It’s not unusual to see changes in the nose in the immediate post-operative period. This occurs for a variety of reasons including the healing process and the resolution of swelling.

When surgeons perform rhinoplasty they utilize a series of detailed maneuvers on the underlying bone and cartilage. In the initial post-operative period, these changes are often obscured by inflammation and swelling. In some cases, as swelling resolves and nasal contour improves, the nasal tip may actually appear to drop. The nasal tip should be more or less stable after the resolution

Answered by Dr. BruneteauMay 13, 2019

Rhinoplasty

Q Thick Nose Skin or Excess Cartilage?

Optimal results for rhinoplasty surgery are dependent upon an accurate assessment of the patients anatomic deformity. This requires a physical examination by a surgeon with experience in this area. In most cases a relatively accurate assessment of the nasal anatomy can be made prior to surgery when patients have prominent nasal structures.

Unfortunately, even when an experienced surgeon examines a patient, it can be difficult to distinguish thickened nasal skin from excess cartilage. Under these circumstances, appropriate adjustments can be made in the operating room to optimize the surgical result. When these steps are taken clinical results are excellent and levels of patient satisfaction are high.

Answered by Dr. BruneteauMay 13, 2019

Rhinoplasty

Q Upper Lip and Nose Tip Immovable After Rhinoplasty

Stiffness of the nose and tip can occur following rhinoplasty surgery. This phenomenon is more likely when extensive dissection is performed at the junction between the nasal cartilage and lip soft tissue.

Although it’s impossible to know exactly what was done in your case without an operative report, it appears that both bone and cartilage were removed from the distal nose. In addition, it appears that the depresser nasi muscles were detached.

These maneuvers involve extensive soft tissue dissection which may be the source of your symptoms. Under these circumstances, prolonged swelling, scarring and structural changes can result in the symptoms that you describe. Structural changes from the use of cartilage grafts and non-absorbable sutures can cause temporary immobility of the soft tissue. A more likely cause is scarring and prolonged swelling.

All of these problems should resolve with the passage of time. In some cases, resolution of lip tightness can be facilitated with gentle massage. It’s important to realize that resolution of these problems may take up to a year following surgery.

In the interim it’s important to be patient and maintain good communication with your plastic surgeon. Your surgeon should be able to reassure you and alleviate your anxiety.

Answered by Dr. BruneteauMay 13, 2019

Rhinoplasty

Q Piece of Thread from Stitches Left After Rhinoplasty

The suture remnant that you describe is most likely a non-absorbable suture. If left alone this suture will probably work its way to the surface and can be easily removed. Unfortunately foreign material does have the potential to become infected. For these reasons, we generally recommend that these suture remnants be removed as soon as possible following surgery.

Answered by Dr. BruneteauMay 13, 2019

Rhinoplasty

Q Should I Have an Open or Closed Rhinoplasty?

Rhinoplasty surgery can be performed through either an open or closed approach. With both of these techniques incisions are made on the inside of the nose along the nostril rim. When a closed approach is utilized no additional incisions are made. The surgeon is able to operate through these nostril incisions but doesn’t have direct visualization of the underlying anatomic structures. In contrast when an open approach is utilized a small incision is made across the columella that connects the two nostril incisions. This small incision tends to heal nicely and is almost imperceptible in most cases. This approach gives the surgeon the ability to lift the skin off the underlying bone and cartilage and directly visualize these anatomic structures.

The approach utilized depends upon a variety of factors including the patient’s anatomy, aesthetic goals and the surgeon’s preference. Historically, the vast majority of rhinoplasties were performed with a closed technique. This has gradually changed over the years and now most rhinoplasties are performed with an open approach. This is probably due to the fact that surgeons can more easily visualize the underlying anatomy when this approach is utilized.

It’s important to understand that most surgeons utilize both approaches. Most surgeons agree that the surgical approach utilized is less important than the surgeon’s skill. For this reason, it’s important to consult a board certified rhinoplasty surgeon with experience in this area.

Answered by Dr. BruneteauMay 13, 2019

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