What is rhinoplasty?
Rhinoplasty is the operation that changes the appearance of the nose. The size and shape of your nose is determined by heredity and formed by the bones and cartilages that are underneath your nasal skin. The nose’s appearance can be altered by trimming and reshaping those bones and cartilages.
If you are considering a rhinoplasty, you should look at your nose in the mirror carefully and try to determine what parts you find unsatisfactory and what you would like changed. Your plastic surgeon can help you evaluate your nose, but try it yourself first.
Some common complaints are a bulbous round tip, a hump along the bridge of the nose, or a nose that is off-center, too long, too wide, too droopy, or just generally too big. Here are a couple examples of what a rhinoplasty can do:
From the side view you can evaluate the profile of your nose and chin.
My chin? What does my chin have to do with my nose?
The nose is only one part of the aesthetic profile of the face. A weak chin can make a nose appear to protrude more than it does, or a weak chin can accentuate a hump on the nose.
A chin implant, placed at the same time as your rhinoplasty, can correct a weak chin. Here is an example:
In the before and after pictures area, there is a section of patients who had chin augmentations at the same time as their nasal surgery. Click here if you wish to go there now.
What else should I look for on my nose?
See if you can find any asymmetries in your nose, such as one nostril wider than the other, or the whole nose off to one side. Asymmetries should be identified before surgery because you need to understand that they are sometimes quite difficult to correct.
During development, the nose and entire face form from two separate halves which merge in the middle. Small differences in the level of the eyes or prominences of the cheekbones can cause asymmetries of the nose which may persist after surgery.
How old do I have to be to have nasal surgery?
Once a young person is beyond the growth spurt of the early teens he is a candidate for rhinoplasty. By that time the nose will have assumed its adult shape, usually at the age of fourteen in girls, and fifteen in boys.
Am I too old to have my nose done?
There is no upper limit to the age at which someone in relatively good health may have a rhinoplasty. Many older adults who have lived with their noses all their lives usually do not want an operation that will markedly change the shape of their noses. However, gravity pulls on the nose just as it pulls on everything else, and the nose tends to droop as years go by. A minimal rhinoplasty can lift the nose and give a subtle impression of youth without a drastic change, making you look the same but better.
On the other hand, some adults may have disliked their noses since they were teenagers. These people often can easily identify what they don't like about the nose, and are quite certain of what they want changed.
Who needs the surgery?
That question is best answered by each individual. A minor physical irregularity such as a bump on the nose may be of no consequence to one person and yet can be of major significance to another. Improvement in the appearance of the nose can also enhance self-esteem and result in a better feeling about one’s appearance, imparting a psychological benefit that cannot be measured in a photograph.
What can be accomplished?
A rhinoplasty can address most dissatisfaction that people have about the shape and size of their noses. However, the operation is not quite as predictable as carving a new nose from a block of marble. Dr. Denenberg cannot put someone else’s nose on your face. He makes carefully planned changes in the structure of the nose you already have.
How does the operation work?
The nose is made up of a firm framework of bone and cartilage that is covered by skin. During the operation, Dr. Denenberg changes the size and shape of that framework. Then the skin will conform to the new architecture of the nose and show the changes.
Many factors influence the final appearance of your nose. The thickness and texture of your skin, the strength, shape, and symmetry of the nasal bones and cartilages, how your body tissues heal after surgery, and, of course, the skill of the surgeon all have an impact. For example, very thick skin can hide rather than display the changes made in the bones and cartilages to a certain extent, and for that reason it is more difficult to make changes in a nose with very thick skin. Because everyone’s tissues react differently to surgery, no surgeon can guarantee the outcome of any operation.
In some cases, especially if your nose has had previous surgery, if it has been fractured, if it requires extensive surgery, or if there has been poor healing, it is possible that a secondary procedure, performed one year after the first, may be necessary to make final adjustments in the appearance of your nose.
The nose must look natural and fit the face. The thickness of your skin, the strength of your facial features, your height, and your sex will influence what can and should be done to your nose. Dr. Denenberg discusses these factors in detail with his patients at the time of the initial consultation.
What else should I consider?
Rhinoplasty is by far and away the most complicated and difficult facial plastic surgery operation. Run away from any plastic surgeon who tells you that your nose would be "easy" to do. It is not hard on the patient, but more than any other operation it exposes the skill (or lack of skill) of the surgeon. You simply must see examples of a doctor's excellent rhinoplasties before allowing him to operate on your nose.
Above all, keep in mind that the goal is improvement, not perfection. Have realistic motivations and expectations, and be ready to accept the minor inconvenience of swelling, bruising, and minimal discomfort after the operation.
This operation is for you. Though a good result may have a pleasing effect on a spouse or friend, do not expect praise or notice from everyone. You are not doing it for them. They are not paying the fees and incurring the minor inconveniences and risks of surgery. If the results are more subtle than dramatic, other people may not even notice. Your friends might not be as observant as you are. Cosmetic surgery that is undertaken with the purpose of affecting others almost always fails to produce the desired results.
