Procedures

More Rhinoplasy FAQs

Specific Concerns and Can They Be Fixed?

In order to fix a nose that is too long, is it necessary to remove tissue?

It is usually necessary to remove tissue to shorten a nose. Tissue removed may include cartilage or internal lining. There are specific instances when a nose can be shortened by changing the shape of the tip cartilages, rather than removing anything to rotate the tip up.

Is it possible to fix a nose that is both too long and has a bulbous tip during the same surgery?

To improve a nose that is both too long and has a bulbous tip I first determine how much of the excess length is attributable to the tip cartilages themselves. If the tip cartilages are a main part of the length then I have a good chance of righting the problem by manipulating their shape or shortening them. However, often I need to address both a long septum as well as elongated lower lateral cartilages, and yes, they always can, and should, be done at the same surgery.

Is it true that swelling can disguise the end result of surgery? How long does this last?

Swelling is a normal and expected part of the healing process and may last 18 months. Usually the acute swelling subsides and the nose begins to look normal by three weeks. As the months go on the nose becomes thinner, smaller and more refined at the tip as the edema resolves.

I have a long nose. Will rhinoplasty change its look from the both the front and the side?

When a long nose is shortened is usually changes the way it looks from both the profile and the front.

Can you fix my nose if I've already had rhinoplasty and am unhappy with the results?

Revision rhinoplasty is the process of improving on the aesthetics and function of a nose that has already been done. I can almost always help these cases, even after several prior rhinoplasties.

I have a bulbous tip and I was wondering how this is fixed and if
tissue is removed during surgery.

Correction of a bulbous tip is very common and requires a great deal of pre op planning. There are many ways of dealing with the bulbous tip and which way is chosen will depend on factors that relate to what the underlying cause of the problem is. I often remove some cartilage, cut and re-connect cartilage as well as us grafting techniques along with sutures to achieve my goals.

I would like to have my round nose straightened and narrowed, but I'm worried that it won't match my face. How do you ensure that the changes you make to the nose stay in balance with the other facial features?

Ultimately the question of balancing the nose with the other facial features is one of judgement, and each surgeon will have a slightly different aesthetic sense. There are never any guarantees that the patient will love their nose, however with the use of computer imaging I can discuss this more fully with them ahead of time in an attempt to understand what they are hoping to achieve.

Once a bump is removed from the nose, is there any pain or tenderness in that area after surgery?

When a bump is removed or made smaller there typically is no persistent pain in the area or tenderness after healing is complete. On occasion people may have some sensitivity in such an area but those are rare cases.

How do I know if I'm a good candidate for finesse rhinoplasty?

The term finesse rhinoplasty refers to a situation where the patient needs only a very minor or subtle change to refine the nose. Whether or not someone is a good candidate for such a procedure depends on how much the patient thinks such a change would benefit them, how confident the surgeon is that he/she could execute such a result, and what the risk/benefit ration is to doing so.

Is rhinoplasty different in any way for men than for women?

While the mechanics of the surgery may be the same for men and women rhinoplasty, the aesthetic goals are very different and so the two operations are inherently different from the start.

What would you do to correct my droopy nose?

A droopy nasal tip needs support and often times projection. There are a myriad of ways to provide these things and the ultimate choice depends on various other factors about the nose and the patient's desires.

When fixing a droopy, hanging nose, how is the columella involved?

When fixing dependent (droopy) tip the columella needs attention because if it is not considered it may become more visible. It is usually quite straight forward to adjust things to compensate for excess columellar show.

Will the front of my nose look different after rhinoplasty?

The nasal tip will only look different if it is changed during surgery. Not all rhinoplasty involves manipulating the tip.

What is tip-plasty and what is finesse rhinoplasty? Is there a
difference between them?

A tip plasty is when the entire procedure is limited only to the nasal tip.there is no bony work or other manipulation. A finesse rhinoplasty just refers to a case where the changes are very subtle. A tip plasty is usually a type of finesse rhinoplasty.

When correcting a bump on the nose, is it necessary for the nose to be broken?

It is not always necessary to break the nose to remove a hump, though it usually is. The breaking of the nasal bones should be an irrelevant point to the patient since they are not going to feel it or suffer as a result; it is just another part of the surgery and the surgeon should not be limited by a patient request to not break the nose. There is more bruising and swelling post operatively from this maneuver but that's the extent of it.

When fixing a twisted nose, does one side have tissue removed,
the other added to or both?

Straightening a twisted nose is difficult and often requires multiple different things be done to achieve the desired result. It is never determined until the case is being performed as to just what will be needed to fix the problem.

I think my nose needs to be brought out from my face. Will this result in scars at the nostrils?

