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Rhinoplasty

Rhinoplasty is among the five most popular plastic surgery procedures performed in the United States, with over 100,000 procedures performed in 2010 alone. For patients who are unhappy with the size and shape of their nose, rhinoplasty, otherwise known as nose reshaping surgery, or a nose job, is a welcomed cosmetic solution. Because the nose is decidedly the most prominent facial feature, altering its size and shape can have a tremendous impact on one’s appearance. When performed by a qualified cosmetic surgeon, rhinoplasty can greatly improve the balance of facial features, helping patients discover newfound confidence. If you have considered undergoing rhinoplasty, there are a few important things to consider. Here you can learn more about the procedure, its costs, the possible risks and benefits, and much more.

What Is Rhinoplasty?

Rhinoplasty is a form of plastic surgery that modifies the shape and size of the nose. While most of these procedures are performed for aesthetic reasons, rhinoplasty can also be used as a solution to structural defects that may cause breathing problems. The nose reshaping procedure is an outpatient plastic surgery treatment that typically lasts one to two hours. During this time your plastic surgeon will sculpt the cartilage and bone of the nose to achieve a specific look. Rhinoplasty can be performed in two ways: open or closed. Open rhinoplasty requires an incision across the columella, and gives a surgeon easier access to the nasal tissue. During a closed procedure, all incisions are made within the nostrils. Your surgeon will decide the best treatment option for you based on your desired results.

Am I a Candidate for Rhinoplasty?

The majority of individuals who undergo nose shaping surgery are unhappy with the appearance of their noses and wish to improve the balance of their facial features. A smaller percentage of rhinoplasty candidates are patients who deal with discomfort or breathing difficulties due to structural abnormalities or previous injuries of the nose. Regardless of the reason for surgery, it is recommended that girls wait until age 14 or 15 and boys a few additional years to undergo rhinoplasty. This will ensure that the nose has finished growing before it is reshaped. Good candidates for rhinoplasty are in good general health, understand the risks associated with surgery, and have realistic expectations regarding the surgery results.

Ideal Nose Reshaping Candidates

A good candidate for nose-reshaping cosmetic surgery may:

  • Have a nose that he or she feels is too large or too small in comparison with other facial features
  • Have a bump on the bridge of the nose
  • Have a wide nose
  • Have a nasal tip that droops, protrudes, or is enlarged
  • Have a bulbous tip
  • Have nostrils that are excessively flared or pinched
  • Have a nose that is crooked or off-center
  • Have been injured so that the nose is asymmetrical
  • Have problems breathing due to irregularities with internal nose structure

Is Surgery Safe for Teens?

Rhinoplasty is one of the most popular cosmetic surgeries among teenagers. It is important for teenage patients and their surgeons to consider whether or not nose reshaping is an appropriate cosmetic surgery option and to ensure that the decision is the patient's, rather than the result of peer or parental pressure.

What Specific Goals Can a Nose Job Meet?

Nose reshaping cosmetic surgery can be used to modify the shape, size, and overall appearance of the nose. In some cases, the plastic surgeon may recommend that a chin implant be inserted at the same time as the nose reshaping. Common goals of cosmetic surgery/rhinoplasty patients include:

  • Narrowing the bridge of the nose
  • Widening or narrowing the nostrils
  • Straightening a crooked nose
  • Nose tip reshaping
  • Altering the angle between the nose and upper lip

In most cases, the incisions used for nose reshaping cosmetic surgery can be hidden inside the nose or placed inconspicuously outside it. Minimal scarring fits in with the overall goal of improving appearance and maintaining a natural look.

General Considerations

A good nose reshaping candidate should have realistic expectations and specific goals that he or she discusses with the cosmetic surgeon ahead of time. Good candidates should be physically healthy and emotionally prepared for both the cosmetic surgery itself and the time needed for recovery.

An initial nose reshaping consultation with a qualified doctor can provide the patient with necessary information. The physician will assess whether the individual patient is a good candidate for nose reshaping after an initial cosmetic surgery consultation and examination.

Visit the DocShop gallery to view rhinoplasty before and after photos.

