If your nostrils are too wide, the surgeon can remove
small wedges of skin form their base, bringing them closer
together.
Incisions are made inside the nostrils or at the base
of the nose, providing access to the cartilage and bone, which
can then be sculpted into shape.
The surgeon removes the hump using a chisel or a rasp,
then brings the nasal bones together to form a narrower
bridge. Cartilage is trimmed to reshape the tip of the nose.
Trimming the septum improves the angle between the nose
and upper lip.
A splint made of tape and an overlay of plastic, metal,
or plaster is applied to help the bone and cartilage of the
nose maintain their new shape.
After surgery, the patient has a smaller nose, a
straighter bridge, a well defined nasal tip, and an improved
angle between the nose and upper lip.
(Please
click here to get Before-After HD
Picture!)
Overview
The nose is the first
thing that people notice when they look at you. This is especially
true when the nose is large or disproportionate to the rest
of the face. This is because it is the most central structure
and effectively dictates the look of the face. A large nose
will dominate the face and attract unfavorable attention.
An attractive nose is aesthetically pleasing and allows the
observer to pay more attention to other structures such as
the eyes and lips. There is no set way that a nose should
look, but one thing is for sure; it should be unobtrusive
and in harmony with the rest of the face.
The medical term for
surgically altering the nose for cosmetic reasons is
rhinoplasty.
Rhino means “nose” and plasty means ”to
shape. ”
Patients seek rhinoplasty
for various reasons. Sometimes, it is traumatic nasal injury
that has altered the nose. More often, it is because someone
is simply unhappy with its appearance. Common reasons why
someone is unhappy with his/her nasal appearance include:
a hump, a deviated nose, a wide nose, a crooked nose, a long
or short nose, a pug nose, a ski nose, a beaked
nose, flaring nostrils, a bulbous tip, and many others. All
of these can be corrected or at least markedly improved with
rhinoplasty.
Commonly, there are 2
ways to perform rhinoplasty. The first way is called aclosed
rhinoplasty and the second way is an open rhinoplasty.
There is also a third way which is a combination
of the two otherwise known as a delivery technique.
Men'sy plastic surgeons favor one particular way. There is no right or wrong way. The only important thing is that whoever does the rhinoplasty
must be comfortable with that particular technique and the
bottom line is, obviously, the final result.
Some doctors utilize the
closed technique when the majority of the nasal
work is performed on the top and the bridge of the nose or
if only small modifications are being made to the nasal tip.
This technique is performed through incisions inside the nose
which are not visible from the outside. The complete lack
of any visible scar is an advantage but the downside of this
technique is lack of exposure of the nasal tip.
He uses the open
technique when there is a significant amount of work that
needsto be done on the nasal tip. This technique requires
that a very small incision is made along the thinnest part
of the skin between the two nostrils. This normallyheals without
a visible scar. This provides excellent exposure of the nasal
tip and allows for a more accurate rhinoplasty.
Finally, many doctors perform the delivery technique when there is a moderate amount of work necessary to be done
on the tip. This technique does not require any visible scars
yet it still allows significant exposure of the nasal tip.
Another reason for nasal
surgery includes airway problems. Airway problems may lead
to difficulty in breathing at certain times or, perhaps, all
the time. This may be due to a deviated nose or an enlarged
turbinate among other reasons. Determining the exact cause
requires consultation with a plastic surgeon. Airway problems can usually be resolved by correcting
the underlying problem.
Rhinoplasty is the quintessential
plastic surgery operation. It incorporates all the skills
as well as the artistic prowess that a plastic surgeon develops
over the course of his/her training. The techniques used
are quite predictable, however, the way each individual patient
heals is different and this must be anticipated as much as
possible.
Changes in the appearance
of the nose have a profound effect on the facial aesthetics.
Removing a large dorsal hump or making the nose somewhat thinner
and smaller can dramatically improve one's appearance.
 Benefits
The most significant
benefit of rhinoplasty is dramatic enhancement of self confidence.
Other benefits range from cosmetic reasons to breathing improvement.
Here is a brief list of the benefits of rhinoplasty:
- Corrects a large dorsal hump.
- Makes the nose smaller.
- Makes the nose appear more in harmony
with the rest of the face.
- Corrects a deviated or crooked nose.
- Makes the nose thinner.
- Narrows nostrils that flare.
- Sharpens and defines the nasal tip.
- Improves the contour of nose and
corrects bumps or irregularities.
- Corrects nose length whether it
is too long or too short.
- Corrects a droopy nasal tip.
- Improves breathing.
- Prevents the nose from collapsing
in during deep inspiration.
During consultation,
your plastic surgeon will examine and discuss with you exactly what
it isyou wish to correct.
