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About Rhinoplasty

FOR ALL PATIENTS CONSIDERING RHINOPLASTY--IT IS IMPORTANT TO READ THE FOLLOWING IMPORTANT POINTS CAREFULLY

1. RHINOPLASTY IS CONSIDERED ONE OF THE MOST DIFFICULT COSMETIC SURGERY PROCEDURES.

2. IT IS IMPORTANT TO CHOOSE YOUR SURGEON CAREFULLY TO MAXIMIZE YOUR CHANCES OF A SUCCESSFUL OUTCOME--THE SURGEON SHOULD BE A FACIAL PLASTIC SURGEON WHO SPECIALIZES IN RHINOPLASTY, RATHER THAN A GENERAL PLASTIC SURGEON WHO DOES FULL BODY PLASTIC SURGERY.

3. THE PROCEDURE NEEDS TO BE CUSTOMIZED TO YOUR FACE AND NOT A "STAMPED" PROCEDURE. DR. RIZK CAREFULLY EVALUATES YOUR WHOLE FACE TO CREATE A NOSE THAT IS IN HARMONY WITH THE REST OF YOUR FACE. A NOSE THAT IS APPROPRIATE FOR ANOTHER PERSON MAY NOT BE SUITABLE FOR YOUR FACE.

4. NEWER ADVANCED RHINOPLASTY TECHNIQUES MAXIMIZE THE CHANCE OF A SUCCESSFUL OUTCOME AND MINIMIZE THE RECOVERY TIME- DR. SAM RIZK USES THE LATEST ADVANCES TO ACHIEVE A STABLE AND STRUCTURALLY SOUND NOSE THAT STANDS THE TEST OF TIME USING STRUCTURAL SUPPORT METHODS WITH GRAFTS AND BETTER VISUALIZATION TECHNIQUES SUCH AS THE HIGH DEFINITION TELESCOPE SYSTEMS TO ACHIEVE A PRECISE AND NATURAL OUTCOME.

5. IT IS IMPORTANT TO UNDERSTAND THAT NO RESULT IS EVER PERFECT EVEN IN THE BEST POSSIBLE SURGICAL OUTCOME DUE TO HEALING FACTORS AND SKIN THICKNESS, PATIENT QUALITIES OUT OF THE SURGEON'S HANDS. SCULPTING THE NOSE, ACCORDING TO DR. SAM RIZK, IS NOT AN EXACTING ART LIKE SCULPTING IN CLAY OR WOOD BECAUSE THE NOSE HAS A SKIN ENVELOPE WHICH COVERS THE STRUCTURE AND MAY AFFECT FINAL OUTCOME. THIN SKIN MAY SHOW TOO MUCH IRREGULARITIES AND THICK SKIN MAY HID THE UNDERLYING DEFINITION. DR. RIZK HAS SPECIALIZED TECHNIQUES TO CHANGE SKIN THICKNESS, EITHER ADDING A SOFT GRAFT TO MAKE THIN SKIN THICKER OR TO SELECTIVELY DEFAT THICKER SKIN AND ADD GRAFTS THAT CREATE MORE DEFINITION IN THICKER SKIN PATIENTS. HOWEVER, THERE IS A CERTAIN SMALL PERCENTAGE OF REALLY THICK SKIN NOSES WHICH WILL NOT BENEFIT FROM RHINOPLASTY.

6. A STRONG NASAL FRAMEWORK IS IMPORTANT TO ACHIEVE BOTH DEFINITION AND ATTRACTIVENESS TO THE NOSE AND A STABLE LONG TERM RESULT BOTH FUNCTIONALLY (IE BREATHING) AND COSMETICALLY.

Noses are one of the most notable features in a face, particularly if they are large, crooked, long, or bulbous. In our culture, whether it is appropriate or not, someone's nose can affect how we perceive them. The nose often symbolizes intelligence, masculinity, femininity, even strength or weakness of character. A nose that's in harmony with other features gives the face a pleasing balance. It comes as no surprise then that rhinoplasty, the medical term for a "nose job", is the most common facial plastic procedure performed in the United States. Dr. Sam Rizk, a New York City Facial Plastic Surgeon and Rhinoplasty Specialist, states that more than 400,000 people have this procedure every year and about 60 percent of rhinoplasty patients are women.

