Nose Surgery (Rhinoplasty)

The eyes and mouth are the communication centers of the face, and convey emotion, intellect and personality. Poets and songwriters do not write about noses! Eyes and lips maybe, but not noses. The nose must be in proportion and harmonize (but not compete) with the eyes and mouth. This I believe is a very important concept. Therefore, regardless of age, the nose is one of the more important cosmetic features of a person’s face only in the sense that the nose must be of a sufficiently “normal” size and proportion that it does not distract attention away from the eyes and mouth.

Teenagers, men and women who are dissatisfied with the shape or size of their noses can improve their appearance through a procedure called rhinoplasty.

Nasal reconstruction, (rhinoplasty), is one of the oldest cosmetic/reconstructive surgical procedures ever developed and is among those most frequently performed today. It has of course evolved from a reconstructive procedure using skin from the arm to replace a missing nose to modern era rhinoplasty which is a surgical procedure in which deformities of the nose are corrected by removing, rearranging augmenting or reshaping the bone or cartilage of the nose. The nose is three dimensional, and to harmonize with the face, must have proper width, symmetry, size and projection. If not, the nose then becomes a distraction, something we don’t want.

Typical reasons for rhinoplasty include improvement of angles and tip angularity, reduction of the width of the nose, or removal of humps on the bridge. These conditions may be the result of natural growth or external trauma to the face. Both profile and frontal face views can be altered through rhinoplasty. The surgery can be performed in conjunction with procedures designed to relieve nasal obstructions, or any of many other facial procedures. Rhinoplasty is usually not performed until a person has reached the mid-teenage years when growth is nearly complete. The exception would be correction of a cleft lip related nasal deformity.

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BEFORE SURGERY

Prior to surgery, a medical history is taken in order to evaluate the general health of the patient. A careful examination is also conducted. Dr. Gordon and patient discuss together how the nose should look in relation to the patient’s other facial features. It is important for the patient to understand that the goal of the surgery is not to achieve some vague concept of the “perfect nose”, but rather, to improve the balance and proportion of the nose and its relationship to the face. Remember, the eyes and the mouth are the communication centers of the face. Digital photography and imaging of the nose allow Dr. Gordon and his patient to evaluate the appropriate procedure to achieve the desired facial balance and proportion. The type of anesthesia to be used, the procedure and possible risks, and complications are also discussed. Pre-operative instructions may include the elimination of certain drugs that contain aspirin in order to minimize the possibility of excessive bleeding. Antibiotics will be prescribed before surgery to prevent infection.

THE PROCEDURE

Rhinoplasty can be performed at the accredited Complete Cosmetic Surgery Center or at Spring Valley Hospital, depending upon the patient and Dr. Gordon’s preference. It is done under general anesthesia with the patient asleep. Pre-medication may be administered to relax the patient.

The procedure is determined by the type of correction to be made. In most cases, incisions are made inside the nose. Working through these incisions, Dr. Gordon is able to cut bone and cartilage, the soft, movable tissue inside the nose, to reshape it. Many times septal cartilage is used to graft & improve appearance, or projection.

To remove a nasal hump, a special file or chisel is used. Bringing together the bones on either side of the face then forms a narrower nasal bridge. In a patient who has a nasal tip that is too large, cartilage and fat is removed or reshaped. The angle between the nose and the upper lip can be improved by elevating or lowering the bottom part of the nose (columella).

In some cases, it is necessary to narrow the base of the nose. This procedure involves removal of skin from the center of each nostril. In order to improve the contour of the noses, it is sometimes necessary to add or subtract tissue, or rearrange the shapes of the internal nasal parts. These procedures can last from one and a half to two hours or more depending upon the extent and complexity of surgery.

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FOLLOWING SURGERY

Following surgery, a lightweight splint is applied to maintain the new shape of the nose. The splint is usually removed in five to nine days. Sometimes a second splint is applied for several more days. Nasal packs are sometimes inserted at the time of surgery to protect the septum. This packing is removed within a day or two. There is frequently some stuffiness of the nose, particularly when work has been done on the nasal septum. Dr. Gordon will advise you when it is permissible to gently blow the nose.

Pain connected with the surgery is minimal to moderate and is controlled with oral medication. Bruising around the eyes occurs but begins to fade within a few days. Discoloration usually disappears in two to three weeks. Swelling around the treated areas slowly diminishes and can be reduced by keeping the head in a slightly elevated position when reclining. You will be given an assortment of homeopathic medications which will significantly reduce swelling and bruising. Cold compresses are helpful during the first 24 to 48 hours. Swelling will be present for at least two to four months. Your final result will take 12 to 18 months! Dr. Gordon will advise you.

During the healing process, great care must be taken to protect the nose from injury. Eyeglasses should be adjusted in order to minimize pressure on the nose. Dr. Gordon will advise you if contact lenses should be worn. Although patients are usually up and around a day or two after the procedure, strenuous exercises, particularly those which might elevate blood pressure, must be avoided for two weeks. Dr. Gordon determines when normal activities can be resumed.

HOW MUCH IMPROVEMENT CAN BE EXPECTED?

The amount of improvement is individual and depends upon the starting point and extent of surgery. In some cases, as when a badly misshapen nose is reconstructed, dramatic results may be obtained. On the other hand, the removal of a slight bump may produce very subtle yet satisfying results. Final results may not be apparent for one year or more, and emphasis should be placed on total facial harmony rather than the creation of an awesome looking nose.

Each year thousands of rhinoplasties are successfully performed on people who want to change the size or shape of their noses. True complications connected with rhinoplasty are rare. On the other hand, close to 20% of patients have complaints, which are generally related to some minor imperfection in the shape of the nose which may or may not be correctible. There are some inherent risks connected with every surgical procedure. No human face or facial part is ever perfectly symmetrical. Possible risks and complications will be thoroughly discussed by Dr. Gordon. Patients can minimize complications by carefully following Dr. Gordon’s directions, and calling the office promptly if a question or problem arises.

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