Rhinoplasty

Next to your eyes, the nose probably attracts more attention that any other feature of your face. Located at the center of your face, your nose also gives people an insight into your ethnicity, your complexion (oily or dry), sun exposure (sun spots or clear), and in some cases even drug abuse as in cocaine. The ethnic ideals of beauty play a strong role in determining which nose is beautiful while another is less perfect. The most common statement among all of our patients who come in for nose surgery is “I want a natural result.” We agree entirely! We aim to achieve an improved appearance to your nose which still suits your face and appears completely natural. We take particular pride in the fact that ALL of our patients desire a natural as we would not want our name associated with any result which is even slightly unnatural.

On the other hand, for various reasons including social ideals of beauty, it has become popular to cross ethnic boundaries to conform to more universally attractive nose. While we completely disagree with belief that all noses should look the same or that Asians should have the same type of nose as Caucasians, we understand such pressures and look forward to discussing your desires in a rhinoplasty. It’s perfectly fine to change a flat African American nose to a narrower nose with more projection. It’s also fine to change a nose with a hump to one which is straight or even with a subtle natural dip. But to do so excessively will yield a mismatch between your face and nose which will be an unnatural result we strongly discourage.

There are two general types of nose surgery: open and closed. In the open approach, a small incision is made at the columella (narrow central portion of the nose between your nostrils) and continued inside of the rim of your nostrils. The skin a the tip of the nose is then gently elevated from the cartilages beneath. The advantage of this technique is the great power it provides the surgeon in viewing the problems of the nose directly. It is then possible to modify the structures within the nose to improve the shape of the nose immediately with little doubt. The open technique is publicized as a “no scar” technique because all of the incisions are inside your nose. It is really incorrectly explained as there are still scars with the closed technique; it just so happens that the scars all the inside your nose. Only the columella incision (usually 3 to 4 millimeters or 1/8 of a inch) is avoided in the closed technique. But if you add the entire length of all the incisions, the closed technique has about DOUBLE the length of scars as the open technique. These internal scars have a higher rate of causing breathing obstruction as in the open technique. With that in mind, in the closed technique the exact anatomical structures are not viewed under direct vision and there is some room for interpretation as to the exact problems with the nose. Instruments are placed through the incisions inside the nose to modify the structures of the nose blindly, but with manual and visual feedback (albeit through the nasal skin) to the surgeon’s artistic hands. If the tip needs modification, the cartilages at the nasal tip are flipped outward to be visualized directly and returned inside the nose after being modified. So the structures are NOT in their usual location or habitat as they are being modified in comparison to the open technique which alters the nasal structures as the lie in their natural positions with respect to other parts of the nose. At this point it may seem we are partial towards the open technique, but there are cases in which each technique is probably best. For instance, in those people who genetically do not form good scars (darker complexion, acne skin, history of keloids) or in basic to moderately complicated nose surgeries, the closed technique is an excellent option. In those requiring a complex rhinoplasty or in moderate to complex rhinoplasty revisions, the open technique is absolutely indicated in our opinion as there is no room for anything but the close inspection of the complex problems as they lie in their natural position within the nose such that precise and deliberate steps can be taken to correct the problems. Together we have had extensive experience with nasal surgery from simple to complex, from first time around surgery to 15th time around revisions of other surgeon’s works. We therefore feel absolutely comfortable performing either technique. If you should have particular preferences in either regard, please let us know such that we can perform the procedure of your choice using your preferred techniques.

An associated condition which has to be evaluated prior to any nose job is breathing obstruction. A deviated septum or a large turbinate (boney structure inside the nose which humidifies the air you breathe) can block your breathing passage. If you have difficulty breathing, a deviated septum or enlarged turbinate can be corrected at the same time as cosmetic nose surgery.