What is rhinoplasty?
Rhinoplasty, or nose surgery, is a surgical procedure designed to improve the appearance of the nose and sometimes the function of the nose as well. The nose can be altered by reducing or increasing the overall size, removing a hump, changing the angle between the nose and the upper lip, changing the shape of the tip or the bridge, or narrowing the span of the nostrils. Some breathing problems may also be treated during the rhinoplasty procedure.
Who is the best candidate for rhinoplasty?
Physically healthy men and women who have realistic expectations and are interested in improving the appearance and/or function of the nose are potential candidates for rhinoplasty. Rhinoplasty is often postponed on younger patients until the nose has completed its growth, which is around the age of fourteen for girls and a bit later for boys.
Are there any age restrictions for undergoing rhinoplasty?
It’s generally advised that rhinoplasty not be performed on younger patients until the nose has completed its growth. This tends to occur around the age of fourteen for girls and a bit later for boys.
What can I expect during a consultation for rhinoplasty?
The consultation will include in-depth discussion about your desires regarding your nose. There will also be a pre-operative evaluation of the nose as well as the overall facial balance. Computer imaging may also be used to aid in communication with patients and offer them the opportunity to have input.
Where is rhinoplasty performed?
Rhinoplasty is often performed in a free-standing ambulatory surgery center or a surgeon’s office-based facility, though procedures can also be performed in a hospital.
What type of anesthesia is used for rhinoplasty?
General anesthesia or a combination of local anesthesia and sedation may be used for rhinoplasty.
How is the actual rhinoplasty procedure performed?
Incisions are made either within the inside of the nose or both inside of the nose and one small one under the tip of the nose. The skin is then separated from the underlying bone and cartilage, which is then sculpted to the desired shape. The skin is redraped over the new framework and the incisions are closed.
How long does the actual rhinoplasty procedure last?
Rhinoplasty generally takes between one and two hours to complete.
Where are the incisions made for rhinoplasty?
Incisions may be solely confined to the inside of the nose, which is referred to as closed rhinoplasty. Sometimes an additional small incision under the tip of the nose is also required, which is referred to as open rhinoplasty. Open rhinoplasty may be preferred in some cases if it can provide better exposure and an overall better result. Other cases, however, can be performed with closed rhinoplasty.
Are there scars after rhinoplasty?
Surgical incisions will results in scars. However, for closed rhinoplasty the incisions are confined to the inside of the nose and result in no visible scarring. Open rhinoplasty includes an additional small incision under the tip of the nose which will result in a well-concealed, fine-line scar that will fade with time.
Is there much pain with rhinoplasty?
Patients may experience some discomfort during the first few days after surgery, but this can be controlled with prescription pain medication.
Will I be able to drive myself home after rhinoplasty?
It’s best to have a family member or friend accompany you on the day of surgery and drive you home.
Will I need someone to help me out at home after rhinoplasty?
It’s best to have a family member or friend accompany you home or to your place of recovery for the evening.
What is the recovery like after rhinoplasty?
During the first couple of days after surgery, some discomfort can occur though this can be controlled with prescription pain medication. Antibiotics and other medicines, such as a saline nose spray, may be prescribed as well. The splints and stitches are typically removed within six or seven days after surgery. Patients may also experience some bruising which will fade enough so that you feel comfortable in social situations by around the tenth day after surgery. Swelling is common and may take months to fully fade. Within one to two weeks most patients can return to work. However, it will be two to three weeks before more strenuous activities can be resumed.
How much time will I need to take off from work after rhinoplasty?
Patients are typically able to return to work within one to two weeks after rhinoplasty.
When can I exercise after rhinoplasty?
Exercise and other strenuous activities can usually be resumed within two to three weeks after surgery.
When are the stitches removed after rhinoplasty?
The stitches are typically removed within six or seven days after surgery.
What are the risks or complications that can occur with rhinoplasty?
Some of the potential complications associated with rhinoplasty may include the following: adverse anesthesia reactions, incomplete improvement, infection, small burst blood vessels, and the need for additional surgery.
Does insurance ever cover rhinoplasty?
Insurance typically does not cover rhinoplasty procedures performed solely for cosmetic purposes. In cases where breathing problems are being treated, some degree of coverage may be provided.
Is it possible to get a rhinoplasty procedure financed?
Financing is available for plastic surgery procedures.
Are there any medications that need to be avoided before surgery?
