Choosing a rhinoplasty surgeon?
Choosing a Board Certified and reputable Facial Plastic Surgeon is of paramount importance. Board Certified in Facial Plastic Surgery means your rhinoplasty surgeon has had extensive training and experience with this particular procedure and has passed rigorous testing dealing with nasal anatomy, function and the art of rhinoplasty surgery. Rhinoplasty is truly an art form, from the initial consultation through the procedure itself to the final result. It is one of the most complex of all cosmetic procedures. If you are contemplating rhinoplasty surgery, you hope and expect to undergo the procedure only once. Choose a skilled Facial Plastic Surgeon with an artistic flair and extensive experience with the rhinoplasty procedure. A good rhinoplasty surgeon will inevitably have a strong reputation in your community.

The rhinoplasty consultation:
Successful facial plastic surgery is a result of good rapport between the patient and the surgeon. Trust begins with the initial consultation. A good rhinoplasty surgeon will help you form realistic expectations and answer specific questions about your unique needs. You can expect a thorough explanation of your rhinoplasty surgeons’ expectations and the risks involved with this surgery. Occasionally additional surgery may be recommended to enhance the appearance of the face. About 20% of rhinoplasty candidates have a recessed chin and would benefit by chin augmentation in conjunction with rhinoplasty to create a better balance of features. Following a joint decision by you and your rhinoplasty surgeon to proceed with rhinoplasty, the surgeon will take photographs and discuss all available options.

What is functional rhinoplasty surgery?
When it comes to the nose, function refers to breathing. In addition to the fact that your nose may not fit with the rest of your facial features, you may have difficulty breathing through your nose. There are many causes for breathing impairment but most commonly it is due to a deviated nasal septum or narrowing of the bone and cartilage framework of the nose. If you are having breathing difficulty and also contemplating rhinoplasty surgery, it makes perfect sense to correct both at the same time. This procedure is referred to as a septo-rhinoplasty. All or a portion of this procedure may be covered by your insurance.

How is rhinoplasty performed?
A rhinoplasty is performed in one of two ways; either closed or opened. In the closed approach, all the incisions are hidden inside the nose, leaving no external scar. This procedure is done by the surgeons feel, rather than direct visualization. Even though I was classically trained to performed closed rhinoplasty, I have found my results over the last 17 years to be more accurate and predictable using the open approach. The only difference between a closed rhinoplasty and an open rhinoplasty procedure is a small incision in the skin separating the nostrils. This is very thin skin and once this incision heals, the resulting scar is imperceivable. When the skin is elevated away in the open rhinoplasty approach, the rhinoplasty surgeon is able to directly visualize the surgical changes that are being made. The Closed rhinoplasty however is still utilized for some minor rhinoplasty surgery problems.  

After adequate exposure, the rhinoplasty surgery proceeds by either removing, adding, or rearranging the underlying bone and cartilage. Imagine the work of a sculpture under the skin. All the irregularities and imperfections can be smoothed out. If there are functional concerns, these are also addressed at this time.

At the conclusion of the rhinoplasty procedure, the skin is redraped over the new structure and conforms to its’ new shape. A splint is added to the outside of the nose to help retain the new shape while the nose heals.

What is expected during recovery?
Immediately after rhinoplasty surgery, patients typically experience nasal congestion and stuffiness, much like what occurs with a normal head cold. Although pain medication is always prescribed, most patients find the discomfort from rhinoplasty to be minimal and relieved by Tylenol or Extra-Strength Tylenol. During the initial recovery, bleeding is a concern; therefore patients are instructed to avoid blowing the nose, heavy lifting or straining for 72 hours. Some patients may experience bruising and minor swelling after the procedure. Cold compresses are helpful to minimize this.

The nasal splint and sutures are removed one (1) week following rhinoplasty. Although the nose may appear slightly swollen, patients are typically comfortable returning to work, school or usual activities at this time. Light exercise is permissible eight (8) to ten (10) days after rhinoplasty. Contact sports, however, must be avoided for six (6) weeks because of possible injury. The nasal skin may be more susceptible to sun injury immediately following rhinoplasty and normal sun precautions are advised. If you wear glasses, special arrangements may be necessary to ensure that the glasses don’t rest on the bridge of your nose. Tape or other devices are sometimes used to permit wearing glasses without damaging the rhinoplasty results.

When are the rhinoplasty results realized?
The healing process following rhinoplasty surgery takes time. Although patients are comfortable with their appearance one (1) week after rhinoplasty, improvements are evident almost every day there after. Most of the swelling is gone by six (6) to eight (8) weeks after rhinoplasty. The final results, however, aren’t evident until six (6) months to a year following nose surgery. However, the changes that occur after rhinoplasty surgery are so gradual that friends and colleagues often can’t pick up on the fact that nose surgery was performed.

Revision rhinoplasty:
After complete healing, the rhinoplasty result may not be acceptable to the patient or surgeon. Sometimes these undesirable changes don’t surface until ten to twenty years after rhinoplasty. Results experienced from techniques used years ago may not be fully realized until much later. One example of this is a rhinoplasty technique devised by Irvin Goldman, which was popular in the 60’s, 70’s, and 80’s. This procedure led to a narrow symmetrical nasal tip, but with continued healing and contraction, may also result in a pinched appearance in some cases.

The amount of revision surgery which is required depends on the degree of nasal deformity. Typically, revision rhinoplasty surgery is more difficulty than the initial virgin procedure because of scar tissue, stiffness, and scar contraction. In some cases, breathing problems may also complicate matters. Where as most initial rhinoplasty procedure involve taking cartilage out of the nose to reduce its size, revision surgery is usually quite the opposite. Cartilage support is often needed in theses cases to rebuild a collapsed nose or to re-establish a better airway for breathing. This support may come from the use of nasal-septal cartilage, ear cartilage bone or synthetic implants.

Adding support in revision rhinoplasty may actually make the nose appear larger, although this isn’t necessarily the case. Some revision rhinoplasty procedures involve minor tweaking to make the initial result all that much more pleasing. Prior to embarking upon revision surgery, a thorough examination and evaluation is highly recommended. All possible options should be explored and discussed.

Frequently Asked Questions (FAQ’s ) about rhinoplasty:

Are there any age limitations for rhinoplasty?
Rhinoplasty surgeons do recommend that candidates, male and female, be at least 15 years of age before considering nose reshaping to allow the nose to fully develop. It is possible to perform a rhinoplasty on a younger person, if there are medical considerations, such as difficulty in breathing. As long as candidates are in good health, there is no upper limitation on age.

What are some factors that could affect the end results of my nose surgery?
Physical considerations like skin type, ethnic background and lifestyle may all affect your new nose shape. Thick oily skin is particularly a problem because this heavy cover will inevitably hide the fine sculptured detail work performed on the bone and cartilage.  Your rhinoplasty surgeon will discuss these factors with you in your consultation.

How many post-operative appointments will I have to make with your surgeon?
Appointments after the rhinoplasty procedure are of vital importance, you would be expected to visit with your rhinoplasty surgeon several times in the months following your rhinoplasty. Every person heals at a different rate and your surgeon will schedule follow-up visit accordingly.
Will I need to have follow-up work done to maintain the reshaping?
There may be some minor changes to your nose due to natural aging, but a nose reshaping surgery is a permanent change. Because of this, it is important to fully evaluate your expectations and reasons for your rhinoplasty prior to the surgery.

What is the next step?
Contact The Sullivan Centre, Columbus, Ohio at 614-436-8888 to schedule your rhinoplasty consultation with a Board Certified Facial Plastic Surgeon. Columbus’s Sullivan Centre and rhinoplasty are a winning combination.