Nose Surgery

Rhinoplasty is a plastic surgery operation designed to improve the appearance of the nose. Breathing and sinus function can also be improved using nasal plastic surgery. The term rhinoplasty means to mold or shape the nose. Dr. Guerra is a skilled and experienced nasal plastic surgeon. Each nasal plastic surgery procedure is individualized to accomplish the goals set forth by the patient and physician. A rhinoplasty can include a full rhinoplasty, open rhinoplasty, closed rhinoplasty, reduction rhinoplasty and/or tip rhinoplasty.

A nose is tailored to fit as best as possible with your face. A truly beautiful nose is in harmony with the rest of your face. This may require nasal plastic surgery to reduce or enhance the size and shape of the nose, including the width of the bony base, tip and nostrils. Nasal plastic surgery can correct birth defects or injury and help relieve some breathing problems. The exact appearance of the nose cannot be determined before surgery.

Some of the reasons that you may be a good candidate for rhinoplasty include:

Rhinoplasty to reduce a nose that appears too large for your face.
Rhinoplasty to remove a bump on your nose.
Rhinoplasty to reduce a nose that appears too wide on front view.
Rhinoplasty for a nasal tip that droops or plunges.
Rhinoplasty to reduce a nasal tip that is thickened or enlarged.
Rhinoplasty to reduce excessively wide nostrils.
Rhinoplasty to straighten a nose that is off-center or crooked.
Rhinoplasty to improve an injured nose.
Rhinoplasty to improve anatomic nasal blockages and breathing.

Analysis and Planning

The goal of surgery is to achieve a natural-looking nose as opposed to one that appears operated upon. Each nose is shaped to fit in with the distinctive features of the patient’s face. The shape of the nose should be improved, and importantly, the appearance of the entire face should be enhanced. Medical grade photographs will be takens to be analyzed in planning for surgery and to define the unique characteristics of your nose and face. Dr. Guerra will discuss the steps involved in your individualized rhinoplasty with you. This discussion includes a disclosure of risks, benefits, imponderables and expected outcomes after surgery. When both parties agree on the operative plan, we will schedule surgery.

Surgery Protocol

Patients usually come to the outpatient surgery center or hospital the morning of surgery. Immediately before surgery, medications are given to promote healing and to keep swelling and discoloration to a minimum. Following surgery, the average patient is able to be discharged to an appropriate recovery facility. We encourage patients traveling from far away to stay nearby for three to seven days following surgery. We generally prefer general anesthesia in which the patient receives sleeping medications supplemented by local anesthetics to fully relax them. In most cases, the length of time required to perform the operation is 1 to 3 hours. Additional time is required to properly prepare the patient and for a recovery room stay.

The surgical procedure is done through incisions inside and/or under the nose. In general, scars are not visible. When work on the nasal tip is necessary, as in revision surgery, it is frequently helpful to expose the cartilages of the nose and repair them directly. Modern concepts in rhinoplasty include building up the nose to achieve an aesthetically pleasing form, rather than just breaking the bones and removing tissue. With my technique, we reposition the nasal bones after incising and releasing their attachment, I do not actually break the bones, eliminating a lot of the discomfort, bruising, swelling and anxiety. We feel this technique allows for better control of the operation and makes recovery easier for most patients.

Importantly, we individualize the procedure for each patient. To accomplish this goal, a clear and accurate diagnosis of the nasal deformity is carried out preoperatively. At the completion of surgery, soft silicone splints are placed inside the nose. Another splint is used to stabilize the new shape of your nose and is applied on top. A moustache dressing is applied to obstruct the nostrils, but we do not ordinarily pack the nose after surgery. With the elimination of nasal packing, discomfort, swelling, bleeding and discoloration are dramatically reduced making patients much more comfortable. With my procedure, the special technique of suturing the internal nasal tissues back in place eliminates the necessity of packing. This technique is another advantage offered by our practice, which makes recovery smoother and reduces much of the undesirable postoperative discomfort.

