Nose Surgery

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Nose reshaping surgery, also known as rhinoplasty, is used to remove a prominent hump, to narrow a wide nose, or to fix a deformity after a trauma to the nose. Nose surgery may also help improve certain breathing problems. Nasal surgery can result in dramatic improvement in a patient’s appearance, and is among the most popular cosmetic surgery procedures. Dr. Hendricks is a meticulous, triple board-certified plastic surgeon in Newport Beach who has performed nose surgery on many satisfied patients from Orange County and the Los Angeles area. He provides natural, subtle results that patients love. For more information, schedule a personal nasal surgery consultation at Pacifica Cosmetic Surgery Center.
Surgical Technique
Open Rhinoplasty
Many surgeons prefer the open rhinoplasty approach during nose surgery because they can gain a better view and better access to the inside of the nose. The incision using this approach is made on the skin between the nostrils or under the nose near the nostrils. Once the incision is made, the skin is moved back to allow access to the internal structures. The incision lines, which heal nicely leaving scars barely visible, are fairly small and usually measure between 2-3 mm.
Closed Rhinoplasty
The closed rhinoplasty technique is used on noses that have features that are easily corrected. It is commonly used when the tip of the nose has good shape and is not too long, too wide, over or under projected. The incision during this approach is not visible after surgery because it is made on the inside of the nose.
During/After Surgery
Rhinoplasty is performed under general anesthesia in an accredited surgical facility and typically takes around 1-2 hours to complete. It is considered an outpatient procedure. After surgery, patients will wear a nose splint and will experience bruising and swelling around the nose and eyes. Once the bandages and splint are removed, the nose will look normal, but it may take longer for the bruising to subside completely. It can take up to a full year for the nose to gain its final contour and softness.
Rhinoplasty FAQs
Are Surgery Fears Normal?
Yes, and this fear is always elevated when surgery involves the face. However, more than 350,000 people in the U.S. undergo rhinoplasty each year making it one of the most common cosmetic surgeries. One way to help calm your fears is to make sure you find a reputable and skilled surgeon that has extensive experience with nose surgery.
Will Nose be Broken?
About half of rhinoplasty patients will benefit from a manual nasal fracture during surgery. This planned break allows access to perform certain functions during surgery such as narrowing the width of the nose or correcting an asymmetrical nose. This is a common practice and heals within just a few weeks following surgery.
What is a Nasal Pack?
Nasal packing is the insertion of gauze and/or cotton packs into the nasal chamber after surgery. These are used to control bleeding, but are not necessary 100% of the time. They are generally used if the surgery includes the septum.
Is Surgery the Only Answer?
Noses that are too large or too wide, or have a specific deformity may only be able to be enhanced through nose surgery. However, the look of some noses may be able to be enhanced using an injectable filler such as collagen, calcium hydroxyapatite, or fat taken from another part of the body, “injection rhinoplasty” may be an option before resorting to surgery. This is an in-office procedure that can help to soften and camouflage a bump, alter the tip of the nose, and smooth out irregularities.
What is the difference between open and closed rhinoplasty?
Open rhinoplasty is a technique for performing nose surgery by use of a new approach that is similar to closed rhinoplasty but with one added component. In the past, rhinoplasty was always performed through one incision inside of each nostrils to avoid any scars on the outside of the nose. This approach was adequate for simple problems of the nose such as a small hump correction or some simple nasal tip issues. The difficulty with the “closed” approach is that it is very difficult to visualize very much through those very small openings. Open rhinoplasty is an extension of the closed rhinoplasty but the two incisions are connected by connecting the two incisions with a small connecting incision across the skin bridge between the two nostrils. The ability to see the structures of the nose using this approach increase 10 fold. Of course, the concern over open rhinoplasty is that the scar could potentially be visible. However, in reality this incision between the left and right nostrils is very difficult to detect provided that the skin is brought together at the end of the operation with very fine sutures and proper aftercare. A surgeon who is board certified in the specialty of plastic surgery by the American Board of plastic surgery is qualified to perform both open and closed rhinoplasty with skill. A physician with those qualifications is best suited to decide whether open rhinoplasty or closed rhinoplasty would be best for your particular nose problem.
Is it possible to have a rhinoplasty without having the unnatural or operated look?
The answer to this question is certainly yes. The art and science behind corrective rhinoplasty has progressed significantly over the last 20 years. We now understand that the cartilage of the nose acts as a framework that controls the ultimate shape of the nose. In the past, doctors were taught to remove cartilage in specific areas which resulted in some contraction of the nose and a resulting shape change. We have all seen people with severely collapsed and contracted noses that resulted after too many operations with more and more cartilage removal. Fast forward about to the early 2000’s when rhinoplasty underwent a 180 degree turn-about. Modern rhinoplasty now involves adding cartilage, or strengthening cartilage with suturing so that a solid structure is created in the ideal shape which reliably results in a strengthening and shaping simply be reduced or removed be. We now know that beautiful balance nasal shape. This modern approach to rhinoplasty is not practiced by all of the physicians of this current generation. It requires through knowledge of the nasal anatomy as well as the cartilage shaping and strengthening techniques , but most importantly, a surgeon should have a keen sense of artistry as well. When the excesses as well as the deficiencies of the cartilage are adjusted in the proper amounts, the result is a predictable, natural appearing and beautifully shaped nose which enhances the rest of the face rather than detracting from it or becoming a focal point.
Can you improve the breathing through my nose?
