Are you a good candidate for Rhinoplasty?
If you are unhappy with the cosmetic appearance of your nose, you should have a consultation with us. As with any cosmetic consultation, the expectations must be thoroughly detailed to make sure they are realistic and attainable. Most patients are unhappy with “bumps” or “humps” on the bridge of their nose. Other complaints commonly include wide or “bulbous” tips, or the nose simply being too big for the face. There are actually a myriad of very minor issues that can be addressed further adding importance to the preoperative consultation.
Functional airway or breathing problems caused by cartilaginous framework deformities can also be addressed such as deviated septums or enlarged structures on the lateral sides of the nose termed “turbinates”.
What is unique about the initial consult?
Rhinoplasty is different from many cosmetic procedures that rejuvenate the face or body. In rejuvenative procedures the goal is restoration of a previous and more youthful look. In cosmetic rhinoplasty, the goal is to actually change the appearance of your nose. Therefore goals and expectations must be outlined as carefully as possible. We do that uniquely with computerized imaging. Using special software, we can project a proposed cosmetic outcome that you can alter, comment on, and finally approve before surgery. This “goal image” is no guarantee of result as the computer heals perfectly while there are many healing variations in the human body. However, even with these variations, it is critical to at least have a common goal. Computer imaging greatly enhances communication.
What exactly happens during Rhinoplasty ? What techniques are used?
I utilize an “open” technique in almost all rhinoplasty cases. This technique uses a small incision across the midline tissue (columella) between the nostril openings underneath the tip of the nose. This incision is carried into the inside of the nose to give more exposure. This approach is the standard of care in most plastic surgery practices and gives the best exposure to the nose. Such excellent exposure allows for more precise manipulation of the tissues. Once exposed, the cartilage and bony framework is altered in various ways to try to achieve the pre-operative goals. A frequently asked question is if the nose will need to be broken. This is usually dictated by the hump reduction. If a significant hump has to be reduced, then this will be improved from the lateral view. However from the frontal view such a reduction will make the nose wider, since the nasal sidewalls angle out. If the nose is wider, then perforations in the bone at the bottom of this nasal sidewall. The perforations facilitate inward movement of these lateral walls and reduction in the width of the nose. Anytime the base of the nose is felt to be too wide, this infracture technique is utilized. If the only cosmetic concerns are in the tip itself, then bony infracture is not needed.
What is the recovery?
Rhinoplasties are typically not painful procedures. There is mild to moderate soreness at times for a few days, but significant pain is rare. A gauze drip pad is placed under the nose to collect some minimal drainage until it stops in a day or two. I do not utilize packing in over 90% of cases. There is tape on the nose for 5-7 days to keep the soft tissue and cartilage shaping secure. If the bones are moved then a splint will be applied for approximately 7 days in addition to the taping. If the bones are manipulated this can also cause some bruising under the eyes, which can take 10-14 days on average to resolve. There is “stuffiness” in the nose for several days to several weeks.
An immediate cosmetic improvement will be noted in most cases upon removal of the dressing at one week. After removal of the splint dressing, swelling will ensue to some point and mask the refinement achieved at the time of surgery. The swelling slowly resolves to give the final result. The final appearance will not be complete for up to one year.
What are the risks?
The main risk of rhinoplasty is an unsatisfactory result. In the best of hands, the scientific literature suggests that a 15% re-operation rate is incurred with this procedure. Re-operation is usually for minor occurrences such as bone spurs that can occur with the bony healing, or excessive scar tissue build up.
The final result is dependent on how much scar tissue is formed from the surgery and how the cartilage holds its new shape. I place internal cartilage grafts to hold the newly shaped cartilage in position, but sometimes the cartilage has a “memory” and mild to moderate relapse can occur. In most instances the overall quality and improvement is highly satisfactory even if some minor flaws are noted. I often tell patients that in over 20 years I have probably never done a “perfect “ surgery and this would include rhinoplasty. In nasal cosmetic surgery millimeters can make a difference. However the overwhelming majority of patients are extremely pleased with the outcome. This understanding is discussed at length during the initial visit so realistic expectations can be set.
There are other complications that can occur such as infection and bleeding. These complications may need to be addressed with another procedure to drain the infection or the hematoma.
How much does it cost?
We do not feel that it would be appropriate or ethical to post prices for procedures on the internet. We do, however, understand that cost is a factor you must consider. We would be happy to speak with you about this so that you may determine whether the procedure you are considering falls within your budget. Our pricing structure is based on the time, complexity, and surgical costs involved. Please feel free to call our office at 214-823-1978 and speak with either Kurthene or Annette for more details.