RHINOPLASTY BASICS AND SURGICAL PROCEDURES. NOSE JOB COSTS

Side view of anatomy of nasal cartilages and bone. Nomenclature of the soft tissue nose anatomy.

A variety of surgical procedures whereby the nose size, shape and contour can be changed.

 

You may feel your nose is too big, too small, too narrow or too wide or perhaps it is crooked, has a bulbous end, a bump or hump in it. Or it might be too long or too short or too protruded or too flat. It might be too short for your face or too drooping.

Whatever cosmetic nose problem you are unhappy with, nose plastic surgery can in most cases* help you achieve the look you want. NosePlasty Clinic surgery is elegant and the nose job costs are 'affordable'.

 

NosePlasty Clinic nose surgery is surgery designed to improve the shape of the nose and this is the primary surgical goal. NosePlasty Clinic incorporates the latest, advanced surgical and anaesthetic principles that makes rhinoplasty surgery safer, more elegant, less invasive and less traumatic than ever before.

 

If you have decided to have nose cosmetic surgery and you have never had nose surgery previously then you are classified as needing primary rhinoplasty. If you are having a rhinoplasty operation for the second (or more times) then you are classified as having revision rhinoplasty.

 

There are five main surgical types of noseplasty 

  1. reduction rhinoplasty to make the nose smaller or narrower or a nose hump is lowered or removed.
  2. augmentation rhinoplasty to give the nose more bulk or make it larger or longer or higher.
  3. revision rhinoplasty which is performed in cases where the result of the first rhinoplasty surgery is unsatisfactory and some modification requires to be done.
  4. functional rhinoplasty-performed simultaneously with cosmetic nose surgery in order to improve the breathing function of the nose. Correction of a crooked nose is also usually performed in these cases for functional and cosmetic reasons. Functional rhinoplasty is often performed to alleviate snoring.
  5. combinations of the above 4 types of surgery performed at the same time.

Non-surgical nose job has recently been added, but this does not involve surgery. It is basically the filling of the nasal tissues with fillers of different types and enhancing or disguising nasal defects. Non-surgical nose job results may last for a year or two depending on the filler used and the tissue reaction to the filler. Most fillers are  'absorbed' by the tissues and therefore the result is temporary. Some fillers are more permanent than others and may not be recommended because the results are temporary. For more information ask your specialist.

 

The surgical approach varies between two recognized surgical methods:

  • the closed method and
  • the open method.

 

In the closed method the surgical incisions are made inside the nostrils and are therefore not visible. 

 

In the open method the surgical incisions are made inside and outside the nostril. When these incisions heal they are virtually invisible to close inspection. This approach is more often used for revision nose surgery.

 

Some surgeons claim that they do only a closed approach, others vary their approach dependent on their preferance as to their experience and what they wish to achieve.

 

Reduction rhinoplasty (reduction noseplasty)

 

Cartilage and bone is removed or re-arranged through incisions inside your nostrils (closed approach) or via an open approach. The skin on the outside of your nose is left untouched (in a closed approach) and shrinks down to the new shape. To keep your features in proportion, it might also be necessary to make your nostrils smaller through small cuts in the skin. This will leave fine scars at the base of each nostril. This procedure is often used in African and Ethnic nose jobs.

 

Augmentation rhinoplasty(augmentation noseplasty)

 

The bone nasal shape is reshaped by augmentation by bone, cartilage or synthetic implants (like silicone). If bone or cartilage is needed to build up the nose it may be taken from your ears or from spare cartilage inside your nose. Sometimes artificial implants are used. This augmentation is usually done via the open approach.

 

Functional rhinoplasty (functional noseplasty)

 

Often the function of the nose is compromised by nasal valve narrowing, or septal or other cartilage deviations or nasal bone narrowing. A surgeon trained also in Ear, Nose and Throat speciality, besides cosmetic nasal surgery, can perform the surgical correction of this. This procedure is best performed at the same time as the cosmetic nasal surgery. NosePlasty Clinic surgeons do not elect to perform purely functional nose surgery because it is performed for medical rather than for aesthetic reasons. It is only performed in combination with cosmetic nose surgery.

 

As with any cosmetic procedure it is important that you review your and your family’s expectations before you decide to proceed.

 

  • Cosmetic nasal surgery is a form of three-dimensional art in surgery. The surgeon performing this artistry must have a sense of beauty and a sense of balance in order to achieve results that enhance, beautify and balance the face. Nose surgery is an art form not very different from sculpture or painting. It is more like sculpture but the sense of beauty and proportion of the surgeon is just as important as in painting. The specialist surgeon must choose his subject just as carefully as the artist chooses his medium. Not every person is a suitable candidate for nose plastic surgery; just as not every subject matter is optimal for every artist or sculptor.

