Rhinoplasty
For nearly a century, rhinoplasty surgeons (plastic surgeons and otolaryngologists) have made it a practice to correct unwanted nasal features when performing an aesthetic rhinoplasty ("Nose Job”). This common operation may be performed as a relatively short outpatient procedure, usually under general anesthesia. The recovery time is approximately one week. Rhinoplasty surgery can be used to help reduce size, refine the tip appearance, decrease nostril size and improve crookedness.
Reduce Size
Most patients (young women, in particular) are seeking a "smaller” nose when they come to the aesthetic surgeon for information about rhinoplasty. Often they interpret a "bump” on their nose as the factor responsible for excessive nasal size.
The degree to which a patient's nose should be reduced in size is dependent on numerous factors such as the patient's gender, overall facial size and shape and even ethnicity.
My favored method for nasal size reduction requires the use of discrete incisions (mostly inside the nostrils) to permit partial surgical removal of excessively large supporting structures of the nose, in such a manner that the resulting nasal appearance is not only smaller, but also aesthetically enhanced. The discrete incisions leave scarcely visible scars across the space between the two nostrils (columella):
In my experience, this procedure requires about one and a half hours of operating time, and it's normally performed as an outpatient under general anesthesia. A plastic "splint” is usually placed on the outside of the nose where it remains for one week. I avoid leaving "packing” inside the nose because of the post-operative discomfort it typically causes. My patients do not complain of significant pain following reduction rhinoplasty.
Full recovery following reduction rhinoplasty, including disappearance of the last little bit of swelling, takes up to 12 months. By one to two weeks following surgery, however, the vast majority of patients are sufficiently "presentable” to resume work or school.
Refine Tip Appearance
A frequent component of the nose that draws attention and gives the impression of the nose being too large is a wide (bulbous) nasal tip. When this is one of several nasal components requiring attention, the nasal tip is re-shaped as a portion of a full aesthetic rhinoplasty. If the bulbous tip is the only nasal problem, it may be corrected using a surgical procedure confined to just the tip area of the nose, known as a "tip plasty.”
Nasal tip reshaping is usually achieved by a combination of removal of excess nasal tip cartilage framework, reshaping the remaining framework with internal sutures and, on occasion, the placement of cartilage grafts taken from elsewhere on the body. The goal is to remove the bulbous appearance and replace it with a refined nasal tip appearance. This is arguably one of the most technically challenging procedures in all of aesthetic plastic surgery.
Decrease Nostril Size
An additional nasal feature felt by many to be objectionable is excessively wide nostrils. This is a feature, which, in turn, makes the nose look too wide across its base. Reduction of nostril size may be achieved through a procedure known as Weir alar wedge excision. With this surgery, a "wedge” of the nostril is removed, in such a manner that the resulting scar falls within the crease made by the attachment of the nose to the adjacent cheek, near the level of the nostril. After healing, the scar is very well disguised and barely noticeable.
Improve Crookedness (Nasal Deviation)
Noses that are not aligned properly in the mid line of the face are said to be "deviated” or "crooked.” Though some deviated noses are without known cause, the vast majority are either due to a known or even an unrecognized prior nasal fracture. Whatever the cause, there is almost always involvement of the nasal septum in the deviation. Because of this, rhinoplasty to correct a deviated nose must also include straightening of the associated deviated septum (septoplasty). Depending upon the extent of the deviation, full correction may not be surgically possible.
Dr. Gruenwald is a board certified plastic surgeon in Baton Rouge, LA and provides aesthetic plastic surgery for those in and around the Baton Rouge and New Orleans areas.
