Rhinoplasty Newport Beach
Rhinoplasty is one of the most commonly performed facial operations. It can be either functional or aesthetic. Functional rhinoplasty is usually undertaken when there is an obstruction in one or both sides of the nasal cavity blocking air passage. This may be due to a deviated septum, prior nasal fracture, or collapse of the normal cartilage structure supporting the nose. Aesthetic rhinoplasty may be undertaken to straighten a crooked nose, narrow a wide nose or tip, or perform any number of refinements to better fit the nose with the rest of the facial structure.
Dr. Reinstadler specializes in natural appearing noses. The goal of this operation is to give you a nose that matches your other facial features and looks like you could have been born with.
Rhinoplasty can be performed through either an open or closed technique. There are pros and cons to each approach. The closed technique offers no external incisions, less post-operative swelling, and the ability to perform many augmentation maneuvers. The open technique requires a small incision through the columella along with internal nasal incisions. This allows complete elevation of the skin and better visualization of the nasal framework. The advantages of open rhinoplasty are that it allows the surgeon to more accurately place grafts and sculpt the nasal structure. The down sides are that swelling lasts slightly longer, and there is a potentially visible incision. It is very uncommon to have any problems with the columellar incision, however. These trade offs need to be tailored to each case.
One of the most common aesthetic procedures performed with rhinoplasty is a dorsal hump reduction. The dorsal hump can be composed of bone, cartilage, or a combination. This can be removed to create either a straight profile, or a slightly curved profile depending on the aesthetic outcome desired.
A common functional component of rhinoplasty surgery is to correct collapse of the sidewalls upon breathing. This is called vestibular stenosis. It can result from trauma or can be something one develops over time. This is usually repaired with the placement of grafts along the septum, allowing for increased air passage through the nose.
Depending on the desired changes, your rhinoplasty will be individualized to enhance the overall facial aesthetics, while maintaining certain ethnic and cultural characteristics.
It is important to first be on the same page with your surgeon. There are many rhinoplasty surgeons who get fantastic results, however their aesthetic choices may be different than your desired outcomes. During the consultation Dr. Reinstadler will use computer software to manipulate your nose. This helps to have a realistic discussion of what is possible from your individual starting point, and to ensure your desired outcome is also the same as his. This will prevent any ‘surprises’ after surgery.
The recovery period is usually not very painful. The most common complaint is the ‘discomfort’ or pressure in the nose and sometimes not breathing well for the first few days. There is an external splint placed which is removed at one week, and there is almost never packing or any other material placed within the nose. Most patients can breathe immediately after the operation though it may feel a bit more congested. If an open rhinoplasty is performed, the small sutures on the columella will be removed when the splint is taken off.
The most important thing to remember following surgery is that swelling is the enemy. In general, we are relying on the body to ‘shrink-wrap’ the skin back to the new nasal framework. When there is significant swelling after surgery, scar tissue can be deposited and obscure some of the refinements. Detailed instructions are given to patients prior to surgery with suggestions on what to do and what to avoid.
The cost of rhinoplasty varies based on the amount of work needed. It will also depend on if there is an insurance component associated with the cosmetic procedure. These will be discussions for after the consultation.
Recovery time after a rhinoplasty is dependent on the person. In general, you will feel a bit tired and your nose will be sore for the first few days. The swelling and bruising will be at its maximum around the third day. After about day three, your energy will return and the swelling starts to subside. Usually at this time patients feel like getting out of the house. You will have a splint on your nose and will still be black and blue, but you are encouraged to get outside and walk around. The splint will be removed along with any sutures at day six or seven. The nose will be swollen and shiny for the following two to three weeks. The inside of your nose will also be swollen and congested. It is not uncommon to feel totally blocked for the first week, but the breathing will improve over the following weeks. I would recommend at least one to two months before any events where photographs will be taken that are important.