Increaing tip projection does not result in any added scarring or any scarring at the nostril rims at all.

During surgery, how will my flat nose be fixed?

Flat noses generally require that cartilage be added to them to build them up and to increase projection. Narrowing the nose also gives the illusion of it not looking so flat. I almost always use the patient's own tissue (ear cartilage, rib cartilage, septal cartilage) but occasionally I will use a synthetic implant.

Is it really necessary to have a consultation in person?

I will never operate on any patient unless I have previously met with them in consultation. Any surgeon that would do so is suspect. It is possible for you to have an initial consultation over the phone after you have sent us your pictures. At that time we can preliminarily assess if you would be a good candidate for surgery. We would still need to meet at least one day prior to surgery so we can discuss everything in person and so I can examine your nose.

Will my insurance company need to contact you before my rhinoplasty procedure?

If the procedure is for functional improvement and medically necessary to correct a problem, then insurance can be applied. We often work with insurance companies in these instances and they usually will require that we pre authorize the case with them beforehand.

Are there any visible bumps or indents if grafts are used to correct a nose that is too narrow?

Whenever a graft is used in rhinoplasty there exists the potential for visible or palpable irregularities, usually at the edges. This is especially true for grafts on the nasal dorsum because the skin is thinner in this area. I do my best to thin the grafts, soften them and bevel the edges and sometimes I may use other techniques, such as covering a graft with soft tissue, to make it blend in. If such issues exist then a some fine tuning may be necessary to correct it.

I'm interested in both chin augmentation and rhinoplasty. Can you perform them both?

I often perform chin augmentation at the same time as rhinoplasty. Often times it is necessary to use a chin implant in order to correctly balance the way a nose looks on the face. Sometimes, by using a chin implant I can leave a stronger nose than I otherwise would be able to if I didn't. Chin implants are extremely powerful in achieving facial harmony and they are relatively easy to perform, low risk, and can always be removed if the patient doesn't like them.

I'd like to have my nose fixed because it hangs too low. Will I have a visible scar after rhinoplasty?

No. It is possible to correct a hanging nose or droopy tip without any external scars. We will discuss which type of rhinoplasty you will most likely need during your consultation. I always do my best to perform my rhinoplasties in a closed fashion. SOmetimes, however, in order to have the most optimal results, an open approuch might be best. We will discuss the likelyhood of either during the consultation.

I have a narrow nose. What do you do during rhinoplasty to make it wider?

To widen a narrow nose there are several things that I can do including lowering the profile, rotating the tip, placing spreader grafts, out-fracturing the nasal bones, and using onlay grafts. Which of these I do depends on the specific nose.

I have a nose that sticks out too far. How do you correct this  
during rhinoplasty?

A nose that sticks out too far is overprojected and there are number of ways to bring it in closer to the face. When the tip is deprojected I must also bring down the profile to compensate and keep the nose balanced.

I have a nose that's too short and I want it to look normal. Can you fix this?

Lengthening a short nose is very difficult but can be done by using a patient's own cartilage to elongate it or by creating the illusion of length with various maneuvers. It is more difficult to lengthen a nose that was shortened as a result of prior surgery than one that is just like that naturally.

What do you do during surgery to make an overly wide nose more narrow?

To narrow a nose I often fracture the nasal bones and bring them in. I also will occasionally narrow the middle part of the nose by removing some of the nasal septum or upper lateral cartilages. The tip cartilages can be narrowed by removing cartilage or by using sutures to change their shape and the base of the nostrils can be narrowed by removing some soft tissue. Occasionally I find it necessary to build up the height of the nasal dorsum to make the nose look narrower.

My nose is overprojected and my nostrils are too long. How do you correct this during rhinoplasty?

When an overprojected nasal tip is deprojected the nostrils will automatically change orientation. There are a number of ways to deproject a nasal tip and this can be done equally well via an endonasal (closed) or open technique.

The end of my nose points upward. How do you correct this during surgery?

If the end of your nose points upward then it can be re-oriented to point forward by using sutures to change it's shape or grafts to elongate it. Sometimes removing some septum or membrane can also accomplish the same goal as well.

Can my pug nose be fixed with rhinoplasty?

Pug noses can be fixed by using various techniques that strengthen and elongate the nose as well as those that increase nasal tip projection. This is a common problem and should respond well to advanced rhinoplasty techniques.

Can you explain the difference between primary rhinoplasty and revision rhinoplasty?

A revision rhinoplasty is a secondary operation that serves to improve upon or correct problems that still remain after prior rhinoplasty. I have done many revision rhinoplasty operations on patients that have had 5 or 6 prior nasal surgeries. I find revisions more technically difficult to do but also more rewarding for myself and the patient.

