Rhinoplasty Procedure Information

Rhinoplasty is a very common procedure. Patients often believe their chin may be too weak or their cheek structure lacking, when in fact,  thinning of the bridge or tip and even lifting the tip can soften or bring harmony to the face. Although if the chin is weaker than desired it is very common to have these two operations together. The rhinoplasty surgery is often described as only mildly painful. It has been described as feeling as if the patient has a head cold rather than having had an actual surgery. Of course, the pain threshold of each patient varies as does the healing time. 

What is Rhinoplasty?
Rhinoplasty is the surgery of the nose to either thin, turn up, augment, shorten, elongate or otherwise bring balance to the face through its alteration. It is also known as a "nose job" and may include  It also and more than likely will include Tiplasty to refine and define the tip of the nose as well. 

Tiplasty is normally the surgery of the nose involving only the cartilages of the nose. Septoplasty, to restore or otherwise introduce functionality as far as ease of breathing to the individual. All three of these can be performed together, but for cosmetic reasons only many patients seek the full rhinoplasty which include the alteration of the bone and cartilage of the nose and not the septoplasty.

Are you a Candidate For Rhinoplasty?
If you are in great physical and emotional health as well as have reasonable expectations, elastic skin and no previous existing medical conditions or bone disorders, are not or have not been on Accutane® for the last 6 months (it causes keloid like scar formation (especially transdermal incisions) and although rare, can cause excessive facial bone growth) you may be a good candidate for Rhinoplasty. Only a qualified plastic surgeon can determine this after speaking to you as well as going over your medical history, examining your facial structure and skin. You must realize that no doctor can perform miracles but a highly skilled surgeon can transform what you do have into a more balanced look altogether.

Rhinoplasty For The Ethnic Nose
The goal should be to perform a rhinoplasty that results in a nose that fits the patient's individual face - not a cookie-cutter type nose. Your facial features should delegate the dimensions of your nose so that a certain 'harmony' can be attained throughout.

Asian Rhinoplasty
Rhinoplasty is intended to add softness and harmony of the face or even functionality to any face, regardless of one's race.  For instance, enhanced projection of the nose can be achieved by a small silicone implant placed through a small incision in the nose.

This implant augments the dorsum (the bridge) of the nose while leaving the tip of the nose the same. Of course, care must be taken to achieve a natural transition from implant to bone. With subtle differences like this the projection of the nose is enhanced without changing the overall ethnicity of the face.

Some individuals may desire to thin out the naturally wide Asian nose with rhinoplasty. This can be done through the use of infractures (where the nasal bones are broken and moved in or reset) to thin out the nasal area and add projection in the process. Outfractures are when the nasal bones are broken and moved outwards.

If it is narrowing of the naturally wide nostrils you desire this can be done by either excising sections from the floor of the nose or at the crease where the side of the nose meets the face. If you would like restructuring and definition in the tip of the nose this can be done by removing key sections of cartilage with scissors or a scalpel.

There really is not difference because of the racial parameters. Although a doctor should make sure that the end result will not look unnatural and out of place. It is more of the way the nose is structured and the possibility of keloid scarring (where excessive scar tissue branches out further than the actual wound) or hypo- (lack of) and hyper- (too much) pigmentation is a little higher is the more ethnic individuals but other than that if a Caucasian individual were to have a flatter, less prominent and wider nose, he or she would need the same type of surgery. Bottom line is the rhinoplasty surgery should be based upon the individual structure of each and every patient's nose and surrounding facial structure - not just because they are of a different race.

African American Rhinoplasty
Rhinoplasty is intended to add softness and harmony of the face or even functionality to any face, regardless of one's race.  For instance, enhanced projection of the African American nose can be achieved by infractures as well.  With subtle differences like this the projection of the nose is enhanced without changing the overall ethnicity of the face. Infractures thin out naturally wide nasal areas and add projection in the process. If this is not adequate implants can be used. Nasal bones are broken (which they are meticulously fractured) and reset as well - It is not as difficult to recover from as it sounds. If a hump is present, an osteotomy (where bone is divided or removed) cab be performed; the dorsal hump can be rasped (filed down).

If it is narrowing of naturally wide nostrils,  this can be done by either excising sections from the alar base (floor of the nose) or at the crease where the side of the nose meets the face. If you would like restructuring and definition in the tip of the nose this can be done by removing key sections of cartilage with scissors or a scalpel.

There really is no difference because of the racial parameters. Although a doctor should ascertain that the end result will not look unnatural and out of place. It is more of the way the nose is structured and the possibility of keloid scarring (where excessive scar tissue branches out further than the actual wound) or hypo- (lack of) and hyper- (too much) pigmentation is a little higher is the more ethnic individuals but other than that if a Caucasian individual were to have a flatter, less prominent and wider nose, he or she would need the same type of surgery. Bottom line is the rhinoplasty surgery should be based upon the individual structure of each and every patient's nose and surrounding facial structure -- not just because they are of a different race.

What Is Septoplasty?
Septoplasty is the surgery of the nose to correct a deviated (crooked) septum. The nasal septum, by definition, 

nasal septum (noun)
: the bony and cartilaginous partition between the nasal passages 

The nasal septum usually is centered directly in the middle of the nose and divides the 2 nasal passages. The septum rests on the maxillary crest (see diagrams). There are several layers to the septum - a bony "base" which lies mire towards the back of the septum, cartilage which covers this bony ridge and   makes up the anterior portion of the septum and mucosa which covers al of this.

Septoplasty address breathing problems, blockages, and other complaints by straightening the septum through surgery. Of course no one has a perfectly straight septum but those of whom have a more crooked septum experience such problems. 

