Rhinoplasty surgery or a “nose job” is a procedure performed to enhance the shape of the nose. Dr. Bray, Jr. will perform a complete analysis of the nose and how it relates to the face and the entire person before performing a rhinoplasty. It is important to look at the relationship of the nose with the eyes, chin, and face. The patient’s height, ethnicity, personality, and career are also important factors. For example, television personalities often request a slightly more narrow nose due to the improved appearance of the nose on TV.
The external nasal exam will include evaluation of the radix, nasal dorsum, nasal tip, and nasal ala. Dr. Bray Jr. will evaluate any asymmetries or contour irregularities. He will then perform an internal nasal exam to assess the septum and nasal airway. Based on this thorough exam Dr. Bray, Jr. will establish the potential adjustments that can be made to improve the shape of the nose. Ultimately, Dr. Bray, Jr. will balance the science of rhinoplasty with the art of rhinoplasty in order to create the best possible nose for the patient.
Reasons for Surgery
Most patients seeking a rhinoplasty, also known as a “nose job”, present with a concern about the size or shape of their nose. This may be the result of trauma or may be natural. The goal in these primary cases is to provide the patient with improved size and shape while maintaining the nasal airway. Dr. Bray Jr. will carefully analyze the nose and based on the patients anatomy determine an operative plan.
Nasal airway obstruction is another reason patients seek nasal surgery. Dr. Bray Jr. evaluates many patients with problems breathing through their nose. This may be done at the same time as rhinoplasty, and nasal airway surgery is usually covered by insurance. Nasal airway problems may be caused by medical conditions such as allergies. If a medical cause is the problem, Dr. Bray Jr. will treat the problem with the proper medication. In many cases, the nasal airway problem is the result of an anatomic deformity. This may be a deviated septum, enlarged inferior turbinates, collapse of the internal nasal valve, or collapse of the external nasal valve. The reason for these anatomic deformities may be congenital, traumatic, or the result of prior rhinoplasty. The surgical treatment for these problems include septoplasty, inferior turbinate reduction, spreader graft placement to support the internal nasal valve, and graft placement to support the external nasal valve. Dr. Bray Jr. has performed many of these procedures and has presented his experience treating the internal nasal valve to other surgeons around the nation.
Previous rhinoplasty/nose job is another reason patient’s may present for nasal correction. Dr. Bray Jr. sees many patients who have had prior rhinoplasty and are not satisfied with the shape of their nose or their nasal breathing. Patient’s should wait at least one year before considering secondary rhinoplasty.
Nasal Bump: Many rhinoplasty patients present to Dr. Bray, Jr. with concern about a bump on the dorsum of the nose. The nasal bump or dorsal hump is caused by both bone and cartilage. When reducing the dorsal hump it is important that the nasal airway is preserved. This may be accomplished by protecting the upper lateral cartilages of the nose while reducing the dorsal hump. In some cases spreader grafts made from septal cartilage may be placed to protect the nasal airway during dorsal reduction rhinoplasty. After reducing the bone, osteotomies may be required to move the nasal bones closer together. After dorsal reduction the goal is to have a nice smooth contour of the nasal dorsum.
Bulbous Tip: The wide or bulbous tip is caused by large wide lower lateral cartilages of the nose. In order to correct this problem, Dr. Bray Jr. will modify the nasal tip cartilages. In some cases he will remove a small amount of excess cartilage. In most cases he will use sutures to shape the nasal tip cartilages. A cartilage graft may also be used in select cases during this type of rhinoplasty.
Wide Nose: Patients concerned with a wide nose tend to have wide nostrils. The width of the nostrils should be equal to the width between the eyes. If the nose is wider than the intercanthal distance then a rhinoplasty with reduction of the nostril width may be indicated. This procedure involves removing some of the nostril in order to narrow the nose.
Underprojected Nose: Some patients are concerned because the tip of their nose does not project out far enough. In many of these patient’s the tip of the nose also seems to droop down. Rhinoplasty for these patients requires cartilage grafts to add projection to the nose. This may be accomplished with a columellar strut, tip graft, and tip suturing. The amount of added projection must be carefully determined by preoperative nasal analysis.
Twisted Nose: Many patients have some twisting of the nose. This twisting is usually accompanied by a deviated nasal septum. The twisting may be congenital or from trauma. In most cases the nasal septum must be corrected to fix the twisted nose. The nasal bones must also be addressed during rhinoplasty. This usually entails osteotomies to allow repositioning of the nasal bones. Spreader grafts along the dorsal nasal septum may also be helpful.
A medical history along with a careful examination is conducted in order to evaluate your general health prior to rhinoplasty. We will discuss with you the way your nose can look in relation to your other facial features. Digital photographs and computer imaging allow Dr. Bray to evaluate the appropriate procedure to achieve the desired results. Pre-operative instructions may include the elimination of certain drugs that contain aspirin in order to minimize the possibility of excess bleeding during rhinoplasty. Antibiotics may be prescribed before surgery to prevent infection.
Method of Surgery
In most cases involving a reduction in shape or size of the nose, angle or removal of a hump, the skin of the nose is separated from the underlying skeleton of bone and cartilage. The bone and cartilage are then reshaped and the skin re-draped over the surface. Patients who have a deviated septum may benefit by correction of this problem. The incisions are placed inside the nose, unless the surgeon uses an open approach, in which case the incisions are made across the tissue between the nostrils. In cases where the nostrils flare, the surgeon may make an incision at the junction between the nose and the skin of the upper lip to narrow the flared appearance. It is not unusual to combine rhinoplasty with chin augmentation to improve the profile.
The recovery from rhinoplasty takes one to two weeks. Most people resume their normal activities within a week or two. Following surgery, a lightweight splint is applied to maintain the new shape of the nose. The splint is removed within a week. Nasal splints may be inserted at the time of surgery to protect the septum. These are removed within a week. There is always some stuffiness of the nose, especially when work has been done on the nasal septum.