Facial Procedures - Rhinoplasty / Nose Surgery

Rhinoplasty / Nose Surgery

Can you make my nose look like the one in this photo?

Photos help the doctor to better understand what it is you like and don’t like – both about the nose you have now and the way you would like your nose to look after rhinoplasty. For that reason, photos can be useful as a place to begin a discussion. However, a cosmetic surgeon can not put someone else’s nose on your face. Surgeons can only make certain changes to the nose you already have.

My nose sticks out too far. Can you fix that?

What you are describing is the projection of the nose. Another term you will hear is projection of the nasal tip. The nose tip droops as we age. Many patients who request rejuvenation procedures are surprised to learn that by rotating the nasal tip slightly upwards, the nose regains a younger appearance.
You can view sample photographs of Rhinoplasty patients in our Photo Gallery.

How do you remove the bump in my nose?

First, when patients ask about a bump or hump in their nose, they are most often referring to the nasal bridge – the part of the nose that creates the profile seen from a side view of the nose. Surgeons refer to the bridge of the nose as the dorsum and a hump is referred to as a dorsal hump. To reduce the size of this, a rasp (like a nail file or emery board) can be used to shave off and smooth down excess bone. Nasal skin is very accepting of this change and will drape or adhere well to the new shape.

My nose is too close to my face. Can you fix that?

Surgeons sometimes use a term “saddle nose” deformity – where the middle of the nose is too close to the face. A low bridge can be traumatic (from an accidental blow to the nose), the result of a disease process or congenital (from birth as seen in Asian noses).

One repair option is to borrow cartilage from the patient’s nasal septum, ear or rib. One obvious advantage of cartilage is that it does not introduce something foreign into the patient’s body. A disadvantage for ear or rib cartilage is the need for a separate incision. Depending on the amount of cartilage needed, there may not be enough nasal cartilage to accomplish the task.

When trying to build up a bridge that was lowered too close to the face, there is often not enough available cartilage left in the nose from the previous surgery. Cartilage can be difficult to carve into the right size and shape and can have rough edges that can show through the skin of the nose.

GortexThere are many artificial materials that are safe to use in the nose. Gortex®, a material that has been used successfully for years in heart surgery to replace valves, is soft, pliable and smooth under the nasal skin.

My nose is too long/I have a droopy nose. Can it be shorter?

The profile line from between the eyes to the tip of the nose gives us the length of the nose. In our before-and-after photographs, we demonstrate how shortening a nose that is too long brings it into proportion with the rest of the nasal features. As we age, the nasal tip loses support and drops. Using a cartilage graft to support the nasal tip, we create a more youthful appearance.

My nose is too wide. How do you fix that?

Many factors contribute to the width of the nose including the distance between the nasal bones, cartilage in the tip of the nose that is too wide and the thickness of the nasal skin, particularly at the tip of the nose. If the nose is too narrow or the nasal tip is turned up too much, the result doesn’t look natural.

Why is a chin implant sometimes recommended with Rhinoplasty?

It’s all about balance. Facial features in good proportion are perceived as beautiful. Chin augmentation readjusts overall facial proportions. In some cases, it is possible to reduce the appearance of the size of the nose just by adding the chin implant for balance. If neck liposuction is requested this can be performed through the same small incision used for the chin implant.

Will I still look like “me” after surgery?

Many of our patients report that, upon return to work and routine daily activities, friends and acquaintances make the following remarks: “Gee you look great. Did you change your hairstyle?” or “Have you been on vacation?” Retaining your uniqueness is the sign of a successful procedure. Although the change may be significant to you, it’s not uncommon that friends and family don’t really notice the specific changes.

Rhinoplasty Incisions IllustrationWill I have any incisions in my skin?

Most likely. See the illustration for placement of incisions in the column that supports the tip of your nose. This is called Open Rhinoplasty. These incisions heal very well and most patients and family members will not notice them after a few weeks.

When a patient wants the base of the nose narrowed, tiny incisions called Weir incisions are made in the outer rim (ala) very close to the junction of the nose to the face. Surprisingly, these incisions heal very well and are often imperceptible to others.

What’s the difference between open Rhinoplasty and closed Rhinoplasty?

In an “open” Rhinoplasty, a small V-shaped skin incision is made in the post that divides the two nostrils so the skin can be lifted up off the tip of the nose. This allows the surgeon to work on the nasal tip cartilage in their natural position and see what needs to be done. It also allows better access to evaluate and correct asymmetry, projection (how far the nose sticks out from the face), overall length, a hump and how straight the nose is.

In closed Rhinoplasty there is no external skin incision. Some surgeons prefer closed Rhinoplasty and can achieve excellent results. We prefer open Rhinoplasty most of the time because an incision that heals extremely well is an acceptable trade off for the benefits of increased access and visualization.

Is it painful?

