Purpose: To improve the appearance of the nose and improve nasal breathing.
Incision: Incisions are located inside the nose and may also include an incision across the columella. The columella is the strip of skin between the nostrils.
Cost: $$$*
Anesthesia:
Typically IV sedation, though some patients may choose to have the surgery
under local anesthesia. Under IV sedation, you will sleep through the
surgery but will continue to breathe independently, without the need of a tube.
Background:
A good nose allows the overall beauty of the face to shine through, particularly
the eyes. Many times, friends and family may not even realize that you
have had a rhinoplasty, simply thinking that you have done something else
to improve your appearance. This is because noses tend to either complement
or detract from the rest of the face without actually serving as a defining
attribute of your appearance. A nose should be appropriate to the face
in its ethnicity, gender, size, and shape. Noses are described by their
dimensions. First is projection, which is how far forward your nose projects.
In other words, if you walked into a wall, how much sooner would your
nose hit the wall than the rest of your face? Next is rotation, which
is how upturned or downturned the nose appears. The naso-labial angle
is the angle from the nose to the lip, which is related to rotation. The
naso-frontal angle is the angle between the nose and the forehead. The
dorsal shape is where we speak of humps, flat, or concave profile. The
ala is the edge of the nostril on the side, and the columella is the skin
between the nostrils. The relationship between these is important and
is referred to as columellar show (how much lower the columella is than
the ala). From the front, we speak of the base width (where the nostrils
insert into the face), the tip width, the bone width (upper nose), and
finally middle vault width. The straightness of the nose is evaluated
from the front. Skin type and thickness are also very important parts
of the character of the nose.
Functionally, the nose works as an air passage. It should allow for comfortable breathing while engaged in normal everyday activities. The nose is not intended to be the primary air passage during exercise. The nose serves to warm, filter, and humidify the air we breathe. The nasal airway can fluctuate from time to time because of the role of the turbinates. The turbinates are inside the nose on the side walls and can change in size, sometimes frequently. When you experience allergies or a common cold, your turbinates can swell and completely block your breathing. They also are the reason some people have trouble breathing when they lie down. The turbinates can be reduced in size for those who need it. A deviated septum can also cause airway obstruction. The septum is the parting wall between the two sides of the nose and is typically a bit crooked, but in some cases may be very crooked and can cause issues. When appropriate, fixing a septum can be part of a rhinoplasty. Finally, the nasal valve area may cause airway obstruction. The valve area is the internal angle, between the septum and side wall of the nose, just inside your nostril. Opening this area is sometimes necessary for improved breathing.
Approach:
Rhinoplasty always includes incisions inside your nose. These incisions
may be connected to each other across the columella. This is referred
to as an “open” approach. Technically, this language is incorrect,
because any incision by definition makes the operation “open,”
even if it is inside your nose. I perform both “open” and
“closed” rhinoplasty procedures, depending on the needs of
the patient.
When a patient visits my office in consideration of a rhinoplasty, we first have a consultation. This takes about 45 minutes and includes a full discussion of what the patient hopes to achieve and how likely it is that I can achieve those goals. Photos are then taken and to simulate the desired changes on a computer, as part of our discussion.
Before & After Photos:
Rhinoplasty Photos
Recovery:
Rhinoplasty recovery is far less onerous than most people think. Believe
it or not, it is hardly painful. Most people will only take pain pills
the first night. The nose will be taped and splinted for one week. Bruises
usually will occur under the eyes and last 7 to 14 days. Generally, a
touch of makeup in the first week is all that is needed to pass casual
inspection. We do not pack the nose. The internal structures are sutured
together instead. You will be able to breathe through your nose after
the surgery, and will not have to endure the pain and suffering of packing
and its removal.
Risks:
Primary risks of rhinoplasty include excessive bleeding, infection, failure
to meet goals of surgery, scarring, and reduction in breathing through the nose.
*Price:
$ = less than $2,000
$$ = $2,000 – $4,000
$$$ = $4,000 – $8,000
$$$$ = more than $8,000