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Rhinoplasty Palo Alto

View Before and After PhotosRhinoplasty is the term given for the cosmetic surgical correction of the nose. The goal of cosmetic nasal surgery is to establish a pleasing profile with facial harmony. Attention is drawn away from the nose, not to it. I have performed well over 1100 rhinoplasties ranging from 13 to 76 years of age. Females usually attain their full facial growth potential around 14 to 15 years. Males are usually candidates for nasal surgery from 15 to 16 years and sometimes older.

There are two different approaches to performing nasal surgery. One is a closed method that is reserved for minor corrections, such as shaving down dorsal humps or narrowing nasal tips. The incision can be made inside the nose. For more challenging corrections, the surgeon may prefer to use the open technique to give more visibility to the surgeon. The open method has a small incision at the base of the nose that is well camouflaged.

Noses differ a great deal and individual assessment is very important. Some changes may include: straightening a crooked nose, making a very large nose smaller, increasing certain dimensions of a nose perceived as too small, shaving down a dorsal hump, building a stronger bridge, getting better tip projection, making a tip narrower or shaped better, or making the nostril flares smaller. On occasion, narrowing wide nasal bones might even be indicated. The surgeon must listen very carefully to the patient’s desires and assess his/her candidacy and realistic expectations. Candidacy depends on anatomical facts plus the patient’s desires. A careful discussion with photography is informative and necessary. The end result should be very natural and non-surgical in appearance.

Function or airways must always be considered. Natural breathing is critical of course to everyone. Airway problems are often corrected simultaneously with a rhinoplasty procedure. A beautiful nose that doesn’t breathe very well is not a successful endpoint. So it’s all about aesthetics and function. Breathing difficulties that developed by nature or trauma can be improved by correcting the airway obstructions or deformities. The latter correction is often referred to as a septoplasty. Other medically necessary corrections can involve turbinate reductions or outfractures, which we often group into the septoplasty category. Rhinoplasties are not covered by insurance. Septoplasties can involve insurance participation.

Probably 99% of the time, the patient’s desires and what is possible and appropriate are in good accord. Occasionally however, a patient may have unrealistic expectations, so careful discussion is important. This is particularly critical regarding nasal surgery. I rarely use computer imaging to suggest a result. This only indicates what a computer can do and may be way off a realistic surgical endpoint. I’d rather use photographs taken of the patient to review together and discuss what changes are possible and desirable. The patient is then given the opportunity to review work that I have already performed on similar noses. One of the wonders of practice in the San Francisco Bay Area is the delightful diversity of our patients. I have done nasal surgery on patients with worldwide heritage (Asian, European, Middle Eastern, African, East Asian Indian, Native American and Hispanic). All do well and merit very individual attention.

A rhinoplasty can be done with conscious sedation or asleep. Although I.V. sedation 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 worth every penny. The alternative to total anesthesia, is a twilight sleep that is accomplished with sedation. The patient is relaxed, but not asleep. You still may feel some discomfort, but it’s minimal.

We make every effort to assure comfort and gentleness. Surgery is usually done on an “out patient” basis where the patient returns home to recuperate. There is no nasal packing unless extensive airway work was performed. A small splint may be 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.

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