Rhinoplasty 101 (Nose Job 101): What you must know before your consultation.

Payman Simoni, MD
Article by
Beverly Hills Facial Plastic Surgeon

Most rhinoplasties are performed because the patient desires an improvement in appearance and/or nasal function. (S)he may simply want a nose which is in harmony with the rest of the face rather than one which is out of proportion with respect to the other facial features. On the other hand, it may be, as is often the case, that the nose is becoming progressively more disfigured the older the patient becomes until breathing difficulty occurs.

At times, patients have deformities of the inside of the nose which impair breathing, cause headaches, or contribute to sinus trouble. These problems cannot be satisfactorily treated medically without simultaneously straightening the external nose.

Like faces, every nose is different; some noses are too long, some too wide, some have large humps, some project away from the face, and so on.

Since rhinoplasty surgery is as much artistic in nature as it is scientific, rarely are any two patients' noses identical. A skilled rhinoplastic surgeon would strive to make each patient's nose fit his or her face.

The alterations your doctor recommends will be determined by many factors, including one's height, age, skin thickness, ethnic background and configuration of other features such as the forehead, eyes and chin. All in all, a rhinoplasty specialist strives to achieve a natural looking nose rather than one which appears to have been operated upon. No patient really wants an assembly line "nose job"; they want a nose individually tailored to their own features.

The nose is reduced in size by removing excess bone and cartilage. The remaining structures are repositioned through a series of carefully planned internal nasal incisions. The skin then heals to the new framework.

Rhinoplasty: The Surgery Protocol

Prior to surgery, certain medications may be given to promote healing and help hold to a minimum the amount of swelling and discoloration, which may occur.

The surgery is usually done in a surgery center or hospital. Following surgery, the average patient can be discharged.

At the completion of surgery, a small protective adhesive dressing and splint are applied to the nose. The external protective splint and tape are to remain in place for about one (1) week.

Although a drip dressing is applied which obstructs the nostrils, some surgeons like Dr Simoni do not "pack" the nose after surgery. Patients, therefore, are more comfortable and generally less swollen. With the elimination of nasal packing, pain, swelling, bleeding, discoloration, etc., are dramatically reduced making the recovery period much more pleasant for the patient. In this technique, the surgeon sutures the internal nasal tissues back in place eliminates the necessity of packing. This technique has been one of the greatest advances in nasal surgery, reducing much of the undesirable postoperative discomfort those patients whose noses are "packed" experience.

Septoplasty: Nasal Breathing Problems

One of the common causes of breathing difficulties is a "deviated" or crooked nasal septum. The septum is a bony and cartilaginous partition that divides the inside of the nose into two chambers. If it is dislocated or leans to one side it can interfere with the flow of air through one or both sides of the nose.

Even patients whose septum is not "deviated" frequently have a dominant nostril (airway passage). Most of us have a dominant eye, hand or foot; it is not unusual for one nasal airway to be better than the other. Your surgeon will evaluate the inside of the nose and attempt to improve the airway if (s)he feels it might be improved with corrective surgery.

Surgery can often straighten or remove the offending portions of the crooked bones and cartilages and improve breathing; however, the membranes lining the inside of the nose can become swollen from one or more of the following conditions:

a. Allergies (hay fever)

b. Changes in temperature or environmental factors

c. Viral infections (colds)

d. Bacterial infections

e. Emotional disturbances

f. Over-use of nasal sprays

g. Exposure to irritants in the air (hair spray, smoke, etc.)

None of these "membrane conditions" are corrected by surgery but if the patient has a deviated septum plus one of these problems, correction of the septum frequently makes it easier for the patient to tolerate the membrane swelling.

Rhinoplasty Specialist

Most Rhinoplasty specialists are usually board certified by the American Board of Facial Plastic and Reconstructive Surgery(ABFPRS). "The ABFPRS certifies surgeons exclusively in facial plastic and reconstructive surgery. The ABFPRS is dedicated to improving the quality of facial plastic surgery available to the public by measuring the qualifications of candidate surgeons against certain rigorous standards."

"To achieve certification by this Board (ABFPRS), a surgeon must:

- Complete an accredited residency training program after medical school that provides training in facial plastic surgery.

- Achieve previous certification by one or both of the basic boards in the field: The American Board of Plastic Surgery or the American Board of Otolaryngology.

- Successfully complete an additional two-day examination (written and oral) focused solely on facial plastic and reconstructive surgery. Present for peer review at least 100 surgical cases in facial plastic and reconstructive surgery for each of the previous two years."

The ABFPRS holds its member surgeons to a published code of ethical conduct.