"The Nose Knows"

A favorite procedure of mine is Rhinoplasty. This procedure is intended to alter or reshape the nose to address features that you may wish to change or improve.

For plastic surgeons, rhinoplasty is a real "finesse" type of operation, which requires all of our skills to achieve the end result: this may include adding or altering cartilage, to e.g. reshape the nasal tip, occasionally I can alter the nasal aperture by resetting the soft tissue where the nostrils meet the upper lip. Many times, I am addressing damage that occurred earlier in life, e.g. hitting your nose on a coffee table when you were a toddler, which produces changes over time as one becomes a young adult.

Rhinoplasty itself is a cosmetic procedure, and I counsel young adults, male or female, that if they want to address nasal cosmetic deformities and they are involved in contact sports, then it might be best to postpone a rhinoplasty until they are through that period in their lives. If they have nasal breathing problems, this could be addressed at any time, especially with nasal trauma: fractures, etc. as intervention at the time of the trauma may prevent problems at a later time.

What to expect

One important thing I like to point out to patients however is that it is not as simple as picking out a nose that you like from a magazine or photo of someone whose nose you like or would like to have. Your face is unique and your nose has certain features that can't be altered: like the thickness and quality of the skin, the structure of and location of the cartilage, etc. In other words: you have to work with what you have and cannot change some of these basic features.

However, I can within these restrictions, make some aesthetic changes that can be quite pleasing. For example a large unattractive nasal "hump" can be removed to put the nasal dorsum more in harmony with the rest of the nose. Also a nose that looks "droopy" at the tip can be "lifted" or "elevated" giving what we call more pleasing "tip projection". It is amazing that very small adjustments to the nose can make a difference in its overall appearance to the observer.

About the procedure

Rhinoplasty can be done on an outpatient basis, and I usually prefer a general anesthetic, although I have done a lot of local anesthetics with anesthesia supplement. If we utilize "osteotomies" i.e. breaking the nasal bones to make them "narrower", patients usually prefer the general anesthetic. Most of the surgery is done "internally" therefore there are usually no sutures to take out, but there can be some nasal packing and perhaps a septal splint if some work is done on the septum at the same time. This can be a little uncomfortable until the packing is removed, and I usually have patients use decongestants, and analgesics, and ice to assist in the post-op period. Depending on the procedure, full vigorous physical activity may need to be postponed for 4 - 6 weeks. Return to work would also depend on the job requirments: if the job is sedentary: 7-14 days would be reasonable.

Having gone through an ENT program and become board-certified in otolaryngology (head and neck/ ear, nose and throat specialty) I also am acutely aware that in addition to looking good, a nose needs to function well. A "septoplasty" can be done at the same time as a rhinoplasty. This procedure is often covered by insurance since it addresses nasal airway problems, which are considered functional. There are also occasions when the septoplasty can improve the appearance of the nose: e.g. straightening out the "crooked septum" can enhance the appearance of the nose.

I personally prefer to use autogenous material (i.e. your bodies own tissues) if needed in rhinoplasty e.g. we can get cartilage from the septum (which is the structure in the middle of your nose, that separates the right form the left side), and/or ear. Since the nose is the central feature of your face, it often gets close scrutiny from the front view and on profile from the side. When I am evaluating a nose in consult, I try to pick out those features that are "pleasing" such as pleasing contour, nice projection, pleasing tip projection, and discuss frankly with the patient what features he of she might wish to address.

Again, I have learned over time that it is not necessary to "over-operate" a nose to get pleasing results. Sometimes "less is more". The nose should look "natural" and "fit your face", also the parts of the nose: tip, dorsum, base, should also be in harmony. And again, nasal function should also be respected, since we all breathe, smell, and filter air through our nose.

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