Rhinoplasty (Nose Surgery) in Boston
What is Rhinoplasty?
Rhinoplasty is a surgery that is performed to change the appearance of the nose. It is also known as cosmetic nasal surgery, or a “nose job”. The patient may also have breathing problems, because of a deviated septum or narrowing of the nasal passages, and would like that corrected as well. Rhinoplasty can therefore be performed solely for cosmetic purposes or to also improve function. Ultimately, the goals are to make the nose look better in terms of overall facial harmony while maintaining (and even improving) functionality of the nose. Experience, talent, and artistic judgement are important characteristics for a rhinoplasty surgeon. In addition, excellent communication between the patient and surgeon, in terms of realistic expectations, is critical.
Types of Rhinoplasty?
Rhinoplasty is often described as either “open” or “closed.” These terms refer to the type of approach that is used to start the rhinoplasty. The only difference between the two is a small incision on the skin between the nostril openings that is done in an open rhinoplasty procedure. This incision is barely visible if not impossible to see after surgery. Surgeon’s preference most often determines the choice between and open and closed rhinoplasty. It is generally accepted that open rhinoplasty allows for a clearer view of the nose structures in their native positions and for more precise placement of incisions, stitches and grafts. Open rhinoplasty is far more commonly performed for primary (first time) rhinoplasty and almost always for revision surgery. Dr. Ahn primarily uses the open approach.
What is Done During a Rhinoplasty?
During rhinoplasty consultations, Dr. Ahn is often asked, “Exactly what are you going to do to make my nose look the way I want it to look?” He answers that most experienced rhinoplasty surgeons have a “toolbox” of maneuvers. Depending on what is needed for that particular nose, he will choose from a handful of techniques to achieve the results that the patient seeks. The key is to have a wide selection of “tools” and this comes with experience, training and continued efforts to improve. During the consultation, Dr. Ahn will review these techniques in detail with the patient so that communication is as good as possible.
What Can be done to the Nose to Make it Look Better?
- MAKE A LARGE (BULBOUS) TIP MORE REFINED AND SMALLER
Patients who have noses with bulbous tips often want them to be smaller and more refined. This is accomplished by removing a small amount of cartilage from the tip while leaving enough to maintain structural integrity. The remainder of the tip cartilage is then shaped using suture techniques. It is very important not to remove too much cartilage and to be precise in the amount that is removed so that the tip is symmetric and strong. Cartilage grafts taken from the septum are often used to strengthen the cartilage and ensure that the tip does not shift or change position.
- CHANGE THE PROJECTION OF THE TIP (MOVE THE TIP OF CLOSER TO OR FURTHER FROM THE FACE)
During the consultation, Dr. Ahn will measure the tip projection using computer imaging. If he determines that the tip is overprojected (too far from the face) he then may recommend deprojecting the tip, moving it closer to the face, to improve the proportions and balance. The opposite is true as well for an underprojected tip.
Moving a tip closer to the face usually involves cutting the tip cartilage and then precisely overlapping the segments so that the tip moves back the correct distance. Moving the tip away from the face, increasing projection, relies on using cartilage grafts that extend from the existing septum (a septal extension graft) to provide support.
- LOWER THE BUMP THAT IS SEEN ON PROFILE
The “dorsal hump” is the bump on the nose, made of bone and cartilage, which is seen on the profile view. It can be familial (your family’s nose) or the result of trauma. Bumping the nose during childhood, such as if one is hit with a ball, can cause the bone to grow.
To lower the bony part, a rasp (a tool that looks like a fine file) is used to gently take down the convex bone. To precisely lower the cartilage, Dr. Ahn uses a micro blade to remove segments that are thinner than a millimeter. Dr. Ahn feels that it is critically important to lower the bump slowly, carefully and with great attention to detail, as a millimeter change can make a significant difference on the result.
