Rhinoplasty (Nose Jobs)
Rhinoplasty is performed to improve the function and appearance of your nose. Your nose is the single most important factor in your overall facial aesthetics. Its central location, coupled with its inherent curvy elegance, makes nasal aesthetics a critical component of how your face appears. Because of this, cosmetic alteration of the nose, known as “Rhinoplasty”, is one of our more common facial procedures. Alteration of nasal shape and structure is a technically challenging procedure requiring a complete understanding of nasal anatomy, nasal physiology, and a comprehensive understanding of facial artistry and aesthetics.
“Without question, Rhinoplasty offers some of the most transformational results available in facial cosmetic surgery”, says Dr. Durkin.
The human nose is a remarkable structure that serves both a cosmetic and functional role. Functionally, the nose serves as a primary airway, allowing for oxygenation (breathing oxygen in), and ventilation (breathing carbon dioxide out). The functionality of the nose is largely defined by its structure, which is incredibly complex. This functionality must be respected and understood by both you and your plastic surgeon prior to surgery, as a beautiful but non-functional nose is not a desired endpoint for either of us. In other words, each individual procedure must strike a balance between beauty and function to be truly spectacular.
Firstly, the structure of your nose is defined in a number of different ways. Your nose is divided into three different vaults:
- Upper Vault/Bony Vault
- Middle Vault
- Lower Vault/Nasal Tip
As shown in the photograph, the vertical division corresponds as well to the support structures present in the nose. The upper 1/3 is almost exclusively bone internally, surrounded by a thin layer of subcutaneous fat and skin. The middle 1/3, or middle vault, shows a transition from the bony structure of the nose into a complex cartilaginous structure. The lower vault, or nasal tip, is composed of cartilage only, covered by nasal skin and a thin layer of subcutaneous fat.
Secondly, the cartilage structure of you nose is crucial towards both functionality and appearance of your nose, especially in the lower vault, or nasal tip. There are three cartilage components to the nose:
- Septal cartilage
- Upper lateral cartilages
- Lower Lateral cartilages
Furthermore, the shape and aesthetics of your nose are primarily defined by the size, position, and orientation of the nasal bones and the cartilaginous structures of the nose. As such, any rhinoplasty procedure must be designed to improve positioning of the nasal bones and cartilages without removing their ability to support the nose. Maintaining support of the nose is absolutely critical to success in rhinoplasty. A balance during surgery must be struck between nasal beauty and nasal structure/support to create a beautiful and functional nose.
Lastly, your nose is evaluated by a number of fixed points and angles as shown in the figure below. There are three angles of critical importance: 1) Nasofacial angle, 2) Nasofrontal angle, and 3) the Nasolabial angle. As shown in the figure below, the size of each angle, and their relationships to each other define the overall aesthetic of the nose. During a rhinoplasty procedure, Dr. Durkin will strive to create as an ideal set of angles possible for your best possible result without compromising nasal function.
The last crucial analytic step in nasal analysis is how the nose relates to the face as a whole. The nose must be harmonious with the overall facial structure, especially from a profile standpoint. As such, the nasocervical angle, as shown below, must be evaluated and managed. Rhinoplasty will almost always impact the overall profile of the face, and its success can be minimized with an underprojected chin. Because of this, an evaluation of the profile of the face must be undertaken during rhinoplasty analysis. It is very common to combine chin implantation with rhinoplasty in the context of an underprojected chin.
Ocean Drive® Rhinoplasty
We believe in creating beauty by supporting the nasal structure rather than removing it or resecting it. With the exception of prominent nasal bumps, we try to create a more ideal and pleasing nose by adding to its support structure rather than by removing it. This does not mean that we seek to increase the size of people’s noses. Quite the contrary, we seek to refine and improve your nose by repairing the natural anatomy present in every nose rather than removing it. We do not believe in resectional approaches to the upper and lower lateral cartilages. Moreover, we believe in re-positioning these critical structures into their ideal positions, and then reinforcing their new position with support techniques, such as cartilage grafting, allograft cartilage grafting, and suture techniques. The only time that we stress a resectional approach is when patients present with large nasal humps. In these cases, we will resect the excess cartilage and bone present in the dorsum of the nose. However, in dealing with the middle and lower vaults of the nose, we are very conservative with resectional techniques, and we always attempt to improve nasal support rather than remove it. Read more about Dr. Durkin and his credentials.
Is Rhinoplasty Painful?
The procedure itself is undertaken under a light sedation anesthesia, and patients have zero memory of the surgery itself, and zero discomfort. After surgery, patients will have more swelling and pressure than pain and discomfort. All patients are given pain medications following rhinoplasty, but most patients do not require the use of them. Pain is not a common complaint following this procedure.
This depends on the magnitude of correction that is undertaken. Patients have minimal or no bruising if there is no need for nasal bone repositioning. However, if the nasal bone has to be moved, patients can expect bruising in the lower eyelids for 5-8 days following surgery. Swelling to the nasal soft tissue can last up to 6 months, but the overwhelming majority of our patients look and feel good at 1-2 weeks. Your final result from Rhinoplasty surgery is seen 1 year following the procedure.
Does Insurance Cover Cosmetic Rhinoplasty?
The short answer is no. Insurance providers can often fund a septoplasty procedure, which is designed to improve nasal airflow by removing a malpositioned piece of septal cartilage, but they will not pay for a cosmetic rhinoplasty procedure. We do not file Rhinoplasty to insurance carriers for coverage.
What is the Recovery Like?
When you wake up from surgery, you will have a dressing on the outside of your nose. This dressing is removed on day 7 after surgery. Sutures are removed day 7-9 depending on how the skin is healing. Patients are able to shower the day following surgery, and can start light exercise at 48 hours following surgery. Swelling to the nasal soft tissue can last up to 6 months, but the overwhelming majority of our patients look and feel good at 1-2 weeks. Your final result from Rhinoplasty surgery is seen 1 year following the procedure.
When can I return to work/school/fly home?
Patients most commonly return to work or school the day following suture removal, usually day 7-9. For patients who fly in for surgery, we request that you stay in the area for nine days postoperatively. We can accommodate for patients who want to fly out earlier, but require that we directly communicate with your physician at home to ensure appropriate timing of suture removal.
Where is my Surgery Actually Done?
Our beachside practice boasts an on-site, state certified operating room and recovery area, located conveniently in the Oakpoint Professional Building on A1a in Vero Beach. Our operating room is dedicated to aesthetic surgery only, and it only serves Ocean Drive Plastic Surgery patients. All employees at Ocean Drive Plastic Surgery are employed full time, and are covered by the strictest levels of privacy, HIPAA compliance, and provide the finest customer service possible.
For our friends to the north, ask about our Brevard county location at 833 E. New Haven Ave., Melbourne, FL 32901.
Can I go Home Right After my rhinoplasty?
Absolutely. Most patients are discharged to home in the company of their loved ones 1-2 hours following the procedure. Patients are given their postoperative appointment schedules prior to surgery, and all medications are filled on premises prior to surgery. This allows patients to minimize their errands and responsibilities following their procedure, and ensures that their medications are correctly distributed?
What kind of Anesthesia is used for Rhinoplasty?
Because our surgery center only provides cosmetic surgery, we have refined and created our own deep twilight anesthetic technique at Ocean Drive Plastic Surgery. The technique is more similar to a colonoscopy type anesthetic than a formal surgical anesthetic. Most patients receive rhinoplasty without a formal general anesthetic. Surgery is most often performed without any endotracheal tube placement, and the use of anesthetic gas, paralytics, and high dose narcotics is minimized. You can read more about our process for safe anesthesia.