Rhinoplasty

Conveniently located to serve the areas of Beverly Hills and Los Angeles

Description

Nose reshaping surgery (technically referred to as rhinoplasty), can improve the appearance and proportion of an individual’s nose, enhancing the balance and proportion of facial features, and often increasing patients’ self-confidence and self-esteem. Rhinoplasty is also performed for non-aesthetic reasons, to correct impaired breathing caused by structural abnormalities in the nose.   

According to the American Society of Plastic Surgeons, rhinoplasty surgery can change:

  • Nose size, in relation to the other facial structures
  • Nose width, at the bridge
  • Nose profile, with visible bumps or depressions on the bridge
  • Nasal tip that is large or bulbous, drooping, or too upturned
  • Nostrils that are large, wide, or upturned
  • Nasal asymmetry and deviation
  • Breathing problems caused by nasal issues, ie. Deviated septum

For years, the vast majority of nasal surgeries were chosen by young adults, but an increasing number of patients from 30-60 years of age are having the procedure done today.   As a result of technologically advanced procedures, patients are enjoying more natural results with a shortened recovery period.  Dr. Gabbay’s  years of extensive training and experience have enabled him to help countless  patients with aesthetic or medical nasal problems.

Options

Rhinoplasty can be performed using a closed procedure, where incisions are hidden inside the nose, or an open procedure, where an incision is made across the columella (the narrow strip of tissue that separates the nostrils). Closed rhinoplasty surgery is best for minor nose reshaping, while open rhinoplasty is geared toward patients needing more extensive nasal reshaping. Through these incisions, the soft tissues covering the nose are raised, allowing the surgeon access to reshape the structure of the nose. Cartilage grafted from other regions of your body can be utilized in rhinoplasty to augment and enhance nasal structures. Pieces of cartilage from the septum, (the partition in the middle of the nose) are generally used for this purpose.

Rhinoplasty is almost always performed as an outpatient procedure, enabling you to go home the same day, and continue your recovery at home. Anesthesia options for nasal reshaping surgery include intravenous sedation or general anesthesia. During your consultation, Dr. Gabbay will determine the optimal surgical techniques to employ during your rhinoplasty, depending on the goals you wish to achieve, and your particular medical background. Fortunately, the incisions used to reshape your nose are very inconspicuous. After your surgery, internal nasal splints and external casts may be utilized to support the nose for about one week, as it begins to heal. Although the majority of swelling subsides within a few weeks, the complete healing process continues for up to a year. If you would like more information about rhinoplasty, please contact Gabbay Plastic Surgery and we will be happy to answer any and all of your questions, and to schedule an initial, complimentary consultation with Dr. Gabbay. You may also click the link below to read a more in-depth description of the rhinoplasty procedure.

Before & After Photos

Anatomy of The Nose

The nose is primarily made up of skin, cartilage and bone, and can be separated into various anatomic sections, including:

  • The Upper Third: The upper third (between the eyes) is the bony part of your nose called the dorsum or bridge. The dorsum runs from the radix (the deepest part of your nose separating your nose form your forehead) to the tip, the nasal bones that make up the dorsum are relatively thin bones that are often repositioned during a rhinoplasty.
  • The Middle Third: The middle third of your nose is made up of two flat pieces of cartilage called the Upper Lateral Cartilages (ULC).  The nasal bones overlap the ULC above and the lower lateral cartilages overlap the ULC below In the midline the upper lateral cartilages fuse to the cartilage of the septum.  You can feel where the nasal bone ends and the ULC begins because it goes from a hard bony feel to a soft spongy feel.  The ULC are primarily responsible for keeping the airways open. A weak ULC can cause breathing problems and create a “pinched” look.
  • The Septum: The septum is a cartilage wall that seperates the nose into left and right halves. It joins the two upper and lower lateral cartilages in the front of the nose and extends from your nostrils all the way back to your throat, serving as the primary nasal support structIure.  If the septum is crooked, too long, or too short, it can distort the appearance of the nose, and deviation (twisting) of the septum can obstruct the nasal passages.
  • The Lower Third: The lower third of your nose is the tip, which is comprised of the two lower lateral cartilages (also called the alar cartilages). The lower lateral cartilages join in the middle of the nose to form the columella (the small column between the two nostrils).  Alar cartilages vary in size and angulation, and provide support to the tip of your nose. Rhinoplasty often involves adjusting the shape and size of the tip of the nose.

Indications

Rhinoplasty is a nose reshaping procedure utilized to bring symmetry and balance to an individual’s facial features. Rhinoplasty is a popular procedure among both male and female patients, and, in addition to serving cosmetic purposes, rhinoplasty can also be performed for medical reasons (ie. to correct sinus problems and breathing issues).