Photo credit: Minas Constantinides, MD, FACS, PC

How Will Rhinoplasty Benefit Me?

Rhinoplasty, also known as nose reshaping surgery, or a nose job, benefits individuals who are unhappy with the size, shape, or functionality of their nose. Through this cosmetic procedure, a skilled surgeon can successfully alter a patient’s appearance, calling attention to his or her other facial features and restoring balance to the face. Not only do subtle changes to the nasal tissue and bone drastically improve the look of the nose, but they can have a significant impact on how an individual is perceived, and how they feel about their overall appearance. Whether a patient opts for surgery to correct crookedness caused by an injury, or if they are looking to alleviate breathing difficulties due to structural problems, rhinoplasty can adhere to a number of aesthetic and functional goals.

Aesthetic Benefits

The most common reason why individuals choose to undergo rhinoplasty surgery is to improve the appearance of their nose. Many individuals feel that the size or shape of their nose is ill-fitted for the rest of their facial features, and wish to have surgery in order to bring a harmonious balance to the face. During rhinoplasty surgery, changes can be made to the bridge, tip, and nostrils, making nose reshaping a versatile procedure. Choosing a qualified surgeon to perform rhinoplasty surgery will ensure that patients receive the most beneficial outcome. Among the aesthetic rhinoplasty benefits are:

  • Facial Symmetry – The slightest imbalance in a person’s nose can make a distinct difference in their appearance. Rhinoplasty can effectively create symmetry in a patient’s face.
  • Improved Shape- Altering the bridge or tip of the nose can draw attention to other areas of the face, creating a harmonious balance.
  • Proportionate Size - Reducing the width of the nose, even by a small amount, can have a significant affect on how the nose fits in with the rest of the facial features.
  • Removal of Bumps or Crookedness

Visit the DocShop gallery to view rhinoplasty before and after photos.

Photo credit: Pacific Plastic Surgery

Functional Nose Job Benefits

In addition to cosmetic advantages, rhinoplasty can be performed in response to health-related issues. When rhinoplasty is performed for functional reasons, insurance may actually cover the cost of the procedure. The two main functional rhinoplasty benefits are:

  • Improve Breathing Difficulties – Rhinoplasty can open narrow nasal passages and correct structural abnormalities, improving a patient’s breathing abilities
  • Correct Birth Defects

Additional Benefits

In addition to the benefits of nose reshaping surgery that are physically evident, rhinoplasty has mental health-related benefits as well. Individuals who are unhappy with the size or shape of their nose feel self-conscious about their appearance and may lack self-esteem. After undergoing rhinoplasty surgery, however, many patients report a markable boost in self confidence. This benefit alone can be enough for patients to receive rhinoplasty surgery.

Are There Risks Associated with Rhinoplasty?

As with all surgical procedures, there are risks involved with rhinoplasty. Bleeding, infection, and reactions to medication or anesthesia are possible side effects of a nose job. In addition, there are several risks that are unique to nose reshaping surgery. These include burst blood vessels that can lead to red spots and small scars on the underside of the nose. Patients also run the risk of being unhappy with the results of the surgery. In those cases, revision rhinoplasty may be performed. Choosing a qualified cosmetic surgeon will reduce the risk of complications.

The Procedure

Rhinoplasty is an outpatient procedure that is typically performed under general anesthesia, although some cases may only require a local anesthetic. It is important to discuss your medical history with your surgeon to determine the best anesthesia option for you. Rhinoplasty can be performed as an open or closed procedure, the main difference being where in the nose the incisions are made. In closed rhinoplasty, incisions are made inside the nose, eliminating the appearance of scarring. With open rhinoplasty, an additional incision is made across the columella- the thin strip of tissue that separates the nostrils. While this may leave behind a small mark, it gives your surgeon greater access to the nasal tissue and is ideal when extensive changes are being made to the nose.

Closed Rhinoplasty

Closed rhinoplasty surgery is generally the preferred procedure for patients because all surgical incisions are made within the nose, eliminating external scarring. Although the incisions are made inside the nostrils, this still leaves the great opportunity for the surgeon to reshape the nose.

