Rhinoplasty Specialist « 2/34 « Paul S. Nassif, MD, FACS Rhinoplasty Specialist

Why would I need a nasal splint?

March 28th, 2012

Question:

I am having a nose job. My doctor advised me that I would wear a nasal splint following surgery but I do not think I need to. Why would I need a nasal splint?

Answer:

Once the cosmetic or functional changes are made during a rhinoplasty, the internal incisions (there is one external incision under the columella if the procedure is open) are then closed with fine suture. A splint is then on the exterior of the nose.

Following rhinoplasty, the splint helps retain the nose’s new shape while it heals. The splint also helps control tissue swelling.

One very important function of the nasal splint is skin compression. During rhinoplasty, the skin of the nose is detached from the bone and cartilage so these structures can be repositioned. The skin itself should not be altered to avoid scarring. Following surgery, the skin will reattach to the bone, but the splint accelerates the process by compressing the skin and reducing swelling. The skin would reattach and swelling would eventually subside on its own, but the splint controls these processes. If a splint were not used, the swelling could persist for months rather than a couple of weeks. Not only would you, the patient, not be happy, but it would take longer for your surgeon to see the results of the surgery.

In addition to a nasal splint, packing may be placed inside the nose immediately following surgery. This packing will be removed the next morning. The nasal splint is usually removed seven days after surgery. Additional dressing may be used if swelling persists. Once the splint is removed, tape is placed on the nose for another seven days. The majority of the bruising and swelling will subside following the first two weeks after rhinoplasty surgery, and the remainder will go down over time. Swelling is 70% resolved after the first three months. The final result of the surgery is not evident for 18-24 months.

During this time, you should avoid any activities that might cause injury to the nose. If you wear glasses, put tape on your nose to avoid putting any stress on the nose.

Pain medication may be prescribed to minimize discomfort during recovery.

It is essential to leave nose dressings in place for the amount of time directed by your surgeon to aid in healing the nose. The nasal splint will speed up the healing process and allow you to see your new nose sooner.

Posted in Recovery, Recovery from Nose Surgery | No Comments »

What to expect the first week after rhinoplasty surgery?

March 28th, 2012

Question:

What should I expect the first week after rhinoplasty surgery?

Answer:

The first two weeks following rhinoplasty surgery are critical in ensuring the recovery process runs on schedule and your nose heals properly.

Immediately after rhinoplasty surgery, fine sutures will be placed in the nose and a splint will be placed on the outside of the nose. Packing material may be placed inside the nose. If so, the packing will be removed the next morning. It will be necessary to have someone present for the first 24 hours following your surgery. He or she will need to drive you to and from the surgeon’s facility. The nose will be swollen and bruised following the procedure. Pain associated with surgery is minimal. Your surgeon will prescribe pain killers which you may use if necessary.

For the first week, you will want to minimize your activities. This is especially the case during the first few days, when you should rest and keep your head elevated. You will have a nasal splint on your nose for the first week, and brown paper tape the following week. These dressings will help the skin contract and heal over the nose, and they will reduce swelling. After the first week, you are encouraged to gradually increase movement and move around the house. You should only do as much as you feel comfortable doing and do not overexert yourself. Vigorous activity, such as running or other types of aerobic exercise, should be avoided for at least four weeks following surgery. At six weeks after the surgery, you will be able to resume normal activity. Contact sports should be avoided for at least 6 months.

Sun exposure and risk of injury must be avoided. If you wear glasses, tape is used to avoid putting stress on the nose.

After rhinoplasty, it is recommended that you take two weeks off work. Going back to work too soon may result in overexertion and increased swelling, which will prolong your healing time.

The majority of bruising and swelling will resolve following the first two weeks. After this time, the nose will continue to heal properly provided that you follow the precautions mentioned here.

Posted in Recovery, Recovery from Nose Surgery, Rhinoplasty | No Comments »

Can I get a nose job to dull my sense of smell?

March 28th, 2012

Question:

I have a very sensitive nose. I am the manager of a paper mill and I do not mind the work, but I can’t stand the smell. I seem to be the only man bothered by it. Can I get a nose job that dulls my sense of smell a little so I won’t be so sensitive to the odors at my job?
Answer:

A nose job will not affect your sense of smell. Nose surgery may change the nasal structure functionally, but any functional change is related to improving your breathing. This might include opening up blocked passages with a septoplasty or correcting structural injuries or abnormalities. Rhinoplasty should not alter your sense of smell at all.

Rhinoplasty is performed to reshape the nose for cosmetic improvements or to correct breathing problems. The natural function of the nose is maintained, if not improved, with rhinoplasty. Therefore, you should look for alternative means to minimize exposure to the smell.

Thank you and I hope this helps answer your question.