It is important to avoid taking certain medications, vitamins and herbs two week prior to your surgery as some medications may cause you to bleed more than normal. A list of these should be provided by your surgeon.
In order to fix a nose that is too long, is it necessary to remove tissue?
It is usually necessary to remove tissue to shorten a nose. Tissue removed may include cartilage or internal lining. There are specific instances when a nose can be shortened by changing the shape of the tip cartilages, rather than removing anything to rotate the tip up.
Is it possible to fix a nose that is both too long and has a bulbous tip during the same surgery?
To improve a nose that is both too long and has a bulbous tip I first determine how much of the excess length is attributable to the tip cartilages themselves. If the tip cartilages are a main part of the length then I have a good chance of righting the problem by manipulating their shape or shortening them. However, often I need to address both a long septum as well as elongated lower lateral cartilages and yes, they always can, and should, be done at the same surgery.
I have a broken nose. Are nasal packings are used to repair it and what exactly are they?
Nasal packing is simply used to minimize bleeding or dripping from the nose after surgery. They are also helpful in compressing the internal tissues to prevent collections and swelling. Packing is generally comprised of some sort of soft absorbent material or strips of gauze. Occasionally I will use stents which are firm pieces of silicone that act to stabilize the internal structure of the nose and prevent internal adhesions from forming.
Is it true that swelling can disguise the end result of surgery? How long does this last?
Swelling is a normal and expected part of the healing process and may last 18 months. Usually the acute swelling subsides and the nose begins to look normal by three weeks. As the months go on the nose becomes thinner, smaller and more refined at the tip as the edema resolves.
Are your rhinoplasty techniques different from those of other doctors and how?
I cannot speak to what other doctors are doing with the noses they operate on. I am very innovative and feel entirely comfortable trying most anything that I feel will yield the result I am looking for. Sound surgical techniques are published and available to all surgeons, yet very few study all of them and utilize them.
I have a long nose. Will rhinoplasty change its look from the both the front and the side?
When a long nose is shortened it usually changes the way it looks from both the profile and the front.
Before the rhinoplasty procedure, can the analysis be sufficiently performed over the Internet?
While computer imaging can be employed to photos sent via the internet and communication can be productive, it is always relevant to examine the patient to determine the specific characteristics of the skin, cartilage, bone and other related features.
Can you fix my nose if I’ve already had rhinoplasty and am unhappy with the results?
Revision rhinoplasty is the process of improving on the aesthetics and function of a nose that has already been done. I can almost always help these cases, even after several prior rhinoplasties.
You have great before and after photos. When can I expect my results of rhinoplasty to look like your after pictures?
Before/after photos should reflect all of the views of a patient, not just a single angle. I usually don’t take photos for 6 months but I prefer to wait for 1 year to see the final result.
How do you correct a nose that is broken and twists to the side?
Noses that are twisted can be straightened by a variety of maneuvers including breaking the bones and re-setting them, straightening the cartilage, applying sutures, and camouflaging things with grafts. Sometimes a combination of these things is necessary to achieve a straight nose.
Does the repair of a broken nose result in a lot of post-op bleeding?
There is usually very little post-op bleeding from repair of a broken nose.
How long after a fractured nose repaired is a cast worn?
I have my patients wear a splint or cast for 6 days.
Is it true that nothing can be done for a nose that’s been broken many times or can it still be fixed?
Although it becomes more and more difficult to repair a nose that’s been broken several times, it can be done.
I have a bulbous tip and I was wondering how this is fixed and if tissue is removed during surgery.
Correction of a bulbous tip is very common and requires a great deal of pre op planning. There are many ways of dealing with the bulbous tip and which way is chosen will depend on factors that relate to what the underlying cause of the problem is. I often remove some cartilage, cut and re-connect cartilage as well as us grafting techniques along with sutures to achieve my goals.
I would like to have my round nose straightened and narrowed, but I’m worried that it won’t match my face. How do you ensure that the changes you make to the nose stay in balance with the other facial features?
Ultimately the question of balancing the nose with the other facial features is one of judgement, and each surgeon will have a slightly different aesthetic sense. There are never any guarantees that the patient will love their nose, however with the use of computer imaging I can discuss this more fully with them ahead of time in an attempt to understand what they are hoping to achieve.
Is there a technique for rhinoplasty that doesn’t require breaking the nose and can you do this?
