NOSE RESHAPING (RHINOPLASTY) NEW JERSEY
About Nose Reshaping (Rhinoplasty)
"The nose is one of the most defining characteristic of the face; even a slight alteration can greatly improve one's appearance."
The most common aesthetic complaints regarding the nose include large size, crookedness, a nasal hump, a wide bridge, a droopy or ill-defined thick tip and excessively flared nostrils. Rhinoplasty can be used to correct a variety of conditions including the appearance of the nose and whether it is in proportion to the other facial features, as well as functional problems including nasal airway obstruction and traumatic injuries. Breathing problems related to the internal nasal structures can be corrected simultaneously with nose reshaping procedures.
When a plastic surgeon evaluates your nose, both the frontal view and the profile are studied in addition to taking into account the shape and projection of your chin, cheekbones, and upper lip. Since the nose may not be fully developed before the age of 16 or 17, we usually recommend that young adults wait until they are at least that age - and possibly older for boys - before undergoing rhinoplasty.
Assuming you are in good health, there is no upper age limit for having your nose reshaped. With age, gravity and the gradual weakening of the supportive structures of the nose, the shape and position of the nose will ultimately change. The nose may appear longer as the tip gradually droops. Thus, it is not unusual to have nasal refinements performed later in life or at the time of a facelift procedure. A simple elevation of the nasal tip may result in a younger and more attractive appearance to the nose.
The concept of nasal refinement has changed dramatically over the past few decades. In former years, the operation was considered a 'reduction rhinoplasty', thereby effectively reducing the size and projection of the nose. Modern rhinoplasty techniques allow us many more options for reshaping the nose.
Noses may need to be lengthened, augmented, or narrowed for the best aesthetic result. Today it is more likely to have a natural looking nasal correction, instead of the very obvious 'nose job' look of yesteryear. Instead of erasing all signs of ethnic origins, many people today prefer to preserve some of the character and ethnic qualities of their natural noses while undergoing only subtle refinements. The major limitations in terms of what you can expect as a result of a rhinoplasty procedure have to do with your skin type, skin thickness, the thickness and position of your nasal bones, as well as the skill of the surgeon you select.
We first examine the nose externally and make note of deformities, deficiencies and asymmetries. All details about the shape of you nose and its relationship to the chin and lips are important and will be taken into account. Next, we perform an internal exam using a lighted nasal speculum which will allow us to see the configuration of your septum, the size of your turbinates as well as the presence and degree of your nasal airway obstruction.
How Is Nose Reshaping (Rhinoplasty) Done?
Rhinoplasty can be performed under general or local anesthesia with intravenous sedation. The incisions are usually made inside the rim of the nostrils. In some cases, tiny, inconspicuous incisions are also made across the bridge of skin separating your nostrils. The soft tissues of your nose are then separated from the underlying structures, and the cartilage and bone causing the deformity are reshaped.
The exact nature of that sculpting depends on your particular problem and your goals with surgery. If your nose is being reduced in size, your nasal bones will be carefully fractured inward at the conclusion of the procedure. If your nose needs to be built up in certain areas, grafts using nasal cartilage, ear cartilage, rib cartilage or bone may be used. Other materials can also be used in the nose including synthetics like silastic implants, human tissue grafts like AlloDerm® or cartilage grafts from a tissue bank. The skin and soft tissues will redrape themselves over your new bony and cartilaginous framework. Breathing problems may be corrected by a procedure called septoplasty, in which the obstructed airway is opened.
Generally, a splint is placed on the bridge of your nose to maintain and protect the newly positioned tissues and structures. You may also have a small bandage placed under the tip of your nose. Packing or soft internal splints are sometimes placed inside the nostrils for additional support and to minimize bleeding. The two basic methods of performing a rhinoplasty include the closed and the open technique.
"There are advantages and disadvantages to both techniques for nasal reshaping and your surgeon will choose the method best for you based on your nasal anatomy and the changes you want."
Closed Technique for Nose Reshpaing (Rhinoplasty)
The closed technique does not require any external incisions. All incisions are made along the internal aspects of the nostril rims or septum. The surgeon uses instruments that are passed through the nostrils to do the work of resculpting the bones, cartilage and nasal structures. It is a great approach for patients who don’t require extensive reshaping, especially involving the nasal tip. The width of the base of the nose can be reduced by removing a small amount of tissue along the inner aspect of each nostril flaring in either the open or closed technique.
Open Technique for Nose Reshaping (Rhinoplasty)
The open technique includes an incision across the columella which is the small strip of skin that rests between the two nostrils. One major advantage of this technique is the ability to completely expose the internal structures of the nose, and to place sutures precisely where they may be required. In general, the surgeon is better able to visualize the inner structures of the nose and can usually produce a better, more predictable result utilizing a greater variety of surgical techniques. With this technique of rhinoplasty, however, the swelling in the nasal tip may take longer to subside. The external scar associated with the open method is usually small and relatively well hidden along the underside of the nose.
The Recovery Period Following Nose Reshaping (Rhinoplasty)
If the nose is being reduced in size or is being straightened, an external splint will generally be applied for five to seven days. The nose may be packed lightly with gauze that will require removal in one to two days. In most cases, the bridge of the nose and the tip will be taped to help minimize swelling. You will be instructed not to get your splint or tape wet. Internal stitches are self-absorbing so they will not require removal. Usually by the end of the first week splints, bandaging and external sutures will be removed. There will be some swelling, pressure and stuffiness for several weeks, but you can usually resume light activity after a few days Activities that would cause blood to rush to your head such as bending, lifting or strenuous exercise should be avoided for several weeks after surgery as may stimulate bleeding. You will be told to keep your head elevated above the level of your heart for the first few days to reduce swelling and make breathing easier. If the nasal bones are fractured, you may have bruising around the eyelid area or bloodshot eyes. Bruising usually peaks at 72 hours and subsides within 10 - 14 days. It will take four weeks before the nose is healed enough to allow full physical activity. You will also need to be careful about blowing your nose. Contact sports or any activity that may risk inadvertent trauma to the nose should be avoided for four to six weeks. It is important to use broad spectrum sun protection, as the skin of the nose may be more prone to burning immediately after surgery.
Your nose may be numb, and the swelling will take longest (up to 6-12 months or longer) to settle down in the tip. If your nose has been operated on previously, the swelling may take even longer to settle down completely. The thicker your skin, the longer it may take to see the final shape in the tip.
What Are The Risks Associated With Nose Reshaping (Rhinoplasty)?
A small amount of nasal bleeding or oozing is common after rhinoplasty. In the rare occasion when it becomes excessive, you may be required to return to your doctor's office or the hospital to have your nose repacked or the vessels cauterized. Infection is also possible but unlikely. Some irregularities of cartilage and bone are to be expected and are present in all noses. Secondary nasal surgery to correct small irregularities or asymmetries will usually not be undertaken for a period of at least 6-12 months after the initial surgery, once the tissues have fully healed and swelling has resolved.
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