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Nose Reshaping Palo Alto

View Before and After PhotosAs with many plastic surgery procedures, the rhinoplasty (nose surgery) procedure is as different as there are numbers of people on earth. We are all different. Our noses are different. Individual assessment is very important. The consultation is critical. Nose surgery (rhinoplasty) is done to straighten a crooked nose, to make a very large nose smaller, or to increase certain dimensions of a nose perceived as too small or just not adequate in certain places. Some people prefer a dorsal hump or bump be removed. Some people prefer a tip to be narrower and better shaped. Some patients prefer the nostrils be made smaller. At times, patients request a stronger bridge or a better tip of increased nasal tip projection. Sometimes, narrowing wide nasal bones are indicated. The surgeon must listen very carefully and plan the rhinoplasty operation in accord with the patient’s desires. A careful discussion with photography is informative and necessary.

Careful planning in rhinoplasty further assures a result that pleases the patient, is very natural and nonsurgical in appearance, and functions well. Function or airway must always be considered. Natural breathing is critical of course to all. Often airway problems are corrected simultaneously with rhinoplasty. A beautiful nose that doesn’t breathe very well is not a successful endpoint. A successful rhinoplasty is all about aesthetics and function.

At the consultation, expectations are discussed and realistic expectations are explained. Probably 99% of the time the patient’s desires and what is possible and appropriate in rhinoplasty are in good accord. Rarely a patient may have unrealistic expectations, so careful discussion is important. Facial pictures are taken and printed. I discuss what the patient wants and what I can do. I am again and again amazed at how intelligent patients are and how well-read they are on most plastic surgery procedures. This certainly is true of surgery of the nose. I rarely use computer imaging to suggest a result. This only shows what a computer can do and may be way off a realistic possible rhinoplasty endpoint. After the patient and I review all of the patient’s pictures we look together at pictures of patients I have done (well over 1100 rhinoplasties) and specifically look at pictures of patients with similar noses to the consult patient. All questions are answered carefully and thoughtfully. All questions a patient may have are good questions.

A rhinoplasty can be done with patients awake or asleep. Although local anesthesia is a possibility it is always nice to be asleep for both comfort and total safety. An M.D. anesthesiologist enhances safety and comfort. Yes, there is a cost for an anesthesiologist but one worth every penny. An alternative to total anesthesia, the twilight sleep procedure is accomplished with sedation. The patient is relaxed but not asleep. You still may feel a little pain but not much. Of course, surgeons tend to be kind hearted people and always make every effort to assure comfort and gentleness.

What is actually done in a rhinoplasty? The rhinoplasty may include many techniques and procedures. Technical aspects in rhinoplasty include adjustment of the nasal bones, removal of bone and cartilage from humps, cartilage adjustment or removal from the tip, cartilage or bone grafts, placement of implants, correction of the airway, and nostril correction for symmetry and narrowing. Surgery is usually done on an out-patient basis and the patient returns home to recuperate. There is no nasal packing unless extensive airway work was done. A small splint is applied for 48 hours or so to protect the nose. Patients return to work, school, or play in 4-7 days. Full recovery takes 6-12 months or longer depending on the procedure. Most patients look fine in 10 days but resolution of swelling takes longer. Sutures are usually the dissolving type but occasionally some need to be removed.

The nose reshaping is a popular procedure which is gratifying to patient and surgeon. I have done rhinoplasty procedures on patients of ages 13 to 76. Candidacy depends on anatomical facts plus the patient’s desires. Secondary nasal surgery after rhinoplasty is needed about 2% of the time for minor adjustment. The needs for major secondary rhinoplasties are rare. One of the wonders of practice in the bay area is the delightful diversity of our patients. I have done nasal surgery on patients with worldwide heritage (Asian, European, Middle Eastern, African, Indian, American Indian and Latin). All do well and all merit very individual attention to their specific nose shape and their desires.

For the proper candidate, rhinoplasty surgery is a much appreciated endeavor and enjoyed by both patient and surgeon.

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