Cosmetic issues rhinoplasty can improve include:

  • Large Nose
  • Hump on the Nasal Bridge
  • Widened Nasal Bridge
  • Drooping Nasal Tip
  • Elongated Nose
  • Upturned Nose
  • Bulbous (round) Nasal Tip
  • Hooked Nose
  • Crooked Nose
  • Flared Nostrils

Medical and reconstructive issues rhinoplasty can be used to treat and correct include:

  • Congenital deformities
  • Scarring
  • Breathing problems: nose reshaping can open or widen narrow nasal passages to alleviate breathing difficulty
  • Injury or trauma to the nose

Deviated Septum: The septum is a partition that divides the nose into two compartments. When the septum is deviated (crooked), this can cause an obstruction of the nasal passages on one or both sides.  Septoplasty is the technical term for the procedure performed to correct a deviated septum. Septoplasty is often combined with rhinoplasty (septorhinoplasty) to give the nose a full cosmetic and medical rejuvenation..   Symptoms indicating that you may need a septoplasty include: frequent sinus infections, headaches, facial pain, nosebleeds, or breathing difficulties.

Large Dorsal Hump: Enlargement of the nasal bone, septum and/or nasal cartilage cause a large dorsal hump.  To correct this problem, bones and cartilages have to be reduced to the desired height in order to create a smooth, aesthetically pleasing nasal profile.

Under-Projected Dorsum: Correcting an indentation of the dorsum and/or tip can be accomplished with dermal filler injections (ie. Juvederm), silicone implants, or grafting using the patient’s own cartilage from a donor site.

Revision Rhinoplasty: Dr. Gabbay specializes in revision rhinoplasty, which is a corrective surgery for patients who are dissatisfied with the outcome of a previous rhinoplasty surgery, or who are suffering from a nasal injury incurred after their first nasal reshaping surgery.

Evaluation

If you have decided to move forward with your rhinoplasty procedure, please contact Gabbay Plastic Surgery, and let us schedule your consultation with Dr. Gabbay.  As an experienced plastic surgeon, he will thoroughly examine and evaluate your facial structure and anatomy, and will discuss your rhinoplasty options with you.   He will take photographs of your face, focusing on the nose, to better understand what issues need to be addressed when customizing a treatment plan designed specifically for you.  He will listen to your concerns and aesthetic goals, assess your medical history, and determine the root of your nasal problems. Once it has been established that you are a good candidate for rhinoplasty, Dr. Gabbay will explain the details of the operation, the different techniques used, the anesthesia options available, and potential risks of the procedure.

Procedure Details

In most cases, the rhinoplasty procedure is performed under general anesthesia, and lasts between 1-3 hours.

There are two general types of nose reshaping techniques:

  • Closed technique: involves small incisions on the inside of the nose
  • Open technique: a small incision is made on the columella (the skin separating the nostrils)

After making the initial incision, Dr. Gabbay will reshape the bone and cartilage to correct the patient’s specific nasal problems. This may involve separating the soft tissues from the bone structure, reshaping the cartilage to produce the new nasal structure, utilizing implants or grafts to enhance the size of the nose, or altering the size of the septum to change the length of the nose.  Dr. Gabbay can also alter the width of the bridge of the nose by shaving the septum and upper cartilages, and can manipulate the nasal bones to push them closer together in a process called “infracture” in order to narrow the bridge of your nose. For round or bulbous noses, Dr. Gabbay can remove a section of the alar cartilage (cartilage at the tip of the nose), and if the tip of the nose needs to be larger, he can utilize a grafting technique with cartilage from the nose or other areas of the patient’s body. Nostrils can be decreased in size by creating a wedge with a skin incision at the base of the nose.

Once the nasal reshaping is complete, Dr. Gabbay will close the incision with a series of small, dissolvable stitches and may insert some soft nasal packing. An external splint will be attached to the nose to aid the healing process and help support the new nasal structure.

Recovery

Following your rhinoplasty, you should arrange for someone to drive you home, and stay with you for the first 48 hours. You may experience bruising and swelling following your rhinoplasty, which will gradually subside over the next 1-2 weeks. Pain medication will be prescribed to manage any discomfort, and you will have regularly scheduled aftercare appointments with Dr. Gabbay to ensure proper healing of your nose. You will be advised to keep your head elevated, and to apply a cold compress to help ease the swelling.

You should avoid putting any unnecessary strain on your nose for a week after the surgery, as this will give the soft tissues inside a better chance to heal.  After approximately one week, your dressings and splint will be removed, and you will be able to gradually resume your regular activities. While you will notice visible improvement in the appearance of your nose after 1-2 weeks, with the appearance of the nose continuing to improve with time.  The final results of the rhinoplasty may not be visible for 3-6 additional months, when the swelling completely subsides.

Potential rhinoplasty complications include: infection, bleeding, increasing pain, breathing difficulty, irregular heartbeat, infection, blood clots, adverse reaction to anesthesia, impaired sense of smell, nasal blockage, rhinitis, bone irregularity, and persistent numbness. Should you experience any of these complications, do not hesitate to contact Dr. Gabbay, who makes sure he is highly available for his patients at all times.

Frequently Asked Questions (FAQs)

Why is a nose job called rhinoplasty?

The word “rhino” means “nose” and the word “plasty” means “to shape or to mold”, so rhinoplasty literally means to shape or mold the nose.

What features can be improved with rhinoplasty?