What is Rhinoplasty?
Nasal refinement, or rhinoplasty, is surgery to reshape the nose. The procedure can make your nose straighter, wider or narrower, longer or shorter. It can change the shape of the tip or bridge. It can change the angle between the nose and upper lip or narrow the nostrils. Tiplasty may be performed when only the tip of the nose needs refinement. Shortening the nose, often by lifting the tip, can make you look younger. The ethnic rhinoplasty is a specific rhinoplasty which requires special training and techniques. According to Dr. Samieh (Sam) Rizk, who is an expert in ethnic rhinoplasty techniques, these ethnic noses involve patients with thicker skin like African American, Middle Eastern/Mediterranean noses, Latino/Hispanic noses and Asian noses. Dr. Sam Rizk further points out that these ethnic noses require specialized defatting 3D techniques to resculpt the tip skin in addition to grafting techniques, rather than cartilage excising techniques used on traditional rhinoplasty patients.

Although nose reshaping is a cosmetic procedure, the procedure can also correct an existing breathing problem. For example, during rhinoplasty, a surgeon can repair a deviated (crooked) septum, which may block the airflow on one side of the nose. The septum is the wall of bone and cartilage that separates the nostrils. This operation is called septoplasty. If other causes of difficulty breathing such as allergies or weak cartilages which collapse on breathing in also exist, those need to be treated as well with medical treatment in combination with surgical treatments. A small percentage of patients with very weak cartilages and thick skin may have too much movement of their nasal skin on inspiration and may require a touch up procedure to insert a cartilage to support the nose skin and preventing it from moving too much while breathing. Additional sinus problems could also be treated at the same time as rhinoplasty with endoscopic sinus surgery, but this requires obtaining a CT scan to determine medical necessity and what kind of problems exist in the sinuses.

Rhinoplasty is considered a permanent procedure; certainly bone and cartilage removed will not grow back and cartilages added or implants added are permanent, although a slight absorption or settling in may occur. However, as we age our noses do become a bit longer, weaker as the ligaments and other tissue lose some of their tension. Older patients seeking rhinoplasty often present with difficulty breathing as well because the nasal skin thickens and moves in and collapses too much on inspiration as the cartilages holding the skin up weakens with age.

Types of Rhinoplasty
Each procedure is tailored to the needs of the individual patient; however, there are two basic types of rhinoplasty. Dr.Sam Rizk, a New York Rhinoplasty Surgeon, customizes his rhinoplasty procedure to the patient and does not do a "signature nose job". The first is open rhinoplasty, which involves placing a small incision across the columella, the strip of tissue separating the nostrils, along with incisions inside the nose. The second type is closed rhinoplasty, in which only internal incisions are used. 3D rhinoplasty, pioneered by Dr. Sam Rizk, involves using 3D telescopes with specialized camera/TV systems inside the nose to achieve a very precise result with minimal trauma. This type of precision rhinoplasty with 3D is the future of "Precision Minimally Invasive Rhinoplasty Surgery", according to Dr. Sam Rizk. Most facial plastic surgeons agree that the best approach is the one the doctor prefers. Open rhinoplasty is sometimes necessary for unusually complex procedures and some revision procedures. Dr. Sam Rizk does both the endonasal (closed) and the open (external) procedures, depending on the goals and complexity of the nose.

Are You a Candidate?
If you've been self-conscious about your nose for as long as you can remember, rhinoplasty can help you find new self-assurance. For all patients, the goal is balanced and attractive facial contours, not an "ideal nose". Dr. Sam Rizk states that there is no universally ideal nose and that an ideal nose depends on the facial contours and the patient's ethnicity. If you're an adult or a teenager in good emotional and physical health, and you want improvement rather than perfection, you could be an excellent candidate for cosmetic surgery of the nose.

Teenagers can have the procedure after they have finished their growth spurt, usually by 14 for girls and 15 for boys. If you're in your teens, your doctor will want to be sure you're seeking the surgery because you want it and not because you're doing it out of parental or peer pressure.