What Is Turbinectomy?
This surgery is also for nasal obstruction and difficulty breathing - usually from redundant mucosa overlying the Turbinate (conchae) structure:*You will more than likely need our Online Rhinoplasty Glossary to translate the terminology used.This section will load in a new, smaller window for your convenience. You may want to keep it open to ease of reference.

  • Turbinectomy (Conchotomy, Turbinotomy):The use of turbinate scissors, cutting forceps and sometimes even CO2 or Electro cautery devices for turbinate mucosa evaporation is used.

  • Turbinoplasty:The removal of turbinate bone structure when there is excess present.  When the lateral part of the inferior (see diagram) turbinate bone and its overlying mucosa needs to be removed this is done by Turbinoplasty.  After the lateral section is removed, the medial section is usually "rolled" or "draped" over any bare bone that may be present. 

  • Inferior Turbinate Sub-mucosa Removal: Sub-mucosa resection can be performed using an Nd: YAG:

Submucous resection is performed on an anatomically deviated, obstructing inferior turbinate, or if obstructing hypertrophic mucosa is unresponsive to vigorous medical management.
As an isolated operation, submucous resection of the inferior turbinate is usually done under local anesthesia. Anesthesia and vasoconstriction is then achieved as in septoplasty. If general anesthesia is used, the technique is the same to achieve maximal vasoconstriction.
After vasoconstriction and anesthesia is achieved, an incision is made with a No. 12 Bard-Parker blade from posterior to anterior along the inferior edge of the inferior turbinate continuing up the anterior aspect of the turbinate. Using a Freer or Cottle elevator, the mucoperiosteum is elevated off the medial and lateral aspects of the turbinate bone. The inferior turbinate bone is fractured and removed subperiosteally with a Takahashi forceps or Jansen-Middleton rongeur, carefully preserving the mucoperiosteal flaps. Excessive mucosa can be judiciously trimmed from the inferior portions of the mucoperiosteal flaps, especially the lateral one. The remaining mucoperiosteum is reflected laterally over the bare bone of the inferior turbinate remnant and packed in place with Vaseline/antibiotic gauze for 4 to 6 days.
Alternate methods of dealing with hypertrophic inferior turbinate mucosa include cryotherapy, linear submucosal central or inferior external electrodessication, or laser debulking. These methods, while simpler, are often less precise and produce additional bleeding and crusting during the healing period. Simple excision of the inferior turbinates, once advocated, often produces severe ozena and nasal dysfunction. Outfracture of the inferior turbinates can be useful for anatomical bony deviations but is not helpful for mucosal hypertrophy of dependent congestion.


Packing IS usually used in Septoplasty and Turbinectomy so be prepared. Expect also, major crusting that can last for up to 3 weeks. Also, dryness, cracking, bleeding and headache can be symptomatic post-turbinectomy. Just be prepared if depression or disorientation sets in as it has been reported that the disruption of the turbinates or consequently the air temperature and humidity can cause the above complaints.

Understanding The Structure Of The Nose
To understand how the appearance of the nose is changed from within or to alleviate functionality problems, one must understand how the external nose is supported and what must be done to the underlying nasal structure in order to achieve these desires and goals. One must also realize that changing one thing can, in turn, change another or at least affect it in some way. This must always be taken into account so it is very important to find a highly skilled surgeon to carry out your surgery. To learn about the anatomy of the nose and face please see our Nasal Anatomy section.

Is There an Ideal Nose?
Although symmetry is considered  beautiful in nature and in engineering. A human being has character and sometimes a little flaw adds a lot to a person's face. For information on facial symmetry formulas and general nasal proportions please see our Is There An Ideal Nose? section.

Nasal Augmentation
For information regarding nasal augmentation - either for congenital deformity cases or simply cosmetic - please see our Nasal Augmentation Section.

References:
 Yale Rhinoplasty Core Curriculum - Yale Medical University
Refinement of the Nasal Tip -Dept. of Otolaryngology, UTMB, Grand Rounds  
Avoidance & Treatment of Rhinoplasty Complications Dept. of Otolaryngology, UTMB, Grand Rounds
Ellenbogen, R - What To Do If You Have a Bad Nose job - article 1999
 (Gray's Anatomy - Henry Gray -1865)
Merriam-Webster Medical Dictionary
Graylab Online Medical Dictionary - UK
Diagrams, anatomy text, Anatomy of the Human Body, Henry Gray (1821–1865)
Online Version of Anatomy of the Human Body - Bartleby.com 
Verbal and Online Interviews/Questions with:

  • Richard Ellenbogen, M.D.

  • James J. Romano, M.D.

University of Iowa Family Practice Handbook, 3rd Edition, Chapter 19; 
Otolaryngology: Nose; Mark A. Graber, M.D. and Laura Beaty, M.D.

Illustrated Encyclopedia of Human Anatomic Variations:

  • Ronald A. Bergman, PhD
    Department of Anatomy and Cell Biology
    University of Iowa
    Iowa City, Iowa, USA

  • Adel K. Afifi, MD, MS
    Departments of Pediatrics, Anatomy and Cell Biology, and Neurology
    University of Iowa
    Iowa City, Iowa, USA
  • Ryosuke Miyauchi, MD
    Department of Anatomy
    Fukuoka University
    Fukuoka, Japan

Olfactory Disorders, Dept. of Otolaryngology, UTMB, Grand Rounds; November 17, 1993:

  • Kelly Sweeny, M.D.
  • Karen H. Calhoun, M.D.
  • Melinda McCracken, M.S.