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Rhinoplasty

RhinoplastyRhinoplasty

Rhinoplasty, also known as “nose reshaping” or a “nose job,” can improve the appearance and function of the nose. From the bridge and nostrils to the tip and overall profile of the nose, nose surgery can correct a variety of aesthetic concerns. Those with breathing problems stemming from structural issues within the nose can also benefit from nose surgery.  Rhinoplasty surgery is a passion and focus at Graham Plastic Surgery. In addition to being an experienced surgeon, Board Certified by the American Board of Plastic Surgery, Dr. Graham has had advanced training in rhinoplasty. In addition to placing a focus on rhinoplasty during his Plastic Surgery Training he has attended the world-renowned advanced Dallas Rhinoplasty Course on two occasions and he is a member of the Rhinoplasty Society of Europe and Toriumi Rhinoplasty Guild.  As a result, Dr. Graham has the knowledge and techniques from the best rhinoplasty surgeons from the US, Iran, Egypt, Turkey, Italy, France, Portugal, Columbia, United Kingdom, and Russia.  This knowledge includes cutting edge advanced rhinoplasty practices such as preservation rhinoplasty and piezosurgery.

Other advanced rhinoplasty training is listed below:

  • 2012 Dallas Rhinoplasty Symposium and Course
  • 2015 Dallas Rhinoplasty Symposium and Course
  • Aesthetica 2014
  • Bergamo Advanced Mini-fellowship in Revision Rhino-septoplasty 2016
  • Rhinoplasty Society of Europe COVID Webinar Educational Series: 10 Challenges in Rhinoplasty 2020
  • Structural, Preservation, and Precision Rhinoplasty with Ultrasonic Piezotome 2021
  • Marina Medical Rhinoplasty Course 2021
  • Seventh Bergamo Open Rhinoplasty Course 2022

Rhinoplasty

Rhinoplasty Candidates

Rhinoplasty candidates include anyone who doesn’t like the appearance of his or her nose.  Many patients have a dorsal hump on their nose that can make the nose more masculine “My Father’s Nose”. Some people simply don’t like the roundness of their nasal tip.  Some feel that their nose hangs to low or is turned too high.  Some people feel their nose just isn’t straight.  All of these deformities can be corrected via rhinoplasty. Rhinoplasty achieves the following:

Facial balance: Whether you feel your nose is too large, too wide, asymmetrical, or has an unattractive angle, nose surgery can improve the size, shape, and overall appearance of your nose. Rhinoplasty will help balance your facial features by creating a nose that is in better harmony with the rest of your face, which can increase your confidence and improve your overall quality of life.

Improved breathing: Rhinoplasty can correct and relieve airway obstructions within the nose, such as a deviated septum or enlarged turbinates, to allow for normal, easier breathing. This procedure can alleviate sensations of congestion and other breathing problems related to the nasal passageway to provide you with improved comfort during your everyday life.

Rhinoplasty Procedure

Dr. Graham performs an open rhinoplasty procedure. Open rhinoplasty surgery begins with an invisible incision on the undersurface of the nose.  The nose soft tissue is then elevated as the underlying cartilage and bone is exposed.  This cartilage and bone is then delicately reshaped to give a more aesthetic look to the nose.  Through several specific techniques the nose can be made to look longer, shorter, wider, or narrower.  Often times the most requested changes are to remove a dorsal hump, make the nose straighter, and make the tip smaller. In rhinoplasty surgery every millimeter counts, and it is the attention to detail that only an open rhinoplasty approach can provide.

Piezosurgery

Piezosurgery is a revolution in rhinoplasty. Popularized by Dr. Aaron Kosins of Newport Beach, Ca, and French surgeon, Dr. Olivier Gerbault, Piezosurgery is the most disruptive technology to happen to rhinoplasty in over 20 years.

Many patients are terrified that a surgeon will have to “break their bones.” Standard rhinoplasty instruments are over 100 years old, and surgeons literally use rasps, or a hammer and chisel to break your delicate nasal bones so they can be moved and narrowed.  This is like trying to create controlled breaks in an egg shell using a hammer and chisel. Like an egg shell,  bone fractures could occur where we did not want them to, and the movement was uncontrolled. Piezosurgery is a revolution for a rhinoplasty surgeon because of the accuracy and precision of the technology. Using piezosurgery your bones can be gently sculpted and cut with more accuracy and with less bruising and swelling. It has been proven in peer reviewed journals that Piezosurgery shortens recovery. More surgical accuracy, less collateral damage, and shorter recovery is whey many surgeons across the world are turning to this instrument.