Why all the attention to the nose anyway?
The nose is the major aesthetic unit of the face, and it is right in the middle. The nose contributes to the face’s strength, its femininity or masculinity, its character.
The nose’s importance is reflected in our language. We may look down our nose at someone, or turn it up at something. Sometimes we can’t see beyond it, or we even cut it off to spite our face. We keep it to the grindstone, poke it into other people’s business, pay through it, and lead someone around by it. Someone may follow his nose, win by a nose, guess your age on the nose, rub noses with someone, or just be nosy. It’s as plain as the nose on your face. And those car keys you are looking for? They were right under your nose.
I can’t breathe out of one side of my nose.
The nasal septum is the partition or wall between the two sides of your nose. If the septum is not exactly in the middle, it may partially or totally block the airway on one or both sides of your nose. During your rhinoplasty, Dr. Denenberg will attempt to correct any deviations or obstructions present in your nasal septum to improve your breathing.
If you do not desire a change in the external appearance of your nose, but just want correction of a breathing problem, you may need an operation called a septoplasty. In this procedure only septal deviations and breathing difficulties are addressed. However, if your nose has been badly broken or if it is markedly crooked, it may not be possible to correct the airway problem alone without straightening the external nose as well.
There are also several conditions that cause nasal blockage by swelling the tissues inside the nose. In these situations the structure of the septum is not at fault, and the septoplasty may not be helpful. Your facial plastic surgeon should be able to make these determinations and counsel you on this matter.
My nose was broken.
After a fracture of the nose, it is usually best to wait several weeks before performing any surgical correction so that swelling from the injury can subside and the results of the injury can be evaluated more accurately. At that time better pre-operative photographs can be taken and an operation planned to correct a nose that has been rendered crooked, wide, or stuffed-up from the injury. Other, more refining aspects of the rhinoplasty can also be done at the same time if the patient so desires.
I’ve had a rhinoplasty before, but I don’t like how it came out.
It is almost always possible to improve the appearance of a nose after previous surgery. Dr. Denenberg will identify with you the areas that need to be changed, and he will explain what can and what cannot be done.
This operation is called a revision rhinoplasty. It is much more difficult than a first-time operation, but it is certainly a good option for someone dissatisfied with his nose after prior surgery. Rhinoplasty is, the most difficult facial plastic surgery operation. Everybody's nose is so different, and there are literally hundreds of different surgical techniques that have to be carefully selected and judiciously employed by the surgeon. It just isn't possible for every plastic surgeon to be an expert in rhinoplasty. About 30% of Dr. Denenberg's rhinoplasty operations are done to correct problems that resulted from operations performed by plastic surgeons who are not expert in rhinoplasty.
I’ve heard the doctor will break my nose, and I’m afraid.
The doctor does not break your nose. A controlled incision is made in the nasal bones, allowing them to be brought closer together to narrow or straighten the nose. Since you have been given the anesthetic at the beginning of surgery, there is no pain during the procedure.
I’m also worried about having the packing removed from my nose afterward.
Dr. Denenberg uses no packing, so, at least in his hands, there will be none to remove.
Will there be any scars from the surgery?
Most of the incisions are well hidden inside the nose and are invisible. A small incision is usually placed across the base of your nose, the part called the columella. Below you can see a picture of the scar after it has healed, and a diagram that shows the incision's location, in blue.
You can see that with conscientious care and good healing the incisions fade extremely well.
Who actually performs the surgery?
In Dr. Denenberg's office, he performs the entire operation from start to finish. Be sure you know who will be performing your operation.
Will insurance pay for the surgery?
Insurance may pay for some of the operation. Many people have difficulty breathing out of one side of the nose. Part of the operation would then be to straighten the air passageways to correct an airway obstruction, and insurance may pay for that component of the operation. Our office prepares any required forms or photographs. Dr. Denenberg is a board-certified Otolaryngologist/Head and Neck Surgeon as well as a Facial Plastic Surgeon and is well trained in surgery to correct breathing problems. Insurance usually will not cover a purely cosmetic procedure.
When will I be able to go home?
If you live out of town, you can go home the day after surgery. Flying is no problem. But remember, if you come to Omaha for surgery, Dr. Denenberg will want to see you one week later, to take off the dressing. We try very hard to minimize the time that out-of-towners need to spend in Omaha, and the number of trips they need to make.
When can I return to work or school?
You may return to school or work in as few as two days after surgery as long as your activities involve no lifting, no strenuous movement, and no long walks. Most people prefer to stay off work for one week until the splint is removed.
What kind of anesthesia is used?
Most likely your surgery will be performed under "twilight sleep" sedation. In "twilight sleep" anesthesia, you are given a medicine through your IV that makes you fall asleep. You feel nothing, and you remember nothing about the surgery. It's usually much more pleasant than having a general anesthetic.
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