Overview of Rhinoplasty

My personal philosophy of rhinoplasty focuses on one essential goal - to achieve a result that makes the patient happy. With this essential goal in mind, I take a conservative approach to rhinoplasty and seek a natural, unoperated look. I avoid over-aggressive resection maneuvers. I focus on maintaining structural support, and seek a natural "unoperated" appearance. I have provided before and after surgical photos in my websites that I hope reflect my approach. Ultimately, success in rhinoplasty is based on well-developed judgment, wisdom, and accumulated knowledge and experience. Like most surgeries, rhinoplasty is both a science and an art. Skill comes from experience and wisdom, combined with a measure of talent. The surgeon must have a detailed understanding of the multiple anatomic variants encountered. The surgeon must also have accumulated the appropriate surgical techniques and experience.

What is Rhinoplasty?

Rhinoplasty is surgery to reshape the nose. It is a very popular procedure - in fact, over 300,000 Americans undergo this operation each year! Common requests include making a nose smaller, reducing the bridge of the nose, narrowing the nose, making changes to the nasal tip, lifting a droopy nose, revising a previous rhinoplasty and others.

What bothers one person about their nose may not bother another person. Still, most rhinoplasty patients know what they do not like about their nose. If you do not like the way your nose looks, if you are willing to undergo a surgical procedure, and if you are in good physical and mental health, then you may be a good candidate for rhinoplasty.

Types of Rhinoplasty - Functional v. Cosmetic, Open v. Closed

Question: Will insurance cover my surgery?
Answer: If your requests are functional (for example, you cannot breathe through your nose, or if you suffered a relatively recent, documented nasal fracture), many insurance companies will cover the part of the surgery that is required to correct these problems.

However, any requests relating to a change of appearance are generally not covered by insurance companies, and do require a cosmetic surgery fee.

Question: How do you do a rhinoplasty?
Answer: The two general types of rhinoplasty are the endonasal ("closed" rhinoplasty - all incisions hidden inside the nose) and the external ("open" rhinoplasty - all incisions EXCEPT one small incision are inside the nose.)  In open rhinoplasty there is one small incision across the columella (the skin between the nostrils).  This incision is generally extremely difficult to see, and is only about 3 mm (1/10th of an inch) long!

I perform both closed and open rhinoplasty. I have written a recent scientific article on this subject, entitled "Open Versus Closed Rhinoplasty." Let me summarize the conclusions for you here: The decision on which technique to use depends on technical considerations with respect to the patient's specific anatomy and his or her cosmetic requests, and also depends on physician experience with both techniques.

This patient had an open rhinoplasty 4 years ago. Look at his base view - see the incision?

The patient below had a closed rhinoplasty. His incisions were all on the inside of his nose:

In my experience, the closed approach is better for some noses, while the open technique is better for others.  For example, in my practice the patient who requests simply a small hump removal may undergo endonasal rhinoplasty, while the patient with a severely twisted nose often requires - for technical reasons - an open approach for the best result.  The approach I pick is based on what I think will provide the best outcome for you, and based upon our detailed discussion about the technical aspects of your procedure.

The female patient shown here underwent an open approach because her nose was  twisted and needed straightening.  If she had only needed profile changes, I might have undertaken a closed approach. Can you tell that her surgery was open?!
 

Fortunately, there are no major disadvantages to either approach.  However, each approach has special advantages for specific situations. Since every nose is different and has unique surgical requirements, I discuss the options with each patient and am happy to describe my surgical plan in detail. 

Ethnic Rhinoplasty

I perform rhinoplasty on all ethnic groups. The categories of ethnic groups include Caucasian, Asian, African-American, and Hispanic. Please see the Ethnic Rhinoplasty Section for more detailed information.

Surgical Philosophy

You should understand the surgeon's philosophy. First, you should find a surgeon who has a philosophy about rhinoplasty! In my opinion, a surgeon who philosophically takes a conservative approach to rhinoplasty is preferable. The surgeon's approach should be one in which he or she avoids over-aggressive resection maneuvers, focuses on maintaining structural support, and seeks a natural "unoperated" appearance.

Limitations of Rhinoplasty - Realistic Expectations

Rhinoplasty can change your appearance, and to a certain degree it can change the way you feel about yourself and how others relate to you. But, rhinoplasty will not "change your life." The patient must have a realistic appreciation of the physical and psychological changes that can be achieved, and must have a realistic appreciation of the potential functional, cosmetic, and psychological risks. We will discuss this more below.

Are you a Good Candidate? Or a Bad Candidate?

If you do not like the way your nose looks and are willing to undergo a surgical procedure, and if you are in good physical and mental health, then you are eligible for a rhinoplasty consultation. During your consultation, I will talk with you in detail and examine you. I will also undertake computer imaging so that I can understand your surgical goal. Then, I will explain my expectations for your surgery and will let you know if I think you are a good candidate.

All patients must understand that surgery is an art and a science. Cosmetic surgical procedures have been repeated successfully countless times and are dependable when executed by skillful, experienced surgeons. Despite the best efforts of a talented surgeon, a complication can still occur. Although most complications are relatively minor and correctable, more serious, debilitating, and uncorrectible complications do occur . There is no way to be certain that a complication will not occur. Plastic surgery is a combination of art and science, and as such can be subject to unpredictables - usually (but not always) minor and correctible in nature. A patient undergoing rhinoplasty must understand this and accept the possibility of a complication.
Once you have chosen a surgeon, have a candid discussion with the surgeon regarding your goals and expectations of surgery. A discussion of the potential complications is critical, so that you understand the risks of a complication.

Age Requirements

Most rhinoplasty surgeons prefer to wait until an individual has completed his or her growth spurt. This means age 15 or 16 for girls, and a little later for boys. Of course, this is a generalization: it is very important to consider the individual's emotional and social maturity level and to make sure that he/she really wants a rhinoplasty.

If you are in good physical and mental health, age is not usually the over-riding factor. Rhinoplasty in the 40s and 50s is relatively common. Perhaps the oldest patients for whom I have performed a rhinoplasty has been for an occasional patient in their 70s.

Emotional Health

It is important that you are in strong emotional health. If you generally happy in life but simply do not like the way your nose looks, and are interested in a cosmetic improvement, then you are probably a good candidate for rhinoplasty consultation.

However, if you are in a stressful period of your life - a divorce, personal or financial tragedy, this is a bad time to have cosmetic surgery. If you believe that having a nose job will change your life, improve a relationship or a marriage, etc... then you should not have this surgery. If you have a psychiatric illness, this illness should be under good control, and you should seek advice from your psychiatrist before giving this further consideration.

Physical Health

If you are in a general state of good health, such that a 2 hour anesthesia and surgery does not present a greater than normal risk, then you probably are eligible for rhinoplasty from the physical health perspective.

However, if you have serious acute or chronic illnesses, you should probably only have surgeries that are absolutely necessary!

Smoking

Smoking delays healing and increases the risk of poor healing and infection. Smokers should be prepared to quit for at least 3 weeks before and after surgery.

And, if you are serious about rhinoplasty, why not use this as an excuse to quit!

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