Improving the shape of the nose
Rhinoplasty is a surgical procedure to re-contour the shape of the nose to create an improved aesthetic result. The surgery can also be performed to improve nasal function. We aim to create a natural-appearing nose that balances well with a patient’s facial features. “Natural” should not be interpreted as minimal change; rather, we define “natural” by how well the nose blends in with the rest of the patient’s face.
Office consultation begins with the patient telling us what changes they hope to achieve with surgery. After evaluation and reviewing pertinent history, the surgeon will discuss the changes that will provide the best aesthetic outcome. Open discussion is essential as we want to ensure that both patient and surgeon agree on what changes will create the most aesthetically pleasing result that can be realistically achieved.
Imaging, using the Canfield Mirror software, allows us to demonstrate a projected result. Through photo morphing, we show patients an approximation of what they can expect as a realistic outcome. Imaging by no means projects an exact result, but it is an invaluable tool to make sure the patient’s and the surgeon’s goals are aligned.
Some of the most common changes that patients request include:
- Reducing the size of a bump on the bridge of the nose
- Narrowing the bridge of the nose
- Narrowing the tip of the nose
- Reshaping the nasal tip
Types of Rhinoplasty
Although cosmetic nose surgery is the most common type of rhinoplasty, there are variations on the procedure.
- Functional rhinoplasty addresses breathing issues such as a deviated septum. Post-traumatic rhinoplasty includes repairing nasal fractures or other nasal injuries.
- Ethnic rhinoplasty addresses cosmetic concerns in non-Caucasian patients while preserving ethnic identity.
- Revision rhinoplasty focuses on correcting problems caused by a previous surgery.
The ideal surgical result after any rhinoplasty is a natural-appearing nose that complements and enhances other facial features. Rhinoplasty should also preserve or enhance nasal function while helping patients to reach their aesthetic goals. We customize the nose to the patient’s needs and combine different techniques to optimize results. We encourage you to view our patients’ results in our photo gallery.
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Consultation
A rhinoplasty consultation provides you with the opportunity to express your desired goals for surgery, set expectations for the outcome of the surgery, and understand the postoperative healing process. From the surgeon’s perspective, it is important to have a good understanding of what changes a patient hopes to achieve through surgery. We will also review any functional breathing problems the procedure can address.
Medical Conditions, Candidacy and Goals
We will ask you to provide a history of prior nasal injuries or surgeries (if applicable), known medical conditions, and medication usage. Once our experts have determined candidacy and discussed your goals and expectations, we will use computer imaging to give you a realistic idea of how your nose will look after surgery and show you results achieved on previous patients (pictures shown with patient consent).
Prospective patients should use the consultation appointment to ask questions they may have about the surgery and the results. After the consultation, patients should:
- Have a better understanding of the process
- Know what to expect before, during, and after a nose job
- Feel comfortable with their plastic surgeon(s)
- Understand the expected results
Procedure
TWO WEEKS BEFORE
You will have a preoperative visit and meet with a nurse. They will review what needs preparation for rhinoplasty and post-operative care. This visit is also an opportunity for you to review your goals with your surgeon and ask questions.
During this meeting, our staff will remind you to avoid the use of blood-thinning medications such as Motrin, Advil, products that contain aspirin, and homeopathic medications or supplements that may have a similar effect. Don’t worry – you will be provided a list of the items to avoid. We will also provide additional prescriptions during this visit, including pain medications and antibiotics as needed.
ONE WEEK BEFORE
You will begin to use a prescription topical antibiotic ointment just inside the nostril starting one week before surgery and continuing for one week afterward.
THE DAY OF
Depending on several factors, your rhinoplasty surgery with Glasgold Group is performed at one of three locations around Princeton, NJ:
- Our accredited in-office surgical suite
- An outpatient surgery center
- Robert Wood Johnson University Hospital in New Brunswick
Nasal surgery is performed either under general anesthesia or with intravenous sedation. We will discuss the anesthesia type at the consultation – the final location decision depends on the procedure, the patient’s preference, and the age of the patient. If we perform the surgery under general anesthesia, the rhinoplasty will take place at the surgery center or hospital.
Usually, the surgery takes about 4 hours. We may use different techniques depending on the patient’s goals, including cartilage grafting, breaking nasal bones, and/or resetting the nasal bones.
