Rhinoplasty: We Know the Nose

Rhinoplasty, better known as a “nose job”, has a special place in my heart. I met the woman who would become my wife 14 years ago when she came to me complaining of her Roman nose – it was “roamin’” all over her face! Although we didn’t start dating until she loved her new nose and “graduated” from my practice, I still enjoy admiring my work of art every day.

The nose is similar to eyelids and breasts in that form and function are both important. Form is essential to balance the chin and the rest of the face, and because it occupies the second most important location on the face (eyes are still #1). Nasal function is vital to normal breathing: inhale through the nose, exhale through the mouth.

Common problems with the shape or size of the nose are the large dorsal hump (my old problem), the bulbous, boxy or droopy tip, and flared nostrils. The hump is removed by removing the bone and cartilage that comprises the hump. This creates an open roof to the nose that requires separating the nasal bones at their attachments to the cheek bones and bringing the nasal bones together, closing the roof. This part of the operation frequently causes “black eyes”. However, the removal of a large hump can greatly reduce the size of an overpowering, large nose.

Bulbous, boxy and drooping tips are corrected by removing excess cartilage from the nasal tip and septum and breaking the spring of the tip cartilages. This narrows, refines and lifts the tip. Flared nostrils are narrowed by excising small wedges of skin and tissue at the outer bases of the nostrils.

Asian noses can suffer from lack of projection, increased width and flared nostrils. A synthetic material called Medpor can be inserted under the nasal skin to augment the nose and project the tip. This will also create the illusion of a narrower nose. Flared nostrils are corrected as previously described.

Most functional problems with the nose are caused by a deviated septum (the partition between the two nostrils) or enlarged turbinates (the bone and mucous membrane “air conditioning” units arising from the sides of the airways). The crooked septum can be repositioned or removed. The blocking turbinates can be removed or trimmed back.

Rhinoplasty for purely functional improvement is performed at the Surgical Center and usually covered by insurance. Rhinoplasty for cosmetic and/or functional changes are performed in my office. The procedure usually requires approximately two hours under general anesthesia. All the techniques except the narrowing of wide nostrils are done inside the nose, leaving no visible scar. I place soft silicone tubes in the airways to allow the patient to breathe post operatively through the nose and to secure the airways. I also put butterfly tapes on the skin of the nose and a small nasal splint to maintain the position of the nasal bones and cartilages. Post operatively, the patients are requested to keep their heads elevated and use ice bags for 3 to 5 days. The splint, tubes and butterfly tapes come off in one week. The bruises usually require approximately three weeks to disappear. Although people imagine rhinoplasty is extremely painful, all my patients tell me, “It wasn’t as painful as I expected”.

Caveat: Rhinoplasty does not cure snoring. Snoring is caused by a flaccid soft palate.

The main, but rare, complication of rhinoplasty is nose bleed. Therefore, the patient is requested to take no aspirin or other blood thinners for at least 10 days prior to surgery. Approximately 10% of rhinoplasty patients require a “touch up” procedure to make the nose look its very best.

Like the filler material Bellafill, which smoothed out my nasolabial fold, I walk the talk for rhinoplasty – I had my nose job about 20 years ago. I still appreciate not being asked by new acquaintances, “Is that your nose or is that a banana you’re eating!”

From my H-Art,

Yale M. Kadesky, M.D.

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