Does my Nose Look Like a Complicated Rhinoplasty Case? (photo)

It sounds like your surgeon has a good straightforward plan that suits your needs. You will definitely require your nasal bones to be fractured to get the best result. I personally prefer the closed rhinoplasty technique but if your surgeon recommends open in your case, that's fine also. It sounds like your surgeon as advised you well. The breaking of the bones is not that big a deal even though it sounds kind of scary. Good luck.

For me, EVERY rhinoplasty is a complicated case.  Your surgeon gets a couple of hours to adjust dimensions and configuration of multiple tissues in the middle of your face to improve your appearance for the rest of your life.  The outcome, to some degree, is not exactly predictable because of swelling and tissue changes induced by the surgical event.  There are, however, guidelines, but these must be adapted to your personal needs and to your anatomy.  Only millimeters and fractions of millimeters make the difference between more or less beauty, more or less harmony with your other features, more or less surgically altered appearance, better or worse breathing, etc... you get the idea.  I go in trying to achieve elusive perfection each time, and this is the essence of the challenge.  There can be no complacency in rhinoplasty, and never does the operation become routine, even for the masters.

        This would certainly not be considered difficult, and the changes you want could be produced without opening the nose.  In this manner, you would have no visible scars and a shorter recovery period.  Find a plastic surgeon with ELITE credentials who performs hundreds of rhinoplasties and rhinoplasty revisions each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.

Kenneth Hughes, MD Los Angeles, CA

Hi Why,   Rhinoplasty is considered to be the most difficult of all facial plastic surgery procedures.  As a patient I would not "worry" about whether the surgery is complicated or not, but rather make sure that I have done my due diligence and chosen my rhinoplasty surgeon carefully (it does not matter whether an open or closed approach is used, it matters that your surgeon has artistic vision!)  I never take anything for granted with any rhinoplasty operation.  That having been said, it does look you have excellent anatomy to begin with, and that an experienced rhinoplasty surgeon should give you a great result.  Good luck and be well.   Dr. P

Avoid open rhinoplasty.  I NEVER open unless it is a traumatic reconstruction or a cleft lip/nose case that is already essentially open.  Any surgeon that is competent at rhinoplasty should be very comfortable doing this closed.  Key points to your rhinoplasty include reduction of the dorsum(including bony vault and upper lateral cartilage reduction by sharp technique and possibly "auto-spreader sutures or spreader graft), a cephalic trim which is a removal of the upper protion of the lower lateral cartilages, and VERY importantly a columellar strut/septal extention graft.  The reason for the columellar strut/septal extention graft is to give you supported auto-rotation of your tip AND IMPORTANTLY to give you more "columellar show."  The columella is the skin part of your nose between your nostrils.  It is the part that is cut in open rhinoplasty and preserved in closed rhinoplasty.  on profile there is not enough of your columella visible and a well placed graft will correct this and enhance you nasolabial angle and tip.  To perform this type of graft effectively septal cartilage must be used so septal harvest is indicated.

 

 

The other very important thing about the columella is that it contains two arteries and a venous drainage system feeding the nose.  If this is cut , healing is much slower and swelling will take about one year to resolve.  This is the main reason that surgeons like myself never open the nose.  The other main reason not to open is that it is very difficult to judge the aesthetics of the rhinoplasty without having the columellar relationship intact.  Other reasons not to open include columellar notching from the scar, scar contraction pulling the tip down, higher incidence of wound complication etc.  I hope this helps!

 

All the best,

 

Rian A. Maercks M.D.

Your nose does not look like a complicated rhinoplasty case. What you describe sounds correct but the final results are based on the expertise and experience of the surgeon doing the rhinoplasty. If you like the noses that he has shown you of his work then you should be getting approximately the same sort of result.

 

The surgery is as complicated as the surgeons experience. A first time rhinoplasty like yours should not be a "complicated" surgery. The more experience the surgeon has the better your chances of getting your desired results.

I have to answer that no rhinoplasty is simple.  I always counsel the patients very carefully on all of the aspects and plans for their case.  It sounds as though you have a very detailed understanding as well.  Although we only have two views for your pictures, I agree with the plans that have been suggested.

I think you should be reassured that your nose is quite straight, symmetrical, and you appear to have a moderate thickness to your skin.  These are really critical components that increase the success rates for your surgery.

Great question!  Above all, communicate with your doctor.  If you need I am sure your doctor can reassure you of the plans and anticipated outcome.

Todd Hobgood, MD

toddhobgood.com

Rhinoplasty surgery is the most complicated of all the facial plastic surgery procedures. With this said, your particular anatomy does not appear overly complicated and your surgeon's plan sounds appropriate. It is critically important that you are comfortable with your decision going in to your surgery. If you need another consultation in order to get there, you should make another appointment to see your surgeon prior to your surgery.

All rhinoplasties are complex operations. In my opinion yours is standard rhinoplasty. But you absolutely need fractures. Best to meet with your chosen surgeon again to FULLY understand the operation.