 

  • Every human nose is as different as the genetic code of that person. Some people have thick sebaceous skin, others very fine, almost translucent skin. Some people have very thin, fragile or even distorted cartilages, others thick curled or abnormally shaped or positioned nasal cartilages. Others have protuberances and deviations of nasal bones, which must be corrected without violating physiological and anatomical principles and many have internal nasal problems that may cause obstructions. Some have mid-vault narrowing and others have tension noses. (Now we are dabbling in nasal, cosmetic terminology which only nasal surgeons understand). See Anatomy and Physiology

 

  • Often the anatomy, the tissues, the skin, the age, the health and the previous exposure to surgery or trauma leaves the surgeon with limited possibilities. These problems have to be expertly dealt with in order to obtain a good result. This takes training, experience and dedication to this art form. The surgeon has to choose his surgical instruments, his sutures, his needles, his dressings, his anaesthetic, his drugs, and his implants more carefully than an artist chooses his chisels, paint, brushes, palette and art medium. The dedicated nose surgeon has to be part artist, part structural engineer and part architect because in some noses he often has to manipulate and construct the nose and use natural cartilages and even synthetic materials in the nose to achieve the cosmetic goals.

 

  • The surgeon needs to be a 'perfectionist', meticulous, surgically precise, highly skilled and sensitive to the needs of his client, and lastly, but not least, humble in that he cannot achieve the impossible and cannot achieve perfection. Beware the surgeon who promises to deliver the shape presented on computer imaging. It is important that there is total clarification and understanding between the surgeon and the patient as to what the goals are before the surgery. Some changes can only be made with the open surgical approach and others can be achieved with the closed approach. (However there are surgeons who claim that they never do an open approach and there are other surgeons who claim they never use the closed approach). It is often more difficult to have minimal changes than radical changes to the nose shape. 'Finesse' changes (changes that are sometimes almost imperceptible to the onlooker) but contribute to important aesthetic changes should be discussed and understood before the surgery. As the Americans say, 'the surgeon and client must be on the 'same page'.  See The Surgeon

In constructive surgery and reconstructive or revision nasal surgery (surgery performed to correct severe nasal injuries or deformities and in surgery done in order to correct unsatisfactory results from previous surgery), the complexity of the surgery increases exponentially. This causes surgical time to often increase to over five or six hours. Expert USA nasal surgeons emphasise this point and as costs are usually proportional to the time spent in surgery they necessarily have expensive nose job costs.

 

  • As much as the human nose is the central focus of the face so is nasal surgery the pinnacle of all cosmetic plastic surgery. No other plastic or cosmetic surgery is as demanding of the surgeon’s skills, talents and aesthetic values. Every surgeon will deliver a different nose according to his aesthetic values and experience. (That is why pre-operative imaging is important.) Success or failure of attaining 'beautiful' shape can often be measured in millimeters. The amount of tissue removed or retained is at the discretion of the surgeon. If too much tissue is removed there is the possibility of nasal shape distortion and if too little tissue is removed there is the possibility that the anticipated nasal shape change will not be attained. Often it is more important as to how much tissue is left behind rather than how much is removed that leads to a good aesthetic result. Scar tissue formation also contibutes to the final nasal shape. Excessive scar tissue formation can distort whereas insufficent scar healing can result in insufficient retraction or pulling together or draping of tissues. Scar tissue formation cannot be predicted or controlled. There is a narrow path that the surgeon must walk during the surgery and the prudent surgeon would rather risk a 'disappointing' outcome than a 'catastrophic' result. A 'disappointing' nose shape will lead to a disappointed patient whereas a 'catastrophic' nose shape will lead to an angry patient.

 

  • There is no magic involved in rhinoplasty; the surgeon’s incisions, tissue removals and additions, grafting, scar formation and contraction and aesthetic values produce the results. The 'Magic" in actual fact is in your surgeon's handsNasal cosmetic surgery is uncommon in the field of surgery because of the number of inter-related, intricate surgical manoeuvres that have to be performed and factors such as precise healing of re-arranged tissues and the unpredictability of scarring. Scar tissue formation is the major unpredictable and uncontrollable factor that neither the patient nor the surgeon can predict. It is the major unknown in nasal cosmetic surgery and it is for this and all the above reasons that no surgeon in the world can predict or guarantee the outcome of the rhinoplasty surgery. This is the risk-reality that every person undergoing rhinoplasty has to understand and accept. See looking for a nose job.

 

* In some cases the skin of the nose is too thick or the condition may be medically related so that any change will not benefit from surgery. In other cases the anatomy may be so distorted or scarred from previous surgery, that a rhinoplasty or noseplasty will not be successful. In some rare genetic problems you may need to be referred to specialist clinics that specialise in maxillo-facial-nasal anomalies. 

 

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Text 26 Nov 2017