Open Rhinoplasty

Open rhinoplasty allows the surgeon the least restricted access to the cartilage and bone of the nose but is also more likely to cause scarring. The incision across the columella makes it possible for the doctor to lift the skin off the tip of the nose and shape the cartilage very precisely. When healed, the incision leaves a very small, almost unnoticeable scar on the underside of the nose. Despite this drawback, some surgeons feel that the open nose job procedure is the best option in many cases.

Nasal Packing

In the initial days following rhinoplasty surgery, it is important to preserve the changes that have been made to the nasal tissue. After closing the incisions made during surgery, your surgeon will place a splint to help retain the new shape of the nose. In some cases your surgeon may also place nasal packing – pieces of gauze that fill-the nostrils. Nasal packing is used to keep the septum in place and reduce bleeding. Nasal packing may cause additional discomfort, but is typically removed within a few days of surgery, and goes a long toward maintaining the results of surgery.

Visit the DocShop gallery to view rhinoplasty before and after photos.

Photo credit: Minas Constantinides, MD, FACS, PC

How Is Revision Rhinoplasty Different from Primary Rhinoplasty?

Revision(secondary) rhinoplasty is a cosmetic surgery that is performed when the outcome of the original rhinoplasty does not satisfy the need of the patient. Patients may be unhappy with the appearance of their nose, or may experience functional difficulty following surgery. Traumatic injury following rhinoplasty is another reason why individuals may opt for corrective surgery. Revision rhinoplasty is similar to primary rhinoplasty in that it can be performed as an “open” or “closed’ procedure. In closed rhinoplasty, the surgical incisions are made inside the nose, to eliminate the appearance of scarring. With open rhinoplasty, an additional incision is made across the columella. While this leaves a small scar, it gives the surgeon more access to the nasal tissue and bone. The goals of your rhinoplasty revision will dictate the type of surgery you receive.

Secondary rhinoplasty differs from the primary procedure in that it may require cartilage or bone grafting. In the event that too much tissue or bone was removed in the first surgery, your plastic surgeon will need to replace this in order to achieve the desired look. Often times, cartilage is taken from the ear or other areas of the nose. In rare cases, it is harvested from the rib, in what is known as a costal cartilage graft. Secondary rhinoplasty procedures may also be more difficult to perform than traditional rhinoplasty surgery because the septum may have been altered or partly removed during the first surgery. The septum forms the framework of the nose, and its presence is necessary for the shaping of the new nose. If this cartilage and bone has been removed or scarred; if the skin is now thicker and more difficult to work with; or if the patient’s airway has been impeded, the secondary/revision nose job may be more complex.

Candidacy

Patients who are unhappy with their previous nose job results are candidates for revision nose job surgery. Whether the nose is deemed too small, too large, or shaped improperly, a skilled surgeon may be able to correct the problem. Patients who experience breathing difficulty following rhinoplasty may also opt to undergo a second procedure. Factors influencing your candidacy for revision rhinoplasty include how many rhinoplasty procedures you have had before, what you hope to accomplish with a revision nose job, and the amount of nasal tissue currently in your nose. Patients who have significant scar tissue left behind from previous surgeries may not be ideal for revision rhinoplasty. A personal consultation, which is offered for free by many cosmetic surgeons, is the best way to determine if you are a good candidate for the procedure. During this time you and your surgeon will discuss your previous procedures, as well as your aesthetic and functional goals for revision rhinoplasty.

Risks and Benefits: What You Should Know about Secondary Nose Reshaping

The main benefit of revision rhinoplasty is that it can help patients finally receive the outcome they desire. This secondary surgery enhances both the appearance and functionality of the nose. Just as with primary rhinoplasty, it can successfully alter the size and shape of the nose to bring balance to the facial features. Revision rhinoplasty has the same risks as first-time rhinoplasty, including bleeding, infection, scarring, nerve damage, and bursting of the blood vessels. Patients also run the risk of again being unhappy with the results of the surgery. Communicating with your surgeon is the best way to ensure that you will be happy with the results of your surgery. Choosing a certified, well-recommended plastic surgeon is also vital. As a patient, it is essential that you choose a rhinoplasty surgeon who understands your aesthetic goals and stay realistic about what revision nose job can achieve.

