Rhinoplasty, or nasal surgery, is one of the most common and popular cosmetic procedures performed today. Both form and function are important aspects of rhinoplasty, and not mutually exclusive of each other--the outcome of rhinoplasty should result not only in an improved appearance, but also an improvement in nasal breathing. We understand that everyone has their own desired outcome, and that the ideals of beauty vary based on culture and ethnicity. Our goal is to work closely with patients to understand their goals, and to achieve a result that is appears natural and not “overdone.”
The philosophy and technique behind rhinoplasty has changed over the past several decades, and will continue to evolve as new techniques and technologies emerge, and as surgeons learn more about the long-term results of nasal surgery.
The appearance of the nose is influenced by many factors, including the texture and thickness of the nasal skin, and the architecture of the nasal bones and nasal cartilages. A natural and aesthetically pleasing result can be achieved by shaping and altering the composition of the nasal cartilages. Excessive removal of cartilage was previously used to make the nose smaller, but can result in loss of support of the nasal airway, a “pinched” appearance, and a “pig-nosed” appearance. Dr. Teng believes that an ideal result can be achieved without having to remove excess cartilage, thereby avoiding poor cosmetic outcomes.
Surgery typically begins with an incision along the bottom of the nose, and extends into the nostrils. This is referred to commonly as an “open rhinoplasty” or an “external rhinoplasty.” This allows improved visualization of the nasal cartilage and better control of cartilage shaping. The incision is well hidden, and often times can’t even be seen after it heals.
Every nose is different, and addressing the profile (side view) and frontal (front-facing) view requires different maneuvers tailored to the patient’s desired result. Many techniques are utilized in rhinoplasty, and we are constantly learning more and improving our techniques. A description of some common techniques are described below:
Removing a nasal hump is a common goal, and can be accomplished by removing part of the nasal bone and nasal cartilage. In other cases, the nose may appear to have too much of a “ski slope” appearance, either from natural causes or from previous surgery. This is fixed by placing additional tissue (usually cartilage) under the skin to provide a straighter, more natural appearance.
Another common concern is the wide nose. The nose may appear wide in general, or in specific places, such as the nasal bridge, the nasal tip, or the nostrils. Narrowing the nasal bridge typically requires breaking the nasal bones in order to reposition them, and may often times result in bruising after surgery. Narrowing the nasal tip may require cutting extra cartilage out of the nose, but may sometimes require placing more cartilage into the nasal tip, especially when the nose appears too close to the face. Narrowing the nostrils is undertaken when the nostrils are wider than the inner corners of the eyes, and often requires additional incisions on the skin. When this occurs (alar base narrowing), the incisions are hidden in the shadows of the nose to minimize the appearance of any scars.
What to Expect After Surgery
A nasal dressing will be placed on your nose after surgery. This dressing will stay in place for 1 week, and will be removed in the doctor’s office at your follow-up appointment. Occasionally, additional dressings will be placed in the ear or on the chest if additional cartilage is taken. The dressings should remain dry as much as possible, and avoid being soaked in water.
Bruising and swelling may be seen over the cheeks and eyelids after surgery. This will resolve anywhere from a few days to a few weeks after surgery. Keeping your head elevated will help alleviate swelling and pain. Pain medication will be provided, but most patients do fine with Tylenol or Ibuprofen alone. Over-the-counter medications and supplements, such as Arnica ointment or pills, can be used to help resolve bruising faster.
The inside of the nose will swell, which may make it difficult to breath through your nose for the first few weeks after surgery. Once the swelling improves, your nasal breathing should be much improved. Crusting along the sutures may also cause nasal obstruction. Cleaning the incisions gently with a Q-tip and hydrogen peroxide will help clear the crusting. Apply antibiotic ointment or vaseline to the incisions after cleaning them will help minimize crust formation. All sutures will dissolve on their own within 1-2 weeks.
While the nose is healing, you will be limited in what you can and can’t do. You will not be able to wear glasses for 6 weeks after surgery while the bones are healing. You will not be able to perform any strenuous exercises or activity for 6 weeks after surgery. Finally, nose blowing and picking are not allowed until the nose is healed.
Finally, while the bones and incisions will heal by 6 weeks, the skin of the nose may remain swollen for much longer. While much of the swelling will go away after 3 months, the nose will continue to heal and refine itself up to 1 year after surgery.
Post-Operative Care Instructions
Instructions can be found here. [Coming Soon]