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Flawless Rhinoplasty

Rhinoplasty is surgery to reshape the nose. It can make the nose larger or smaller; change the angle of the nose in
relation to the upper lip; alter the tip of the nose; or correct bumps, indentations, or other defects in the nose.

During rhinoplasty, the surgeon makes incisions to access the bones and cartilage that support the nose. The
incisions are usually made inside the nose so that they are invisible after the surgery. Depending on the desired
result, some bone and cartilage may be removed, or tissue may be added (either from another part of the body or
using a synthetic filler). After the surgeon has rearranged and reshaped the bone and cartilage, the skin and tissue
is redraped over the structure of the nose. A splint is placed outside the nose to support the new shape of the nose
as it heals.

Rhinoplasty may be done using general or local anesthesia. It is usually done as an outpatient procedure but
sometimes requires a 1-night stay in the hospital or surgery center. Surgeons who do rhinoplasties typically have
training in either plastic surgery, otolaryngology (ear, nose, and throat specialty), or both.

What To Expect After Surgery
The splint and bandaging around your nose will be removed in about a week.  Your face will feel puffy and the area
around your eyes and nose will be bruised and swollen for several days. Cold compresses can help minimize the
swelling and reduce pain. Your doctor may also recommend pain medicine. It takes about 10 to 14 days before most
of the swelling and bruising improves.

You may need to keep your head elevated and relatively still for the first few days after surgery. It may be several
weeks before you can return to strenuous activities.

Why It Is Done
Rhinoplasty can change the size, shape, and angle of your nose and bring it into better proportion with the rest of
your face.  Rhinoplasty may also correct structural problems with the nose that cause chronic congestion and
breathing problems.

How Well It Works
The results of rhinoplasty may be minor or significant, depending on what kind of correction you want. It is important
that you and your plastic surgeon agree on the goals of the surgery. If your expectations are realistic and your
plastic surgeon shares them, he or she will probably be able to give you the results you want.

The results of rhinoplasty are permanent, although subsequent injury or other factors can alter the nose’s
appearance. Cosmetic surgery should only be done on a fully developed nose. Complete development has usually
occurred by age 15 or 16 in females and by age 17 or 18 in males. If surgery is done before this time, continued
development of the nose can alter the surgical results and possibly cause complications.

You can always expect temporary swelling and bruising around the eyes and nose after rhinoplasty. Other problems
that may occur include:

-Injury or holes to your septum (the wall that separates your nostrils).
-Skin problems, including breakdown of skin tissue (skin necrosis) and irritation from the tape and bandaging.
-Infection. Preventive antibiotics may be given after surgery to reduce the risk of infection.
-Serious nasal blockage caused by swelling inside the nose.
-Complications of anesthesia.

We've created a handy glossary so you can get familiar with some of the most common
terms associated with rhinoplasty.

Alar Base Reduction
If a surgeon says you need an alar base reduction, this is another way of saying he's going to reduce
the size of your nostrils.

Alar Plasty
Alar plasty is also known as tip plasty. This is a surgery that focuses on the tip of the nose more than
any other surrounding area. This procedure helps to narrow and define the tip of the nose.

Bulbous Tip
If a nose has a bulbous tip, that means the tip is wider than the rest of the nose, which can cause it to
look disproportional.

Closed Nasal Reduction
A closed nasal reduction is when a patient's nose can be treated without requiring any incisions. Under
the right circumstances, there are techniques that make it possible to reposition the nasal bone
structure without requiring invasive surgery.

Closed Rhinoplasty
This is also known as an endonasal nose job, which is the preferred choice for many patients who
undergo a nose procedure whenever the option is available to them. This is because a closed
rhinoplasty involves incisions that are made inside the nose, so scars aren't visible on the outside.

A columella is the main column of the nose that separates both nostrils.

When a patient undergoes rhinoplasty, it's normal to have some temporary scabs in the nose. This
phenomenon is known as crusting.

Dorsal Bump
When a patient comes in wanting a nose job, it's likely because of unwanted dorsal bumps, or naturally
occurring camel-like humps on the nose. Thankfully, smoothing out the nose and eliminating dorsal
bumps is a simple task for many surgeons.

Dorsal Aesthetic Lines (DAL)
When the bridge of the nose ends, these lines are known as Dorsal Aesthetic Lines. These are the
defining lines of the nose that follow up to the tip of the nose and up to the forehead.

After a nose job, it's pretty normal to experience some edema, or swelling of the tissue in the nose,
especially around the tip.

Front Droop
This is also called tip ptosis, or a hook nose. As the name implies, when the front tip of the nose droops
downwards, this is known as a front droop.

