Rhinoplasty, Deviated Septum

Background: This 27 year old man consulted with me about plastic surgery to improve the appearance of his nose. He had had no previous nasal surgeries or trauma. He was very unsatisfied with his nasal appearance, on a scale of 1-10, he characterized his satisfaction with his nose as a 3. In order of importance he wanted:
1. Change the hook appearance on profile view
2. Straighten the nose on frontal view
3. Reduce the tip size
4. Increase the width of the middle portion of the nose on frontal view
5. Improve his breathing
Finally, he noted that he did like the masculine appearance of his nose and didn’t want to change that with a nose that was too small or skinny for his face.

When I met him his initial questions were about the healing time and he wanted to know if one procedure would be enough. Most patients take 5-7 days off and are surprised with how easy the recovery is. One procedure is usually enough, in my practice I perform secondary procedures 5% of the time. Frequently I am able to make small refinements with temporary or permanent facial Dermafillers.

Regarding this case, like most noses, he has a lot of good characteristics; a strong bridge, strong tip cartilages and the size in general is pretty good. On profile his nose has a curved shape, on frontal view the tip is disproportionately large compared to the middle of his nose and the tip is deviated to the right.

The important thing is to preserve the good things, making precise refinements to the areas that could be tweaked to make a great looking nose. In particular, half of the curve seen on profile may be fixed by reducing the hump, but building the bridge up a little above the hump and increasing the projection of the tip improved the other half. On frontal view, the nose looks better not just by making the tip as small as possible, but also widening the middle portion of the nose.

We were able to see these possible changes using a computer-imaging program.

Procedure: Open Rhinoplasty with osteotomies to straighten the nose, cartilage grafts to build up the radix, the middle third, and increase tip projection. The bony and cartilaginous portions of the hump were reduced.

Recovery/ Results: The one month results show early improvements in the contour and overall shape. At one month patients may sometimes see 20% of final results, there is still a lot of swelling which will decrease over the following 4 to 9 months.