Not all rhinoplasty involves breaking the nose and there are many instances in which I do not need to do this. Only break the nose when it is essential to obtain the proper balance or result that the patient requests.
Once a bump is removed from the nose, is there any pain or tenderness in that area after surgery?
When a bump is removed or made smaller there typically is no persistent pain in the area or tenderness after healing is complete. On occasion people may have some sensitivity in such an area but those are rare cases.
How do I know if I’m a good candidate for finesse rhinoplasty?
The term finesse rhinoplasty refers to a situation where the patient needs only a very minor or subtle change to refine the nose. Whether or not someone is a good candidate for such a procedure depends on how much the patient thinks such a change would benefit them, how confident the surgeon is that he/she could execute such a result, and what the risk/benefit ration is to doing so.
Can you show me over the Internet what my nose would look like after rhinoplasty?
I prefer not to perform computer imaging over the internet if I have not yet examined the patient. There are just too many factors that would be assumed and it may be a worthless endeavor or even one that is inaccurate.
Is rhinoplasty different in any way for men than for women?
While the mechanics of the surgery may be the same for men and women rhinoplasty, the aesthetic goals are very different and so the two operations are inherently different from the start.
If we disagree about things at the consultation, what happens?
If I consult with a patient and we have a disagreement about what should be done or how to accomplish our goal or even on what is possible then I prefer to refer that patient to another surgeon that may be more appropriate for that particular patient. I will not operate on this patient because I feel they may not be content with the result, even if I do my job well.
What would you do to correct my droopy nose?
A droopy nasal tip needs support and often times projection. There are a myriad of ways to provide these things and the ultimate choice depends on various other factors about the nose and the patient’s desires.
When fixing a droopy, hanging nose, how is the columella involved?
When fixing dependent (droopy) tip the columella needs attention because if it is not considered it may become more visible. It is usually quite straight forward to adjust things to compensate for excess columellar show, it just cannot be forgotten.
Will the front of my nose look different after rhinoplasty?
The nasal tip will only look different if it is changed during surgery. Not all rhinoplasty involves manipulating the tip.
Do you have any special training in facial plastic surgery? I want to make sure that my nose after surgery still fits my face.
I am a board certified Facial Plastic and Reconstructive Surgeon and my training prepared me to be a good judge of facial aesthetics overall and how the nose balances with respect to the other features.
Is it possible to finance my rhinoplasty procedure?
My office does not finance surgery. Many patients choose to put the cost on a credit card and finance it that way.
What is tip-plasty and what is finesse rhinoplasty? Is there a difference between them?
A tip plasty is when the entire procedure is limited only to the nasal tip. There is no bony work or other manipulation. A finesse rhinoplasty just refers to a case where the changes are very subtle. A tip plasty is usually a type of finesse rhinoplasty.
When correcting a bump on the nose, is it necessary for the nose to be broken?
It is not always necessary to break the nose to remove a hump, though it usually is. The breaking of the nasal bones should be an irrelevant point to the patient since they are not going to feel it or suffer as a result. It is just another part of the surgery and the surgeon should not be limited by a patient request to not break the nose. There is more bruising and swelling post operatively from this maneuver but that’s the extent of it.
When fixing a twisted nose, does one side have tissue removed, the other added to or both?
Straightening a twisted nose is difficult and often requires multiple different things be done to achieve the desired result. It is never determined until the case is being performed as to just what will be needed to fix the problem.
I think my nose needs to be brought out from my face. Will this result in scars at the nostrils?
Increaing tip projection does not result in any added scarring or any scarring at the nostril rims at all.
During surgery, how will my flat nose be fixed?
Flat noses generally require that cartilage be added to them to build them up and to increase projection. Narrowing the nose also gives the illusion of it not looking so flat. I almost always use the patient’s own tissue (ear cartilage, rib cartilage, septal cartilage) but occasionally I will use a synthetic implant.
Will my information be private or will others have access to it?
All patient information is private unless I have written position to discuss it or show it.
Is it really necessary to have a consultation in person?
I will never operate on any patient unless I have previously met with them in consultation. Any surgeon that would do so is suspect.
Will my insurance company need to contact you before my rhinoplasty procedure?
If the procedure is for functional improvement and medically necessary to correct a problem, then insurance can be applied. We often work with insurance companies in these instances and they usually will require that we pre authorize the case with them beforehand.
Are there any visible bumps or indents if grafts are used to correct a nose that is too narrow?