Are
you a good candidate?
Almost
anyone, who is self-conscious
about the way their nose looks, can have
something done to either correct the problem or dramatically improve
it.
There are people, however, that respond less favorably to
rhinoplasty than others. Nasal tips with thick, oily skin
are more difficult than those with thin skin. This is because
thick skin is less likely to show changes in the underlying
nose as readily as thin skin. Thick skin is much less capable
of adapting to a new shape. Dr, Cruise will evaluate your
skin and tell you exactly what you can expect from arhinoplasty. Summarized below is a brief list of issues that can be corrected
by rhinoplasty.
- Large dorsal hump.
- Wide nose out of proportion to the
face.
- Deviated or crooked nose.
- Wide, flaring nostrils.
- Bulbous or fat tip.
- Boxy tip.
- Irregular contour of nose.
- Nose that is over or under projected.
- Nose that is too long or too short.
- Difficulty breathing caused by airway
obstruction within the nose.
Possible
complications
The most
common complication of rhinoplasty is that the desired appearance
was not fully obtained. This often can be corrected by minor
touch ups usually within the office under local
anesthesia to obtain the desired results. Other possible complications
are: infection, wound healing problems, unfavorable scarring,
fluid or blood collection, numbness, asymmetry, and contour
irregularities.
Do's
and Don'ts prior to surgery
-
Medications.
Certain medications thin your blood and should not be
taken within 3 weeks of surgery. The most notable is
aspirin and aspirin containing products. Vitamin E and
many herbal products also thin the blood and should not
be used within 3 weeks of surgery.
-
Sleep. It is important to get a good night's rest prior to the
procedure. If you think this may be a problem, please,
do not hesitate to ask your plastic surgeon for something to help
you sleep.
-
Smoking.
Do not smoke within 3 weeks before and after surgery.
Smoking has a profound effect on reducing wound healing
capabilities. It significantly increases the likelihood
for infection, wound healing problems, and scar formation.
It also affects your airway, therefore, makes anesthesia
much more difficult.
-
Eating.
Do not eat within 8 hours of surgery and do not drink
within 6 hours of surgery. It is OK to take medications
with a sip of water. Please discuss all medications with
your doctor and the anesthesiologist.
-
Washing.
It is a good idea to wash the surgical area thoroughly
the night before and the morning of surgery. Blow your
nose and clean it the morning of surgery using a Q-tip.
It is most helpful to trim your nasal hairs 3 days before
the procedure. Do not apply any make up
-
Arrival.
It is best to arrive on time to make sure things go smoothly.
Please be sure to have someone else drive you.
-
State
of mind. Remember, this should be a happy
and exciting time. A certain amount of nervousness is
normal but you should not be overly concerned.
Anesthesia
The anesthesiologist will discuss with you what type of
anesthesia is best for you prior to the procedure. He/she
will take into consideration your medical history, the procedure,
and your personal wishes.
General anesthesia is typically used. Minor rhinoplasties
may be performed under local anesthesia, with or without sedation.
After
the procedure
The procedure itself
will take approximately 2 hours.
-
Immediately.
Right after the operation you will be watched for 1 or
2 hours and encouraged to walk around. Of course, there will be swelling and bruising but there
is surprisingly little pain. You will have a splint on
your nose and a dressing under your nostrils. When you
lay down you must keep your head elevated usually on 3
pillows to prevent swelling.
-
That
evening. It is recommended that you take
it easy. You can walk around, eat, but not too much more.
You must sit and lay with your head up on at least 3 pillows.
You should take as much pain medication as necessary and
try to go to sleep early. You will be given medication
to help keep the swelling down as well as to prevent infection.
-
First
48 hours. You can take a body shower
the next day. Be sure to use cool water. Let the water
rinse over your nose and splint. Leave the splint in place. There will be some oozing from your nostrils. This is
to be expected. When you get out of the shower dab dry. Reapply a dressing under your nose as necessary. The tip
of your nose will be markedly swollen as it swells more
than any other part. Be sure to take your antibiotic and
anti-swelling medication.
-
First
week. Your first postoperative visit
with will be most likely at one week. Sutures may be removed. Leave the splint on. You will be swollen with some bruising
under your eyes. The majority of the bruising and swelling
will go away in about 2 weeks. Finish the antibiotic prescribed.
-
Beyond.
Swelling will not completely resolve for about 6 months
especially in the tip. It takes at least 3 months for
the swelling to go down and then another 3 months for
the skin on the tip to contract leaving you with the desired
result. The final result will not be evident until 6
months when all the swelling has resolved and skin contraction
is complete but you will certainly notice a significant
improvement right away.
Recovery
time
The swelling and bruising will resolve in about two weeks.
