Rhinoplasty and Revision Rhinoplasty

 

Rhinoplasty

Rhinoplasty (Nose Job) is the reshaping of the nose and is one of the most common facial plastic procedures that our Board Certified, Fellowship trained surgeons perform.

Some of the most common reasons for having rhinoplasty are

  • a bump on the nose
  • a drooping or ptotic nasal tip, which can get worse with smiling
  • a wide or large nose
  • an aging nose that is droopy and causes difficulty breathing
  • a crooked nose after trauma
  • a flattened or saddled nose from a septal perforation
  • a bulbous nasal tip
  • wide or flaring nostrils
  • an upturned nose
  • an overly projecting nose
  • poor breathing through the nose
  • A nose that just doesn’t fit the face

No matter the reason, small changes in the nose can dramatically enhance the appearance of the face. Our surgeons understand that every face is unique, and therefore every nose is unique. As a dual board-certified Facial Plastic Surgeons and Otolaryngology-Head and Neck Surgeons, they also understand that a nose is only as good as it functions. Therefore, making the nose look good must come with making sure the nose works as good as it looks!  During your consultation, our surgeons will make sure they examine your nose inside and out.  This will ensure that form and function are both addressed during your procedure.

Rhinoplasty is performed under general anesthesia, which is administered by a board-certified Anesthesiologist. Most of the incisions are hidden inside the nose. Often there is the need for an external, small hidden incision in the skin between the nostrils. For those who need their nostrils narrowed significantly, there might be small inconspicuous incisions that are hidden in the crease between the nostrils and the face. After the surgery is complete, an external splint is used to protect the surgical results. Both the splint and sutures (if external) are removed after 5-7 days. There is some swelling and bruising, but these are minimal.

After surgery, pain typically is not a large concern for most patients.  Instead, most patients are tired from anesthesia, and there is some discomfort.  Often, patients feel as though they have a cold – their head feels heavy, and they are stuffy. Patients are ready to return back to work (depending on what the activities of work are) or school after one week. Much of the swelling comes down within the first 6-8 weeks. The nose will continue to improve every day. The final results are clear early but might take a year to complete all reduction in swelling. Light exercise can be initiated around 3 weeks (no heavy lifting or impact exercise). Full contact sports need to wait for 6 weeks to allow the nasal bones to heal fully. Contacts are fine, but glasses can exert asymmetric pressure on the nasal bones. Ask your surgeon for options if you wear glasses. If you would like, all your post op appointments can be scheduled ahead of time to help plan. After the first few, visits are regularly scheduled at 3-month intervals for one year to check on the healing process.

Revision Rhinoplasty                   

Revision Rhinoplasty, or Secondary Nose Job, is nasal surgery done to correct a poor outcome in appearance or function after a previous surgery. Sometimes it’s because of unforeseen complications such as infection or nasal injury in the immediate postoperative period. In other instances, it might be due to inexperience of the primary surgeon, or the use of techniques that aren’t the standard of care. It may be that there is still a bump on the nose, or that too much of the hump was taken down. Sometimes the nose is crooked, or the nasal tip does not look right. Maybe your nostrils are asymmetrical and too large. In any case, repair of the nose in these instances is especially complex and requires a surgeon with special expertise in this part of facial plastic and reconstructive surgery. As our surgeons are dual board-certified in Otolaryngology-Head and Neck Surgeon as well as Facial Plastic and Reconstructive Surgeon, this is something that they have had extensive training in.  They have co-authored many articles and have presented at national conferences.

In most instances, revision rhinoplasty is done under general anesthesia and on an outpatient basis. Depending on the needs of the surgery, a tiny incision is used and typically hidden in between the nostrils. The remainder of the incisions are hidden inside the nose. As the nasal deformity is corrected, cartilage sometimes needs to be replaced or repositioned to help achieve the best possible results. Given that revision surgery is more complex, sometimes additional sources of grafting material can be required.  Your surgeon will address these issues with you at the time of your consultation.  Suture techniques can also be used to address the nasal tip. After the surgery is complete, an external nasal splint is placed to help protect the nose for 5 – 7 days. If there are external sutures, they will also be removed in 5 – 7 days.

After surgery, pain typically is not a large concern for most patients.  Instead, most patients are tired from anesthesia, and there is some discomfort.  Often, patients feel as though they have a cold – their head feels heavy and they are stuffy. Patients are ready to return back to work (depending on what the activities of work are) or school after one week. Much of the swelling comes down within the first 6-8 weeks. The nose will continue to improve every day. The final results are clear early but might take a year to complete all reduction in swelling. Light exercise can be initiated around 3 weeks (no heavy lifting or impact exercise). Full contact sports need to wait for 6 weeks to allow the nasal bones to heal fully. Contacts are fine, but glasses can exert asymmetric pressure on the nasal bones. Ask your surgeon for options if you wear glasses. If you would like, all your post-op appointments can be scheduled ahead of time to help plan. After the first few, visits are regularly scheduled at 3-month intervals for one year to check on the healing process.  Because of the complexity of revision rhinoplasty, swelling can take longer to come down. Typically, most surgeons allow for all the swelling to come down over two years, not just one year as in primary rhinoplasty

Combining Septoplasty and Sinus Surgery with Rhinoplasty

Often patients who initially present to our dual board-certified Facial Plastic Surgeons for rhinoplasty evaluation also have frequent headaches and sinus pressure, recurrent sinus infections or difficulty breathing through their nose. Patients commonly ask if the inside of the nose can be addressed at the same time as rhinoplasty. As dually board-certified Otolaryngology Head and Neck Surgeons and Facial Plastic and Reconstructive Surgeons, our physicians are uniquely qualified to help with both the outside and inside of the nose. Taking care of the sinuses at the same time as rhinoplasty or other cosmetic procedures is a very common practice and for good reasons.  First, patients are already under anesthesia and adding sinus surgery will not change your recovery time significantly. Repairing your sinuses also will not in any way affect your outcome from rhinoplasty. In fact, healthy sinuses can help prevent a postoperative infection following rhinoplasty. Secondly, repairing functional issues can allow for some of the material harvested during septoplasty to be used for the rhinoplasty portion, instead of being discarded at the end of surgery. In fact, the septum is the best reservoir for grafting material. Moreover, fixing the septum at the same time as rhinoplasty allows our surgeons to secure the structural integrity of the nose, so that the results hold permanently.  And finally, repairing the inside of your nose at the same time can in some cases help with some of the costs associated with your surgery. Make sure you ask our surgeons for a more specific proposal for your surgery bases on any functional issues that need to be addressed.