“Beauty Through Mastery” Serving Miami, Boca Raton, Florida and surrounding areas
Rhinoplasty is regarded as one of the most challenging operations in plastic surgery. There are several factors that contribute to the complexity and inherent challenges in rhinoplasty. The nose is the confluence of several different types of tissue including bone, cartilage, muscle, fat, and skin. These elements of the nose naturally blend together making the nose the centerpiece of the face.
Surgical alteration of the nose requires a deep understanding of nasal anatomy, as well as the technical skill, and artistry required to create beautiful and natural results. Furthermore, the nose itself is a small structure relative to the entire face, and therefore, a beautiful result is often merely a difference of a few millimeters. Understanding the delicate aesthetic balance of the nose, together with a passion for rhinoplasty are essential to achieving consistent, pleasing, and natural results.
Dr. Paul N. Afrooz has had a passion for rhinoplasty since medical school, during which he spent elective time with Dr. Bahman Guyuron, one of the foremost world experts in rhinoplasty and revision rhinoplasty. During that time, Dr. Afrooz cultivated his passion for rhinoplasty through research and the writing of seminal articles and book chapters in rhinoplasty.
Following residency training at the University of Pittsburgh Medical Center, Dr. Afrooz trained with two additional world rhinoplasty experts, Dr. Rod J. Rohrich, and Dr. C. Spencer Cochran. Dr. Rohrich serves as Editor-in-Chief of the Journal of Plastic and Reconstructive Surgery, as well as Chairman of the Dallas Rhinoplasty Symposium. Dr. Cochran is also a world leader in rhinoplasty and the successor of Dr. Jack P. Gunter, well-known as a pioneer in rhinoplasty.
During fellowship, Dr. Afrooz participated in over 150 rhinoplasties; honing and mastering the intricacies of the operation. Rhinoplasty remains his greatest passion in plastic surgery, and he now serves as faculty for the Dallas Rhinoplasty Symposium, and has served as faculty for the International Dallas Rhinoplasty Symposium. He continues to serve as a rhinoplasty educator as the author of numerous book chapters and rhinoplasty articles in peer-reviewed journals.
WHAT IS THE GOAL OF RHINOPLASTY?
The goal of rhinoplasty is to create a natural, aesthetically pleasing nose that enhances the overall appearance of the face, while also alleviating any problems with breathing. Some of the common issues that lead patients to seek rhinoplasty include a bump on the bridge of the nose (known as a dorsal hump), a crooked or asymmetric nose, or a nasal tip that is too wide, droopy, or bulbous. Some patients may simply desire minor refinement in one area of the nose. An additional reason that patients pursue rhinoplasty is due to difficulty breathing through one or both nostrils. Rhinoplasty offers the means to provide aesthetic enhancement, improved contour, and improved breathing.
HOW IS A RHINOPLASTY PERFORMED?
Rhinoplasty is typically performed through either the “open approach” or the “closed/endonasal approach.” The difference in approach refers to the placement of the incisions that are used to gain surgical access to the nose. In the closed, or endonasal approach, the incisions are made on the inside of the nose. In the open approach, the incisions are placed on the inside of the nose with the addition of a 3 mm incision across the columella, which is the area of skin on the bottom of the nose that separates the nostrils. While there are certain indications for the closed technique, Dr. Afrooz believes that the open approach facilitates the precise visualization of the underlying structure of the nose, as well as the precise correction and shaping of these structures, in order to deliver pleasing and lasting results. The incision on the columella is well-hidden, leaving a scar that is virtually imperceptible.
After the incisions are made, the underlying nasal bones and cartilage are readily visualized, shaped and altered through various techniques. If the nasal bones are excessively wide, extremely precise cuts of the nasal bones are performed in order to mobilize the bones so that they may be reoriented in a more aesthetically-pleasing manner. These cuts of the nasal bones are called osteotomies. Likewise, if the nasal bones are too narrow, asymmetric, or deviated, precisely designed osteotomies are used to correct these imperfections.
Many patients seek rhinoplasty due to a bump on the bridge of their nose. This is referred to as a dorsal hump. Often times, a patient may simply want the bump to be removed. A common misconception is that this is a very easy correction. The “bump”, which is referred to as a dorsal hump, is usually due to prominent bone and cartilage at the point where they join. Removing this bump requires precision and advanced methods of reconstructing the adjacent areas that are disrupted in the process. In addition, reducing a bump may have additional effects on the appearance of the width of the nose, and may make the bridge of the nose appear wider. Therefore, it is essential to understand how changing one dimension of the nose effects the relative appearance of other parts of the nose.
The tip of the nose is another area that motivates patients to seek rhinoplasty. Sometimes the nasal tip can be too wide, round, or bulbous. Through the open approach, the cartilage in the tip of the nose can be altered through advanced techniques which create a more defined, refined, and aesthetically-pleasing nasal tip. These techniques include methods to redefine, raise, lower, or simply alter the shape of the nasal tip to one that is more aesthetically pleasing.
The nostrils are an important aspect of the appearance of the nose and sometimes, it is the appearance of the nostrils that motivates patients to seek rhinoplasty. Nostrils that are excessively wide or flared can be corrected by removing tissue from the area where the nostril joins the cheek. These incisions are well-concealed and precisely designed to the exact millimeter in order for to narrow the nostrils or correct flaring of the nostrils. Narrowing the nostrils must be performed carefully in order to preserve their natural appearance and congruence with a patient’s ethnicity.
RHINOPLASTY FOR BREATHING PROBLEMS
Normal breathing depends partly on the anatomy of the nasal septum, the adjacent sidewalls, and structures within the nose called turbinates. A deviated septum may contribute to breathing problems, but other nonsurgical factors such as allergies and chronically swollen tissue within the nose may also contribute to poor suboptimal breathing. Improvement of breathing after surgery in these cases may be limited despite complete correction of a coexisting structural deformity.
A large portion of breathing problems can be resolved by correction of the portion of the septum that is deviated, or blocking the nasal passage. If the turbinates are large and blocking the nasal passages, they are typically reduced in their size to create a larger nasal passage for airflow. If breathing is compromised by collapse of the nasal sidewalls during inspiration, there are several techniques used to support and open the internal nasal valve. Sometimes, these techniques involve the use of cartilage grafts termed “spreader grafts.” Spreader grafts can provide additional support to straighten the nose, but may also slightly widen the nose, therefore, they are used only if necessary.
WHAT IS THE RHINOPLASTY RECOVERY PROCESS?
Depending on the extent of surgical correction, the initial recovery period is usually between 7-10 days. During this time, patients will likely have a small splint on the nose, as well as soft silicone splints in each nostril. These splints provide support and reduce swelling during the healing phase. The sutures used inside the nose are almost always absorbable and will not need to be removed. The stitches on the outside of the nose are removed between 6-8 days.
Very few patients complain of pain or discomfort after rhinoplasty. The biggest inconvenience is the requirement to rest and take it easy after surgery. Proper rest and reduced activity is essential to minimize swelling and ensure a smooth recovery.
While the initial period of postoperative swelling resolves in about 4-6 weeks, residual swelling exists for 12-18 months. Therefore, the true results of a rhinoplasty cannot be entirely appreciated until 12-18 months.
To learn more about rhinoplasty, please call our Miami office at 305.854.8828 to schedule your confidential consultation with Dr. Paul N. Afrooz, rhinoplasty specialist.