Some people with sedentary jobs go back to work after 3-5
days. If your job, however, requires strenuous activity then
it may take as long as 2-3 weeks to return to work. Most
people return to work in about 1 week.
Consultation
We have outlined below what you can
expect from your rhinoplasty consultation. Read carefully,
as there are many suggestions that will save you time, clear
up questions, and help you convey to your plastic surgeon
what you want to accomplish.
Health History
All cosmetic surgery consultations
begin with a thorough health history. This is especially
true if general anesthesia is being used but also applies
to local anesthesia. Rhinoplasties may be done under general
or local anesthesia depending what needs to be done and
on the preference of both the plastic surgeon and the patient.
Prior to meeting with your plastic surgeon you will be given
a health history questionnaire to fill out in the
waiting area. There are 5 areas of your health you will
be asked about. Be sure to answer it with detail so that
your surgery and anesthesia can be optimized for you.
General health problems are important
to discuss so that your surgery is as safe as possible.
Be sure to mention any chronic illness. Of particular concern
are: high blood pressure, diabetes, heart problems, liver
and kidney disease, stroke, cancer, bleeding problems, and
wound healing problems.
What will the plastic surgeon do
if I have medical problems?
In short, he will make sure your health
is optimized as much as possible to ensure your safety.
This may mean referring you to your private physician.
If you have a
health problem or are over 50 years of age you can often
save yourself time by getting a letter from your private
physician prior to your cosmetic consultation stating what
the health problem is, how it is being treated, and whether
or not you are able to tolerate general anesthesia safely.
If you are seeing
any specialist (cardiologist, kidney doctor, psychiatrist,
etc. ) be sure to bring a letter from them stating you are
able to tolerate surgery.
If you are not able to tolerate general
anesthesia it may be possible for your procedure to be done
under local anesthesia, with or without sedation. This
must be discussed with your plastic surgeon.
On your questionnaire you will be asked
about previous surgeries. Be sure
to identify any problems you may have had with anesthesia.
Of particular concern are previous cosmetic surgeries especially
if you do not like the result and are interested in revision.
With rhinoplasty it is especially important to mention all
previous nasal or sinus surgeries. Previous trauma to the
nose is important. If you have traumatic changes to your
nose it is helpful to bring in pictures of what you looked
like before your injury.
Be sure to list all medications you
take including aspirin and over-the-counter medications.
These are important as they may increase bleeding and affect
your surgery. It is extremely important to stop taking
aspirin and aspirin containing products at least 10 days
before surgery. Tylenol is a good alternative. Here is
a partial list of aspirin containing products and other products
to be avoided prior to surgery.
Information about medications that
cause allergies is very important so that these medications
can be avoided. Of particular importance is the reaction
you had, especially if you had trouble breathing. Be sure
to include this information! Nausea is not an allergy but
it is important to mention as well.
-
Smoking, Drinking, and Drug
Use
These 3 will certainly affect your surgery
and MUST be mentioned so that your surgery can be optimized.
Smoking causes a profound decrease in wound healing and will
lead to worse scarring and a less favorable result.
With large procedures such as a face lift, neck lift, tummy
tuck, and breast lift smoking must be stopped at least 2-3
weeks before and after surgery. Otherwise, the results could
be disastrous leading to non-healing wounds, poor scarring,
and/or infection. With smaller procedures such as
eyelid surgery, nose surgery, breast augmentation, and liposuction
smoking will hurt the overall result but this may or may not
be noticeable. In this case smoking cessation is strongly
advised but is not mandatory.
Specific Nose Issues. During your consultation you must be
very accurate with nasal problems. Of particular concern
is a history of breathing problems, sinus problems, nasal
drug use, nasal trauma, and any previous nasal surgery.
If you had previous nasal surgery, call the surgeons office
and have them fax over the operative note. Bring
this operative note to your consultation. This is very
helpful so that your plastic surgeon can see what has been
done. Revision rhinoplasties are challenging because of
the scar tissue left by the first operation.
What Do You Want To Change?
It is important that
you have a clear idea of what you want changed when you
go for consultation. The least favorite thing a plastic
surgeon wants to hear is: What do you think I need done?
Look
in a mirror and identify what bothers you. Be specific.
It is helpful to break up the nose into four parts. 1)
Dorsum 2) Tip 3) Alae 4) Airway obstruction. Evaluate
each one of these areas individually as this is what the
plastic surgeon does in his exam.
-
Common complaints
-
Dorsum: Too wide, too narrow,
too big, too small, deviated.
-
Tip: Too big, too pointy, too
long, too pushed up, droopy, deviated.
-
Alae: Too wide, too bulbous, nostrils
too big.
-
Airway: This must be examined
individually.