AFTER SURGERY
After we complete the surgery, you will rest in the recovery room before we discharge you to go home. Recovery room time is shorter if we perform the surgery under intravenous sedation. A family member or friend must accompany you and drive you home from surgery. You should also plan on having someone stay with you until at least the morning following surgery.
Recovery
IMMEDIATELY AFTER SURGERY
After your rhinoplasty surgery, the surgeon will place tape and a small metal splint on the bridge of the nose.
There will also be a small gauze pad taped under the nostrils. We then provide you with additional gauze and instructions on how to replace it.
Unlike the bandage on the nose, the drip pad is changed as needed. You will begin to change the gauze less often after the first few days. Many find that, within 48 hours, drainage has reduced so much that replacement gauze is no longer needed.
THE INITIAL RECOVERY PERIOD
The first postoperative visit will be at 6-7 days after surgery. We will remove the tape, splint, and sutures. You can apply make-up once this bandage is off.
Following surgery, there are varying degrees of swelling and bruising. Bruising occurs under the eyes and should mostly resolve within 7 to 10 days. The swelling usually peaks a few days after surgery and will then decrease. When you finally have your dressing removed, you will appreciate the already noticeable change in your profile. At one week after surgery, it is common for the nose to look wider than expected on front view due to swelling.
RETURNING TO NORMAL ACTIVITIES
Most patients are comfortable returning to work or school 10 days after surgery. However, this is just an estimated time frame because of individual variations in healing time. It is important that patients inform us of any significant events they may have scheduled following surgery so we can adequately discuss their expectations for recuperation and recovery time.
You can return to full strenuous activity three weeks after surgery. It is important for patients to avoid tanning for the first few months as this may lead to nasal swelling. We recommend proper use of strong sunblock when spending time outdoors.
IN THE MONTHS AFTER SURGERY
After the first postoperative visit, patients return for their second visit at about one month after surgery.
Patients will have experienced significant progression in the healing process. However, there will still be minor swelling in the nose.
Subtle changes and decreases in the swelling will gradually occur over many months.
* Each patient is unique and individual results may vary.
Side Effects And Risks
While choosing the right surgeon and following all pre- and post-operative instructions reduces surgical risks, rhinoplasty carries many of the same potential risks, side effects, and complications as other surgeries. Patients should know the following risks before they move forward with the procedure:
- Bleeding
- Poor healing
- Poor aesthetic outcome
- Infection
- Scarring
- Nasal septal performation (hole in the nasal septum)
- Skin tissue necrosis
- Numbness
- Skin discoloration
- Prolonged Swelling
- Breathing issues
- Anesthesia complications
Prospective patients who have any specific concerns regarding risks should bring them up during their rhinoplasty consultation in Princeton, NJ, so our surgeons can discuss and address them.
Why choose The Glasgold Group
Rhinoplasty New Jersey is a complex and custom procedure that requires a high level of skill and knowledge to perform properly. At the Glasgold Group, our surgeons have decades of experience while patients and peers alike respect them for the beautiful, natural-looking results they produce consistently. By choosing the Glasgold Group for your procedure, you can expect results of the highest caliber and the knowledge that your safety and satisfaction are top priorities.
- Dr. Robert Glasgold has an American Board of Otolaryngology – Head and Neck Surgery Certification.
- Dr. Robert Glasgold is a Fellow of the American College of Surgeons.
- Dr. Robert Glasgold is a co-director of the Facial Plastic Surgery Fellowship Program of AAFPRS.
- Dr. Robert Glasgold has an American Board of Facial Plastic & Reconstructive Surgery Certification.
- Dr. Mark Glasgold is a Fellow of the American College of Surgeons.
- Dr. Mark Glasgold is a co-director of the Facial Plastic Surgery Fellowship Program of AAFPRS.
- Dr. Mark Glasgold has an American Board of Facial Plastic & Reconstructive Surgery Certification.
- Dr. Mark Glasgold has an American Board of Otolaryngology-Head and Neck Surgery Certification.
Frequently Asked Questions
Imaging software helps you and your surgeon visualize the goals of your rhinoplasty surgery. In our offices in Princeton, NJ, we use the Canfield mirror imaging program and 3-D Vectra program. With these imaging devices, we attempt to show a result that is realistic and appropriate for you.
It is important to note that imaging does not provide the actual exact result. Instead, it represents a planned goal and helps patients get a sense of what their new nose will look like. Pre-operative imaging helps align the goals of both the patient and the surgeon.