Whenever a graft is used in rhinoplasty there exists the potential for visible or palpable irregularities, usually at the edges. This is especially true for grafts on the nasal dorsum because the skin is thinner in this area. I do my best to thin the grafts, soften them and bevel the edges and sometimes I may use other techniques, such as covering a graft with soft tissue, to make it blend in. If such issues exist then a some fine tuning may be necessary to correct it.
Is there a difference between a broken nose and a nasal bump or are they the same thing?
A bump on the nose may be the result of trauma or just because the nose is shaped that way. There are some subtle differences in treatment of these two entities but they should both be amenable to correction.
I’m interested in both chin augmentation and rhinoplasty. Can you perform them both?
I often perform chin augmentation at the same time as rhinoplasty. Often times it is necessary to use a chin implant in order to correctly balance the way a nose looks on the face. Sometimes, by using a chin implant I can leave a stronger nose than I otherwise would be able to if I didn’t. Chin implants are extremely powerful in achieving facial harmony and they are relatively easy to perform, low risk, and can always be removed if the patient doesn’t like them.
I’d like to have my nose fixed because it hangs too low. Will I have a visible scar after rhinoplasty?
I have a narrow nose. What do you do during rhinoplasty to make it wider?
To widen a narrow nose there are several things that I do including lowering the profile, rotating the tip, placing spreader grafts, out-fracturing the nasal bones, and using onlay grafts. Which of these I do depends on the specific nose I am working on.
I have a nose that sticks out too far. How do you correct this during rhinoplasty?
A nose that sticks out too far is overprojected and there are number of ways to bring it in closer to the face. When the tip is deprojected I must also bring down the profile to compensate and keep the nose balanced.
I have a nose that’s too short and I want it to look normal. Can you fix this?
Lengthening a short nose is very difficult but can be done by using a patient’s own cartilage to elongate it or by creating the illusion of length with various maneuvers. It is more difficult to lengthen a nose that was shortened as a result of prior surgery than one that is just like that naturally.
What do you do during surgery to make an overly wide nose more narrow?
To narrow a nose I often fracture the nasal bones and bring them in. I also will occasionally narrow the middle part of the nose by removing some of the nasal septum or upper lateral cartilages. The tip cartilages can be narrowed by removing cartilage or by using sutures to change their shape and the base of the nostrils can be narrowed by removing some soft tissue. Occasionally I find it necessary to build up the height of the nasal dorsum to make the nose look narrower.
My nose is overprojected and my nostrils are too long. How do you correct this during rhinoplasty?
When an overprojected nasal tip is deprojected the nostrils will automatically change orientation. There are a number of ways to deproject a nasal tip and this can be done equally well via an endonasal (closed) or open technique.
The end of my nose points upward. How do you correct this during surgery?
If the end of your nose points upward then it can be re-oriented to point forward by using sutures to change its shape or grafts to elongate it. Sometimes removing some septum or membrane can also accomplish the same goal as well.
Can my pug nose be fixed with rhinoplasty?
Pug noses can be fixed by using various techniques that strengthen and elongate the nose as well as those that increase nasal tip projection. This is a common problem and should respond well to advanced rhinoplasty techniques.
Can you explain the difference between primary rhinoplasty and revision rhinoplasty?
A revision rhinoplasty is a secondary operation that serves to improve upon or correct problems that still remain after prior rhinoplasty. I have done many revision rhinoplasty operations on patients that have had 5 or 6 prior nasal surgeries. I find revisions more technically difficult to do but also more rewarding for myself and the patient.
When it comes to rhinoplasty for children, are there any special considerations to take into account?
Children that have yet to fully mature may be adversely affected by a rhinoplasty because their faces have yet to become fully developed and may continue to change. In this scenario the rhinoplasty yields a result that may initially look good but that doesn’t look good as the jaw bone grows or other facial features change. Additionally, the nasal septum serves as a secondary growth center for the midface and it may be impacted by surgery, interfering with midfacial development (although the recent science on this suggests it may not be so important).
After my rhinoplasty procedure, will more of my nostrils be visible from the side?
During the rhinoplasty, is the bump really “shaved” off?
There are different ways of taking down a bump on the nasal dorsum. It can be rasped or filed down and this can be done manually or with a power tool. It can also be removed with an instrument called an osteotome that is like a chisel.
Where is the rhinoplasty surgery performed in relation to your office?
