Candidates for Surgery

Candidates have a nose that is cosmetically unattractive or does not "fit" with other facial features. Internal reconstruction to improve breathing is also frequently performed at the same time to improve nasal airway function.

Rhinoplasty is done to improve the appearance of the nose and/or the ability to breathe through the nose. The operation, therefore, may be considered cosmetic, functional, or for some patients both. Nasal deformities may be present at birth, be a result of injury or develop with aging and growth. Traumatic injuries (broken nose) or changes from previous surgeries may result in significant acquired deformity.  Chin augmentation with a small implant may help create better facial harmony and an improved profile when used, making the size of the nose more proportionate to other facial features.

Most often, patients request removal of a "hump" on the nose, refinement of a round nasal tip or elevation of a drooping tip.  Noses which are crooked, too wide, long, pointy or flat may be improved.  Realistically, there are limitations in achieving the final goal and the ultimate outcome will vary from patient to patient.

Frequently, the nasal septum (the cartilage separating the right and left nasal passages) is deviated and needs to be corrected.  A crooked nose may worsen this disorder and, therefore, requires correction at the same time; this operation is called a septo-rhinoplasty.  Inferior Turbinates are parts of the nose which help to add moisture and filter inspired air. These structures can be enlarged for many reasons such as seasonal allergies, secondary to a dry environment or a deviated septum causing air turbulence and contribute to airway blockage. When this occurs, the doctor will recommend their removal as part of the nasal surgery. Other problems, such as narrowed passages and airway "collapse", may require placement of cartilage grafts for structural support. On rare occasions, scar tissue within the nose from previous injury or surgery may block air flow and require correction.

Intended Result

The intended result is to provide the patient with more attractive nasal shape in better proportion to other facial features.  Additionally, the procedure can repair blocked nasal passages if necessary.

Procedure Description

A cosmetic rhinoplasty is frequently done with general anesthesia or intravenous sedation with local anesthesia in an outpatient surgery center.  Functional surgeries with septal turbinate, scar correction or the need for grafts usually require general anesthesia.

Cosmetic Rhinoplasty usually involves hidden incisions within the nostrils.  A small nick in the skin, a few millimeters, is sometimes placed at the upper nose near the corner of the eye to narrow the nasal bone base diameter.  These heal as imperceptible scars in the vast majority of our patients. More complex nasal operations, such as a tip Rhinoplasty, often require a small incision in the skin at the base of the nose (columella).  This tiny scar is barely visible, yet it allows the surgeon to "lift" the nasal skin and directly view all of the cartilage and bone requiring correction.  This is termed an "open rhinoplasty". To narrow the base of the nose, small incisions (Weir incisions) are placed in the groove where the nostril meets the cheek.

Cartilage and bone grafts are often taken from within the nose (septum), ear cartilage or rarely, rib.  Synthetic nasal implants, such as silicone, may also be used to build-up portions of the nose. This is called an Augmentation Rhinoplasty and is often performed in Asian patients and after trauma where there is deficient projection of the nasal dorsum.

Changes necessary to correct functional breathing problems or deformity from an injury should be covered by insurance. The insurance carrier will not cover charges which they determine are cosmetic in nature.  Often this will not be determined until the insurance company reads the operative report and compares pre-operative and post-operative photos. When possible, we will assist you in obtaining pre-authorization from your insurance company.  Pre-authorization information can be obtained from your insurance company and we suggest you contact them prior to surgery.

Post-Operative Healing

Patients go home with an external splint or special tape.  The splint is usually removed in 7-10 days. Internal soft silicone splints may be used after septoplasty and remain in place for 1-3 weeks.

Initial discomfort is easily controlled with oral medication and head elevation.

Majority of swelling and bruising subsides progressively over 2-4 weeks.

External sutures (if any) are removed in 4-6 days. Internal sutures dissolve spontaneously.

An early result is evident in 3 months.  Final results become evident in 12-14 months which is the time necessary for complete tissue softening.

Areas of sensitivity or numbness will slowly resolve; the tip of the nose will feel stiff or "woody" and this will improve over the first several months.  Other temporary conditions may include some airway or sinus blockage, nasal drainage, lumps and irregularities.

Risks of Surgery

The specific risks and the suitability of this procedure for you may be determined only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are unusual.

Before and After Photos

These are actual case photos of one satisfied patient. To browse our extensive Before & After Photo Gallery, click here.