Types of Rhinoplasty
Primary rhinoplasty is the term we use for operating on the nose that hasn’t had any surgical procedure before.
Secondary Rhinoplasty (Revision Surgery)
Secondary rhinoplasty is when revisional surgery is being performed on the previously operated nose.
During your consultation with Dr. Nelson, he will discuss whether you have had any nasal trauma in the past, as well as any significant sinus, airway, or breathing issues. It is during this time that you will fill him in on the things you wish to change concerning the function and look of your nose.
Dr. Nelson will assess the shape, contours, projection, and size of your nose. In addition, he will assess the inside of your nose, paying particular attention to the quality of the inside tissue lining, whether your septum is deviated, how well your airway functions when breathing in and out, and whether any of the internal structures are swollen or out of the norm.
Dr. Nelson believes it’s a fine idea to bring in photos of the types of noses you prefer, so he can better see what you are wanting, and then we can better see if it is achievable in your case. Information is always a good thing in helping us help you obtain your goals. Pictures sometimes help us explain what can’t be achieved on occasion.
Before and After Photographs
Dr. Nelson will go over photographs of numerous patient who have had this surgery to help explain the choices they made and what was done to accomplish their goals. In addition, we typically take photographs so we can do a computer imaging consult with you regarding your nose, any desired changes, and how those changes might look.
A word of caution here is that everyone needs to remember that although we can make your nose look anyway you want on a computer screen, no one should ever assume that is the exact nose you will achieve. The computer is a great teaching tool to help you and Dr. Nelson get into each other’s head about what is realistic, but remember, it is a computer image, and your tissues may behave differently than pixels on a screen.
Once you have informed Dr. Nelson of the things you wish to change in your nasal shape, he can outline what can be done to accomplish those results. It is common for patients to think they can just have the dorsum (top part) of the nose reduced as a simple procedure and that’s it. We have to remind our patients that the nose is three dimensional, and all the components of the nose are so interconnected that once one area is made smaller, the area right next to it will look larger, so we have to carefully assess the whole picture and adjust other parts of the nose to keep everything in balance.
A perfect example of this is that you will notice that when we see a patient for rhinoplasty, one of the first things Dr. Nelson looks at is the person’s chin. Many patients with a weak chin and possibly a bit of extra fat deposits under the chin, will have that make their nose look larger. An under projecting chin gives the illusion that the nose is larger and over projecting. Therefore, don’t be taken back if Dr. Nelson makes some comments about your chin during your consultation; this is all part of bringing your face into balance.
Dr. Nelson will show you some cases where only a little change in the nose was performed, but it was a chin implant that made the face and nose look more balanced. Not every nose can necessarily be made to the exact shape you want for your own skin, and your airway may limit some of the moves we can make on your behalf. There is no point on having a cute small nose if you can’t breath through it, and there’s no point in trying to have a nose that exactly matches a picture if the bones might collapse or the nose would be completely out of sync with your face.
While minor rhinoplasty changes may be performed under local anesthesia, most of our “formal” rhinoplasties are performed under general anesthesia (full sleep) as an outpatient procedure.
Open vs. Closed
Rhinoplasties are performed either “open” or “closed”.
Open rhinoplasty means there is an incision that is across the fleshy part of your nose in the midline that connects to the upper lip; this is called the columella. An incision across the columella and then inside the inner edge of the upper nostrils allows the skin the be gently lifted off the structures of the nose, so it is “open” to direct visualization.
A closed rhinoplasty means the incisions are placed completely inside the nose, so the visualization is a bit more indirect and done more by looking into the nostrils to see things. Some incisions used in a “closed’ rhinoplasty still allow us to move the nasal skin largely out of the way to provide excellent approaches to the surgery being performed.
One incision is not superior to the other; some of this is related to the style of incision the surgeon prefers, and sometimes the complexity of the nasal surgery may dictate the incision.
There has been a trend over the last twenty years for more rhinoplasties to be done via the open approach; some of that change has been with adjustments in the internal suturing techniques that can help the open technique be more precise. Dr. Nelson performed all my rhinoplasties 20 years ago “closed,” and now perhaps 90 percent of his rhinoplasties are performed “open.” However, now a few more maneuvers are performed that make open rhinoplasties more reliable in Dr. Nelson’s hands. Don’t get too focused on the individual incision as much as the results your surgeon gets with their preferred approach.
Shaping and Contouring
The actual shaping and contour maneuvers Dr. Nelson uses to achieve your new look are too anatomically involved to outline here, but realize Dr. Nelson may trim off excess where indicated, add grafts of cartilage or bone when necessary, and place sutures into the structures to support them in new places or shapes to make your nose have the right contours. It may involve removing some bone and cartilage to make a nose less “Romanesque,” or it might mean laying some graft material onto the cartilage and bones to shape the nose better if it slopes too much or is too flattened on the top. Dr. Nelson will use the appropriate shaping and contour maneuvers to provide you with a nose that is excellent in both form and function.
Most patients will have little or no significant pain immediately after the procedure, for numbing blocks are used while you are asleep. This allows you to get home and get comfortable and start any medications you need as the blocks wear off hours later. Essentially all patients will have some taping or a splint on the nose to help control swelling in the early recovery stages of healing. We will visit with you several times in the first weeks of recovery.
I hope this gives a quick overview of a nasal surgery consult. To schedule your consultation with Dr. Nelson, please call us at (520) 575 – 8400 or fill out our online contact form. We look forward to meeting you!