I perform over 95% of my rhinoplasty operations in my office at Lasky Clinic. We have a fully accredited outpatient surgery center and use excellent, top quality anesthesiologists that are very accustomed to working with me on a daily basis. This relationship between anesthesiologist and surgeon is very important in creating trust and results in a safer, more efficient operation and a more comfortable experience for the patients.
After repairing a narrow nose, how long is it until the swelling is reduced after surgery?
Whenever a rhinoplasty is performed it will result in swelling that takes many months, if not a year to go away.
When having my thin nose fixed, should I be concerned that it will no longer look right on my narrow face?
If a patient has a very narrow nose but also has a very thin face than it may be advisable to forego nasal surgery. This is a very important point, as the nose must balance with the other facial features. The nose does not float in space all by itself and it msut fit into context of the rest of the person.
I’ve already had one primary and two revision rhinoplasties. Am I still a candidate for surgery?
If someone has already had several rhinoplasties and they are still unhappy they may still be able to be fully corrected. This necessitates finding the right surgeon and allowing him/her to carefully examine you and create a surgical plan. There are cases that should be left alone but these are the rare ones. In my experience I usually can improve on things and the post operative course is usually easier for these patients than their prior surgeries.
I’ve heard that the tip of the nose has many intricate things in it and that makes tip-plasty very complicated. Is that true?
Surgery that involves the nasal tip must be done with precision and foresight as to what the effects of healing will be. Wound healing and scar contraction often impacts the way the tip heals and, as such, these need to be considered when operating on the tip.
Does swelling of the tip really take longer to clear up?
Swelling post operatively often stays longer at the tip because it is the most dependent (lowest) part of the nose and also because the skin here is thicker. Additionally, I rely on the healing process to help create the desired tip shape and this process takes time.
I’m from out of town and will be traveling to you for my rhinoplasty. Do offer a travel discount?
My office has several arrangements with nearby hotels whereby we can get a discount for patients. These hotels are all nearby and at various price points.
How long will I need to plan on staying for my rhinoplasty if I’m traveling from out of town?
If a patient is traveling to me for surgery and will be flying then I advise they stay for 9 days. The reason for this is that the cabin pressure on the planes will cause swelling to occur and the nose will then take longer to get to its desired shape. Rarely, this may impact the final result. There is no medical risk to flying earlier and often time patients do it and I have seen no ill effects thus far, but ideally I would have them wait.
What happens if I have problems after my rhinoplasty since I live in another state?
If a patient were to have any acute problems after rhinoplasty that need urgent attention, they would occur within the first week. Otherwise, the problems that develop over time are less in need of immediate attention and can be addressed by me at a later date or via the internet with correspondence. If something were to require a medical visit, I would contact a colleague in the patient’s vicinity and have them evaluated.
My nose is twisted on the bottom front part rather than the top. Can this be fixed?
If the nose is twisted at the lower part it implies that the cartilage is misshapen. This may be due to the septum or the tip cartilages and generally can be straightened with good results.
My nostrils are uneven because my nose is all twisted. Can both be fixed?
Nostril asymmetry is extremely difficult to fix, especially if it is due to congenital factors where the nostril attaches to the face. Asymmetries that result from tip cartilage variability are less difficult to repair.
Is there some way that you can make sure my nose won’t look strange from the side when fixing it because it’s upturned?
A good surgeon will take into account all of the views of the nose when operating so as to keep it looking natural and balanced.
I’m worried about my information. Who will have access to it?
All medical information is kept private and no unauthorized person is allowed access to it whatsoever.
How does a nose become twisted?
Noses become twisted from a variety of causes such as trauma or tumors. Often times the nose is injured when someone is very young or even at birth and only becomes curved as that person ages and the cartilage bends more and more. Cartilage tends to distort more with age and the soft tissue support diminishes. There are certain ethnic peoples that have larger nasal septums and occasionally these are just too large for the soft tissue envelope that encloses them and this results in a twisted or curved nose.
Are there any special considerations for my rhinoplasty because I’m African-American?
Black people generally have thicker skin, softer cartilage and less cartilage than white people. As a result Black noses usually appear flatter, wider and mushier at the tip. These elements require that rhinoplasty involving Black noses be done differently than those done on White noses. I usually use cartilage grafts to increase support and to push out on the overlying soft tissue. Building up these noses offers a greater chance of success than merely removing cartilage; unfortunately there are still many surgeons that routinely do the latter and the results are sub-optimal.