The splint removal is done in the office after applying a liquid that helps dissolve the adhesive under the splint. A soft cotton applicator is used to lift the splint gently off the skin of the nose. You will feel some pressure just from the cotton swab but, in general, it is not very painful. Any sutures will be removed at the same time. The nose will be very shiny due to the occlusion of the skin glands, so we recommend the use or a toner or astringent a few times per day to decrease the oil production.
Swelling is patient dependent and also varies with the type and extent of rhinoplasty performed. If you had a reductive rhinoplasty (hump removed, tip brought closer to face, etc.) your swelling will last a bit longer. If you imagine you are making the nasal framework smaller but laying the same skin back over the top, it will take a while to ‘shrink wrap’ back to the structure. If you have an additive or reconstructive rhinoplasty involving increasing the structure size, your swelling will improve faster because the skin is stretched over the new framework.
In general, the swelling goes through phases. The first is the acute surgical phase where there is bruising and swelling from the initial tissue injury. It is important for the first 72 hours to keep icing the eyes and nose. The splint molds the edema and when it is removed, the nose may actually become a bit more swollen for a day or so. I recommend avoiding the use of eyeglasses or sunglasses for three weeks following surgery. These may cause dents and result in permanent irregularities. Over the next three to four weeks, the swelling at the top of the nose over the dorsum decreases. This can make the area above the tip look more swollen even though it is just a relative discrepancy. The swelling in the area above and below the tip takes the longest to resolve. I see patients back every few months and can use steroid injections to make the swelling improve more efficiently. Usually at the six-month mark, the swelling is mostly gone throughout the entire nose. The following six months see the small refinements as the tissue finally molds back onto the underlying structure. This is why most surgeons recommend waiting a full year to see the ‘final’ results.
I recommend doing some walking within the first few days after surgery. I usually have patients limit their exercise to this until the splint and sutures are removed. A week after surgery you can start increasing the pace of your walks or use the elliptical machine. Two weeks after surgery, you can start back with running and gentile weight lifting. I recommend waiting three weeks before returning to yoga, pilates, cross fit, or other heavy lifting. Exercise will increase swelling so just know that the following day your nose will look a bit puffier.
Insurance companies may cover some components of rhinoplasty. It will depend on what the actual issue is. Taking down a bump or narrowing the tip is never paid for by insurance. If you had a traumatic event and the nose changed shape or the septum is now crooked, these may be functional components that insurance should cover. Each surgeon is different on what insurance companies they are contracted with or if they are part of the network. These factors will all influence if and what the insurance will pay for. The insurance-based components can be performed at the same time as a cosmetic rhinoplasty. If done together, many times the cost to the patient for anesthesia and the operating room are reduced.
A closed rhinoplasty is performed when all the incisions are inside the nose. A closed rhinoplasty is indicated in certain situations and has positives and negatives. It is a good option when moderate work is needed or if no structural grafts need to be placed. The swelling improves faster and there is no external incision to worry about. The down sides are that there is limited visualization and the placement and suturing of structural/functional grafts is more difficult. Many times a closed rhinoplasty may be performed for small revision procedures.
An open rhinoplasty consists of similar incisions inside the nose but in conjunction with a small incision across the columella. This affords the ability to lift the soft tissue off the underlying cartilage and bone for better visualization. This is the preferred method when any functional work needs to be done, or if very specific maneuvers need to be performed under direct vision. The small external incision heals very well and is usually not noticeable within a month or so. The swelling does last longer than a closed rhinoplasty but each case is different and warrants a discussion about pros and cons.
The best age for a rhinoplasty is when the patient decides that the worries about undergoing surgery are outweighed by the final result they wish to achieve. Many times these are at transition points in life – going to college, new job, getting married, or a traumatic event that damaged the nose. Young teenagers should avoid nasal surgery as their nose is still growing. I recommend waiting until about 16 years old in females and 18 years old for males. There are some exceptions to this rule, but it is a good guideline.