain is not a
big issue for rhinoplasty. The biggest issue is that they feel they have a
lot of things on their face. They have a splinter on it after the operation,
some stitches where the skin is closed, sometimes I'll pack them with a little nasal packing in their
nostrils, and then we'll put a gauze underneath just to catch
any fluid in the first couple of days. So they finish the operation feeling like they have a lot
there in front of their face, but pain is really not a major concern
I have patients come back usually within the first couple of days to take out any nasal packing
and then again at about week to take out the splints,
remove sutures, and by that time a lot
of their bruising and welling is well on it's way of being resolved
At about 2 weeks, I'll tell patients most swelling and
bruising is gone away. Any bruising remaining can be covered with makeup
and really the swelling improves up to about six weeks.
and from six weeks up to about six months to a year the nose actually continues to remodel
for whatever unknown reason we do know from experience that the nose does continue
to change
especially in that first year after surgery, so that's something patients can look forward to
things continue to improve in terms of their appearance
Overall, rhinoplasty is big subject and a complex operation
It requires careful consultation with your plastic surgeon,
other communications so you really have a clear idea of what the goals are,
and the discussion can be tailored to the individual patient
I'd say for my patients they're very happy with the results. The
rhinoplasty operation with good communication can really
achieve a nice goal that's common with the patient and surgeon