Rhinoplasty, one of the most common plastic surgery procedures, is performed to reshape, reduce or augment a person’s nose

Cosmetic Rhinoplasty can be used to remove a hump, refine and sculpt the nasal tip, narrow nostril width, change the angle between the forehead and nose or nose and  mouth. Detailed consultation is important, employing computerized digital simulation of potential results, to ensure that the patient and surgeon have agreed on aesthetic goals and any limitations. Girls after age 13, and boys after age 16, have generally achieved nasal maturity. At this point they may be candidates for cosmetic rhinoplasty. As younger patients, without a rigid self-image, the degree of satisfaction from rhinoplasty tends to be very high. Especially careful consideration of aesthetic changes to the nose is required in older patients seeking Rhinoplasty.

Reconstructive Rhinoplasty is used to correct injury, birth defects, or adverse effects on nasal form and function that  arise from various diseases.

Combining rhinoplasty with septoplasty and/or turbinate reduction can effectively treat certain breathing problems, such as nasal obstruction caused by nasal fractures, a deviated septum, nasal valve collapse or turbinate hypertrophy.

Rhinoplasty is an outpatient procedure performed under either local or general anesthesia. It may be performed using either an “open” or “closed” techniquecertain changes are best achieved through one of these approaches or the other, and it is important that the surgeon be well skilled in both techniques.

An open rhinoplasty involves a tiny incision across the columella just under the tip of the nose where healing is inconspicuous. This allows improved access for very precise changes to nasal structure. Remaining incisions are hidden within the nostrils, just as with the closed approach. Regardless of the technique indicated, the underlying bone and cartilage is sculpted, and any incisions are closed with tiny absorbable sutures.

While the most significant changes will be noticeable right away, swelling is variable, and resolves over the next two weeks. Subtle changes become evident after a few months when healing is complete. Patients with realistic goals for rhinoplasty are generally very happy with the new shape of their nose. The exact results depend on the patient’s nasal bone and cartilage structure, facial shape, skin thickness and age.

Goals of Rhinoplasty
Maintain or improve nasal airway function
Balance the size of the nose with the other facial features
Modify the width of the nose at the bridge
Improve the nasal profile, including removing humps or depressions
Contour a nasal tip that is too large, “boxy,” drooping or upturned
Change the angle between the nose and the mouth
Narrow and reshape the nostrils
Correct asymmetry or deviation
The best candidates for rhinoplasty:

Are at least 13 years old;
Have finished facial growth;
Are generally healthy;
Do not smoke;
Are seeking rhinoplasty for personal reasons, not pressure from others;
Have realistic goals for the procedure.

Rhinoplasty Procedure
Rhinoplasty is usually an outpatient procedure performed under IV sedation or general anesthesia.

Dr. Butler is experienced with a wide variety of techniques for rhinoplasty in Santa Monica. In endonasal (“closed”) rhinoplasty, incisions are kept within the nostril openings. In open rhinoplasty, a cosmetic extension of those incisions is made on the column between the nostrils. After healing this is rarely visible. Each approach may be ideal in a particular patient’s case.

The underlying bone and cartilage is sculpted. Often, fine sutures and one’s natural cartilage used as strengthening grafts are used. Obstructive deviation of the septum is altered and can also provide cartilage if needed for grafting.

At the conclusion, absorbable sutures are used for repair and a specialized dressing is applied.

Most rhinoplasty procedures require one to two and a half hours.

Recovery and Results after Rhinoplasty
Length of recovery and the results achieved depend on the extent of surgery, the patient’s tissue quality, skin thickness and age.

For most patients, swelling and bruising are minimal by ten to fourteen days after surgery, though the final subtle refinements may not be apparent for six to twelve months. Dull ache addressed with medication is common but problematic bleeding, infection, or healing problems are rare. Generally patients return to work or school after one week. Contact lens use can be immediate, but eyeglasses can not be rested on the nose for seven weeks. Some intermittent morning puffiness of the nose can occur during the post-operative year. Patients with realistic goals are generally very happy with the new shape of their nose.

Risks of Rhinoplasty
Significant complications associated with rhinoplasty are rare. These may include persistent pain, bleeding, infection or anesthetic reactions. In general complications are minor and handled simply in our office.

David M Butler MD, FACS,
Board Certified Facial Plastic Surgeon, and Renowned Artist