Nose Reconstruction

(Rhinoplasty)

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Rhinoplasty is a word which means mold or form a nose. In ancient times noses were amputated as a punishment for adultery. The earliest rhinoplasties were to reconstruct the nose after this punishment. Today a total reconstruction of a nose is a procedure that rarely is performed. Today noses are operated to improve their function, appearance or both. The father of modern rhinoplasty was Dr. Joseph in Germany. He was murdered by the Germans in the 1st World War. He not only came up with the methods and basic concepts used to do an endonasal rhinoplasty, he also designed many of the instruments that are still used today.

Because the nose has an internal and external lining it presents several unique challenges for the surgeon. I have heard surgeons say that doing endo-nasal surgery was like operating at the end of a pipe. Experience is particularly important to be a good rhinoplasty surgeon. I did my first rhinoplasty as a resident in 1969.

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I feel privileged to have worked with what I consider to be some of the best rhinoplasty surgeons in the world. In addition I feel uniquely qualified as my first training was in Otolaryngology (ear, nose and throat) and did more than a 100 procedures for the Navy after my residency. I then completed my plastic surgery residency.

I do not believe all rhinoplasties have to be done with what is called the open technique. The open technique it where an incision is made across the center part of the nose (columella) and the skin is lifted up over the dorsum of the nose. I do the vast majority by using the closed procedure where all incisions are made inside the nose. Unfortunately in most teaching programs the emphasis has been in recent years to teach the open approach.

When I perform a rhinoplasty I try to make the nose fit the face and many times I am able to minimize the appearance of facial features that are not in good balance such as a long middle third of the face.

In my opinion you should not do rhinoplasty surgery if you can not straighten the nasal septum. I have seen on many occasions where after the height of the dorsum is reduced of what pre-operatively was a straight nose, becomes a crooked nose post-operatively. This occurs because as the septal height is reduced the septum had a preexisting deviation at the lower level and it was not corrected during the procedure.

The following are some questions commonly asked by patients:

Will I have a great deal of pain after my surgery?

If you do not pack the interior of the nose the pain is minimal. I do not use nasal packing.

Will I have a great deal of swelling and bruising after surgery?

No. Again I do not pack the nose. The venous return from the nose is through the nose and then into the Cavernous venous sinus in the brain. If you tightly pack the nose you obstruct these venous channels and thus increase the venous pressure of that area. This has the effect of making every little venous injury leak until you develop high venous pressures in the tissue to force the return in the usual direction. Arnica Montana is a chemical that decreases bruising. You can purchase this at a health food store or just eat pineapple (pineapple contains this substance).

Can I wear my eye glasses after surgery?

As long as you have the splint to support the glasses (about 7 to 10 days after surgery) you may wear your glasses. After the splint is removed you can wear your glasses if you support them in such a manner that they are not being supported by the nose. One way is to suspend them with tape from your forehead skin. You need to do this for about 6 weeks after surgery. The eye glasses pads can move the nasal bones much like braces do to teeth. At 6 weeks your nasal bones should be very solidly healed and not effected by your glasses.

When will I see my final result?

You should look very normal at 6 weeks post operatively. Even though you look good you still have significant edema in your nasal tissues. The nasal tip stays edematous longer than the balance of the nose. It usually takes about 6 months for this to completely clear.