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Rhinoplasty

Rhinoplasty, also known as a nose job, is a procedure to reshape or resize your nose. Many patients are dissatisfied by the appearance of their nose because it draws unwanted attention and is not in balance with the overall facial appearance. Even a slight variation in proportion or symmetry can detract from the beauty of other facial features.

Patients seeking rhinoplasty are often unhappy with an abnormally small or large nose disproportionate to the rest of the face. Others wish to correct a bridge that is crooked or has a bump, also known as a dorsal hump deformity. There are also patients with abnormalities of the nasal tip who wish to improve symmetry, achieve better definition, or adjust the position. While some patients have isolated concerns, others may exhibit multiple irregularities at once. The best candidates for rhinoplasty are individuals who wish to refine and reshape their nose while maintaining realistic expectations of what surgery can help them achieve.

The goal of rhinoplasty is to provide a balanced and pleasing shape to your nose while maintaining a natural look that is harmonious with the rest of your face. Rhinoplasty is a delicate operation of allusion and sculpting that can produce dramatic, beautiful results. Cosmetic changes to the nose, however, are inextricably linked to vital functions such as nasal breathing. Too often you hear from other patients who had cosmetic rhinoplasty, but then developed difficulty breathing through the nose. This link between cosmetic appearance and function makes rhinoplasty arguably the most complex and challenging of facial plastic procedures. Ultimate success requires a facial plastic surgeon, such as Dr. Hilinski, who has specialized training in not only cosmetic enhancement of the nose, but also expert knowledge of functional (breathing) nasal surgery.

“I can’t believe that it has been a year since you did my surgery! I am so happy with the results. I don’t think I can truly express how thankful I am and what a positive impact it has made on me.”
Sarah

Rhinoplasty Procedure

Rhinoplasty can be performed using either an “open” or “closed” surgical technique. Open rhinoplasty involves making a small incision underneath the nasal tip, which becomes nearly imperceptible after it heals. Closed rhinoplasty involves incisions that are made entirely within the nose. There are advantages and disadvantages to both techniques. Certain individuals would benefit more from one than the other. The technique that is best suited for your nose can be discussed in detail during consultation with Dr. Hilinski.

In most cases, you will have an opportunity to sit down with Dr. Hilinski prior to surgery to view computer-generated before and after images of your face and nose. Using this cutting edge computer morphing technology you will be better able to appreciate realistic changes that are expected to result from surgery.

Dr. Hilinski performs most rhinoplasty procedures in an outpatient surgery center. Deep sedation or general anesthesia is commonly used and the surgery typically takes two to two and a half hours to complete. Most rhinoplasty patients go home the same day as their surgery.

Rhinoplasty Recovery

Patients can expect an initial recovery of five to seven days. Bruising and significant swelling are uncommon. Stitches are removed within five to seven days. Although many patients take a week off of work or school, some are able to return within a few days after surgery. Although, light activity is permitted after the first two weeks, vigorous exercise should be avoided for at least four to six weeks. While most patients are presentable in public within seven to ten days, the majority of soft tissue swelling can take several months to fade and the nose will continue to undergo healing and remodeling of the shape for upwards of a year and beyond in some cases.

For more detailed information on nasal reshaping, please also visit our online San Diego rhinoplasty tutorial and our extensive San Diego rhinoplasty blog focusing on the latest news in nasal reshaping. To view examples of the type of transformation Dr. Hilinski can help you achieve, browse through our rhinoplasty patient before and after photos gallery.

Frequently Asked Questions About Rhinoplasty

To provide an in-depth look at rhinoplasty and what you can expect at every stage of the process, Dr. Hilinski has answered common questions that patients tend to ask about their procedure.

What is rhinoplasty?

Rhinoplasty is a surgical procedure designed to reshape the appearance of the nose. There are many changes that can be made to the nose. The bridge height may be reduced or the bridge of a wide nose narrowed, a crooked or poorly aligned nose may be improved, the bridge height may be elevated, the middle one-third of the nose may be reduced, or the tip may be altered. However, it must be emphasized that every nose is different and requires a tailored plan when deciding on the appropriate technique to be used. Rhinoplasty is one of the most challenging plastic surgery procedures to perform successfully with stable, long-term results.

Where is the rhinoplasty procedure performed?

Most rhinoplasty procedures are performed in the outpatient surgery center.

What type of anesthesia is used for rhinoplasty?

Deep sedation or general anesthesia can be used in most rhinoplasty procedures.

How is rhinoplasty performed?