Posted in Nose plastic surgery, Rhinoplasty | No Comments »

Rib cartilage in rhinoplasty surgery

March 28th, 2012

Question:

I have heard that cartilage can be taken from a person’s rib to be placed in the nose. How is rib cartilage used in rhinoplasty surgery?

Answer:

When material is needed to build up portions of the nose, like the radix between the eyes, cartilage is taken from another body part and grafted onto the nose. Cartilage from the ear and rib work very well for this procedure. The graft may consist of crushed cartilage or perichondrium from the rib. The perichondrium is a layer of dense, irregular connective tissue which surrounds the cartilage of developing bone. The perichondrium may be used to bind the crushed cartilage together in the shape needed to augment the nose.

Synthetic materials can be used but cartilage from the patient’s own body often creates better results. The body is less like to reject it and infections are unlikely.

The cartilage from the ribs is called costal cartilage. It connects the sternum to the ends of the ribs. Its flexibility allows the chest to enlarge and contract during respiration. Cartilage from the ribs is both strong and flexible, making it ideal for restructuring the nose.

A recent study conducted by the Department of Otorhinoparyngology at the Istanbul Training and Research Hospital in Turkey found that tensile strength and flexibility of rib cartilage varies based on the rib from which it was taken. Costal cartilage from the seventh rib has similar properties to septal cartilage, while cartilage from the sixth rib is more flexible. Cartilage from the eighth rib is preferred where more strength is needed.

Rib cartilage is used much less frequently than ear cartilage for rhinoplasty. The cartilage in the ear is much easier to access with fewer risks of complications. Harvesting rib cartilage requires that an incision be made in the chest cavity, whereas taking cartilage from the ear is a superficial surgery.

Cartilage is typically used to build up the patient’s dorsum or radix and give the nose more prominence. For this procedure, the cartilage will typically be crushed and rolled in temporalis fascia and placed underneath the skin. This roll of cartilage provides the proper shape and structure for the nasal bridge. Cartilage can also be used to reshape the nasal tip in some cases.

A physical examination of your nose by a rhinoplasty surgeon will determine if a cartilage graft is right for you.

Posted in Cartilage for Rhinoplasty, Rhinoplasty | No Comments »

How can I be sure my nose job will reflect my individuality?

March 28th, 2012

Question:

I have recently started considering a nose job to reduce the size of my nose. I am a 24-year-old woman and I am concerned that if I get a nose job, it will be a “cookie cutter” job that does not reflect my personality or look like me. How can I be sure that my nose job will reflect my individuality?

Answer:

You can ensure that your new nose will reflect your individuality by going to a surgeon with whom you have good communication. The surgeon should be willing and able to tailor the rhinoplasty surgery to your individual need, and you should feel comfortable expressing your concerns and goals to your surgeon. Good surgeons know there is no single perfect nose that fits every face. Your nose should suit you.

Computer morphing software, like I use with my patients, is helpful in seeing what your doctor has in mind before surgery. Computer imaging software allows us to morph the patient’s “before” photographs to predict what their new nose will look like. While it is not exact, it does serve as a guideline during surgery.

I have many years of experience as a rhinoplasty specialist and I always strive to create a natural result. Changes to the nose can be subtle and preserve the patient’s look with just minor revisions. Small changes can have a big impact on the appearance of the nose and the face. Therefore, I am conservative in my approach. The result should look like your nose, only better.

You can view before and after photos of previous patients on my website, www.rhinoplastyspecialist.com. I have performed minor revisions, such as removing a hump from the nose, to major changes, like reducing the overall size of the nose with multiple techniques. The photos demonstrate how the patients’ results look natural and unique to them. That is the goal with every rhinoplasty surgery.

Please send any photographs to my Patient Care Coordinator at ana@spaldingplasticsurgery.com and I would be happy to evaluate them for you. In addition, please feel free to call my office at 310-275-2467 if you wish to schedule a consultation. Thank you and good luck!

Posted in Septoplasty | No Comments »

Is my rhinoplasty tax deductible?

March 28th, 2012

Question:
I’m 44 years old, a father of 3 young children and really have a huge nose. I’ve been seriously thinking about getting a nose job for professional reasons. Is this tax deductable?

Answer:
Rhinoplasty surgery is not tax deductable. If there are functional problems present, such as breathing issues, your insurance company may cover some or the entire functional portion of your surgery. The amount covered by insurance varies by the carrier. Your insurance company will not cover elective rhinoplasty performed for cosmetic reasons. Contact your insurance provider for specific rules and exceptions.

I am assuming your profession is related to your appearance based on your question. Even under these circumstances, a nose job would not be tax deductible.

Thank you for that question.

Posted in Rhinoplasty | No Comments »

Using cartilage grafts for patients with thin skin

March 28th, 2012

Question:

Can cartilage grafts be used on patients with thin skin?