Piezosurgery uses ultrasonic energy (vibration) to cut hard tissues. Have you ever had a cast? When a cast comes off, it must be removed with a saw. However, the cast must be removed without hurting your skin. That is where ultrasonic vibration plays a role. When a saw vibrates at a certain frequency it will cut hard tissues like a cast or bone without cutting soft tissue like skin. The Piezotome device used in rhinoplasty follows the same principle. The instrument vibrates at 3,000 vibrations per second, cutting only bone and hard cartilage, while leaving delicate soft tissue behind.

Dr. Graham purchased his piezotome from the French company, Comeg, as it is an instrument not commonly used in the United States. He now uses it on all of his rhinoplasties due to its increased accuracy and its ability to beautifully sculpt the nasal bones.

Structural versus Preservation Rhinoplasty

  • Structural Rhinoplasty refers to the method of performing rhinoplasty by deconstructing and then reconstructing the structures of the nose to achieve the desired rhinoplasty result. Specifically, this involves splitting the nose down the middle of the septum to isolate and then treat it’s bony and cartilaginous components. This technique can be somewhat uncontrolled and lead to irregularities, as it is difficult to replace what nature has created.
  • Preservation Rhinoplasty, which is a newer technique, attempts to achieve the same rhinoplasty results by preserving the nose’s natural structures, thus yielding a more natural appearing result. There are also hybrid techniques that combine the two techniques. Not everyone is a candidate for preservation rhinoplasty, as it is dependant on the correct anatomy. However, for those with the appropriate anatomy and surgical goals, it can yield better results than the traditional structural techniques.

Cone-Beam CT ScanningRhinoplasty

For complex cases, Dr. Graham may order a Cone-Beam CT Scan. Popularized by Italian Rhinoplasty surgeon, Enrico Robotti, Cone-Beam CT scanning is becoming a standard in preoperative evaluation of rhinoplasty patients. Popular for some time in American dental offices, Cone-Beam CT scanning is affordable, safe, and accessible. Instead of using a fan-shaped beam in traditional CT scanning, the Cone-Beam CT scanner uses a pyramidal shaped beam to capture images in multiple dimensions. This allows better images at a much lower dose of radiation. The main practical advantage for cone-beam computed tomography is the specific ability to accurately view and analyze in three-dimensions the bony structures of the maxillofacial skeleton,while allowing one to assess its relationship to the soft tissue. Accurate, submillimeter-resolution images can be provided of higher resolution than traditional computed tomography, in formats that allow ideal three-dimensional visualization. Understanding the detailed bony and cartilage anatomy of the nose is invaluable to preoperative surgery planning, as it allows the surgeon to accurately plan all of the surgical steps and required instrumentation.

Will insurance pay for my rhinoplasty?

Insurance companies may cover the cost of a rhinoplasty if it is performed to correct a structural problem that impairs breathing. Dr. Graham may be able to use your insurance to pay a portion of the procedure.

What are the risks associated with rhinoplasty?

Please refer to the following form published by the American Society of Plastic Surgeons (ASPS)

What is the recovery time following rhinoplasty surgery?

This is dependant on the type of work you perform.  Many patients with office jobs only require a week after rhinoplasty.  During that first week both an internal and external nasal splint will be in place. You will most likely also have some bruising around your eyes. After the first week you can return to work, but likely with some bruising, although makeup will cover the majority. However, patients who perform heavy labor may require 2-4 weeks to recover.You may drive when you are off narcotics and feel confident to control the car, even in an emergency.  Most patients are able to drive within 1-2 weeks.

What is a liquid rhinoplasty?

A liquid rhinoplasty refers to performing nasal reshaping using fillers such as Restylane, Juvederm, or Radiesse. This can help shadow a dorsal hump or refine a tip. This may be a more economic option for some patients, although the results aren’t permanent.

How much does rhinoplasty surgery cost?

The average cost of rhinoplasty in the US is $6-7000. Dr. Graham’s pricing for rhinoplasty can be found here.

ACS