We can perform rhinoplasty through either an open or closed (endonasal) approach. In our practice, we perform almost all surgeries through the open technique. An open approach combines the use of incisions inside the nostrils with an additional small incision that hides in the columella (the skin between the nostril openings).
The advantage of the open technique is that it provides better visualization of the underlying nasal structure with the ability to more effectively and precisely re-contour the nose. The scar in the columella typically fades well over time and becomes difficult to see.
Reshaping the upper portion of the nose (aka the bridge or dorsum) involves alterations in the bone and cartilage. When reducing a bump, we can shave the bone and cartilage components down. When needed, we can elevate the dorsum with the use of cartilage grafts or implants. Reshaping the nasal tip requires alterations of the cartilaginous structural components responsible for the external appearance of the tip.
Depending on the desired changes in the nasal tip, we can alter the tip cartilage by removing excess cartilage responsible for a wide-appearing tip. Suturing the existing cartilage to change its shape and adding cartilage to strengthen areas that are weak creates a more defined nasal tip shape.
Almost universally, we use an open rhinoplasty approach. This means there is an almost imperceptible incision in the skin between the nostrils (the columella). Additionally there are incisions made on the inside of the nose.
The surgeries are performed either in a hospital setting or outpatient ambulatory surgical facility. In either case, patients go home the same day of surgery.
The addition of cartilage in the nose, cartilage grafting, is an important tool for reshaping the nasal tip. The open technique allows precise placement and suture stabilization of these grafts.
The preferred source of cartilage for the grafts is the nasal septum; this involves removing a non-structural component of the septum and creating the grafts from it. We can use auricular (ear) or costal (rib) cartilage when there is an inadequate source of septal cartilage (usually because of patients having prior septoplasty and/or rhinoplasty surgery).
Yes. Because the basic nasal structure is frequently misaligned so that you are not just altering the size or shape of the nose you are dealing with the asymmetries which sometimes can be significant.
Augmentation of the nasal dorsum is almost routinely performed in Asian noses. Asian patients generally complain that they do not have much of a bridge and request this. Dorsal augmentation can be accomplished with a variety of materials. Cartilage can be taken from the nasal septum or the ear or donor cartilage may be used if these areas are not sufficient. In addition, gortex is an excellent means of dorsal augmentation. It has a very natural feel, adapts readily to the contour of the nose and does not move. I’ve used this frequently with great success. Having just come back from Vietnam, where I performed five rhinoplasties during a pro bono Face to Face program, in each case, I had to augment the dorsum. The common means of dorsal augmentation in Asian countries is a pre-formed Silastic implant. This has a higher incidence of problems than gortex or cartilage. In addition, when building up the dorsum, we frequently have to project the nasal tip in order to balance the increased height of the rest of the nose. This is always done with cartilage grafts, generally taken from the septum.
Natural implants would generally be considered those taken from the patient’s own material. We frequently use grafts in rhinoplasty taken from the patient’s septum or ear. Rib cartilage can also be used and this can be taken either from the patient or from a donor.
The tip of the nose is the lower one-third. There are cases in which the upper two-thirds are acceptable and don’t require any change. In these cases the surgeon can focus on the tip of the nose and re-contour it. Usually this involves narrowing, improving definition and rotation of the nose.
The most common age related change is due to lack of support of the nasal tip. With aging and loss of some skin elasticity the tip can appear to droop giving the nose a longer appearance. This also can accentuate a small protrusion of the nasal bones that was not apparent before. This certainly can be fixed. We have written extensively on the fact that the drooping nose can be one of the most aging facial features in a mature woman.
While the majority of our rhinoplasties are done under general anesthesia, we also do many under sedation. The determining factors are the patient’s preference and specific aspects of the surgery. This is discussed at the time of consultation.
The most common age related change is due to lack of support of the nasal tip. With aging and loss of some skin elasticity the tip can appear to droop giving the nose a longer appearance. This also can accentuate a small protrusion of the nasal bones that was not apparent before. This certainly can be fixed. We have written extensively on the fact that the drooping nose can be one of the most aging facial features in a mature woman.
PROCEDURES
Our high level of training and experience allows us to focus on providing each patient with natural-looking surgical results and rapid recovery in the safest environment possible.
INJECTABLES
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