Answer:

Great care has to be taken when using cartilage grafts on the noses of patients with thin skin. There is a possibility of the cartilage graft showing through the skin. However, a highly skilled rhinoplasty surgeon can often insert grafts in such a way that they will not show through the skin. Surgeons may also use specialized techniques to conceal cartilage grafts in patients with thin skin.

Cartilage grafts are used to build up portions of the nose to give them more definition. For example, rolled cartilage may be inserted into the bridge of the nose. If the patient’s skin is thin in this area, the roll of crushed cartilage may be visible. If positioned properly, the graft should not be seen. The dissection of the pocket for the graft must be precise. Edges of the graft should be tapered to ensure seamless blending with the existing nose.

In cases where the cartilage graft does show through, the surgeon may use a temporalis fascia graft to camouflage the graft. The temporalis fascia is a strong fibrous layer of tissue at the patient’s temple. It can be place under the skin over the cartilage graft. Alloderm is another type of graft that can be used to cover cartilage.

Another option used by some surgeons is using fillers to plump the thin skin for thicker coverage of the cartilage graft. This is risky since some fillers are temporary.

Cartilage graft show-through can also appear after surgery, when the nose has healed and the skin has contracted. This effect is more pronounced with thin skin. If the cartilage is visible at this point, revision rhinoplasty may be necessary.

Your rhinoplasty surgeon can further discuss your options and goals. An examination of your nose will reveal if your skin is considered thin and your surgeon will design the surgery plan to address it.

Posted in Cartilage for Rhinoplasty | No Comments »

Beauty – It’s All About Angles and Millimeters

January 31st, 2012

Beauty is in the eye of the beholder, but it turns out that most of us do see beauty in the same faces. The more symmetrical a face is, the most beautiful it is. I have studied the multidimensional nature of beauty and found that it is a mathematical equation based on the placement of the features on individuals’ faces.

“When we look at the face – the subtle placement of features, the eyes, the nose, the chin, brow and lips – all add together to define a beautiful face. We see examples of this on magazine covers daily. Most celebrities and models deemed beautiful by popular opinion have symmetrical facial features.
A face can be analyzed to determine the symmetry of its features. The face is divided vertically into five equal parts. Facial height is divided equally into three horizontal parts from the hairline to the eyebrows, the eyebrows to the nose, and the bottom of the nose to the chin. This grid provides a means by which to measure the face’s symmetry.

This information is valuable to cosmetic and facial surgeons because it allows us to analyze patients’ faces and work toward providing greater symmetry. A few millimeters difference between the eyebrows or the nostrils can have a significant impact on the overall appearance of the face. By making slight changes to the nose during rhinoplasty, I can add to the face’s overall symmetry and beauty.

Posted in Uncategorized | No Comments »

Will a non-surgical nose job fix a bump on my nose?

September 28th, 2011

Question:
I’ve heard of the 15-minute non-surgical nose job and I would like more information. I don’t have a large nose but I have a bump on it that I would like removed. Is this possible with a non-surgical rhinoplasty? Is this a painful procedure? Will there be redness and swelling that would keep me out of work?

Answer:
For patients who are reluctant to undergo surgery but still desire augmentation of their nose, non-surgical rhinoplasty is an option. This technique works best for dorsal augmentation, meaning it works best to fill up the nasal bridge on patients with shallow or flat bridges. Facial fillers are used to augment or build up the dorsum instead of surgical techniques such as cartilage grafts. Like fillers injected in other areas, the effect is not permanent and the length of augmentation will depend on the patient and the particular material injected. There will be a bit of swelling but nothing that will keep you out of work. You cannot use fillers to specifically eliminate a hump on the nose. Thank you and I hope this helps.

Posted in Fillers, Non-Surgical, Rhinoplasty | No Comments »

Where are incisions made during a nose job?

September 27th, 2011

Question:
Where do the incisions occur for a rhinoplasty? Will the marks be very visible scars after the surgery?

Answer:
It depends whether the surgery is open or closed. For a closed rhinoplasty, all the incisions are made inside the nose. With an open rhinoplasty, the only external incision made is under the columella. Due to the level of my experience, and the meticulous nature in which I perform an open rhinoplasty, the scar resulting from a columellar incision I make will appear minimally visible. Thank you and I hope this helps answer your question.

Posted in Rhinoplasty, Scarring | No Comments »

Rhinoplasty Specialist

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Why would I need a nasal splint?

What to expect the first week after rhinoplasty surgery?

Can I get a nose job to dull my sense of smell?

Rib cartilage in rhinoplasty surgery

How can I be sure my nose job will reflect my individuality?

Is my rhinoplasty tax deductible?

Using cartilage grafts for patients with thin skin

Beauty – It’s All About Angles and Millimeters

Will a non-surgical nose job fix a bump on my nose?

Where are incisions made during a nose job?

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