Ethnicity is a factor in some rhinoplasty procedures, You and your doctor can best decide how much to soften a bump, for example, or narrow the base of the nose and still achieve harmony with the rest of your features-focusing on your face and its individual, distinctive attractiveness.

Many people seek rhinoplasty after a nasal fracture. Your surgeon will want to wait several months after the injury, until the swelling goes down, before performing the procedure.

If you're unhappy with an earlier rhinoplasty, you may be a candidate for revision rhinoplasty a year or more after the first procedure, which must heal completely before new surgery is performed.

Your Rhinoplasty Procedure
The operation usually takes one to three hours, depending on the complexity. Once anesthesia is given, small incisions will be made. Through these incisions, the doctor will sculpt your bone and cartilage to achieve the desired shape and may add or remove cartilage and bone. External incisions, virtually invisible once healed, if performed, are hidden in the creases of the nose.

Depending on the structure of your nose and the desired result, your surgeon may use one or more of these techniques:

-Narrow or widen the bridge.
-Maneuver bone and cartilage to sculpt the new shape.
-File or chisel excess bone at the bump.
-Remove small wedges of skin to narrow the base of the nose.
-Suture to narrow flared nostrils.
-Trim cartilage at the tip.
-Add nasal cartilage, or bone or cartilage from another part of your body to build up the nose.

Once the nose is reshaped, the doctor will look at your new structure and make minor adjustments as needed before applying an external splint. Dr. Sam Rizk, a New York Rhinoplasty Specialist, who is double board certified in facial plastic surgery, states that he does not use packing in the nose and instead, uses specialized tissue glues to help diminish bruising and expedite the healing process. The external splint usually stays in place for 5-7 days and helps protect the nose from bumps, maintain the new shape, decrease swelling, and keep the nasal structures in place during the early part of healing. Finally, the surgeon will put a gauze drip pad under your nose to absorb blood and mucous. This drip pad usually stays there for the first few hours and can be removed once the dripping stops. Dr. Sam Rizk believes that packing is uncomfortable, increases swelling, and prevents drainage (drainage is a good thing because it means that fluid is not collecting under the skin causing more swelling), and it is painful when it's time to remove the packing from a tender, healing nose.

After Your Rhinoplasty
You'll go home the same day of your surgery. Most doctors will want to see you 5-7 days after your surgery. Your doctor will likely instruct you to sleep only on your back with your head elevated for the first week after your surgery. You will be able to return to work or school in as little as 5 days after your rhinoplasty, on average. This may vary one or two days more, depending on individual healing.

The first postoperative visit will include splint removal, removing sutures and cleaning the nose inside. Sutures inside the nose are not removed as they absorb on their own. Only if sutures are placed in the columella are they removed. Take your glasses to the visit. Some doctors advise taping your glasses to your forehead for several weeks or supporting them another way until the nose is healed.

You'll see a change in your nose immediately after surgery; however, complete healing can take six months to a year. It often takes this long for all the swelling to subside (this is swelling that you or your friends/family may not know exists). In some cases, your friends and family may say they can't see any difference. Improvement can be subtle and gradual, but if you've chosen a first-rate surgeon, there will be improvement that you'll be aware of even if others are not.

Side Effects
You'll have clear mucous drainage or blood-tinged mucous drainage for the first few days. Occasionally, there is a small amount of blood in the drainage for a few days. Change the gauze pad as often as needed. Rarely, a patient will have a runny nose for several months.

The inside of your nose may be swollen and the incisions may be crusty for several weeks; this may affect breathing through your nose and you need to keep your nose moist with saline over the counter spray and ointments. You may want to sleep with a humidifier running.

You may have low-grade fever and chills for a day or two after the rhinoplasty and this is normal in the first 2 days. If you have fever that persists beyond the first 2 days, call your doctor.

Combining Rhinoplasty with Other Procedures
It's not uncommon for facial plastic surgeons to recommend chin augmentation along with rhinoplasty, since a small chin can make the nose look larger. In fact, chin augmentation is usually recommended in about 30 percent of rhinoplasty patients. You might also benefit from laser skin resurfacing or eyelid surgery at the time of your nose reshaping. Other procedures like facelifts may be done at the same time as well.