- STRAIGHTEN A TWISTED NOSE
During his residency training, Dr. Ahn was fortunate to train at San Francisco General Hospital, where many patients had “twisted” noses as the result of trauma. Because there were so many people with crooked noses, Dr. Ahn and his fellow residents were able to study how best to treat a twisted nose with surgery. As such, Dr. Ahn has extensive experience with operating on the twisted nose.
The twisted nose is often the result of multiple episodes of trauma, or at least one significant incident that resulted in a broken nose. There are many factors that may contribute to the twisted nose including: a deviated septum, misshapen cartilage and displaced, previously broken nose bones. All of these need to be addressed during rhinoplasty to make the nose straighter. With a severely twisted nose, because so many forces have been holding the bone and cartilage in a twisted position, it is not always possible to make the nose perfectly straight. It can be made to be significantly straighter.
- CHANGE THE OVERALL APPEARANCE OF THE NOSE WHILE MAINTAINING ETHNIC CHARACTERISTICS
Experienced rhinoplasty surgeons are sensitive to the concept of ethnicity preservation in rhinoplasty surgery. Not everyone wants a stereotypical northern European nose. In fact, most patients want to retain the characteristics of their specific ethnicities. They just want a nicer version of their current nose and a result that does not make them look like a different person. Dr. Ahn ensures that during the consultation there is excellent communication in terms of the patient’s goals. For example, some want to remove a familial bump and make the nose straight while others want to retain some of the bump but just want it to be smaller. Dr. Ahn takes great pride in his ethnic preservation rhinoplasties.
EXPECTATIONS AND LIMITATIONS
While Dr. Ahn will always strive for excellence, a “perfect” rhinoplasty result is not always achievable. It is extremely important that both the doctor and patient have realistic goals. Some factors that are less favorable in terms of ultimate outcome include:
- Oily and thick skin
- Extremely thin skin
- A twisted or crooked nose
- Asymmetric and abnormally positioned nasal cartilage
Understanding this, excellent communication is critical in the preoperative consultation process. Dr. Ahn uses his computer based Mirror Imaging morphing tool and the patient’s photos, not just to show the potential results of surgery, but also to “get on the same page” in terms of realistic outcomes. When that happens, ultimately the patient ends up with the most satisfying outcome.
RECOVERY AFTER RHINOPLASTY
Immediately after surgery, a small cast will be placed on your nose to protect it and to keep the structure stable. Your nose will be stuffy and there will be bruising around the eyes. You will apply ice or cold peas to the nose to reduce the bruising and swelling. Most patients do not complain on pain and often stop taking pain medication the day after surgery. The cast and sutures are removed 1 week after surgery. At that point, the vast majority of the bruising has subsided. Most of the swelling goes away within the first 2-3 weeks but there is a small percentage, particularly in the tip, that can take up to a year to resolve.
Some activities will be prohibited 2 weeks after surgery such as physical exertion and strenuous activity.
If you would like to learn more about rhinoplasty, please schedule a personal consultation with Dr. Ahn. He can recommend an appropriate course of treatment after evaluating your aesthetic needs and goals. Contact the Aesthetic Wellness Center by calling or emailing us today.
Cost for Rhinoplasty Surgery
Cosmetic nasal surgery, also known as rhinoplasty, is not considered to be medically necessary and therefore is not covered by your insurance company.
In general, the cost of rhinoplasty increases with the skill level of the surgeon and the complexity of the procedure. Rhinoplasty performed by a more experienced and qualified surgeon will likely cost more. Rhinoplasty that involves more extensive work, especially in the case of a revision rhinoplasty, will have higher surgical fees as well.
At the Aesthetic Wellness Center, our costs for rhinoplasty surgery involve three separate components:
- The surgeon’s fee.
- The anesthesia fee.
- The cost for the facility.
Financing the Cost of Your Nose Job
Here at the Aesthetic Wellness Center we like to provide you with all of the costs associated with the rhinoplasty at the time of your consultation.