Rhinoplasty is the procedure to improve the appearance of your nose. The nose, when out of proportion to your face, becomes prominent both to you and those around you. But every nose is different, as is every face. There are numerous factors that go into the recommended procedure including the gender, ethnicity, skin thickness, and the overall proportions of the face. For this reason, no two operations are the same.
But it is important when choosing a rhinoplasty surgeon that he not only is skilled in improving the cosmetic appearance of the nose but also appreciates the nose for its most basic function, breathing. Dr. Guy trained in Otolaryngology-Head and Neck Surgery before his Facial Plastic Surgery Fellowship where he had extensive training in all aspects of the nose from the cosmetic to reconstruction, allergies, sinus problems, and acute trauma. He understands that getting the best result involves not only improving the appearance of the nose but also maintaining its function. This is also where limitations come in regarding how refined or narrowed a nose can be made. If too much support is removed from the nose it may look very nice early on, but as time goes on it can develop obstruction and a pinched appearance. Having a surgeon who appreciates the nose and understands the healing and how the nose evolves with time and minimize many of these risks.
One of the biggest concerns patients have regarding rhinoplasty involves the use of "packing." By understanding the anatomy of the nose, Dr. Guy avoids the use of nasal packing to allow for a more pleasant post operative recuperation. Most patients are able to return to work or school within a week of surgery. For those not doing any rigorous activity then they may return even sooner. Dr. Guy can discuss all of this with you at the time of consultation.
A revision rhinoplasty is exactly what the name implies, a revision. There are many reasons why one undergoes a revision rhinoplasty. It could be that the first surgery did not live up to your expectations. It could be that during the healing process the scar tissue formed in such a way that led to an undesirable result. It could also be that trauma occurred in the post operative period which affected the final result. Lastly, it could be that the original goals of surgery were not realistic based on your anatomy. The most common reason for this is based on the facial structure and thickness of the skin.
Whatever the reason you are seeking revision, there are certain concepts to keep in mind. You need to wait at least an entire year before proceeding with any revision. The reason is that the nose holds on to swelling more than any other structure. As a result, if you consider operating before the edema/swelling resolves, you may be left with a suboptimal result. Second, the predictability of healing declines with each operation. Therefore, with revision, the goals of the operation need to be more clearly defined. This is because there are usually fewer improvements that can be reliably created because of the unpredictability of healing. All of this can be discussed with Dr. Guy at your consultation.
To better understand some of the techniques and surgical options, the information below describes various surgical techniques. This list is not meant to be comprehensive but may help better prepare you for any surgical procedures.
For those with a wide nose that is not in harmony with the face, several options exist. If the bones are wide then controlled cuts in the bones, called osteotomies, can help to narrow this area. This would not impact tip of the nose or the base of the nose. This is often combined with removal of humps from the nose to avoid making the nose appear wider after the hump is removed. For excess width in the tip then suture techniques may be needed. This includes techniques such as intra and interdomal sutures. More aggressive techniques can be utilized in those with thick skin to show changes such as a Goldman technique or modifications of this technique. Ideally the base of the nose should not extend passed the inside corners of the eyes. If it does, then a small incision at the junction of the bottom of the nose and the ala (the parts that go around the nostril), can be used called a Weir incision to narrow this area. This latter option can even be performed under local anesthetic in the clinic.
For those who have a hump, it is most commonly a combination of bone and cartilage. The bone is the more firm part at the top, and the cartilage is the softer part. These humps tend to develop around puberty as the face and nose both elongate. To correct this, both the bone and cartilage need to be addressed. These are most commonly shaved down with surgical instruments such as rasps or a Ruben osteotome. Depending on the size of the hump, as the hump comes down it can give the nose a wider appearance. To help prevent this, once the hump is removed osteotomies can be performed to narrow the nose. To preserve nasal breathing after such a large hump is removed, sometimes the use of spreader grafts (cartilage usually donated from your septum) or auto spreader grafts (using the redundant side parts of the nose called the upper lateral cartilage flipped on itself) are used.
For the rotation of the nose on men hit should be almost a right angle (about 90-95 degrees). In women the nose is slightly more turned up around 100 degrees. For noses that fall out of this range there are surgical techniques to correct this. They may involve plumping grafts at the junction between the nose and the lip to increase the angle, columellar strut grafts to help both the projection of the nose and the angles, lateral crural strut grafts, lateral crural steal, or alar cartilage set backs. As you can see, there are various options and each option is more suited to accomplish not only changing the angles but correcting something else. Depending on your anatomy, Dr. Guy will discuss the appropriate option with you.
For those with breathing issues this is usually caused by a combination of a deviated septum, turbinate enlargement (these are structures on the sides of the nose that help to warm and humidify the air but can become enlarged and obstruct), collapse of the external nasal valve (the entrance to the nostrils), and collapse of the internal nasal valves (a very common area and the most narrow area of the entire airway). Depending on if you have a history of trauma or previous nasal surgery, certain causes of obstruction become more common. Dr. Guy can evaluate your nose and even show you a video inside of your nose to show your narrowed area. Correcting the cause of the obstruction is important, and often spreader grafts can be utilized to further improve the airway. These are grafts placed along your nose that not only help to straighten the external appearance but also open up the internal nasal valve.
There are many more techniques that exist but these are some of the more common ones. Depending on your individual nose, Dr. Guy will make specific recommendations to help improve both the appearance and the function of the nose. The use of our Vectra 3D software can also be of benefit to help show you in real time what different surgical techniques will accomplish with your nose. This is an excellent teaching aid that helps you and Dr. Guy come to a decision on what your goal end result would be. Schedule your consultation today to learn what can be done to help improve the appearance and function of your nose.
3 Dimensional Imaging
Have you ever wanted to learn what a rhinoplasty would look like on you without undergoing surgery? Dr. Guy Facial Plastic Surgery offers the Vectra H1 computer editing software. This utilizes a special 3D camera to create a 3 dimensional picture of your face. We can then use advanced editing tools to simulate the results of a rhinoplasty or a rhinoplasty and chin augmentation. It also performs an analysis of your nose to provide you with up to date information regarding proportions, angles, and how the nose relates to the rest of the face. This is an amazing teaching tool and an excellent way for you to see how different changes that can be surgically created will affect your appearance post operatively. Learn more about the system in the video below.