Rhinoplasty (nose job) is one of the least understood and most technically difficult operations in plastic surgery. Everyone can spot a patient who has had a poorly performed rhinoplasty. Fortunately for patients, recent changes in philosophy and advancement of techniques have led to more natural results. Many doctors wrote books and articles about rhinoplasty. Below you’ll find a discussion of some of the more common errors seen in cosmetic rhinoplasty.
Why People Seek Rhinoplasty
One of the most common complaints from rhinoplasty patients include prominent dorsums. In the past, many plastic surgeons over-resected the dorsum of the nose resulting in a scooped out look (ski jump). This happened by removing too much bone and cartilage and by not correcting the tip adequately. In the modern era of rhinoplasty, we now strive for a more natural look with a conservative resection leaving the dorsum nearly straight.
Another common complaint in patients include a wide nasal tip. In the past, correction lead to a nasal tip. Over-resection again happened. How many people have you seen with extremely small, balled up nasal tips? Again, this happened all the time in the 1970’s but doesn’t happen anymore. Staying with the same theme (removing less), more conservative approaches with cartilage removal and septal excision results in a natural, less surgical looking nasal tip.
Patients need a successful first surgery. Redo operations make things difficult. With each surgery the amount of scarring increases. Additionally, the possibility of complications such as nasal skin necrosis or deformity of cartilage grows. Accordingly, some surgeons do not perform secondary procedures. Instead, they refer patients to specialty surgeons.
In performing rhinoplasty, a thorough pre-operative evaluation and well thought out plan followed by precise surgical technique ensure a successful result.
First, a local anesthetic goes into the nose with epinephrine to reduce bleeding. Sometimes local anesthetic goes in or on the nasal septum if septal surgery will be necessary.
Incisions go on the outside of the nose and also on the inside of the nostrils. Then, the surgeon dissects the skin away from the underlying structures allowing excellent visualization of the deformities.
First the prominent dorsum is cut down (sometimes excised) to the appropriate level. This includes removal of bone and cartilage. Later the nasal bones are fractured and very carefully pressed together to narrow the nose and to eliminate the “open book” deformity. Now the tip is freed up and the lower lateral cartilages are trimmed to narrow the nasal tip. Here, the surgeon should leave an adequate amount of tip cartilage (5-6 mm) to establish a natural look. Over-resection here leads to a small, balled up tip with a natural look.
Next, the surgeon stitches up the remaining cartilage with multiple sutures to achieve tip projection and to also narrow the tip. Under-resection of the septal tip leads to a parrot beak deformity.
Following, attention turns to the nostrils. Small amounts of skin at the base of the nostril gets removed.
Finally, the surgeon evaluates the nose for final revisions followed by suturing of all incisions. Intra-nasal packing is usually not necessary.
After Rhinoplasty Care
Healing doesn’t take long but swelling of the tip may take 6-12 months to resolve. Bruising acts as a concern with broken nasal bones. It resolves in 1-3 weeks.
When contemplating this procedure, we recommend undergoing advanced computer imaging. That way, you and your surgeon agree on an expected result. If you are considering cosmetic rhinoplasty, ask your surgeon about their experience and view before/after pictures of their work.