Rhinoplasty: Reshaping the Nose
Rhinoplasty is surgery to reshape the nose. During this surgery, a hump can be removed, the nose can be narrowed, and ridges can be smoothed. The angle between the nose and lip may be changed. The nostrils can even be narrowed if they are too wide.
Who may consider rhinoplasty?
Anyone who desires to improve the appearance of his/her nose. Many people consider the nose to be a defining feature of the face. If you are unhappy with the appearance of your nose, rhinoplasty can help bring the nose into balance with your other facial features. However, patients must have physically matured before undergoing rhinoplasty in order to avoid disruption of the growth plates. The age of maturity is usually 15 years of age in women and 16 years of age in men.
Will rhinoplasty improve breathing through my nose?
Rhinoplasty is an operation that affects the shape of your nose. If your nasal passages are obstructed, your surgeon will discuss procedures which may be performed at the same time as your rhinoplasty to help improve your nasal breathing. Examples of such procedures include straightening the nasal septum (septoplasty), reducing the size of the inferior turbinates, or reshaping the cartilage of the nose.
How is rhinoplasty preformed?
Patients are given either intravenous sedation or general anesthesia, depending on the nature of the procedure and the patient’s preference. Patients under sedation are in a “twilight” state. Patients under general anesthesia are completely asleep for the entire procedure.
In an “open” rhinoplasty, the surgeon makes a small incision on the columella (the area between the nostrils below the nasal tip) and then reshapes the nasal bones and/or cartilage. Sculpting may be achieved through several techniques. The skin is then placed over the reshaped structure and closed with fine stitches. During a “closed” rhinoplasty, the surgeon makes all incisions inside the nose. Accessing the nasal structures from within permits rhinoplasty to be preformed without any visible scarring
The procedure is usually performed in 1-3 hours.
What to expect after rhinoplasty
After surgery, a small splint will be applied to help the nose heal in its new shape. Nasal packs and/or soft splints may be inserted inside the nose. Packing is usually removed the day after surgery. The splints are usually removed one week after surgery.
Patients usually experience mild discomfort. Temporary effects you may expect after surgery include:
- Puffiness of the face
- Tenderness of the nose, cheeks, and upper teeth
- Bruising and minor swelling under the eyes
- Headache
- Minimal blood-tinged secretions
- Nasal stuffiness
Most patients are able to return to work or school within seven days. Strenuous activity and prolonged sun exposure should be avoided for two to three weeks.
Eyeglasses (including sunglasses) may not rest on the bridge of the nose until the nose is fully healed.
The “final” appearance of the nose following rhinoplasty manifests 12-18 months following surgery. However, the nose, like the rest of the face and body, continues to change with age with or without surgical intervention.
Chin Implants (Mentoplasty)
Chin implants are recommended for patients who have a recessed or “weak” chin. Augmenting a weak chin can help achieve better balance.
Patients are given either intravenous sedation or general anesthesia, depending on the nature of the procedure and the patient’s preference. Patients under sedation are in a “twilight” state. Patients under general anesthesia are completely asleep for the entire procedure.
Depending on the type of implant and the preference of you and your surgeon, the implant can either be placed through an incision in the mouth or an incision under the chin.
The patient can expect swelling, tenderness, and possible bruising over the chin area which resolve during the week following surgery. The diet is modified for the first few days after surgery to avoid the need to chew a great deal.
Cheek Implants (Malar, Submalar, or Malar-Submalar)
Strong cheekbones have always created the illusion of beauty. By increasing the definition of the face, the overall appearance is enhanced. Shallow cheekbones, resulting from heredity or the resorption of bone, occur naturally as we age. This creates a flat, hollow look. Augmenting the cheekbones can help provide more definition to the cheeks and provide better balance to the facial bone structure.
Patients are given either intravenous sedation or general anesthesia, depending on the nature of the procedure and the patient’s preference. Patients under sedation are in a “twilight” state. Patients under general anesthesia are completely asleep for the entire procedure.
Depending on the type of implant and the preference of you and your surgeon, the implant can either be placed through an incision in the mouth, under the eye, or in the temporal hairline.
