Facial Plastic Surgery Blog

This is a nice summary of rhinoplasty, written by a reporter who attended one of my lectures…

http://www.shlnews.org/?p=101

Recently, the New York Times published an article that focuses primarily on revision rhinoplasty surgery (http://www.nytimes.com/2009/10/29/fashion/29Skin.html). I am glad that this was published, as it highlights a few issues regarding facial plastic surgery, and rhinoplasty in particular. Revision rhinoplasty is a significant portion of my practice in San Francisco, so I thought I put a few pertinent issues down in the blog.

First, surgery of any kind is not without risk. Even something that may seem straightforward may not turn out exactly as planned. The reasons for this are not always obvious. For example, it may seem a simple issue to remove a ‘bump on the nose’. However, for every action we perform in rhinoplasty, there are often non-obvious consequences that require remedy. In this case, if we remove the so-called ‘dorsal hump’ without any other changes to the nasal structure, we could end up with an awkward-looking nose (open roof deformity). To prevent this, we often must ‘break the bones’ of the nose to ‘close’ this open roof. These maneuvers themselves can have consequences on nasal shape and breathing…..and so the list goes on.

Now, the above example was relatively simple one…in more complicated maneuvers (hump reduction + tip changes), the variables increase. One can imagine that this is why we often call rhinoplasty one of the most difficult procedures in facial plastic surgery, and one that requires experience.

In the case of revision rhinoplasty, the complexity level increases exponentially, as we are operating on a nose that has been operated on before. Thus, every aspect of the surgery is more difficult: the initial opening of the nose is more difficult (scar tissue), developing a plan is more difficult (because we often don’t know with certainty what we will find ‘under the hood’, so to speak) and execution requires more skill (we may have to retrieve ‘grafts’ from other parts of the body, such as the ear or rib). Most importantly, once again, is experience, as this increases the likelihood that the surgeon has seen similar situations before and knows how to deal with the unexpected.

Recovery from revision rhinoplasty in the short-term is usually not much different that primary rhinoplasty. However, I find that the minute swelling that occurs in rhinoplasty takes a bit longer to resolve in revision cases—at least 1 year.

For more information on rhinoplasty, visit www.sfrhinoplasty.com

In my rhinoplasty practice in the San Francisco/Palo Alto/Bay Area, I have found several questions that are commonly asked.  Here are a few of them.  I may update this regularly.  If you have a question that you’d like to ask that is not addressed here, please email info@drmost.com.  Or, for more information you can visit www.drmost.com and www.sfrhinoplasty.com.

Rhinoplasty FAQs

Will a septoplasty change the shape of my nose?
Septoplasty is typically done without changes to the shape of the nose.  Certainly, it is not the goal of the procedure.  In cases where the caudal (bottom) of the septum, near the nostrils, is deviated, correction may result in a difference in appearance.
Note that many patients will elect to have a rhinoplasty (to change the shape of the nose) at the SAME TIME as the septoplasty.  Commonly, Dr. Most sees patients in his office for revision surgery who say they had a ‘septoplasty’ many years earlier.  In most cases, a rhinoplasty was also performed.

What is the recovery from rhinoplasty like?
Most patients feel the need to take a few days (up to a week) off from work.  Typically, the nose is taped for 6-8 days, and this alone often is reason enough to ‘lay low’ for a few days.  Usually, the pain is quite well tolerated, and patients are provided with pain medicine to ensure their comfort.  We recommend patients follow this schedule:
First week: No strenuous activity
Second week: May begin light aerobic exercise
Third week: May begin lifting weights
Sixth week: May resume full activity

I heard that it takes a year to recover from rhinoplasty—is that true?
Actually, no.  However, it can take a full year for the result of rhinoplasty to be ‘finalized’.  That is, while most of the swelling, etc. will be gone within weeks, the final tiny amount of swelling within the skin, and changes due to the healing process, can take a year.  This is common knowledge amongst those familiar with rhinoplasty, and is probably where the above statement originated.
What is “Ethnic rhinoplasty”?
This term is used to describe rhinoplasty in the non-Caucasian nose, and is perhaps not a good term.  Many of the aesthetic ‘norms’ used to describe the ‘ideal’ nose were based upon the Caucasian nose (particularly the female Caucasian nose).  Thus, these ‘ideals’, if applied to everyone, would result in disharmonious results.  In other words, the nose would not fit the face.  Dr. Most realizes this and is one of the first to promote ethno-centric rhinoplasty.   In other words, there are no ‘cookie-cutter’ rhinoplasties.  Each patient is evaluated individually and surgical goals are made together, with the patient, to achieve a natural result.  The result is a natural rhinoplasty, with a form that is in harmony with the other facial features.

