SAUL R. BERGER   M.D.
818.990.4545
PLASTIC, COSMETIC AND RECONSTRUCTIVE SURGERY
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Introduction to Rhinoplasty: Part 1

September 2017

Rhinoplasty refers to surgery of the nose intended to change its appearance or structure, and is commonly used interchangeably with the term “nose job.”  There are different plastic surgery techniques that have been developed for use in rhinoplasty, and each procedure is, ideally, customized for a patient’s specific needs or goals.  People considering rhinoplasty usually wish to change specific features of the nose, such as size or shape in order to make it more attractive, although they may also have breathing issues that need to be corrected as well.  Although your plastic surgeon will analyze your own situation and create a surgical plan that is best for you, it is helpful that you identify exactly what aspects of your nose you would like to improve before your consultation so that your surgeon understands your goals clearly.

 

Simplifying it, there are only several types of adjustments in rhinoplasty that can be used to achieve results.  First, one can reduce parts of the nose by “shaving” down or removing, such as reducing bone or cartilage that causes the appearance of a large bump.  Second, one can re-shape what is already there, such as narrowing a very wide or unattractive tip.  Third, one can add more to the nose, such as when the tip needs to be enhanced because it is not well positioned.  In this third category, there are options of adding tissue from the patient’s own body, tissue that has been obtained from a donor, or completely synthetic material manufactured specifically for implanting in the body.

 

Some people seeking a “nose job” do so primarily for reasons of breathing problems, and they may have what is referred to as a “deviated septum.”  The septum is basically the dividing “wall” of tissue that separates the left and right sides of the nasal passage inside the nostrils.  Usually the septum is a solid structure made of cartilage and tissue, but it may be weakened or have holes in it because of injury, surgery or cocaine abuse.  Surgery of the septum, or “septoplasty,” is a procedure that helps correct any bends or abnormalities in the septum that block the airway and create difficulty breathing.  This may have no effect on the appearance of the nose, or could improve appearance by straightening the profile or creating other cosmetic changes.  While it is possible for patients to have their health insurance cover a septoplasty for breathing issues, the insurance companies do not provide coverage for cosmetic alterations of the nose.

 

I am often asked about the incisions used for rhinoplasty, as they are not always visible or obvious to many people.  Plastic surgeons think about rhinoplasty incisions in two general categories.  The “closed” rhinoplasty places incisions inside the nose and out of any significant visibility.  The “open” rhinoplasty places an incision in the skin located between the nostrils which, if done properly, should have minimal or no visibility.  For the surgeons who advocate an open approach, the rationale is that the use of the incision allows better access and visualization to make the necessary changes and improvements.  Surgeons may have a preference as to which approach they prefer, and this is something that should be discussed as part of the consultation.

 

In the next article, we will review the process of the consultation and more details about the operation and healing process.