Physical
Exam
The key to the nasal
physical exam is to determine exactly what is causing
the problem. Rhinoplasty is a high finesse procedure
and requires that the plastic surgeon knows exactly what
you want. If there is a particular nasal characteristic
that you like, it is helpful to bring in a picture of
someone with this particular feature. Obviously, this
look will not be duplicated but it helps convey your wishes.
Below is a typical
sequence that an experienced plastic surgeon uses to evaluate
each nose. The nose must be evaluated in relation to
other facial characteristics.
When looking at the nasal dorsum,
there should be a continuous curvilinear line that begins
within the eye brow, joins harmoniously with the radix
of the nose, and continues to the tip. When the dorsum
is too big or too wide this continuity is broken and the
nose appears out of place or too big.
Removal of a large, dorsal hump
or narrowing a wide dorsum will correct this problem
and give a smaller, more pleasant appearance. Often
this will require an osteotomy which means breaking
of the bones in order to reposition them correctly.
Nasal osteotomies usually cause bruising around the
eyes that lasts about 17 days.
The image on the left outlines the typical location
of the osteotomy. After the nasal bones are broken they are then repositioned medially to narrow the
nasal vault.
This repositioning is one of the methods many doctors
use to improve the balance between the eye brow and
the nasal tip as described above.
Nasal deviation can occur
anywhere in the nose from the bridge to the tip. It
is a very difficult problem to completely correct but
can usually be improved tremendously. The treatment
depends on the cause. The cause may be within the nasal
bones, the upper nasal cartilages, the lower nasal cartilages,
the septum, or all of the above. Usually, the nasal
bones will need to be broken and repositioned.
The cartilages will also
need to be repositioned. If one's nose has a concavity
on one side it may be necessary to fill this gap with
a cartilage graft. This cartilage is usually obtained
from the nasal septum inside the nose.
Postoperatively, after an osteotomy
or deviation correction, one will need to wear a nasal
splint for 1 to 2 weeks. Complete bone healing takes
about 6 weeks. Swelling of the nasal dorsum lasts up
to 6 months but the majority is gone by 6 weeks. This
is quicker than the tip, which takes a year for the final
result to be evident. Once again, the majority of the
swelling is gone by 6 weeks.
The tip should be a smooth
continuity of the dorsum. Too large of a tip will cause
people to focus on it. An attractive tip does not draw
attention. A large or deviated tip causes the observer
to immediately focus on this area. Nasal harmony with
the rest of the face is disrupted.
The most common cause of a
large, bulbous tip is a large, rounded lower lateral
cartilage. This can be
reduced and a sharper tip created if the overlying skin
is not excessively thick.
Long noses are often caused by long
septums. Shortening the nasal septum willcorrect this.
Droopy nasal tips are usually caused
by poor tip support. Correction can be obtained by adding
support and bringing the tip upward.
Short noses have a
pushed up appearance and/or can have an irregular contour. Correction can be achieved by lengthening the nose using
cartilage grafts.
Deviated tips, as mentioned above can
have many causes and are more difficult to completely
correct. While it may
be said for all rhinoplasties, it is even more true with
deviated rhinoplasties-The first operation is critical. Secondary rhinoplasties are much more difficult because
there is always scar tissue to deal with from the first
operation. For this reason, it is essential to go to a
plastic surgeon with considerable experience in rhinoplasty. See above picture of woman with deviated dorsum as well
as deviated tip.
An attractive alae, like the tip, should go unnoticed.
When they become too wide or too large they draw negative
attention. The most common complaints with the alae
are that they are too wide, too bulbous, or the nostrils
are too big.
Alae reduction is accomplished
by removing a precise amount of the alae at its
base.
Airway obstruction is a significant
problem and the causes are numerous. Airway obstruction
that can be relieved during rhinoplasty fall into two
categories.
The most common is enlarged
turbinates. Turbinates are three mounds of mucosa
on the inside on each nares. They are called the superior
turbinate, middle turbinate, and the inferior turbinate. They humidify the air as it travels to your lungs and
help trap foreign particles. Enlarged turbinates may
impede airflow. Correction involves reducing the size
of the turbinates by either cauterizing them or excising
them.
The other common cause is
nasal deviation. A deviated septum
will cause turbulent airflow with each breath and make
breathing much more difficult. This will often be markedly
improved or resolved when the deviated septum is repositioned
or removed.
Evaluation of the nose would be incomplete without mentioning
the importance of the chin. Einstein was right even when
it comes to facial proportions. Everything is relative. A small chin makes the nose appear larger.
A strong chin gives a more authoritative look to men
and a more attractive triangular shape to women. Ideally,
the chin should project forward to the level of the lower
lip in woman and slightly farther in men.
|