Are there special considerations for Asian rhinoplasty?
Yes (see above).  Dr. Most’s philosophy is to evaluate each patient individually.  In Asian rhinoplasty, there are typically a few commonalities in anatomy that must be looked for and recognized if present.  For example, the request is often made to ‘raise the bridge’ of the nose.  Some surgeons perform the same surgery for all Asian rhinoplasty surgeries. However, not all noses are the same.  Furthermore, not all patients with the same nose will want the same look from surgery.  Therefore, it is imperative to have surgeon with both experience and the patience to listen to your concerns/desires before proceeding with Asian rhinoplasty.

Non-invasive revision rhinoplasty

Revision rhinoplasty is one of the most challenging procedures in facial plastic surgery. Nationally, rates of revision range from 3-10%, and result when significant imperfections occur after rhinoplasty surgery, or when breathing obstruction occurs.

Traditionally, imperfections are corrected by reduction (if the imperfection is a bump) or addition (if the imperfection is a depression) of tissue to the nose, and is performed surgically.

With the advent of newer, longer-lasting filler materials, we can now fix imperfections of the latter variety in the office. My preferred method is to inject saline in to the area to first test what it would look like and how the patient likes it. We can then use the filler material to fill in the area. Typically, however, the filler is not permanent, but results can last for a year or more.

I have had success with this technique and think it’s a great addition to our tools for revision, especially in patients who do not want to undergo another surgical procedure.

For more information on rhinoplasty, visit www.sfrhinoplasty.com or www.drmost.com

Functional Rhinoplasty

Rhinoplasty, or nose-job, is classically thought of as an operation to change the shape of the nose. Of course, we have our noses for a reason. Not only are our noses important for the movement of air, but also for filtration, temperature and water regulation. So, preserving these functions can be important to our well-being.

Unfortunately, we (as surgeons) forgot this as rhinoplasty grew into primarily a nose-reshaping operation in the 1950s through the 1990s. I have personally seen many patients who had rhinoplasties decades ago (while I was still a grade-schooler!) and have problems breathing.

For these patients, the answer is a ‘functional’ rhinoplasty–a rhinoplasty to improve nasal function. For many such patients, a second operation can be done that improves the ability to breathe through the nose. I have recently published an article documenting the improvement in quality of life after such surgery (Archives of Facial Plastic Surgery, 2006).

Recognition of the importance of nasal function, as well as form, is leading to a change in the way leading rhinoplasty surgeons approach the operation. Not only should short-term aesthetics be considered, but also long-term function. For this reason, I always consider nasal function in my aesthetic rhinoplasty operations.

If you are thinking about rhinoplasty, make sure your surgeon has an understanding of the importance of preservation of nasal function. For more information, visit www.sfrhinoplasty.com

What is a rhinoplasty?

Rhinoplasty is one of the most common procedures performed in the San Francisco Bay Area, and nationwide. Rhinoplasty (nose reshaping or ‘nose job’) is a procedure to alter the external appearance of the nose, improve nasal breathing, or both. The goal of rhinoplasty surgery today is to create a harmonious relationship between the nose and face, while maintaining nasal airway function.

Are all rhinoplasties the same?

I have to answer this with an emphatic “NO”. Everyone’s face is different. The goal of modern rhinoplasty is to create a harmonious appearance to the face. Moreover, a patient’s gender, ethnicity and height will all have a bearing on what should be considered the aesthetic ‘ideal’ for that patient’s nose. I consider all of these and discuss these with my patients, comparing my opinion with theirs and come up with a mutually agreeable plan for surgery. I recommend that all those seeking rhinoplasty have more than one consultation, and spend a good amount of time with their surgeon discussing options.
What is the procedure like?

The procedure is usually performed under general anesthesia. Incisions are primarily internal, though a small external incision is sometimes used. The bone and cartilage of the nose is reshaped, and care is taken to preserve the breathing function of the nose. Typically, I am able to improve nasal breathing even during cosmetic surgery of the nose. My patients may expect 5-7 days of swelling in the nose. I use absorbable sutures that do not need to be removed, and uses advanced techniques that allow me to avoid packing in most cases.

If you have questions regarding rhinoplasty, please post them here and I will do my best to answer them for you.

OR, visit www.sfrhinoplasty.com for more information