What’s new about rhinoplasty?
Today’s rhinoplasty is completely different from the rhinoplasty of the 1980’s and 1990’s. In the 1980’s and 1990’s, rhinoplasties all looked the same. The noses were scooped out and the nasal tips were turned up. The goal of rhinoplasty today is to give the patient a nose that is in balance and harmony with the rest of the patient’s face, not a nose that looks operated upon. A successful rhinoplasty makes your nose blend into your face so that when someone looks at you, they focus on your eyes and not on your nose.
What are the different types of rhinoplasty?
A rhinoplasty is a surgical procedure that changes the external appearance of the nose. Rhinoplasties can be broken down into two major categories: Closed Approach Rhinoplasty (more accurately termed Endo-Nasal Rhinoplasty) and an Open Approach Rhinoplasty. With recent improvements in injectable fillers, there is a third category called Non-Surgical Rhinoplasty. The patient’s nose and the changes to be made to the nose usually dictate the type of rhinoplasty to be performed. Before going into the different types of rhinoplasties, it helps to understand the terms we use to describe a person’s nose.
When researching rhinoplasty, it is very helpful to know and understand the terms that we use to describe a nose. By understanding the terminology, you will be better able to communicate to your doctor your concerns that you have with the shape and appearance of your nose.
The most common concern patients have with the appearance of their nose is called a “dorsal hump”. A dorsal hump is the bump on the bridge of the nose that can be seen on the side or oblique views. A dorsal hump is made up of the bones of the nose, as well as the cartilage that attaches to the nasal bones.
The second most common concern patients have with the appearance of their nose is “nasal tip projection”. Nasal tip projection is how far the tip of the nose extends out from the cheeks. In other words, it describes “how big your nose is”. So if you have a big nose in relationship to your face, it would be described as being over-projected.
The third most common concern patients have with the appearance of their nose is “poor tip definition”. Poor tip definition is when the patient has a large nasal tip or a tip shape that is not aesthetically appealing.
The fourth most common concern patients have with the appearance of their nose is that it is “crooked or twisted”. A nose is crooked when the tip of the nose points either to the left or right of midline. A nose is twisted when the tip is in the midline, but the middle third of the nose goes to the left or right of midline.
My nose is “wide”. A nose can be wide at one or all of the following segments of the nose; the upper third of the nose, the middle third of the nose, and the lower third of the nose. If the lower third of the nose or “nasal base” is wider than the inner corners of the eyes, then it is described as having a “wide nasal base”
“The tip of my nose hangs down”. When the tip of the nose hangs down, it is called “nasal tip ptosis”. Nasal tip ptosis can be present all of the time or it can occur when one smiles. If it occurs when someone smiles, it is because the muscles are pulling the tip of the nose down.
Patients can have one concern or many concerns when it comes to the shape and appearance of their nose. During your consultation it is important that you voice all of your concerns and that you are as specific as possible with your concerns. Also, if you are having difficulty breathing through your nose you should tell Dr. Stanislaw this during the consultation; there may be a way he can help.
An endo-nasal or closed rhinoplasty is when all of the incisions are made on the inside of the nose. The Facial Plastic Surgeon works through your nostrils to make changes to the structure of the nose. Because of the limited access working through the nostrils, the Facial Plastic Surgeon is limited in the changes that can be made to the shape of the nose. An endo-nasal rhinoplasty / closed rhinoplasty is very good for changing a dorsal hump, changing tip projection, or changing tip ptosis. The benefits of an Endo-Nasal or Closed Rhinoplasty include no visible scars, usually a shorter operative time, and a shorter recovery time when compared to an open approach rhinoplasty.
An open approach rhinoplasty uses a very small incision across the skin that separates the nostrils (columella). The incision allows the tissue to be lifted off the cartilage and bones of the nose, so that the structure of the nose can be directly visualized. An open approach rhinoplasty is ideal for making the nasal tip look smaller and symmetric, making the nose look smaller, straightening the nose, and removing a dorsal hump. Essentially, by being able to directly visualize all of the structural supports of the nose, an open approach rhinoplasty can address all concerns. The surgical time is usually longer than a closed rhinoplasty (endo-nasal rhinoplasty), but this is usually because more areas are being addressed. The recovery time (swelling of the nose) for open approach rhinoplasty is usually longer than an endonasal / closed rhinoplasty, again this is usually due to the fact that more work is being done.
What type of rhinoplasty is right for you?
During the consultation, Dr. Stanislaw will listen to your concerns about the appearance of your nose and he will examine the outside and inside of your nose. Dr. Stanislaw will then discuss with you the technical considerations of your rhinoplasty and recommend either an endo-nasal rhinoplasty / closed rhinoplasty or an open approach rhinoplasty.
What is the procedure for rhinoplasty?
Rhinoplasty is performed under general anesthesia at an outpatient surgical center. Generally, you go home after the surgery.
The length of the surgery depends on the individual nose, the amount of change that needs to be achieved, and if it is a primary rhinoplasty or a revision rhinoplasty.
You will need someone to drive you to and from the outpatient surgical center.
There is very little post-operative discomfort after a rhinoplasty.
For the first 24 hours after surgery, there are small dressings inside each nostril. While the dressings are in your nose, your nose will be stuffed up. There is no discomfort associated with the dressings inside of your nose, save the stuffed up feeling. These dressings are removed in Dr. Stanislaw’s office the day after the surgery. The removal of the dressings from inside of your nose literally takes one second. After the dressings are removed you will be able to breathe through your nose.
On the outside of your nose there will be a metal splint that maintains the structure and it needs to be kept clean and dry. This splint will be removed on the seventh day after the rhinoplasty.
You can shower the day after the procedure but you can’t get the splint wet. The splint needs to be kept clean and dry for a week.
If you have sutures on the outside of your nose, you must apply Aquaphor (a special non-prescription petroleum jelly) to the sutures three times a day.
No bending, lifting or straining for one week after the procedure.
You must sleep with your head slightly elevated for one week.
The sutures are removed in 7 days.
If you don’t want people to know that you had a rhinoplasty, you should plan on laying low (downtime) for about 10 days.
What is the appointment schedule like for rhinoplasty?
- Initial Consultation
- If you are over 50 years old or if you have significant medical issues you will need a preoperative clearance from your primary care doctor.
- Preoperative Visit (for photos, instructions, prescriptions, consents, and to answer questions).
- Post-operative visit at 7 days for splint removal.
- Follow up 1 month, 3 months, 6 months, and 12 months after the Rhinoplasty.