Rhinoplasty is a commonly requested plastic surgery procedure at the San Francisco Bay Area office of Dr. Joseph Mele. Since the nose is the most central feature of the face, a nose that is too small, too large or misshapen can make you feel extremely self-conscious.
Rhinoplasty Before and After Photos
Thanks to Rhinoplasty, Dr. Mele and his experienced staff can reduce the size of an overly large nose, enlarge a small nose and eliminate abnormalities in misshapen noses. Rhinoplasty surgery can dramatically improve overall appearance and significantly increase self-esteem.
Your Rhinoplasty Consultation
Dr. Mele will spend time discussing your expectations and the specifics of your Cosmetic Nasal Surgery procedure to ensure that you are comfortable with each facet of your nose surgery. Dr. Mele uses state-of-the-art computer simulation during your consultation to facilitate communication, and help make certain that you are fully informed before surgery. Making certain expectations match results helps assure that you will be satisfied with your results. Our office is relaxing, and our friendly support staff will instantly put you at ease.
General Approaches to Rhinoplasty (Nose Surgery)
When we get down to basics, there are only two ways to change the shape of the nose. Either volume is removed, like to lessen a bump on the nose, or volume is added to create definition when absent. Often the combination of lowering bumps and building up more refined features is utilized. This allows for the reduction of a big nose, with enhancement of the best features.
The concept of reduction is pretty easy to understand. When the nose is too large, a portion is removed to reduce the size. This is done with attention to the aesthetics of the nose to form a new, smaller, nose that remains proportionate to your face. The simplest example is the treatment of the dorsal hump, a bump on the upper nose. Removal of the bone and cartilage that supports the skin in this area, creates a smooth nasal dorsum. However, sometimes the nose looks like it has a bump because the tip it hooked. In this situation, adding volume and projection to the tip may be advantageous, or even preferable.
Augmentation Rhinoplasty (Nasal Autografting)
Sometimes adding volume to the nose is the best solution. Nasal autografting is a technique that allows for recycling of your own cartilage. The cartilage typically removed during rhinoplasty can be used, or if insufficient, additional cartilage can be borrowed from the nasal septum, ear and less commonly the rib. Since your own cartilage is used, your body accepts it, and long term augmentation can be obtained. The simplest example is the dorsal onlay graft used to augment a flat upper nose for Asian Rhinoplasty, or to build up the bridge of the saddle shaped nose deformity often seen after trauma.
Closed Rhinoplasty vs. Open Rhinoplasty
The debate between closed rhinoplasty or open rhinoplasty, continues to this day. Each technique provides both advantages and disadvantages, and the final determination of which technique is best for your nose depends on an careful, professional evaluation of the aspects of your nose you want changed. The exact type of surgery needed to provide the safest and most predictable results, will determine whether the open rhinoplasty or closed rhinoplasty technique is right for you.
One hundred years ago, most rhinoplasty was performed closed. Closed rhinoplasty eliminates the small incision between the nostrils used in the open technique. Closed nasal surgery works well for dorsal reductions (removing the bump on the nose) and narrowing of the wide upper nose. For these standard rhinoplasty maneuvers, the open technique does not provide much advantage. Since the closed technique incisions are all inside the nose, they are hidden. However, the small external scar needed in the open technique usually heals extremely well and is very difficult to see in most circumstances. The closed technique may have less post-operative tip swelling, but when similar operations are performed, it is difficult to demonstrate the difference. There can be more problems with symmetry of the nasal tip with the closed approach, because the lower nasal cartilages providing support for the tip cannot be completely seen at the same time in their natural position.
Open rhinoplasty has simplified tip rhinoplasty. Its pioneers have advocated for it superior visualization of the lower nasal anatomy. The difference between open nasal surgery and closed nasal surgery is the 1/4 inch incision made between the nostrils. This small columella incision allows the nasal skin to be lifted, and the underlying cartilages to be seen in their normal position. While the nasal tip cartilages can be seen with the closed approach, it is necessary to deliver (pull out) one side at a time for tip work. The open technique reveals both sides simultaneously, and facilitates the symmetry of the result.
Specific Corrections with Rhinoplasty (Nose Surgery)
The term rhinoplasty encompasses a wide variety of surgical procedures and non-surgical approaches. Below are a few examples of what can be accomplished with cosmetic surgery of the nose:
Reduction of a Dorsal Hump
One of the more common reasons to have nasal surgery is to reduce the dorsal hump. The dorsal hump is the bump located on upper aspect of the nose caused by excess bone or cartilage. A small incision is made, often inside the nose, and the excess is removed. Sometimes, after larger reductions, the nose needs to be narrowed, and the nasal cartilage and bones can be brought together.
Reduction of the Nasal Tip
When the nasal tip is large, it can give a boxy or bulbous appearance to the nose. Nasal tip surgery can reduce a large tip, and give a refined appearance. By providing enhanced definition of the tip, the entire nose appears smaller. By bringing the nasal tip into proportion with the rest of the nose, a more pleasing appearance can be created. The nasal tip can be addressed through open rhinoplasty to help improve the symmetry nasal cartilage, or via closed rhinoplasty depending on the type and amount of correction you desire.
Rotation of the Nasal Tip
When the nasal tip is droopy, it can give a sad or hooked appearance to the nose. Nasal tip surgery can rotate the tip of the nose up, providing enhancement of the profile. By bringing the nasal tip up, a more youthful appearance can be created. Care is taken not to over-rotate the tip; however, as this can expose too much of the nostrils.