Rhinoplasty surgery involves a multitude of surgical techniques that can be used to reshape the nose, the choice of which is based on a thorough preoperative nasal analysis that includes an assessment of the external and internal nose. The two main approaches in rhinoplasty are the “closed rhinoplasty technique” and the “open rhinoplasty technique.” The closed rhinoplasty technique utilizes hidden incisions that are made on the inside of the nose. The skin (overlying soft tissue) is lifted off of the underlying framework of the nose which consists of cartilage and bone, and these are then carefully altered to achieve the desired new shape. The upper two-thirds of the nose (consisting of the bony vault and cartilaginous middle vault) is often reshaped in situ, or in its native position. In contrast, altering the tip of the nose with the closed technique requires the cartilage to be withdrawn outside of the nose before it is reshaped. Appropriate changes are made to the cartilage while it is outside of the nose, then it is replaced back into the nose.

The open rhinoplasty technique utilizes the same internal incisions made with the closed technique, but it also includes a short incision made across the columella, or the skin between the nostrils. This external incision allows the surgeon to lift the skin off of the underlying cartilage and bone, allowing for complete and direct exposure of the entire framework. In comparison to the closed technique, open rhinoplasty affords a much wider visualization of the underlying structures, particularly the nasal tip region. This allows for more predictable and accurate alterations to the cartilage and bone.

There are a number of alterations that may be made to the nose including changes in the bridge height and bridge width, improvement of a crooked or poorly aligned nose, and changes to the tip of the nose. Once the desired changes are achieved, the incisions are then closed with meticulous technique and the nasal skin is then taped to minimize soft tissue swelling. If the nasal bones have been reshaped, an external nasal cast will be placed for additional stabilization.

In cases where the nose skin is relatively thin, our facial plastic surgeon, Dr. Hilinski, will often recommend the use of a fascia graft to help thicken the overlying nose skin from the inside. He prefers the use of temporal (temple) fascia as opposed to other materials such as Alloderm (acellular dermis) because fascia is your own tissue and it provides a more reliable, durable result. Temporal fascia harvesting involves the use of a hidden incision within the hair-bearing scalp (without shaving the hair) that heals relatively quickly. After the nose has been reshaped, the fascia is placed over the bone and cartilage framework and below the skin. This helps to provide an additional “cushion” layer that aids in making the nose look smoother and more natural as it heals. Patients with thicker skin usually do not require fascia grafting during rhinoplasty.

Who is a good candidate for rhinoplasty?

Patients who desire refinement and reshaping of their nose and have realistic expectations for the outcome may be good candidates for rhinoplasty.

What is closed rhinoplasty?

Closed rhinoplasty is a rhinoplasty approach in which hidden incisions are made on the inside of the nose, as opposed to open rhinoplasty which involves incisions on the inside of the nose as well as a small incision between the nostrils on the underside of the nose.

What is open rhinoplasty?

Open rhinoplasty is a rhinoplasty approach which utilizes the same internal incisions as with the closed technique, though an additional short incision is also made on the underside of the nose between the nostrils.

What changes can be made to the nose with rhinoplasty?

Every nose is different and requires a tailored plan. However, the following will help to summarize the most common techniques used in both closed and open rhinoplasty. In most cases a combination of techniques will be required to achieve the desired results. When reshaping the bony vault (the upper one-third of the bridge), it is common to “reduce” the bridge height by contouring down the bony prominence. Narrowing the bridge (for a wide nose) utilizes techniques to cut the nasal bones near the attachment to the cheek, which helps to bring the two sides of the nose closer together. When addressing a crooked nose or one with poor alignment, the bone is mobilized, or fractured, to allow for repositioning of the bones into better alignment.

In many cases, the middle one-third of the nose (the middle vault) requires a reduction in height to maintain balance with the upper one-third. The middle vault of the nose is made of cartilage and, therefore, requires additional consideration. Rhinoplasty surgeons should make every attempt to avoid over-reduction of the middle vault as this can lead to long-term problems with nasal breathing (termed internal valve collapse) and the clichéd “ski slope” deformity. This collapse of the middle vault is often not seen within the first nine to twelve months following surgery and typically manifests sometime beyond this period as an external deformity (pinching of the middle vault region and a scooped out appearance) and functional compromise. Techniques that help to avoid these unwanted complications include the use of spreader grafts which are hidden grafts made out of the patient’s own cartilage that are strategically placed after reducing the bridge height. Spreader grafts help to reinforce the middle vault region by compensating for the removal of the bridge cartilage. They are also commonly used to help reshape the bridge when there is an asymmetry between the left and right sides.

