Rhinoplasty   (nasal contouring)      

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Improving a facial feature felt to be out of harmony with the rest of the face may make a positive difference in the way you feel about your appearance and may improve self confidence. Rhinoplasty is a surgical procedure designed to change the outward shape of the nose making it more balanced with the rest of your facial features.

Rhinoplasty is typically considered a cosmetic procedure and is not covered by insurance. Surgery to improve breathing is called septoplasty.  I prefer to have breathing problems corrected by the Ear, Nose and Throat doctors.  My specialty lies in improving the outward appearance. 

   
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Rhinoplasty, is an outpatient procedure usually done while you're asleep. Depending on your particular needs, rhinoplasty can increase or decrease the size of the nose, realign malposition, change the shape of the bridge, tip or nostrils, change the angle between the nose and the upper lip, reduce a hump or fill up a dip. The possibilities and combinations are endless. I think that's one of the reasons I'm so fond of doing rhinoplasty surgery. There's a significant artistic challenge in determining balance and manipulating the body tissues while maintaining a natural look. I also love the technical challenge of working in small spaces. The successful rhinoplasty is the one that makes someone compliment you without knowing why. We strive to improve your look….. not make you look like someone else.

The first and, I believe, one of the most important aspects of successful rhinoplasty surgery is our consultation. We need to be able to develop a relationship where we can communicate well together. After all, I want to make sure I try to achieve your ideas, not necessarily mine. We need to talk very specifically about your concerns. It doesn't help me if you say your nose is too large or unattractive. We need to try to be very specific.

   
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It's my personal opinion that this isn't the place for computer imaging. To tell you the truth, the computer can make it look like your left ear grows out of the center of your forehead but we all know your body won't let me do that surgically. The same principle holds true with cosmetic surgery. Just because it can be drawn on the computer screen, doesn't mean it can achieved surgically. I'd rather spend what ever time it takes until I'm comfortable I understand your concerns and feel certain the expectations are realistic.

The nose is basically a triangle. I like to talk about the shape of the nose in terms of this triangle. For instance, I want to know whether or not you feel your nose is too long from A to B, too wide from C to D, or E to F, etc.

Rhinoplasty is precision procedure with most of the incisions on the inside of the nose. Occasionally, I may have to tuck incisions in the base of the septum (center partition) or the curve of the nostrils. Nasal bones may have to be cracked and repositioned to change the shape. You will have a vaseline soaked gauze strip loosely packed in the nostrils and a metal splint taped to the nose when you wake up from surgery. You will also have a little drip pad beneath the nostrils which you can change as necessary. The packing is usually only in place for 24-48 hours but the splint will be worn all the time for 7-10 days and then at night for sometime after surgery. Patients do not complain about this procedure being particularly painful, just annoying. Everyone is always anxious to get the packing out and, of course, the splint is not very attractive. You can make things a lot more comfortable for yourself if you will block your nostrils with a dampened cotton ball and practice breathing through your mouth for a few days before surgery.

Once you have recovered from surgery, you may go home from the surgery center but you'll need a driver, someone to stay the night with you and bring you to the office the next day for your 24 hour checkup. Just like any other surgical site or injury, you can expect some swelling and bruising. It's a good idea to bring dark glasses since you may be light sensitive. Sleep with the head elevated. Keeping cool compresses on the eyes as directed will minimize swelling and discomfort.

We will call pain and antibiotic prescriptions to your pharmacy before surgery. Patients usually don't complain about this particular procedure being terribly painful but there's no question it's annoying for a few days and, just like any other surgery, there's some element of postoperative discomfort. The internal sutures dissolve.  If you have any sutures on the outside they are usually removed in 5-7 days. When we first remove the packing you'll get a big burst of air but soon after the nose will feel stuffy like you have a cold. A couple of over the counter nose drops in each nostril, three times a day will help. You may wear makeup "around the splint" at any time. Most people are back to work, etc., in 5-10 days which mostly depends on just how private you want to be. You're never really incapacitated, and after the first three days, you may gradually resume all normal activity except heavy lifting and straining which should be avoided for a couple of weeks. Avoid contact sports for three months after surgery. You may shower the day after surgery but keep the face out of the water. On the second day after surgery you can shampoo, in the shower, by keeping the head tilted back to avoid getting the splint wet. If you have to sneeze…..just let it come out, don't try to hold it in. We want to avoid high pressure on these delicate tissues that have been repositioned.

At the time of your first consultation, I'll take a medical history. I'll need to know if you take any medications. Since aspirin acts as a blood thinner which will cause more bleeding and bruising, please avoid all aspirin products 10 days before surgery. Of course, smoking stands the chance of diminishing the success, or prolonging the healing, of any surgery.

All surgery has some inherent risk. The typical things you're advised of whether you’re having a baby by C-section or your gall bladder out, i.e., infection, bleeding, hematoma, bruising, swelling, etc.  Rhinoplasty rarely produces any complications. In fact, I haven't seen any in my career; however, there are a few things unique to this procedure you should be aware of.

Although it's not a complication and not that common, the primary possible consequence of this surgery is dissatisfaction. We anticipate and hope your results will meet your expectations but that's really a guarantee no surgeon can make. You might think I did too little or too much. All surgery leaves scars. We place these scars where they are generally inconspicuous and rarely detectable; nevertheless, all scars are permanent and not totally predictable. We are operating on the skin, cartilage and bone. Interference with the sense of smell would be unexpected. The tip of the nose will feel numb for some time after surgery but I've never known this to be anything other than temporary. Although rare, any surgery can result in poor healing or tissue loss. Most patients are delighted with their results but occasionally it may take more than one surgery to get you to what you feel is your optimum look. It's human nature to sometimes get to one point only to want a little more. Every once in awhile, particularly in the case of a very large nose, I may not be able to reduce the size as much as desired, and remain safe, in one surgery. I would much rather do what I feel is safe, even if it means the chance of a small touch up procedure, rather than push the envelope and chance a complication.

In the beginning, almost every patient is concerned that not enough was done. You'll see the big changes in the first few weeks when the majority of the swelling goes down. It can take months or even a year or longer; however, for the subtle operative swelling that's not obvious, particularly in the tip, to go down entirely. I tell all my patients not to expect to be at your final result until at least 12 months after surgery.  In some patients, particularly those with thick skin, it may take even longer.

Rhinoplasty won’t dramatically change your life. In most cases, with a little makeup and a couple of fibs, it's easier to be private than you might think. Friends, co- workers, etc., may offer vague compliments but it's rare for anyone to notice specific changes in your appearance. The more attractive, balanced appearance of the nose will benefit you for the rest of your life. It's not that we want to be something or someone that we're not, we just want to be the best we can with what we have to work with.

                                          
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