When it comes to rhinoplasty for children, are there any special considerations to take into account?

Children that have yet to fully mature may be adversely affected by a rhinoplasty because their faces have yet to become fully developed and may continue to change. In this scenario the rhinoplasty yields a result that may initially look good but that doesn't look good as the jaw bone grows or other facial features change. Additionally, the nasal septum serves as a secondary growth center for the midface and it may be impacted by surgery, interfering with midfacial development (although the recent science on this suggests it may not be so important).

After my rhinoplasty procedure, will more of my nostrils be visible from the side?

No. This tends to happen with overly agressive rhinoplasty. Over time the nostril begins pulling upward due to scar contracture. This can be prevented with certain specific rhinoplasty techniques.

During the rhinoplasty, is the bump really shaved off?

There are different ways of taking down a bump on the nasal dorsum. It can be rasped or filed down and this can be done manually or with a power too. It can also be removed with an instrument called an osteotome that is like a chisel.

Where is the rhinoplasty surgery performed in relation to your office?
I perform most of my rhinoplasty operations at an outpatient surgery center right by our office. It is a fully accredited outpatient surgery center and I only use excellent, top quality anesthesiologists that are very accustomed to working with me on a daily basis. This relationship between anesthesiologist and surgeon is very important in creating trust and results in a safer, more efficient operation and a more comfortable experience for the patients.

After repairing a narrow nose, how long is it until the swelling is reduced after surgery?

Whenever a rhinoplasty is performed it will result in swelling that takes many months, if not a year to go away.

When having my thin nose fixed, should I be concerned that it will no longer look right on my narrow face?

If a patient has a very narrow nose but also has a very thin face than it may be advisable to forego nasal surgery. This is a very important point, as the nose must balance with the other facial features. The nose does not float in space all by itself and it must fit into context of the rest of the person.

I've already had one primary and two revision rhinoplasties. Am I still a candidate for surgery?

If someone has already had several rhinoplasties and they are still unhappy they may still be able to be fully corrected. This necessitates finding the right surgeon and allowing him/her to carefully examine you and create a surgical plan. There are cases that should be left alone but these are the rare ones in my experience. I usually can improve on things and the post operative course is usually easier for these patients than their prior surgeries.

I've heard that the tip of the nose has many intricate things in it and that makes tip-plasty very complicated. Is that true?

Surgery that involves the nasal tip must be done with precision and foresight as to what the effects of healing will be. Wound healing and scar contraction often impacts the way the tip heals and, as such, these need to be considered when operating on the tip.

Does swelling of the tip really take longer to clear up?

Swelling post operatively often stays longer at the tip because it is the most dependent (lowest) part of the nose and also because the skin here is thicker. Additionally, I rely on the healing process to help create the desired tip shape and this process takes time.

What happens if I have problems after my rhinoplasty since I live in another state?

If a patient were to have any acute problems after rhinoplasty that need urgent attention, they would occur within the first week. Otherwise, the problems that develop over time are less in need of immediate attention and can be addressed by me at a later date or via the internet with correspondence. If something were to require a medical visit, I would contact a colleague in the patient's vicinity and have them evaluated.

My nose is twisted on the bottom front part rather than the top. Can this be fixed?

If the nose is twisted at the lower part it implies that the cartilage is misshapen. This may be due to the septum or the tip cartilages and generally can be straightened with good results.

My nostrils are uneven because my nose is all twisted. Can both be fixed?

Nostril asymmetry is extremely difficult to fix, especially if it is due to congenital factors where the nostril attaches to the face. Asymmetries that result from tip cartilage variability are less difficult to repair.

Is there some way that you can make sure my nose won't look strange from the side when fixing it because it's upturned?

A good surgeon will take into account all of the views of the nose when operating so as to keep it looking natural and balanced.

How does a nose become twisted?

Noses become twisted from a variety of causes such as trauma or tumors. Often times the nose is injured when someone is very young or even at birth and only becomes curved as that person ages and the cartilage bends more and more. Cartilage has memory and tends to distort more with age and the soft tissue support diminishes. There are certain ethnic peoples that have larger nasal septums and occasionally these are just too large for the soft tissue envelope that encloses them and this results in a twisted or curved nose.

Are there any special considerations for my rhinoplasty because I'm African-American?

Black people generally have thicker skin, softer cartilage and less cartilage than white people. As a result, Black noses usually appear flatter, wider and softer at the tip. These elements require that rhinoplasty involving Black noses be done differently than those done on White noses. I usually use cartligae grafts to increase support and to push out on the overlying soft tissue. Building up these noses offers a greater chance of success than merely removing cartilage; unfortunately there are still many surgeons that routinely do the latter and the results are sub-optimal.

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