Rhinoplasty – October 2012

“Rhinoplasty” literally means “molding or shaping a nose.” In my opinion, this surgery demands more judgement, precision and planning than most we perform. Traditionally the surgery is done by ENT surgeons, or general plastic surgeons. It is my opinion that the general plastic surgeon, who spends most of their time working on other body locations, does not have the focus on nasal anatomy and function required to perform a functionally and aesthetically proper nasal surgery. Those trained in my area work continuously on the head and neck, and perform some form of nasal surgery multiple times per week. ENT surgeons also are trained to recognize and correct abnormalities of nasal and sinus function. Very often, a patient will present with poor nasal airflow, recurrent sinus problems, and in addition, require or desire a change to the visible exterior of their nose.

I am usually able to correct breathing abnormalities and reshape the nose to the desire and specifications of the patient during one outpatient surgery rarely lasting more than 2 hours. If there is a documented history of trauma or injury to the nose resulting in these problems, most insurance companies will cover a majority of the expense of these procedures. Our office always pre-authorizes these surgeries with the insurance company so our patients are not faced with unexpected or excessive “out-of-pocket” expense. On rare occasion, the patient’s insurance will decline to pay for any portion of this surgery; fortunately these are unusual cases.

I feel it is important to be cautious, as doctor and patient, to assure that expectations are realistic before surgery. I am always candid about what I will be able to achieve with my patients, and as a rule, their expectations are quite reasonable.

In general there are two approaches to rhinoplasty:  open and closed. The “open” technique uses an external incision, usually at the base of the nose, to access the bone and cartilages. In this technique, the skin is quite literally peeled off the nasal framework, and laid back down it upon completion. Patients undergoing an open rhinoplasty will always show a telltale scar at the base of their nose.  Almost exclusively, I use the “closed” technique, meaning the incisions are hidden internally and not visible. Except in rare circumstances, I am able to correct even severe deformities through this approach. Unless the surgery is purely cosmetic in intent, my first priority is to achieve the best nasal airway I can. I do not make external nasal changes that might compromise the breathing passage.

Most of my patients requesting a rhinoplasty are motivated by a nose deformity that resulted from an injury, recent or old. Just as we inherit eye and hair color, the sizes and shapes of noses are inherited genetic traits, and many of my patients are self-conscious of their “family” nose (see Figures 1 and 2).

Figure 3 and Figure 4

I also perform reconstruction of noses damaged or destroyed by infectious or inflammatory disease, or malignancy. Very often, I am able to “rebuild” a nasal framework with bone and cartilage grafts harvested from the ear, rib or hip (see Figures 3 and 4).

Our “textbook” warns that up to 20% of patients may be dissatisfied with the outcome of rhinoplasty. In my practice the actual percentage is under 10%. Certainly there are circumstances when a revision (“tweek”) or secondary rhinoplasty is indicated. Since revisions are more challenging, my goal is always to be as precise as possible the first time around.

If you are interested in discussing a rhinoplasty, alone, or in conjunction with correction of sinus issues, please feel free to give us a call.

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