Hanging Columella
As we already explained, a columella is the inside column of the nose that separates the nostrils. For
some people, the columella continues past the nostrils, which we refer to as a hanging columella. This
is a common complaint from patients and is also easily treatable.

Long Nose
When the nose has a dorsal hump or a drooping tip, it looks aesthetically longer when it's looked at
from the front. This is what surgeons refer to as a long nose.
Nasal Dorsum
A nasal dorsum is essentially just the nose's bridge. Starting from the lower eyebrows and ending at the tip of the nose, a
nasal dorsum is a defining feature that can add essential symmetry. Many patients come in wanting to make their nasal
dorsum more defined or pronounced.

Open Rhinoplasty
When a patient's nose needs some major adjustments made, an open rhinoplasty will be required. In other words, a
surgeon will need to make an incision to go in and adjust the nasal skeleton. This leaves a noticeable scar that will
become less and less visible with time and care.

Pig Nose
When the bridge of the nose appears to be rather high and elevated as if it ends abruptly, this is known as a pig nose.
Some patients have a pig nose directly after the procedure, however, this is only temporary. Once it begins to heal and the
swelling goes down, it will look more normal. Sometimes a surgeon has to overestimate so that the final results will look
the best once the tissue begins to relax.

Pinched Nose
When the bridge of the nose is overly narrow, it can look disproportional. The typical "ideal" nose has parallel lines that
are straight and more proportional than the appearance of a pinched nose. Plastic surgeons are well equipped to
improve this issue and provide symmetry to the nose.

Polly Beak
Unfortunately, after a nose job, some patients have excess cartilage on the tip of their nose that it can't support. This can
cause the tip of the nose to sag and curve down like the beak of a bird. Doctors call this a polly beak. This is a common
problem and can be treated.

Primary Rhinoplasty
A primary rhinoplasty means the first nose procedure that a patient has. This is typically a surgery that's done on a "virgin"
nose, so to speak, which hasn't undergone any procedures in the past.

Secondary Rhinoplasty
If a patient requires a second surgery, this is known as secondary rhinoplasty. There are many reasons that a patient
could come back for another procedure, such as future sinus polyps, short nose, polly beak, or any multitude of issues.
Whatever the cause is, it's helpful for a surgeon to know that there has been previous work done so that they can take the
necessary cautionary steps to ensure the successful outcome of a secondary rhinoplasty.

Short Nose
Similar to pig nose, when the patient has an unusually high bridge of their nose, or short nose, the asymmetry can cause
many people to desire surgery to fix this.

Spreader Grafts
Typically from the cartilage of the ears or septum, a spreader graft is what a surgeon will create for support and
nose-contouring purposes.

Tip Projection Under/Over
Surgeons are a bit obsessed with tip projection, and for a good reason. That's because the tip projection is a defining
feature of the nose. For example, a nose with a tip that's below the high point of the nose has an under-projecting tip. On
the other hand, the "ideal" nose has a tip that's slightly above the nasal bones, or over projecting. If a surgeon does this
correctly, a nose is more aesthetically pleasing.

Turbinate Or Turbinal
A turbinate, or turbinal, refers to the long and narrow bones on the sides, middle, and inside of the nose. They work to
warm up the air before it's inhaled by the nose. Unfortunately, when we fight infections or suffer from allergies, they can
puff up and even change color. While it's very dangerous to have them completely removed, your surgeon can certainly
reduce their size to make them less visible.
The following illustrations explain important parts of the nose when considering rhinoplasty.  Understanding the anatomy
of your nose helps facilitate communication about your rhinoplasty surgery and other nasal surgery between you and
your doctor.  This is not meant to be a comprehensive review of nasal anatomy.  
The tip and supratip are common areas of intense or severe
swelling after rhinoplasty.  Patients often want to change the
nasolabial angle.  Increasing (making it more obtuse) the angle is
called tip rotation.  Decreasing it is called counter rotation.  
Reduction of a dorsal hump (rhinion) is a common request.  How
far the tip sticks out is called projection and thus recessing the tip
is called "tip deprojection".  A "hanging columella" or the opposite
problem "columellar retraction" are seen most prominently from
the lateral view.  A hanging columella will make the nostrils
appear large.
The lower third of the nose can be narrowed by alar base
reduction.  Injury to the soft tissue triangles during rhinoplasty
results in notching which is a difficult problem to correct.
Nasal subunits - The dorsum is the broad area over the
top of the bridge of your nose.  The ala are the wings off
to the side of your nasal tip.  The side walls are the area
above the ala and lateral to the dorsum down to the nose
cheek junction.
An Introduction to Rhinoplasty