A number of changes to the shape of the nose can be achieved through a rhinoplasty procedure.  Noses can be made bigger or smaller, wider or narrower, shorter or longer, droopy noses can be lifted, and the bump on the bridge of your nose can be corrected.

How is rhinoplasty performed?

The surgery is performed by reshaping the cartilage and bone under the skin of your nose.  After the deep structures are corrected appropriately; the skin will be re-draped over the new framework.

Will there be incisions outside the nose?

Most of the incisions for rhinoplasty are made inside the nose, however there are circumstances that require small incisions to be made outside the nose, but they are placed in inconspicuous areas.

Will there be visible scars after my rhinoplasty surgery?

Typically, most of the incisions are inside the nose, and the small incisions Dr. Gabbay may need to make outside your nose tend to heal nicely.  Thick or raised scars are very rare after a rhinoplasty surgery.

Is a rhinoplasty procedure permanent?

As a general rule, the end results of a “nose job” are typically permanent. The aging process will have an effect on the appearance of your nose as your face changes, but the overall reshaping and new nasal structure should remain.  Despite the permanence of rhinoplasty, some people choose to reshape their nose if their face changes with maturity, and some want maintenance or touch up surgery to maintain their appearance.

What are the risks of rhinoplasty surgery?

The risks of rhinoplasty are typically minimal, but may involve bleeding and nasal obstruction. You will discuss all of the risks and complications that may occur during your consultation with Dr. Gabbay.

How long does a rhinoplasty surgery take?

The length of surgery depends on what you are having done but the procedure typically averages from 1-3 hours.

How soon can I go back to work after my rhinoplasty?

Depending on the procedure, and the amount of work you had done, one week is typically enough time for you to miss work. After one week, in most cases, your dressing will be removed allowing you to wear make-up to cover any aesthetic issues.

Will I get black eyes?

Not everyone bruises around the eyes after rhinoplasty, however, if black eyes do appear, they typically resolve within 7-10 days after the procedure. Avoiding certain medications, or herbal supplements that may thin your blood, will help reduce the risk of bruising after rhinoplasty

Can I breathe through my nose after my surgery?

Typically, you can breathe through your nose after surgery, although there will be some swelling of the nose during the healing process and this may make you congested.

How bad is the pain from a rhinoplasty?

The discomfort after rhinoplasty is typically minimal and can be easily controlled with prescription pain medication, and most patients only need to take Tylenol.

How long does the swelling last?

Much of the initial swelling resolves within a week, and after 2-3 weeks, 80% of the swelling is usually gone. The remainder of the swelling will gradually fade over the course of the next 6-12 months.

How soon will I be able to exercise?

Light aerobic exercise may be resumed after one week, and in most cases, strenuous exercise can be resumed at two weeks.

Am I too young to have a rhinoplasty?

Rhinoplasty can be performed on young men and woman after their facial growth has been completed typically 15-16 years-of-age for a woman and 16-17 years-of-age for a man.

What is a deviated septum?

The septum is a partition that divides the nose into two compartments. It is made up of both bone and cartilage, which are covered on both sides with the mucous membrane of the nose. When the septum is crooked (deviated), obstruction of the nasal passages usually occurs on one or both sides of your nose.

What is septoplasty?

Septoplasty is the term used for the surgical correction of a deviated septum.  A septoplasty involves reshaping of the abnormally shaped septum to make it straighter.

At what age are you too old to have a rhinoplasty?

As long as the patient is in good health and has realistic expectations, there is no age limit for having rhinoplasty surgery.

If I have rhinoplasty surgery, will I have problems with my nose or sinuses later in life?

Rhinoplasty surgery typically does not create sinus problems, however; if rhinoplasty is performed to make your nose smaller and you have a deviated septum, there is a risk of creating breathing difficulty, if the issue is not addressed during your initial surgery.

Can I have a rhinoplasty if I have allergies or sinus problems?

If you have allergies or sinus problems, rhinoplasty surgery can still be performed, unless you have an active sinus infection.  In this case, it is best to postpone your rhinoplasty until the infection is cleared up.  Many people who have sinus issues, actually have a deviated septum, and by correcting this your breathing passages will be improved.

Is rhinoplasty a successful procedure?

More than 300,000 people in the United States have rhinoplasty each year with a high rate of satisfaction. It is important to keep in mind however, that cosmetic surgery can improve your appearance, but it cannot make you perfect.  If your goals related to cosmetic surgery are realistic, the results of rhinoplasty can be very fulfilling.

How do I know if my expectations are realistic?

If you are considering rhinoplasty, during your initial consultation with Dr. Gabbay, he will ask you what bothers you about your nose and how you would like to change it.  In addition, he will evaluate the structures of your nose; including your underlying nasal bones and cartilage, your overlying skin, and your other facial features. From this examination, Dr. Gabbay can tell you if your expectations are realistic, and whether a rhinoplasty will enhance your natural facial beauty.

Will I see the final appearance of my new nose immediately?

You will see a new and improved nose immediately, however, since it takes time for your tissues to heal, it may take months before you see the final effect of your rhinoplasty.