Rhinoplasty Nose Enhancement Surgery: From the Perspective of a Plastic Surgeon

By Dr. Vincent Perrotta

Published on February 08, 2011

The nose is very visible. It sits in the center of the face and projects forward like a marquee on the front of building. It cannot be concealed with clothing or altered with make-up. The visibility of the nose makes it one of the body parts most commonly corrected by plastic surgery. In 2009 alone, more than 138,000 rhinoplasties were performed across the United States.

The majority of patients who seek plastic surgery for their nose are self-conscious about their prominent hump. Others complain of a nose that is too long, large, round, wide, or crooked. Some were born with the nose they dislike. Others acquired theirs from physical trauma.

Today, most plastic surgeons that perform rhinoplasties utilize the "open technique." Through a tiny skin incision across the columella (skin between the nostrils) and two internal (invisible) incisions, we expose the entire skeleton of the nose. This enables us to correct any type of deformity with utmost precision. Via the "open technique," we also have unparalleled access to the septum, which we frequently straighten out in order to improve air flow.

Correcting a nasal deformity usually consists of one or more of the following maneuvers: Reducing the dorsum or hump

• Triangulating the tip
• Raising or lowering the tip
• Thinning the tip
• Increasing or decreasing projection of the tip
• Correcting the deviated septum
• Straightening or narrowing the bony pyramid

Having the technical skill needed to perform these maneuvers is only half the battle. The surgeon must also have an artist's eye. It is the surgeon's sense of form and beauty that guides him or her in deciding how far to go with each maneuver. This sense of form and beauty ultimately determines the end result: whether or not the nose ends up beautiful by itself and in harmony with the rest of the face. The plastic surgeon is either an artist or not.

When choosing a surgeon for your rhinoplasty, you should make sure the surgeon you are considering is either board certified or eligible by either the American Board of Plastic Surgery or the American Board of Facial Plastic and Reconstructive Surgery. You should also review some of the surgeon's results. When it comes to the appearance of your nose and face, visual results is what counts. Therefore, demand to see not one but several pairs of before and after photos of your prospective surgeon's patients. Great before and after photos won't guarantee a good job on your nose, but it will indicate that your surgeon understands the standards of nasal aesthetics and is able to repeatedly produce a result that incorporates them. If any surgeon is unable or unwilling to display good before and after photos, you should look for another plastic surgeon.

A consultation by a board-certified plastic surgeon is much more than an office visit; it is an extensive process. During the first visit, the surgeon obtains a thorough history of the problem. He or she carefully examines the shape of the nose and the quality of its air flow. The surgeon and staff take digital images and measurements of the patient's nose. He or she performs morphing on those digital images in order to share, immediately or at a later visit or via email, different scenarios or possible results with the patient. This is how the surgeon makes certain that he or she and the patient are on the same page. The surgeon uses the measurements to perform dimensional analysis, a system that ensures personal judgments are consistent with established standards of nasal and facial aesthetics. Lastly, during the second or third office visit, the surgeon performs the pre-operative physical exam and finalizes the surgical plan.

At Peninsula Plastic Surgery, we perform the majority of our rhinoplasties in the surgery-center, a non-hospital setting. Patients undergo IV sedation and local anesthesia or general anesthesia. The procedure normally takes one to two and a half hours. Following surgery, we no longer use the uncomfortable nasal packing of the past. Surgeons now insert soft sponges that prevent bleeding at home. We generally remove these sponges on the day after surgery. If we utilize an external splint, it remains in place for 10 days. By the fifth day after surgery, the great majority of swelling has disappeared, however, bruising can last for up to three weeks.

Minor complications are uncommon and major ones are rare. We have a certified operating room attached to our office, so if any revisions are in order, we are able to provide them at little or no extra cost to the patient.

In some cases, health insurance companies cover part or all of the rhinoplasty. They usually cover the correction of a deviated septum or any abnormality that interferes with air flow. Occasionally, they cover the correction of the external deformity if it resulted from trauma.

Here are a couple “before and after” images of some of our patients. These noses have not been digitally altered in any way.

This patient actually already had a rhinoplasty and a revision performed by a surgeon of another practice. She still was unhappy with the hump on the dorsum of her nose as well as the shape of the tip. The surgeon performed an open rhinoplasty (and a mini-face lift). After surgery, the patient said she said she felt more attractive than she ever did.

This patient was very self-conscious about the shape and size of her nose. She also felt it was too masculine. The surgeon enhanced her nose via an open rhinoplasty. The patient said she feels more beautiful and self-confidant than she ever has before.

At Peninsula Plastic Surgery, our Maryland and Delaware plastic surgeons perform rhinoplasty and other facial cosmetic surgery procedures.