714-834-0101
Most patients of mine are surprised to find out rhinoplasty (nose surgery) was the second most common cosmetic procedure performed in the United States last year. Breast augmentation, as always, was number one.
The nose is the center of the face and a large, unattractive nose will distract from the rest of the face. It is amazing to see how beautiful some of my patients are after the nose is made more balanced to the face.
The nose is like a chain. If one portion of the chain is loosened or tightened, it will affect the rest of the chain. Therefore, when a patient says "I just want my hump removed," the procedure may or may not be as simple as removing the hump. It may require addressing many more aspects of the nose for a balanced and natural look.
The most important factor regarding rhinoplasty, as with all cosmetic procedures, is to make sure the patient is doing the procedure for the right reason and with realistic expectations. A person with a thick, oily nasal skin will NEVER have a refined, cute nose (such as Natalie Portman, as one patient had requested). Therefore, the patient must realize the final objective is to improve his/her nose as much as possible within the anatomical limitations imposed.
Typically, most patients have a dorsal hump with poorly defined or large nasal tip with varying degrees of tip drop. Some patients, depending on ethnicity, may also have a wide nasal tip. This requires removing excess skin and fat from between the nostrils and bringing the nostrils inward.
It is critical your surgeon does an intra-nasal examination with a speculum and head-light, since changing the visible dimensions of the nose may affect breathing, if the inside anatomy of the nose is not addressed. In most cases, your surgeon will obtain cartilage from the nasal septum and use it for giving support to the tip. If you have short and or narrow nasal bones and vault, spreader grafts may be needed. Spreader grafts are pieces of cartilage, typically obtained from the septum, which are placed as support between your septum and the cartilage next to the bony part of the nose. The support will lessen the chance of breathing problems after surgery.
There are two approaches to the nose: closed and open technique. The closed technique is the original method of rhinoplasty. All the incisions are made inside the nose. The advantage of this technique is no outside incisions, less swelling (especially in the tip area), and possibly faster recovery. The disadvantage of this technique is limited visibility and accessibility, thus limiting the true potential of what can be done during a rhinoplasty. The open procedure uses the same incisions as the closed technique, with the addition of an external incision under the waist of the columella (the skin area between your nostrils). This additional incision allows the entire skin envelope to be elevated from the nose, thus giving the surgeon a three dimensional view of the nose. This greater access allows for inclusion of many techniques which are difficult or impossible to perform with the closed technique. The disadvantage of this technique is the potential of a visible scar (although I have never seen one if the incision is closed properly), more swelling in the nasal tip area (this is more common in my experience) and potentially longer recovery. I limit the closed technique for patients who only need reduction of a dorsal hump or simple septoplasty (correction of deviated septum) or narrowing of the nose without spreader grafts. If a patient requires "the works", then an open technique provides more predictability and control.
It is critical the patient understands the recovery period for a typical rhinoplasty. Just like any procedure, after surgery the area operated on will be swollen. Imagine all that swelling confined to a small surface area such as the nose! It will take 6-12 months for the nasal skin envelope to shrink down to its final shape. The nose will continue to change even after the first year, but the changes are more subtle.
"Will insurance cover my surgery?" This is a very common question. The short answer is: yes and no. Insurance companies will only cover a procedure if it is medically necessary. Therefore, if a patient has difficulty breathing with a deviated nasal septum and large inferior turbinates (meatus), your insurance company may cover the procedure. Insurance companies WILL NOT cover the cosmetic portion of rhinoplasty, and the patient must pay separately for the aesthetic portion.
Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience in both cosmetic and reconstructive surgery. His office is located in Orange County, California. To schedule a consultation, please conact us at 714-834-0101.
Élan Institute for Plastic Surgery
2010 East First Street, Suite 270
Santa Ana, CA 92705
Phone: 714. 834. 0101
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