The patient can expect swelling and tenderness which resolve during the week following surgery. The diet may be modified for the first few days after surgery to avoid the need to chew a great deal.
Understanding Facial Rejuvenation
As one ages, skin and its underlying structures loosen. This is due to a loss of elasticity and a loss of volume. Genetics, sun exposure, smoking, and lifestyle contribute to the rate and extent of the signs of aging. Various procedures may be performed to help restore a youthful appearance. Some of these procedures include a facelift, a necklift, an eyebrow lift, and an eyelift (blepharoplasty). Please be aware that none of these procedures address the quality of the skin itself. While it may be obvious, it is important to realize that none of these procedures stop the aging process. They only “reset the clock” so that you improve some of the signs of aging.
Facelift
In a facelift, the majority of work is preformed on the structures beneath the skin. A layer of tissue deep accounts for much of the loosening that occurs with age. This layer is repositioned to restore the natural curves of the face. Each layer of the facial tissue must be adjusted to provide a pleasing, long lasting result. Excess skin is then removed and gently re-draped over the face. Sometimes, fat transfer and/or facial implants are recommended with a facelift in order to restore volume lost with age.
Most patients who undergo facelift surgery are in their forties to sixties, but facelifts can be done successfully on people in their seventies and eighties as well. Typical concerns that may be addressed by a facelift are:
- Change in the shape of the face
- The appearance of jowls or fullness along the jaw line
- Loose facial and/or neck skin
- Fullness and/or “banding” in the neck
- Improve folds of the face (e.g., nasolabial fold)
- Reposition a “droopy cheek”
A facelift can make you look younger and refreshed. It should not distort your appearance or give you an unnatural look. It will also not restore the vitality of your youth. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.
Browlift
The eyebrows help relay emotions one feels, including anger, surprise, sadness, and happiness. The aging process can cause the eyebrows to droop. This may cause an individual to appear tired, worried, or sad even when he/she is not feeling these emotions. Restoring the eyebrows to their natural position can help rejuvenate the aging face and help relay your true emotions to other individuals. This procedure can also help you better visualize your upper eyelids. In people with severe brow drooping, it may help improve or correct peripheral visual loss. In such cases where this type of visual loss of documented by an eye doctor, insurance may cover some of the cost of the procedure. The eyebrow lift may also be performed to correct eyebrow asymmetry (two eyebrows that are at different heights).
There are many ways to perform a browlift; the best approach varies with each patient. Your physician will explain the advantages and disadvantages of the different approaches during your consult. In general, browlifts are done through incisions that are either hidden in or behind the hairline. Usually, this procedure is performed using an endoscope to minimize the size of the incisions and reduce recovery time. Sometimes (especially in male patients), the incision is hidden in a prominent forehead crease.
Eyelid Lift (Blepharoplasty)
Sometimes, despite a great night of sleep, you may still appear tired or sad. This is often due to excess skin and/or fat causing “puffy” bags or prominent grooves. Blepharoplasty, or eyelid surgery, is a procedure to remove excess skin and/or fat from the upper and lower eyelids. Sometimes, the fat is repositioned to fill deep grooves that develop under the eye with age. This helps restore a youthful appearance and avoid the hallowed look often associated with this procedure.
In people with severe eyelid hooding or drooping, this procedure may help improve or correct peripheral visual loss. In such cases where this type of visual loss of documented by an eye doctor, insurance may cover some of the cost of the procedure.
The incision for the upper blepharoplasty is hidden in the natural upper eyelid crease. The incision for the lower blepharoplasty is either made under the eyelash line or inside the pink tissue (conjunctiva) of the lower eyelid.
If you have any problems with your eyes, including, but not limited to, dry eyes, glaucoma, cataracts, if you have Graves’ disease, autoimmune disorders such as Lupus, or have had any surgery on your eyes, it is critically important to relay this information to your surgeon.
Aesthetic eyelid surgery can help improve many of the signs of aging. The goal is improvement, not perfection. Human beings, by their very nature, are not perfect. During the initial consultation, you will be asked to look into a mirror and point out exactly what you would like to see improved. This will help your surgeon understand your goals and expectations.
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