What Is Rhinoplasty?
Dr Sharma’s Approach to Rhinoplasty
Selecting your surgeon
The nose is the central feature of the face. In an aesthetically balanced face, the nose blends in naturally with the surrounding facial features. However, if the nose is too large, too long, or has an unnatural curve to it, it can dramatically impact the facial harmony and overall appearance. This draws attention away from other beautiful and flattering features of your face. If you wish to improve the shape or function of your nose, you may be a good candidate for a rhinoplasty with Facial Plastic and Reconstructive surgeon, Dr. Giriraj Sharma in Newport Beach, CA.
WHAT IS RHINOPLASTY?
Rhinoplasty, also known as a “nose job”, is a surgery performed to enhance the aesthetics of the nose in order to restore balance and harmony with your natural facial feature. Rhinoplasty can also be performed for functional purposes, such as nasal obstruction which impairs breathing, or to correct deficiencies from a prior nose surgery.
For many patients, the primary purpose of a rhinoplasty is to improve the cosmetic appearance of the nose. Common features of the nose which are addressed with rhinoplasty include a high bump along the bridge of the nose (dorsal profile), a broad or bulbous nasal tip, a drooping or under-rotated nasal tip, a long or over-projected nose, or a wide nose. Often times, a combination of these features creates a disproportionate nose which does not balance well with the rest of the face.
DR. SHARMA’S APPROACH TO RHINOPLASTY
Dr. Sharma most commonly uses the open structural rhinoplasty technique. This involves placing a small incision at the base of the nose (in the columella) to gently lift the skin and soft tissues so that the underlying structural anatomy of the nose is fully exposed. Open rhinoplasty allows your surgeon to fully visualize the structural anatomy of your nose and identify any deficiencies and irregularities. With the nasal anatomy exposed, the surgeon is able to reconstruct the nasal dorsum and septum, as well as meticulously craft the nasal tip cartilage to the exact shape and position desired. The incision at the base of the nose is designed and positioned in a manner that it is almost imperceptible after the healing process is complete.
Cartilage grafts, typically taken from the nasal septum, can be used to stabilize the nose, improve the airway and to set the position of the nasal tip. In select cases, Dr. Sharma utilizes a Temporalis Fascia graft to reconstruct the nose. Temporalis fascia can be easily harvested from underneath the scalp above the ear. This is a natural graft which adds subtle improvements in contouring of the nose, and is a tool utilized by advanced rhinoplasty surgeons. Additional grafts which may be utilized in your surgery include ear cartilage or rib cartilage. Rib cartilage grafts are often required for Revision Rhinoplasty cases where there is insufficient septal cartilage to properly reconstruct of the framework of the nose.
There is no single correct or best approach to rhinoplasty. Each plastic surgeon will have their preferred surgical methods which fit best in their hands, resulting in their unique aesthetic and quality of outcomes. Variables such as skin incisions, piezotome or ultrasonic instruments, surgery duration, anesthesia type and recovery time are often used – and exaggerated – as marketing tools by plastic surgeons to promote their respective rhinoplasty methods. While different styles of rhinoplasty approaches exist and can be very effective for the right patients (e.g. closed rhinoplasty, preservation rhinoplasty), Dr. Sharma emphasizes to all patients that the most important things to consider when choosing a surgeon are experience, expertise and the quality and longevity of their outcomes. In the end, what matters is your result.
The recovery process after rhinoplasty is generally divided into an early recovery phase (1 to 2 weeks) and long-term recovery (1 to 2 years). The early phase includes at-home wound care, activity restriction, head elevation at nighttime, and variable amount of swelling. The long-term recovery involves the gradual reduction of swelling over the course of at least 1 year.
Factors that affect the rhinoplasty recovery process include type of rhinoplasty performed (e.g., primary vs. revision rhinoplasty), complexity and extent of surgery, patient’s skin thickness and type (e.g., small vs. large pores) and adherence to post-operative instructions.
Day of Surgery
The majority of Dr. Sharma’s rhinoplasties are performed under general anesthesia. A family member or friend will need to drive you home and help take care of you for the first evening and overnight. For out-of-town patients, we can recommend a luxury hotel or assist in arranging a luxury post-operative recovery facility in Orange County. With advance notice, overnight private nursing care can be arranged if desired or necessary.
You will wear a splint (small cast) and some tape over your nose for 1 week. During the first week, symptoms such mild discomfort in the nose and face, nasal congestion and variable amounts of swelling and bruising can be expected. Swelling peaks on the Days 2-3 after surgery and then starts going away. The majority of visible swelling and bruising (if present) subsides in the first week. Your splint and sutures will be removed in the clinic at your 1 week appointment. After your dressings are removed, you can gently wash your nose.
After 2 to 3 weeks, a significant amount of swelling will have subsided. At this point, most patients feel comfortable being in public or around their family and friends, without feeling self-conscious about swelling or bruising. For the first 2 weeks after surgery, you should avoid exercise and strenuous physical activity to minimize the risk of bleeding. Most patients feel comfortable returning to work after 1 week.