In some patients, the bridge requires augmentation, or elevation of the bridge height, in order to bring the nose into better balance with the face. In these cases, it is best to use the patient’s own cartilage if possible. The choices for cartilage grafts include the septum, the ear (auricular), and the rib (costal). If these are not an option for harvesting the cartilage, one may consider the use of cadaveric cartilage (taken from a cadaver) or alloplastic implants (such as Gore-Tex®).

When reshaping the nasal tip, every attempt should be made to preserve as much of the native cartilage as possible. This is typically accomplished by altering the tip contour using specific suture techniques that permanently bend the cartilage into the desired shape. In some cases it is still necessary to remove or shave excess cartilage in order to achieve the desired tip definition. In these cases, it is imperative that the rhinoplasty surgeon be more conservative as to avoid compromising the support of the tip. When over-aggressive techniques are used to achieve maximal definition, it is usually at the expense of tip support which can lead to postoperative pinching and collapse of the nasal tip. In still other cases, it is necessary to add cartilage (such as shield grafts and lateral strut grafts) to the tip in order to achieve the desired shape.

How long does the rhinoplasty procedure take to perform?

Surgical times for rhinoplasty may range from two to two and a half hours.

Where are the incisions made for rhinoplasty?

The location of the rhinoplasty incisions will depend on whether a closed or open approach is used. If a closed rhinoplasty approach is chosen, the incisions are hidden entirely inside of the nose along the inner nostril rim and the septum (the wall separating the left from right nasal passage). If an open rhinoplasty approach is chosen, a short incision is made in between the nostrils half way between the nasal tip and the upper lip. This incision is shaped as an inverted V which is less visible than a straight line. With proper technique, this incision is virtually undetectable after the healing process.

Are there scars after rhinoplasty?

If a closed rhinoplasty approach is chosen, the incisions are hidden entirely inside of the nose, resulting in no visible scarring. If an open rhinoplasty approach is chosen, a short incision is made on the skin between the nostrils halfway between the nasal tip and the upper lip. Because this incision is shaped as an inverted V, it is less visible than a straight line. Furthermore, with proper technique, this incision and resulting scar are essentially imperceptible once healed.

Is rhinoplasty a painful procedure?

Pain is not a significant component of the healing process after rhinoplasty.

What is the recovery like after rhinoplasty?

Patients can expect five to seven days of initial recovery where bruising and swelling may be more noticeable. We have all of our rhinoplasty patients use Arnica Montana before and after surgery which significantly helps minimize bruising after rhinoplasty, as well as the degree and duration of swelling. Pain is not a significant component of the healing process. Most patients will begin to look presentable in public within seven to ten days after surgery, though a majority of the soft tissue swelling will take several months to disappear. The nose continues to undergo healing and remodeling of the shape for upwards of a year and beyond in some cases. Patients with thinner skin will often see a resolution of their swelling faster than patients with thicker skin, as thicker skin does not “shrink wrap” around the new nose as quickly. Patients who undergo realignment of the bridge for a crooked nose deformity or narrowing of the bones should be seen more frequently during the first six to eight weeks after surgery. In some cases, patients will be instructed on how to perform “digital exercises” that help to maintain the proper alignment and position of the bones.

When will I be able to return to work after undergoing rhinoplasty?

Patients are usually able to return to work within seven to ten days after rhinoplasty.

When will I be able to exercise after my rhinoplasty procedure?

Patients may resume aerobic activity (reconditioning) within ten to fourteen days after surgery while more strenuous activity (resistance workouts) can be resumed within three to four weeks. Some patients will note a temporary increase in swelling after resuming their workout routine.

When are the stitches removed after the rhinoplasty procedure?

The stitches are removed within five to seven days after the rhinoplasty procedure.

Are there risks or complications with rhinoplasty?

As with all types of surgery, there are potential risks associated with rhinoplasty. The risk of infection and bleeding as a result of rhinoplasty is very low. The most common complication following rhinoplasty is related to a less than optimal aesthetic result. Despite the execution of a technically sound rhinoplasty procedure, asymmetries and/or unwanted contour changes can result. Every rhinoplasty surgeon has had their share of patients with less than optimal cosmetic results, and the national average for patients requiring revision rhinoplasty to further refine the shape of their nose ranges between 10-40%. Because of his advanced training and experience in revision rhinoplasty, Dr. Hilinski averages closer to 5% in terms of those patients of his who require revision surgery.

Does insurance cover the rhinoplasty procedure?

Insurance usually does not cover rhinoplasty procedures which are performed for cosmetic purposes. Some coverage may be available when treating breathing problems or deformities. Patients should check with their own insurer. For additional assistance with the total cost of rhinoplasty, please ask us about financing for facial plastic surgery procedures.

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