Nasal Surgery / Rhinoplasty

Before & After

A nose can be one of the most distinguishing features on a face. Even relatively small irregularities of the nose can alter ones appearance in dramatic ways. There is no such thing as the “perfect” nose and one nose does not fit all faces. The ideal nasal shape is one that remains inconspicuous and blends in with the surrounding facial features. We seldom can close our eyes and picture the nose of our favorite actor or model, but an unattractive one, on the other hand, is quickly noticed and stands out, be it too large, crooked, or bulbous.

The goal with all our rhinoplasties is to make the nose look natural, allowing other features that better define beauty to stand out and be noticed. When successful, the Rhinoplasty makes the eyes appear brighter, lips fuller, and cheeks rounder. The procedure can change the shape and size of the nose, making it smaller, straighter or more refined and elegant. Rhinoplasty is performed with patients of all ages, from teenagers to mature adults. Functional problems such as nasal obstruction may also be amendable to corrective surgery and are often covered by insurance carriers.

Understanding the Procedure

Rhinoplasty is usually performed under general anesthesia with you completely asleep. For minor touch ups or under certain medical conditions, it can be done with local anesthesia . The incisions for this procedure are inside the nostril and occasionally extend across the bottom of the nose in a zigzag fashion. These incisions heal remarkably well and remain inconspicuous. Through these incisions, we adjust the bone and cartilage framework which defines the shape of the nose . When the goal of the surgery is to modify the upper one-third of the nose, the surgery will often require some manipulation to the nasal bones. This may include sanding down small bony irregularities or creating a controlled fracture of the nasal bones in order to make more dramatic changes such as straightening the nose or reducing a larger hump. The lower nose is supported by cartilage and can be accessed through these same incisions. Changing the shape of the cartilage, and thus the appearance of the nose, is often achieved by the placement of strategic sutures, small cartilage grafts, and careful incisions within the cartilage. The skin covering will then drape over this new structural support and the external shape of the nose is thus changed.

While the most dramatic change of your nose is immediately after the dressing is removed, it is extremely important to keep in mind that some swelling persists. The final result of the Rhinoplasty takes at least one year, and many argue a couple years. The skin and overlying tissues contract and tighten very slowly and continuously.

What to Expect After Surgery

The incisions are all closed with very small stitches which dissolve over several days. It is normal to find small pieces of these sutures as they dissolve. A bandage is placed over the bridge of the nose and generally remains in position for approximately six days. As a general rule, no packing is placed inside the nose although some nasal obstruction can occur from normal swelling.

Once you return home, it is best to relax with your head elevated, such as in a reclining chair or in bed with multiple pillows. A small piece of gauze taped under the nose may collect any drainage during the first day or two. This drainage is normal and it may appear bloody. Light ice packs placed over the eyes can also minimize subsequent bruising and swelling and should be applied for the first three days. Your surgeon will give you nasal sprays to help reduce intranasal swelling and to keep it clean during this healing phase. Small amounts of Vaseline applied around the nostrils provide additional comfort and reduces crusts.

You should not blow your nose and the nasal dressing should be kept dry and intact.  It is important to avoid accidental trauma, even from that of a pet or from holding a young child.

Frequently Asked Questions?

Will the surgeon have to break my nose in order to reshape it?
The upper third of the nose is made of nasal bones and when a significant change to this area is needed, the surgeon may need to break these bones in order reposition them. These fractures are created with small instruments specifically designed for this purpose. This step will not be painful, either during the operation or after. For modifications of the nasal tip, the nose does not have to be broken.

What type of complications can arise with a rhinoplasty?
Complications with nasal surgery are not common but on occasion some people have more bleeding than usual and a temporary pack within the nose may be necessary. As with all cosmetic surgery, the possibility exists that the aesthetic outcome is not precisely as you hoped and revision surgery may be called for.

Is this procedure covered by health insurance?
Elective cosmetic surgery to change your external appearance is not recognized by most insurance carriers as a medically necessary procedure. Consequently, insurance companies generally do not cover rhinoplasty procedures. There are occasions where the primary problem is nasal dysfunction, i.e. nasal obstruction, and many insurance companies will acknowledge the medical necessity of improving the nasal airway and may reimburse for this. It is recommended to check with your insurance company in advance.