Rhinoplasty ( Nose Reshaping )

Dr. Herve` Gentile is a specialist in primary and revision Rhinoplasty. He is triple board certified in the 3 specialties that encompass nasal surgery and has taught Rhinoplasty to other plastic surgeons.  Nose reshaping is the most noble of the plastic surgery procedures and also the most difficult of them all. It refines a most important aesthetic feature of our appearance and is a very popular plastic surgery procedure. It is also commonly performed on graduating teenage girls as it can dramatically enhance their self-esteem.

There is perhaps no other plastic surgery procedure which blends artistic and technical skills to the degree required in aesthetic rhinoplasty. Performing corrective rhinoplasty is one of the greatest challenges because the surgeon has to attempt to apply his aesthetic judgment to each individual case and no two noses are quite alike.

He must correct abnormalities very similar but which often require accomplishment by totally dissimilar methods.

In spite of the modern trend toward a unisex, there are distinct differences in the nasal and facial characteristics of individuals according to their sex.

Accordingly it would be unacceptable to fashion a male nose on a distinct female face or a female nose on a man’s face.

The typical male nose is relatively larger than that of the female and is covered with thick skin tissue. The dorsum is relatively wider and a dorsal hump is an accepted feature of the male physiognomic profile.

The typical female nose overall is relatively smaller than that of the male with a thinner skin covering. A narrow dorsum is desirable and a slight concavity of the dorsal line (the “soft sky slope line”) is quite acceptable and pleasing. The lobule should be narrow and the tip should have a more triangular shape viewed from the front and below. The tip should also be rotated at a greater degree than the male on the lateral profile providing a more softer and gentler overall look.

In both sexes the non-operated nose tends to elongate with the aging process. This growing or lengthening of the nose is due to the drooping of the tip and a more thick, coarser wrinkled skin and lastly to indrawing of the lips secondary to bony change in the alveolar (the gum) processes of the jaws.

Rhinoplasty can be appropriately performed on teenagers after age 16 provided  they have reached their full and complete facial growth.

Planning

The nose is the most prominent feature in your face and the goal in nasal surgery is a nose that looks good in addition to a nose that works well.

Planning therefore must also address whether your nasal breathing is adequate, because appearance and function cannot be separated if a good surgical result is to be achieved. If your abnormalities interfere with breathing through your nose and are the result of trauma, some insurance companies may pay for some of the surgery, but this is getting harder every day. Photographic documentation and my operative note are required. Therefore the consultation is most important since your particular needs are taken into account with my nasal examination and facial/ body analysis to form a preconceived idea of the ideal shape of your nose. All our faces when studied carefully exhibit facial and nose asymmetry, in other words the two halves of the face and the nose do not look exactly alike. This is a desirable characteristic since it adds to the face what artists refer to as “interesting.” Cosmetic make-up techniques may be used to balance an existing asymmetry or to do just the opposite in a very symmetrical face, since a very symmetrical face is less interesting. The entire appearance of the individual must be taken into consideration, for example, a tall person can tolerate a larger nose, whereas a smaller nose is more harmonious in shorter individuals.

Sometimes photographs are taken to help both of us analyze your nose and face and communicate your concerns and desires. The photographs should be viewed only as a teaching tool and not be constructed in any way as a guarantee of your result. It does, however, help put your unrealistic expectations aside, demonstrate the asymmetries and help you in evaluating, if needed, the need for chin augmentation. By the same token, although we have the software to do computer imaging, our office does not use it anymore as it is fraught with errors and provides a falsified view of your nose that can lead you to have unachievable and therefore unrealistic results.

With rhinoplasty, many changes can be made:

  • Dorsal humps can be taken away.
  • The nose’s upper lateral cartilages and bones can be altered.
  • If the nose is too small, the dorsum (bridge of the nose) can be built up.
  • To make the base of the nose less wide, the sides can be brought inwards.
  • To make breathing easier, the nasal septum can be addressed.
  • If your nasal tip appears boxy, it can be made more triangular. This can be done by resculpting the lower nasal cartilages.
  • Once the alterations have been made, dissolvable stitches will be used to seal your nasal incisions. To avoid as much discomfort as possible, nasal packing is not used, but your nose will be splinted for support.