Timing

We perform corrective nasal surgery on people from all walks of life, including the very young and those more advanced in age. While extensive corrective nasal surgery is not recommended in children prior to puberty, if a severe breathing problem is present, it should be corrected. All final corrections are deferred until after puberty and parents should expect the child to require additional surgery to obtain the best cosmetic result. The nose has growth centers and does not mature until puberty. Girls mature enough by 15 years and boys at age 18 can have surgical correction of the nose. We often find it necessary to individualize the age factor because some boys and girls mature earlier. We prefer to see young men and women whenever they become interested in having nasal reshaping, even though surgical correction may be delayed until maturation is complete. Early correction of unwanted nasal deformities can give young people more self-confidence and improved self-image. Parental involvement in a child’s treatment is highly encouraged.

Nasal fractures

Fractures or dislocations of nasal bones and cartilage can occur when the nose is injured. Minor trauma has been known to damage growth centers, producing a crooked nose as the individual develops. With most injuries, considerable swelling is present, and bone and cartilage dislocations and fractures are difficult to diagnose. X-rays do not help to identify fractured cartilage and are usually not helpful in identifying nasal bone fractures. Fortunately, most nasal fractures usually do not require emergency surgery and can be treated within 6 weeks of the event. As swelling subsides, the nose may appear crooked and obstruction of breathing may persist. These conditions are often the result of fractured or dislocated bones and cartilages. In each individual case, specific recommendations depending on the existing circumstances and conditions are made. In some cases, desired changes in the external appearance of the nose can be made while correcting fracture damage.

Nasal Blockage Surgery

The deviated nasal septum is one of the most common causes of breathing difficulties. The septum is a bone and cartilage structure that divides the inside of the nose into two halves. When it becomes dislocated or leans to one side, the septum can block air flow through the nose. We will evaluate the inside of the nose in an attempt to improve the airway. When corrective surgery can improve breathing, we will recommend this procedure. Surgery can straighten and remove any offending portions of the septum, this typically improves breathing; however, the membranes lining the inside of the nose can become swollen after surgery. Patients with a history of breathing problems will generally have varying amounts of nasal blockages for several weeks following surgery. Breathing improves when all swelling resolves. After surgery, increased mucous production is a contributing factor and antihistamines/decongestants can relieve most symptoms.

The membranes lining the nasal septum can be affected by certain conditions that are not corrected by surgery. However, in patients with a deviated septum and one or more of the conditions listed below, correction of the septum frequently makes it easier to tolerate membrane swelling. We might recommend that patients see an allergist for any of the following medical conditions:

Seasonal allergies.
Changes in temperature or environmental factors.
Viral infections, such as the common cold.
Bacterial infections.
Emotional disturbances.
Abuse of nasal sprays.
Exposure to smoke and other irritants.

Nasal Blockage and the Aging Nose

As patients age, they frequently experience breathing difficulties. As we reviewed above, with increasing age, the nose begins to droop which alters the optimal angle of breathing. Additionally, as the nose progressively drops, breathing difficulties can worsen. Other deformities on the inside of the nose can develop, which further impair breathing. Patients can experience headaches and other sinus symptoms. These problems usually cannot be treated adequately with medications. However, nasal surgery can simultaneously straighten the external nose and repair any internal blockages.

The Aging Nose

A large proportion of our patients seek our help to deal with nasal disfigurement that occurs as a natural result of aging. The nose tends to droop and appears longer and less attractive over time. Many older patients explain how they disliked their nose for some time. Age is not a reason to avoid having corrective nasal reshaping, as long as the patient is in good health. A longer, drooping nose is a telltale sign of aging, and lifting the drooping tip of the nose is performed to give a more youthful appearance. Nasal reshaping in more mature individuals is often performed at the same time as other facial rejuvenation procedures to improve many of the undesirable signs of aging.