Rhinoplasty is a very complicated operation and difficult to do well. It takes a lot of knowledge of the nasal anatomy and experience in sculpting the nose to achieve a pleasing outcome. When it is done well, the new shape of the nose will subtly transform the face.
There is a lot of debate about the two different techniques of rhinoplasty: an open or closed technique. The only difference between the two techniques is the incision made on the columella, which is under the tip of the nose that separates the two nostril openings. The debate among plastic surgeons has been around for a long time. Because the anatomy of the nose is complicated and the amount of precise work that is needed to achieve a great outcome is crucial, I only use the open technique. Why? Because the scar on the columella, when it is done right, never is a visual problem. (The incision on the columella only becomes a problem when the scar is very noticeable or scarring is irregular. Both could distort the nose. So, why would these things happen? The answer is pretty simple. Sloppiness and a lack of knowledge of the anatomy of the surgeon.)
My approach to rhinoplasty is to change the parts of the nose that are not aesthetic and harmonize them with the parts of your nose that have high aesthetic value. I go over the shape and the anatomy of the nose in detail. We will discuss what we like and don’t like. I will examine the nasal septum to see if there is any deviation. Then, I will explain what changes I would like to make to your nasal shape and nasal septum (if needed); this should be in line with what you are thinking and perhaps much more detailed. I will explain the design of the open technique and how I will correct each part of your nose.
A septoplasty may be needed for two reasons. The first reason is for a deviated septum and improve breathing through your nose. Another reason to perform a septoplasty is to use the septal cartilage for the rhinoplasty. Some people do not have the proper cartilage support of the nasal tip, and septal cartilage is the ideal material to use for shaping the nasal tip.
Sometimes, a nasal implant will dramatically improve the flat dorsal shape of a nose. Choosing the right implant shape and size is critical to the proper outcome and an improved natural aesthetic appearance of your nose. Otherwise, you may have significant problems with your nose looking strange and not natural in appearance.
Once the operation is over, an external nasal splint is applied over steri-strip tape. An internal nasal packing or splint is placed if a septoplasty is performed. The nasal packing can be removed after a couple of days. The external nasal splint is removed after one week.
The shape of the nose is apparent after the splint is removed. It takes about 2 weeks for the bruising around the eyes to disappear. After one month, most of the swelling will be gone, and you will have a better sense of how the shape of the nose will be. However, it will take 6 to 8 months for the final and more subtle changes to occur.
I have many, many years of experience with rhinoplasty and revision rhinoplasty. That is why I favor the open technique because I have so much more control during the operation to do meticulous and precise work. Again, expectations of a person have to be in line with what is possible. Trying to do too much, as we all know of Michael Jackson, could be disastrous. That is why I will always strive to create The Natural Look.
The shape of your nose can also be improved with hyaluronic acid fillers or Radiesse. With the longer lasting hyaluronic acid, Voluma, the improvement should last longer than a year. With Juvederm, Restylane and Radiesse, the product may last a couple of months to 8 months but usually not more than one year. The injection of hyaluronic acid or Radiesse has to be done with meticulous care in order to avoid damaging the blood supply to your nose. This is easily done with proper knowledge of the anatomy.