Problems breathing through either nostril can suggest narrowing of the internal airway of the nose due to a deviated septum as well as other problems such as sinus enlargement. Even severe allergies can cause nasal breathing problems and that particular cause of difficult breathing is better treated with medication than with surgery. Previous surgery which has resulted in partial nasal collapse from excessive cartilage removal as discussed above (see QUESTION-3) can also be a reason for difficult breathing through either one or both nostrils. Because there are multiple causes for restricted nasal breathing, a complete internal and external examination of the nose is required as a baseline for drafting a comprehensive plan of correction of breathing difficulties at the time of any corrective or cosmetic rhinoplasty procedure.
Will I have bruising after surgery?
The risk of bruising is present with any surgery of the face or body. Therefore, there is the chance of either small or significant degree of bruising after rhinoplasty surgery. The amount of bruising is usually related to the complexity of the surgery plan which relates to how difficult the initial problem is that requires correction. If the nasal surgery plan is to correct only the soft tissues and cartilage, then the chance of noticeable bruising will be typically negligible. If the corrective surgery requires fracturing and moving the nasal bones either closer together or on occasion further apart, visible bruising is more likely. In all cases visible bruising may be present for 5 to 10 days in most patients. This is easily camouflaged by cover-up makeup techniques. A recent clinical trial found that the administration of a natural hormone called DDAVP just prior to nasal surgery significant decreased the amount of bruising in all patients as well as shortening the length of time until bruising was no longer visible.
Will I have visible scars?
Visible scars after rhinoplasty are unusual. For scars to be visible after surgery there must be external incisions as part of the rhinoplasty plan, such as when the surgical approach is the “open” rhinoplasty approach (See QUESTION-2 above) This technique involves connecting the two side of the nose by making a connecting cut on the bridge of skin between the two nostrils. Fortunately when repaired with very precise surgical technique, the scar is in many cases imperceptible. In a few patients the nostrils can appear too large or the very wide, especially when the tip of the nose is much flatter than normal. The correction of this problem requires external incisions to reduce the size or the width of the nostrils. With proper surgical planning, the scars are designed to fall within the crease of the nostril where it joins the cheek skin, so when delicate and precise repair is performed, these scars are also barely perceptible..
Are there any age restrictions for undergoing rhinoplasty?
Usually, the facial bones will stop growing in women about two years after their first menstrual period. In men, facial growth stops around age 16 but can continue up to age 20. Ideally, facial growth should be complete before a rhinoplasty is considered appropriate. This guideline makes the need for revision rhinoplasty less likely because the nose is not expected to change much when facial growth ceases. With rules there are always exceptions. For example if there is a very significant deformity of the nose or face which impacts a boy or girl socially or psychologically, it would be acceptable to perform a corrective surgery before facial growth is completed as long as the patient and parents are aware that revision or additional correction may be more likely needed in the future. Not all surgeons agree with this approach, but the risks of anesthesia and surgery in this modern era of medicine is insignificant and pales in comparison to the degree of psychological damage that can be inflicted upon children with cranio-facial deformities because they are advised to “wait a few more years” before correction is undertaken because facial growth is not completed.
In order to fix a nose that is too long, is it necessary to remove tissue?
This is an interesting question. The nose can be in reality truly too long or there can be an abnormality of the tissues of the nose that give the perception that the nose is too long. In the first case, where the nose is truly too long from the bridge of the nose (between the two eyes) extending to the tip of the nose, tissue is usually removed to shorten the length. When a nose appears to long because of an abnormally such as an upper lip that is too short, or when an abnormality of the bridge of the nose makes the nose appear too long, then those issues should be addressed. Another situation in which the nose can appear abnormally long is when the cartilages at the tip of the nose are slanted forward and downward as if they have slid off the end of the nose as occurs to some degree in most people as they age. This problem can be easily corrected by repositioning the tip cartilages in the proper location without the need to remove tissue.
Is it true that swelling can disguise the end result of surgery? How long does this last?
Swelling after nasal surgery typically is completely gone by 12 months following the operation. Surgeons and many patients who have undergone nasal surgery are well aware that very small amounts of swelling in the facial or nasal tissues can disguise subtle abnormalities or irregularities related to nose surgery. Therefore before and after photographs of a patient who is only three months after nose surgery probably does not represent the true result of the surgery because subtle swelling may hide irregularities that will become noticeable when the swelling is gone around the 12 month time frame. The exception to this rule is revision nasal surgery. When a second rhinoplasty is necessary to further correct any nasal deformity, the resolution of swelling can take as much as 18 months because of the internal scarring from the first operation.
Do you have some before-and-after examples?
It is important for anyone considering either cosmetic or functional nasal correction to review before and after photographs that reflect the actual work of the surgeon they are interviewing. The Before and after sets should include at least 5 different viewing angles for every patient. If some of the views are missing it may mean those views didn’t turn out so well. The time frame from surgery to photos ideally should be one year, however not every patient will return for photos a year after their operation of all has gone well and they do not have any concerns. Although many surgeons are completely qualified to perform nasal surgery, techniques vary from doctor to doctor and it is important to ensure that the surgeon you have chosen is comfortable with the concept of constructing a collagen skeleton as the framework for the shape of the new nose (See QUESTION-2 Above). Simply removing cartilage from the nose without considering facial balance as well as balance of the lower third of the nose relative to the remainder of the nose can result in the “operated look”. Most experts recommend reviewing multiple before-and-after images on the surgeons website to be sure that the results appear natural, balanced, and proportional before committing to surgery. As always your search should begin with doctors who are certified by the American Board of Plastic Surgery.

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