Rhinoplasty West Palm Beach, FL

What is Rhinoplasty(Nose Job)?

Rhinoplasty is a plastic surgery procedure that can reshape the nose and help to improve nasal function. Many changes can be made to the nose including a reduction or increase in overall size, removal of a hump, reshaping of the tip or bridge, narrowing of the nostrils, or a change in the angle between the nose and upper lip. Reshaping the nose can help to achieve a more aesthetic facial appearance by creating harmony among the facial features. Today’s techniques for rhinoplasty are more natural and creative, focusing on reshaping, sculpting and restoring skeletal deficiencies rather than performing large volume removal and resection of bone and cartilage.

Open vs. Closed Rhinoplasty

Patients often ask about or are concerned about whether their rhinoplasty will be done by an open or closed technique approach. They express concerns about the external columella incision in the open approach, which they fear will leave a visible scar as well as longer periods of swelling and healing. Some will only seek out surgeons who exclusively do the procedure the way they want it done.

Dr. Schwartz uses both the open and closed approach but counsels not to worry about the approach as much as the desired result. “After evaluating what a patient needs to have done to get the result they want, I’ll tell them what approach I’m going to use” says Dr. Schwartz. “I don’t think the external incision creates a problem scar and I think getting the result you want is worth a little more healing time”. “If a patient is set on a certain approach and I don’t think I can get the result that way then I’ll recommend they see another surgeon who can.”

Dr. Schwartz feels that it comes down to training and experience. There is no “right or better way” to do a rhinoplasty. Some surgeons are very comfortable with open rhinoplasties only, some with closed and some with both.

The following patients illustrate how Dr. Schwartz uses both open and closed rhinoplasty for his patients. All patients are seen at over 3 years after their procedures.

Benefits of Closed Approach

From a patient’s point of view, the biggest benefit of a closed rhinoplasty is that there are no visible scars on the exterior of the nose. A person can enjoy the benefits of a nose job without the scar serving as evidence of the surgery.

Another benefit of a closed rhinoplasty procedure is that it typically has a shorter recovery time. Since fewer incisions are made during the procedure, there is less that needs to heal, as well as less swelling after surgery. Patients still need to take a week or two off from work and to take it easy for the first month or so after surgery, but they are more likely to feel better and to see improvement more quickly, compared to those who have an open procedure.

Benefits of Open Approach

If a closed rhinoplasty means less recovery time and no visible scarring, you might wonder why anyone would want an open rhinoplasty. As it turns out, an open procedure allows the surgeon greater access to the interior of the nose. During an open rhinoplasty, a surgeon can do things to the nose he just can’t do during a closed surgery.

For example, during a closed rhinoplasty, the nasal cavities remain divided. It’s more difficult for a surgeon to fully reshape the cartilage during a closed procedure and it can be challenging for a surgeon to re-drape the nasal skin during the surgery. During a closed rhinoplasty, there’s an increased risk for deformity of the nasal cartilage and for excess stretching of the skin in the nasal area.

In contrast, during an open surgery, the surgeon has easy access to the interior of the nose. The top of the nose is flipped up, similar to the way you might open the hood of a car. The surgeon can clearly see and manipulate the nasal skeleton. It’s also easier for a surgeon to work on the tip of the nose during an open procedure.

While the open technique does involve making a scar across the columella, the tissue that divides the nostrils, the size of the incision and the location of it means that it is likely not to be very visible once all is said and done. In many cases, the incision heals nicely, leaving almost no visible scar. Since the incision is placed on the underside of the nose, a person would have to lean down and stare directly up at another person’s nostrils to even catch a glimpse of it.

How Do You Choose your Nose Job?

In the end, deciding between open and closed rhinoplasty isn’t as simple as answering the question of “external scar or no external scar?” Your surgeon will evaluate what changes you’d like made to your nose, your expectations for the surgery, and a variety of other factors when deciding whether an open or closed procedure is best for you.

In fact, it can be a red flag if your surgeon insists that he only performs one type of rhinoplasty and not the other. While an open procedure might make sense for the majority of cases, it’s not always the best option. The same is true of a closed technique. You want to work with a surgeon who has the experience with and understanding of rhinoplasty to be able to choose the technique that best suits you and your nose.

The Deviated or Crooked Nose

The patient with a crooked or deviated nose presents a special challenge in rhinoplasty. The deviation may be a result of previous trauma or just an aberrant growth pattern.

These types of noses often have asymmetrical features, uneven amounts of bone or cartilage on either side, areas of collapse opposite areas of excess prominence. Often underappreciated is the amount of internal deviation which may also be present and if not also corrected will doom the aesthetic result to failure. The surgeon also must take into account the natural tendency of “cartilage memory” to return to it’s original deviated position even after correction and take steps to counteract this.

Deviated or Crooked Nose (Before & After)

The Rhinoplasty Procedure

Working through the incisions, Dr. Schwartz will reshape the nose to the desired appearance. Contemporary rhinoplasty emphasizes creativity in fashioning a new nasal architecture by reshaping, sculpting and restoring skeletal deficiencies as opposed to large volume removal and resection of bone and cartilage. This is a more natural and creative approach which has the added benefit of decreased bruising, a quicker recovery, and more natural, lasting results.

Rhinoplasty and Aging

A common myth is that the nose “grows as we age”. This is not so. The nose does not “grow”, but the ligaments that support the cartilages lose their strength and ability to support the nose and that combined with the loss of facial volume (especially if the upper gums have receded) results in the appearance of drooping, larger nose. This is often disturbing to patients who feel that “they never looked the way before.” It can also result in functional problems because as the nose droops it may impinge on the breathing passages as well. It is also a myth that patients experiencing these changes are “too old for rhinoplasty”.

The following patient exhibits what great results can be achieved by performing conservative rhinoplasty in older patients.

This active 80 year old male still runs distance races. He complained of increasing airway problems from his drooping nose along with difficulty in shaving his upper lip. Preoperative photos show the deviated, elongated nose with drooping tip cutting off his breathing along with creating the illusion of dorsal hump due to poor tip support. While generally healthy there were definitely concerns about doing elective surgery at this age. A conservative rhinoplasty and septoplasty done under local anesthesia provided him great relief with low risk and quick recovery.

Post-operative photos demonstrate straightening of his nose with increased tip support and elevation thus improving his airway and allowing him to more easily shave his upper lip. Conservative lowering of the profile and tip shaping add a more youthful look as well. He now reports his running to be the best he has done in years.

At what age can rhinoplasty be performed?

Rhinoplasty can be performed on patients over the age of sixteen, or once the nose has completed its growth.