Revision

Revision rhinoplasty is one of the most difficult procedures to perform because you are dealing with a 3 dimensional structure composed of skin, cartilage and bone. Although the goal is the same as the primary rhinoplasty the natural tissues have often been severely compromised and the results are more unpredictable due to the previous and now the new scarring for which the surgeon has no control since he is at the mercy of the healing process. Therefore, if you are needing a revision, it is important that your aesthetic expectations be lowered.

Procedure

The procedure lasts about one to two hours and sometimes longer depending on whether a septoplasty is necessary (correction of the middle partition which separates the inside of the nose called the septum ). The operation is performed in our private surgical office suite or in the hospital, required for coverage by the insurance companies ( = extremely a rare event today ), generally under local anesthesia with IV sedation (a twilight sleep in which you will feel no pain and you will be breathing on your own ) or general anesthesia. The choice is yours, but most are comfortable and happy having selected IV sedation.

Dr. Gentile’s preference is for a closed approach, which leaves no outside visible scars. The incisions are placed inside the nose and then, reshaping can be performed: your hump can be removed or the dorsum built up if the nose is too small; the tip can be elevated and sculptured by trimming the lower nasal cartilages transforming a boxy tip into a refined triangular one; the sides of the nose that widen the base can be brought together to narrow them; the nasal bones and upper cartilages can be trimmed and repositioned, and the septum, if necessary, can be altered to correct the internal deformity and improve your breathing. After the incisions are closed with self-absorbable sutures, a splint is place on your nose. Most of the times I do not use any nasal packing and this will lessen your discomfort. Sometimes, especially in revision nasal surgery, the operation requires an open approach via a small inverted V incision placed at the base of your columella (otherwise it is identical). Dr. Herve` Gentile will work with you to set up realistic expectations communicating clearly what can and cannot be done. Remember that no plastic surgeon can promise you perfection as there is no such thing when dealing with the human nose.

Recovery

After the operation you will be going home but you must have somebody stay with you that night. You must keep your head elevated at all times for a few days and any pain can be controlled by medication.

 

Your bruising and swelling will disappear gradually in the ensuing days and generally you will be presentable in ten days. For females make-up is encouraged, especially around the eyes. Most people return to work within a week to ten days. After a few weeks you can resume all your normal activities but you should avoid contact sports for at least six weeks. You must also avoid wearing glasses for a month which can alter the shape of your nose, trauma which occurs commonly in picking up little children and sunbathing since this will promote swelling.

Once your splint is removed at about one week post-op you will be able to see your new nose. Although you may be able to see some changes, it will take months before all the swelling subsides and post-op photographs are taken. During this time your family and friends may think you probably changed hairstyles and do not see dramatic changes, but your new nose should look natural, harmonious and in balance with your face and not look operated. Your new nose should not draw any attention to you. The idea is not to recreate a new nose for you but to enhance and redefine the one you have.

During this period you will be also be seen in the office to monitor your progress. The final result achieved is usually permanent and is the result of your healing ability, avoidance of any injuries and your previous nose shape and asymmetry. Occasionally additional changes and revisions may require further procedures.

Cost

The cost will vary depending on the surgeon’s reputation, level of expertise,  the complexity of your surgery and whether it is a primary or a revision procedure. However, this is definitely a procedure that you do not want to compare prices but instead you should  carefully and conscientiously research your surgeon and make sure that he has considerable experience in rhinoplasty surgery, a stellar reputation  and a resume of consistently favorable results.  The range can vary between $5,800 to $7,000 or more for revision surgery. The cost is all inclusive and includes all fees, anesthesia and operating room charges but excludes only  lab costs if needed.

Photographs

For your convenience you may view a few selected cases in our Rhinoplasty Before & After photo gallery. To see our extensive photographic catalogues of pre-operative and post-operative photographs please contact our office and schedule a complimentary consultation.