By 2-3 months, the majority of swelling has cleared and your nose will appear more refined and natural. For a minority of patients who experience greater than average swelling (typically patients with thicker skin types), a steroid injection to the nose is performed in clinic to help reduce swelling. At this point you may resume more strenuous physical activity including contact sports and underwater swimming.
For the majority of patients, the healing process after a primary rhinoplasty is complete around the 1 year mark. This includes resolution of swelling and fading of your surgical incision. For some patients, this process can take up to 1.5 to 2 years depending on their skin type, healing rate and complexity of surgery. Revision rhinoplasty healing can often take up to 2 years.
HOW TO CHOOSE YOUR RHINOPLASTY SURGEON
Rhinoplasty is the most technically complex surgery of the face. Therefore, it is important to select a surgeon who specializes in cosmetic surgery of the face, has performed a high volume of rhinoplasty procedures, and who uses the most advanced rhinoplasty techniques. As a Board Certified Head and Neck Surgeon who specializes in Facial Plastic Surgery, Dr. Sharma is one of very few surgeons who specializes in cosmetic and complex reconstructive surgery of the nose.
Dr. Sharma takes pride in being very detail oriented during every step of your rhinoplasty journey. During your consultation, he will evaluate your nose in depth and discuss every aspect of your nose which contributes to its form and function. This level of orientation to detail also applies to his surgical planning process and his technical methods during surgery.
Dr. Sharma’s philosophy with rhinoplasty is to meet his patient’s goals while creating an attractive, aesthetically balanced and functional nose. Your nose should fit perfectly with your unique facial features and ethnic background. Every plastic surgeon’s preferred aesthetic and style of noses is slightly different. At the same time, every rhinoplasty patient is unique with regards to their facial proportions, ethnic features, anatomy and goals for surgery. It is important to seek out a surgeon whose values, eye for beauty and skill set fit best with you and your goals.
FREQUENTLY ASKED QUESTIONS
Will I be under general anesthesia for a rhinoplasty?
For a traditional rhinoplasty, yes. There are multiple factors which determine which level of anesthesia is required for a particular surgery, including optimizing patient comfort and safety, the site of surgery (e.g. the nose is part of your airway), risks of surgery and duration of surgery, to name a few. For Dr. Sharma’s rhinoplasties, general anesthesia is always administered by a Board Certified Anesthesiologist or Certified Registered Nurse Anesthetist (CRNA) and is proven to be very safe. Most patients are awake within 15-30 minutes after the end of their surgery and ready to be discharged home.
In some cases, where only minor changes to the nose are needed, surgery can be done under IV sedation (“twilight” anesthesia) or local anesthesia only. This depends on the extent of surgery needed. You should talk to your surgeon about anesthesia for rhinoplasty if you have any questions!
How much swelling and bruising can I expect after rhinoplasty?
How much pain can I expect after rhinoplasty?
How long should I plan to take off work?
Dr. Sharma advises his rhinoplasty patients to take approximately 1 week off from work. Mild nose and facial discomfort can persist for the first few days after surgery. During this first week, your nose will be covered with tape and a small cast. These dressings , as well as sutures, are removed at your 1 week post – operative appointment. During the first week, you can expect some drainage from your nose the first few days, crusting inside your nose, and mild congestion. It is also important to limit your physical activity in the first 2 weeks after surgery, so as to not raise your blood pressure and increase your risk of bleeding.
Is a septoplasty performed at the same time as a rhinoplasty?
Septoplasty is performed to correct deviated septal cartilage or bone which may be blocking your nasal airway or to correct any deformities which are affecting the shape of your nose. A septoplasty can be a stand-alone surgery or performed at the same time as rhinoplasty. While the term “septo-rhinoplasty” is often used to describe this combined surgery, Dr. Sharma’s rhinoplasties almost always include septoplasty.
A septoplasty can consist of a variety of techniques and maneuvers to address deformities in the septum. Common techniques used are: (1) Removal of a piece of cartilage (graft) from your septum. This is used to create smaller, meticulously designed grafts to reshape and reconstruct your nose; (2) Correction of any deviated portions of the septum; (3) Trimming any excess septal cartilage which may be affecting the length of your nose or the rotation of your tip; (4) Repositioning the front of the septum so it is aligned exactly midline.
Can I have a rhinoplasty if I have had filler in my nose before?
For most patients, Yes. As always, candidacy for rhinoplasty is made on a case-by-case basis, depending on your history, nasal anatomy, surgical goals and Dr. Sharma’s recommendations. However, in most cases, hyaluronic acid filler can be safely dissolved at least 2 weeks prior to surgery so that your surgeon can assess the external anatomy of your nose and properly plan for surgery.
While the majority of filler naturally resorbs within 1-2 years, there is always some leftover filler which does not resorb. If your nose filler was placed less than 2 years before your rhinoplasty, the filler can be dissolved by your surgeon in the clinic with hyaluronidase solution. This procedure is completed within 10 minutes and has minimal discomfort.