Reduction of the Nasal Base
For patients with wide nostrils, reducing the width of the nasal base may be desired. Small Weir Excisions can be made along the edge of the ala, the skin around the sides of the nostrils. Further reduction of the nasal width can be achieved with a spanning suture. It is important to consider exactly what about your nose you would like to change, so that you can get the most from your Rhinoplasty Consultation appointment.
A flat nose can be corrected with nasal augmentation. A nasal graft, or nasal implant, is placed below the skin of the nose to augment the nasal bridge. This provides an enhanced, stronger nasal profile.
Post-traumatic Deformities (Fixing Broken Noses)
Nasal fractures are one of the most common facial fractures. A fractured nose can give a flattened appearance, or result in a nose that is no longer in the midline. Adjustments can be made to a broken nose in the week after injury, or can be delayed 6 weeks to allow the boney fragments to unite. Repair of nasal deformities after trauma is directed toward restoring the normal anatomy, and the approach needs to be individualized.
Dermal fillers, more commonly used to reduce facial lines or for lip augmentation, can be used to reshape the nose also. Small changes can be made rapidly, and with minimal downtime, when nasal depressions are present, or minor nasal augmentation is desired.
Additional Procedures with Rhinoplasty
It is safe to combine Rhinoplasty with additional corrective and cosmetic procedures? The most commonly combined procedures include:
Rhinoplasty with Septoplasty
Septoplasty is performed to straighten a deviated septum. If you have difficulty breathing through one side of your nose, your septum may be deviated. This can be from trauma, a broken nose usually means a broken septum, or it may just be the way your septum developed. Septoplasty is a technique used to straighten the septum and open up the constricted airway.
Rhinoplasty with Turbinate Reduction
Turbinates are normal folds in the nasal lining that heat and add humidity to the air we breathe. The lowest turbinate, also termed the inferior turbinate, happens to placed at the narrowest portion of each nasal airway. When the inferior turbinate swells, it can restrict, or even block, the airway. Since each side has its own inferior turbinate, air flow in one or both sides can be restricted. Since the turbinates can expand an shrink, the blockage may be intermittent. Seasonal allergies tend to worsen these symptoms, and the turbinates tend to slowly enlarge as we age. There are several different ways to reduce the turbinates, and if this is a problem for you, be certain to discuss your options with Dr. Mele, during your consultation.
Rhinoplasty with Chin Augmentation (Chin Implants)
Often a large nose is made to look larger by a small chin. In this situation, chin augmentation may provide the solution you want. Microgenia, is the medical term for small chin. Microgenia is corrected by a chin implant inserted via an incision placed discretely under the chin or inside the mouth. Chin augmentation can be performed at the same time as your rhinoplasty to help provide overall balance to your face with a single surgery.
Rhinoplasty with Chin Augmentation Before and After Photos
Other Cosmetic Procedures
Rhinoplasty is often combined with other cosmetic procedures. This provides the advantage of one anesthetic and one recovery period for multiple surgeries. Some of the most commonly performed cosmetic plastic surgery procedures are also the most frequently combined procedures. Our patients often combine: Facelift (Rhytidectomy), Eyelid Lift (Blepharoplasty), Breast Augmentation (Breast Implants), Tummy Tuck (Abdominoplasty), and Liposuction (Liposculpture).
Your Rhinoplasty (Nose Surgery) Procedure
Every rhinoplasty surgery is different. At our San Francisco East Bay Area (Tri Valley), Walnut Creek office, each surgery is customized to best meet your objectives and goals. During most rhinoplasty procedures, Dr. Mele will remove or rearrange nasal cartilage and if necessary, reposition the bone to reshape the nose. Non-surgical rhinoplasty is also available for more subtle nasal augmentations. The goal of nose surgery is to achieve a proportionate, natural-looking nose that is in harmony with the other features of your face.
During rhinoplasty, San Francisco, CA, plastic surgeon Dr. Mele can reduce the size of an overly large nose, enlarge a small nose, or minimize the abnormalities of misshapen noses. In order to accomplish your desired goals, he may need to remove cartilage and reposition the bone to reshape the nose. By making subtle changes, Dr. Mele can greatly enhance the shape and size of your nose. The goal is to create a natural-looking, more proportionate nose, which is in harmony with the other characteristics of your face.
When evaluating my Walnut Creek Rhinoplasty patients, it is important for me to evaluate the entire face. The interplay of the nose with the eyes, mouth, cheeks and other important landmarks must all be taken into consideration. A large nose and a small chin can interact to accentuate the disproportion. In other words, a small chin makes a large nose look larger and visa versa.
Depending on your condition and needs, additional procedures may be performed with nose surgery, such as facelift surgery (“Rhytidectomy”), eyelid surgery (“Blepharoplasty”), and/or brow lift surgery (“Forehead Lift“). During an initial consultation, Dr. Mele will help decide on the procedure(s) that are right for you. Before and after Plastic Surgery Photos are available to view, featuring some of Dr. Mele’s excellent work.
Attention to proportions are an important key to a successful rhinoplasty. Like all of cosmetic surgery, it requires a combination of art and science, an eye for ratios and the surgical skill to craft them.
Schedule a Rhinoplasty Consultation
For more information about rhinoplasty or to schedule a consultation, call or contact our plastic surgery practice online today.