Nose Surgery (Rhinoplasty)
Rhinoplasty, also known as nose surgery, makes alterations to change the appearance of the nose. This surgery increases or decreases the nasal bridge, reduces the size or width of the nose, narrows the nostrils, changes the angle between the nose and upper lip, or reshapes the tip of the nose. The surgical techniques employed depend primarily on individualized goals that are established for each patient. Patients seeking rhinoplasty might also have a functional complaint, such as difficulty in breathing. A deviated septum or swollen inferior turbinates are common reasons for obstructed nasal airways. These can be treated by a nose surgery. Beverly Hills plastic surgeon, Dr. Charles Hsu, performs nose surgery for cosmetic or medical reasons with outstanding results.
Best Candidates for Rhinoplasty
The nose may appear too large or too small
The nose does not seem to fit with the rest of the face
The nose is crooked, badly shaped, or out of alignment
There’s a nasal blockage inside the nose that causes trouble breathing
A birth defect exists that the patient wants to have removed
Rhinoplasty, also known as nose surgery, makes alterations to change the appearance of the nose. This surgery increase or decrease the nasal bridge, reduces the size or width of the nose, narrows the nostrils, changes the angle between the nose and upper lip, or reshapes the tip. The surgical techniques employed depend primarily on individualized goals that are established for each patient. Patients seeking rhinoplasty might also have a functional complaint, such as difficulty breathing. A deviated septum or inferior turbinates are common reasons for obstructed nasal airways. Beverly Hills plastic surgeon, Dr. Charles Hsu, performs nose surgery for cosmetic or medical reasons with outstanding results.
Rhinoplasty is performed under local anesthesia with IV sedation in approximately 2-3 hours. Dr. Hsu will perform either an open or closed approach to start the nose surgery. Then, he will take different steps depending on the patient’s needs. For example, if the primary concern is to remove a nasal hump, a surgical rasp or file is used to shave down the cartilage. If the nasal tip is too large, the cartilage is trimmed and stitches are used to reshape it.
Recovery and Post-Op
Immediately following surgery, Dr. Hsu will place a split on the outside of the nose to protect it and minimize swelling, as well as packing inside the nose for optimal healing. In the first 48 hours, patients should use a cold compress or hand towel in 20 minute intervals on the surgical area to minimize swelling. Patients must keep their head elevated and dry during recovery periods. One week after surgery, bruising and swelling has subsided in most patients enough for makeup and concealer to cover any remaining bruising. Patients usually stop taking pain medication after about 5-7 days and plan their work schedules accordingly. During the recovery period, Dr. Hsu recommends walking within the house several times per day to speed healing and minimize the possibility of developing blood clots.
From Dr. Hsu
“Aesthetic nasal surgery (or rhinoplasty) is a large topic. In fact, there are entire textbooks that are written about this one surgery alone. The reason for that is that the variations of nasal anatomy between different patients, as well as the functional and cosmetic requirements of the procedure, make the operation one that requires careful planning and good communication between patient and surgeon in order to maximize the results. I enjoy aesthetic nasal surgery a great deal. I feel that since the nose is centrally located, small improvements in nasal shape can affect the overall appearance of the face.
In the majority of my patients, I prefer an open rhinoplasty approach, which means that the nasal skin and fat are lifted up off of the underlying cartilage and bone, so that I have complete visualization and control of the nasal framework. This allows me to be as precise as possible in sculpting the nose to create the final goal. Patients’ nasal frameworks vary quite a bit, so after exposing the area, I will usually use a variety of surgical techniques to do so.
Often times, I will use some of the more complex techniques that I have used for the more difficult reconstructive nasal surgery cases, to be used for aesthetics as well. Not every nose is the same, so the operation is highly individualized for each patient.”
Frequently Asked Questions
What is a Open Approach to Rhinoplasty?
After numbing the area, Dr. Hsu will make incisions to access the bones and cartilage that support the nose. There are two general techniques for making the incisions: open and closed (endonasal). Typically, Dr. Hsu advocates for the open rhinoplasty approach because it fully opens the nose, providing better visualization of the nasal structures and a more direct route for surgical manipulation. The small scar at the base of the nose is barely visible once it heals.
What is a Closed Approach to Rhinoplasty?
The approach used will be based on the requirements of the specific procedure and in consideration of the patient’s preference and Dr. Hsu's best judgment. With the closed, or endonasal approach there is a more limited dissection of nasal tissues, but it offers excellent visualization of nasal structures, and eliminates the visible scar at the base of the nose.
Other options for Nose Surgery?
In addition to incision options, there are various methods for augmenting the nose or smoothing surface deformities.
Autologous cartilage grafts taken from the nasal septum (the wall inside the nose that divides one air passage from the other) offers the best chance for a natural result. If cartilage and bone have already been removed from the nasal septum, then ear or rib cartilage and sometimes bone from the skull are other options.
Although solid silicone implants are available for nasal surgery, these are foreign materials that may become infected or react poorly with your nasal tissues and have to be removed. That is why natural cartilage, if a supply is available, is the best option.
Fillers or fat grafts may also be injected to smooth the nose, to camouflage deformities or indentations, or to add volume in desired areas.