What Kind of Results Can I Expect?

Rhinoplasty surgery is one of the most common plastic surgeries performed each year. This procedure allows surgeons to make a number of changes to the structure of the nose, drastically altering a patient’s appearance. The results of rhinoplasty surgery, however, are not without limitations. Before undergoing rhinoplasty, as with any other surgical procedure, it is important to understand all possible outcomes and set realistic expectations. Below is some information on rhinoplasty results, and what patients can expect following surgery.

Setting Expectations for Nose Surgery

Rhinoplasty surgery, also known as nose reshaping surgery, can be used to correct a number of aesthetic flaws. The surgery can result in a greater balance of facial features, the elimination of bumps or unevenness, and a noticeable change in the size of the nose. In order to achieve ideal results, however, it is important for patients to be completely candid with their surgeon prior to surgery. In the initial surgical consultation, patients should discuss their specific needs and aesthetic goals in order to assure that these goals are realistic and attainable. Your surgeon will evaluate the current form of your nose in order to determine which changes are realistic. For example, patients who are undergoing revision rhinoplasty may have more restrictions on the results of the surgery. Fortunately, even small changes-millimeters added, subtracted, or shifted- can have major, positive effects on your overall appearance.

 

A Preview of Rhinoplasty Results

With modern technology, patients can actually get a preview of what the results of their rhinoplasty surgery might look like. Digital imaging technology allows surgeons to construct 3-D virtual models of the face as it will appear. It is important to note, however, that while this 3D model will serve as a guide for the surgeon, there is no guarantee that the nose job will yield those precise results.

Visit the DocShop gallery to view rhinoplasty before and after photos.

Photo credit: Paramount Plastic Surgery

How long until I see final results?

Rhinoplasty is unique in that the final results of the surgery can take up to one full year to develop. Side effects such as swelling and bruising around the nose and eyes can hinder the appearance of the nose for the first two to three weeks. While subtle changes may be visible in the first weeks following surgery, most individuals will need to be patient in regards to the final outcome. In the months following surgery your nose will begin to settle in to its final shape. Because the final results of rhinoplasty take a significant amount of time, patients are discouraged from undergoing revision rhinoplasty until a full year has passed.

Will there be permanent scarring?

As with almost all forms of plastic surgery, there is a possibility for scarring following rhinoplasty. In closed rhinoplasty, all incisions are made inside the nostrils and will therefore not leave behind any visible scars. In open rhinoplasty, an additional incision made across the columella may leave a small scar behind. Fortunately, due to the size and location of the incision this scar is usually unnoticeable.

What if I am not happy with my results?

Unfortunately, despite a surgeon’s best efforts there are some occasions where patients are unhappy with the results of their surgery. This can stem from a number of causes including surgical error or unrealistic expectations on the patient’s part. Because the final results of rhinoplasty can take up to a year to develop, it is important not to panic if the nose hasn’t taken its ideal shape in the first few months. If a patient is unhappy with the nose even after the final shape has stabilized, there are options for treatment and correction. Depending on the extent of changes that need to be made, a surgeon may recommend non-surgical nose reshaping or secondary (revision) rhinoplasty.

How Much Does Rhinoplasty Surgery Cost?

Because the rhinoplasty procedure is different for each patient, the cost of treatment will vary depending on a number of factors. Among the elements that go into the cost of rhinoplasty surgery are medical testing, surgeon’s fees, facility costs, anesthesia fees, prescriptions for medication, and other post-operative care, if applicable. It is important to discuss the total cost of surgery with your physician, as well as payment and financing options. Patients who are undergoing rhinoplasty as a health-related procedure may be covered by insurance.

According to the Academy of Facial Plastic and Reconstructive Surgery, 41% of patients who received rhinoplasty surgery in 2010 were between the ages of 22 and 35.

Contact a Facial Plastic Surgeon

To schedule your personal rhinoplasty consultation, contact a local facial plastic surgeon.

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