While some people are born with noses that perfectly fit their faces, many others find that their noses are out of proportion to the other features of their faces. This draws the attention immediately to the nose when they look in the mirror or at photos of themselves, or when others look at their faces.
Rhinoplasty, also known as a nose job, is reshaping of cartilage and bone of the nose to bring the nose into balance with the rest of the face. When the nose is in proper proportion, the first feature others will see is the eyes, which increases the overall attractiveness of one’s face.
What Features Can Be Improved with Rhinoplasty?
The most common feature that patients seek to have corrected is the bump or hump on the bridge of the nose. This feature is called the dorsal hump, and dorsal hump reduction is a part of most rhinoplasties. Other common problems that are frequently addressed with rhinoplasty include:
- A wide or bulbous nasal tip
- A flat nasal tip
- A droopy nasal tip
- Wide nasal bones
- Large or wide nostrils
Rhinoplasty has evolved considerably in the past 40 years. Techniques in the past removed a considerable amount of tissue from the nose; while this approach initially produced very cute and attractive noses, there was very little support left in the nose, and over 10 to 20 years after surgery, the features of the nose would retract or collapse, producing an “operated-on” and unnatural appearance as patients reached their 40s and beyond. Today, we have learned that the best and longest-lasting results are obtained by making each surgery only as invasive as is necessary to achieve each patient’s aesthetic goals, and by ensuring that each patient’s nose has good support by removing as little tissue as possible and by placing cartilage grafts when necessary. To this end, rhinoplasty can be performed through either a “closed” approach or and “open” approach, the choice of which is determined by each patient’s current nasal structure and the areas of the nose he or she wants to have refined.
What Is a Closed Rhinoplasty?
In a closed rhinoplasty, all of the incisions for the surgery are made inside of the nose. It can be considered more a minimally-invasive technique for rhinoplasty compared to open rhinoplasty. The extent of surgery is less than in an open rhinoplasty, and therefore the healing process is easier and quicker. Closed rhinoplasty is the ideal approach for someone who has a normal-sized nose but with a large bump or hump on the bridge of the nose (the dorsal hump) that he or she wants removed, and who otherwise wants no or minimal refinement to the nasal tip.
What Is an Open Rhinoplasty?
In an open rhinoplasty, most of the incisions for the surgery are inside the nose, but one small incision across the bottom of the nose (the columella) is required. This is the ideal approach for someone who needs a moderate or large amount of work done on the nasal tip, or who has a very large nose. The open rhinoplasty approach provides the ability to make large changes to the nose in a very controlled fashion, so while the duration and extent of swelling are usually more compared to closed rhinoplasty, this approach provides superior outcomes in complex cases.
How Is a Rhinoplasty Performed?
Dr. Russell performs all of his rhinoplasty procedures in the operating room under general anesthesia at a local hospital or outpatient surgery center. Rhinoplasty is an outpatient procedure, and patients can expect to go home an hour or two after the procedure has finished. Every procedure is customized to each patient’s individual anatomy and desired appearance. Once the patient is under anesthesia, Dr. Russell uses specialized rhinoplasty instruments to remove excess bone and cartilage where necessary, narrow the nose when necessary, and add cartilage to the nose when necessary. If grafting is needed, cartilage is taken from the patient’s nasal septum (most common), ear (in a hidden location), or rib. Dr. Russell will let you know during your consultation if he sees that cartilage grafting is likely to be needed based on your anatomy and your aesthetic goals. Finally, if the nostrils are excessively large or wide and the patient wants them reduced, a separate procedure, called an alar base reduction, can be performed to bring the nostrils into harmony with rest of the nose and face. An alar base reduction can be performed with either closed or open rhinoplasty.
Once the bone and cartilage of the nose are reshaped, the incisions are closed, and a cast is placed on the nose to stabilize the new shape of the nose. This cast is left in place and then removed 1 week after surgery.
How Long Is Rhinoplasty Recovery?
Recovery after rhinoplasty is most accurately viewed as a series of stages, as described below. However, from a practical standpoint, patients need to plan to be off from work or school for the first week while the cast is in place. Once the cast is removed at 1 week, patients can return to work or school, and at 2 weeks after surgery, patients can resume normal activities.
- Week 1: immediate recovery from surgery; cast removed at the end of the week
- Week 2: 80% of the swelling of the nose resolves by the end of this week
- Weeks 3-8: An additional 10% the swelling resolves during this time; each week the nose looks more refined
- Weeks: 9-52: The final 10% of swelling resolves over the course of a year; subtle refinement of the nose occurs as this last bit of swelling resolves.
Is There an Age Limit for Rhinoplasty?
Rhinoplasty is generally not performed while the nose is still growing, but can usually be performed after puberty, as growth nears completion. Teenage patients who want a nose job often have the procedure a year or two before college and gain a boost of self-confidence as they head into adulthood. If a nose deformity is severe and causing difficulty breathing, such as can occur from a car accident or sports injury, younger patients may benefit from having surgery to correct the deformity sooner rather than later.
There is no upper age limit for rhinoplasty. As we age, the nasal tip begins to droop, which makes the nose longer and contributes to an aged appearance. For this reason, some patients will combine a rhinoplasty with another procedure such as a facelift or browlift for maximal facial rejuvenation.
At your consultation, Dr. Russell will evaluate the external and internal structure of your nose. He will note your skin thickness, underlying bone and cartilage strength, and nasal function. These factors all play important roles in deciding which surgical techniques are needed to accomplish the changes you desire.
While it’s important for your surgeon to examine your nose, it’s also vitally important for you to express how you want your nose to appear. Dr. Russell will take pictures of your nose during the consultation and use morphing software to illustrate the changes that are possible with your individual nose, and the two of you will work to determine which changes should be made to get the result you want. What you want your nose to look like has just as much impact on what Dr. Russell will do during surgery as the current structure of your nose does.
If you are interested in a closed or open rhinoplasty in Charleston, SC, consider Dr. Joseph Russell. He is a board-certified facial plastic surgeon who has been trained by one of the world’s premier facial surgeons in New York City, and is known for his own meticulous attention to detail and compassionate care for his patients. Please contact our office at (843) 576-3302 to schedule a consultation.
VIEW MORE PLASTIC SURGERY RESULTS:
Rhinoplasty (Nose Reshaping) | Eyelid Lift | Deep Plane Facelift | Endoscopic Brow Lifts and Forehead Lifts | Otoplasty (Ear Pinning Surgery) | Lip Augmentation | Laser Skin Resurfacing / Skin Peels | Cheek Augmentation | Chin Augmentation