After any surgical procedure, some discomfort can be expected. All patients are provided with prescriptions for pain medication. Patients sometimes use the prescription medication two to three days after surgery and then switch to acetaminophen. It is uncommon for patients to report unmanageable pain after surgery. Numbness behind the two front teeth is common and temporary.

When can I go back to work?

Most patients take one week off work but others prefer two weeks. The cast on the nose comes off one week postoperatively. At that time, any residual bruising and swelling can be camouflaged with make-up. Patients who are more concerned with privacy prefer two weeks off work.

Can I drive myself home after surgery?

NO. Because of the effects of anesthesia, patients are not able to drive themselves home after the surgery.

How old do I have to be to have a Rhinoplasty?

Rhinoplasty should be performed only after nasal development is complete – for most patients this means after puberty. In general, surgeons do not like to perform cosmetic Rhinoplasty until a patient is about 16. Along with being more physically developed, a patient under 16 may change their concept of beauty as they mature. A patient needs to be mature enough to participate fully in the decision-making process as well as comprehend fully the procedure itself.

What’s the septum?

The septum is the internal divider of the nose made up of two components:
1) septal cartilage – the mobile, lower part of nose closer to lips, and 2) bony septum – the immobile upper portion of nose closer to eyes.

What is a septal perforation?

The nose is divided by the septum, a wall made of cartilage and bone that separates the right side of the nose from the left. A perforation is a hole or opening. Septal perforation is a hole in the septum. Trauma (whether from an accident or repeated nose picking) and nasal surgery are the most common causes of septal perforations but other causes include cocaine drug abuse.

Location and size of a septal perforation makes a big difference. If a septal perforation is small and posterior (close to the face), oftentimes it causes no problems and a patient may even be unaware they have a septal perforation. If a septal perforation is anterior (towards the tip of the nose), air passing through the opening can make a distracting whistling sound. Because airflow is disturbed by the communication between the two sides of the nose, patients complain of nasal airway obstruction. Septal perforations can result in chronic crusting which compounds airway obstruction and creates a maintenance problem. Patients with septal perforations must keep edges of the nose lubricated so they don’t dry out and bleed.

From a cosmetic standpoint, a septal perforation can spell trouble. If a septal perforation is large enough, bridge (profile line) support is lost, creating a weakened area in the nose that can collapse. This can result in a “dent” in the profile.

Septal perforation repair is challenging – even for an experienced surgeon. If a septal perforation creates any of the problems discussed above, the perforation should assessed for repair prior to Rhinoplasty.

Will I be awake during surgery?

Using IV sedation (medicine administered through an IV) and local anesthesia (numbing medication administered in the surgical area), patients are asleep during surgery. Patients do not hear or feel anything and are comfortable during surgery. Patients wake up very soon after the surgery is completed.

Can I have a face lift or brow lift at the same time as Rhinoplasty?

Rejuvenation surgery such as a browlift to address frown lines between the eyes, facelift or Contour Thread Lift to address a “turkey wattle” neck, blepharoplasty to remove “bags” of excess fat and skin around the eyes, and skin resurfacing such as a chemical peel to improve fine wrinkles can all be performed at the time of Rhinoplasty.

Nasal CastWhat do I look like when I wake up from surgery?

Following the procedure, you will have a cast on your nose with a drip pad under your nose to collect the mucous drainage. Your nose will be swollen. You may have some bruising under your eyes, however, this typically is more pronounced 24-48 hours after the procedure.

How long will bruising and swelling last?

For most patients, bruising and swelling lasts about a week. If you bruise easily, it could last up to two weeks, however, this is uncommon.

What does it feel like when I wake up from surgery?

Your nose will be stuffy – like having a bad head cold – and you may experience a headache. We will make sure you are not nauseated or queasy. Our nurses will be right there with you as you wake up from surgery to give you special attention. You may notice numbness on the roof of the mouth or behind the two front teeth. This will resolve with time.

Tell me more about the nasal packing.

After surgery your nose will be packed with soft nasal packing. There will be soft silastic splints along each side of your septum (divider of the inside of the nose) and a cast on the outside of your nose. The nasal packing will prevent breathing through your nose so you will have to breathe through your mouth. Your mouth will become very dry. Drinks at the bedside along with a humidifier (cool or warm) may help.

What’s a drip pad?

Following surgery, soft gauze dressing is placed under your nose to contain draining red-tinged mucous. This drainage through your packs onto your drip pad is normal. Following your procedure the nurses will teach you how to change the drip pad, which you will need for about 24-48 hours.

When will I look normal?

Most of our patients tell us that they look “normal” at about two weeks. You will still notice swelling and your final result is still a ways off. However, at two weeks you know you are well on the way to recovery.

How long does healing take?

Healing from rhinoplasty to evaluate the final result takes one full year. However, after three months, most patients have about 90% of their final result.

You can view sample photographs of Rhinoplasty patients in our Photo Gallery.