Rhinoplasty can offer a dramatic enhancement in facial appearance. The most common rhinoplasty involves the reduction of a hump and/or reshaping of both bone and cartilage. Today, in addition to incisions hidden inside the nose, most rhinoplasty procedures include a tiny incision across the columella, the skin under the nose between the nostril openings. The incision is rarely visible. This allows the skin to be elevated for complete exposure and visualization of the underlying structures which are to be modified. This in turn allows greater accuracy in sculpting and the use of sophisticated shaping techniques which are otherwise almost impossible.

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Sometimes the nose is too small and needs to be built up using your own cartilage or in some cases a nasal implant. It is very helpful to visualize our extensive collection of before and after pictures showing many different examples of rhinoplasty procedures. Everyone is different. As with so much of plastic surgery, your starting anatomy defines your range of opportunity. For example a really large nose has too much skin to be made into a tiny nose without risking deformity. (Most people can think of at least one celebrity example of this!) We spend a great deal of time teaching and establishing realistic expectations to be sure our patients will be happy with their rhinoplasty.

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Dr. Walker is an amazing surgeon. She is very detail oriented, her bedside manner is excellent, and you can tell she truly cares about her patients. She is very thorough in her explanations and makes sure you understand.

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Computer Imaging for Realistic Rhinoplasty Goals

We have found computer imaging to be a valuable tool to demonstrate what is possible and to further help establish realistic expectations. This is complementary and we perform computer imaging on 100% of our rhinoplasty patients to be sure we have an idea of each individuals goals prior to scheduling the surgery.

Why Choose Dr. Stagnone for Nose Surgery

Rhinoplasty Procedure and Technique

Rhinoplasty (“Nose job”) is most commonly performed today as an open rhinoplasty which includes an incision across the columella, the thin bridge of skin separating the nostrils. The rest of the incisions are inside the nose, allowing the skin to be precisely lifted off the bone and cartilage so the internal structures can be visualized and the nose more accurately reshaped. Most nose procedures are done to make a large nose smaller, smoother and in better proportion to the face.

In the most common rhinoplasty, the cartilages that shape and support the tip are sculpted then reshaped with sutures to control the width and position of the tip of the nose. The hump, if present, is “sanded down” with a rasp which is used like a nail file to reduce the prominence and correct the profile. There are two nasal bones that meet in the middle like the roof of a house and when they are “shaved down” with the rasp, often a gap results between them, similar to the roof of a house if the top foot or two was removed. In order to close that gap (“open roof”) the bone must usually be broken free from their rigid attachment to the adjacent facial bones. This allows them to be “pinched together”, closing the open roof and narrowing the nose. The nasal bones are broken free with a type of chisel called an osteotome.

The skin is placed back over the newly shaped bone and cartilage and a splint is applied after all of the incisions inside and out are closed with stitches. The splint protects the delicately repositioned bones while they heal.

What Can I Do to Prepare for My Rhinoplasty Surgery?

After your consultation, you can expect our team to support you throughout the remainder of your surgical process. You'll be given detailed pre- and post-operative instructions at the right time, as well as time to receive answers to all of your questions. In general, it's advisable to prepare for rhinoplasty with a few simple steps, such as:

  • Follow your pre-op instructions regarding medications and supplements. You'll need to avoid items that are known to increase bleeding. Examples include aspirin and ibuprofen. Herbal supplements like vitamin E can also increase the risk of excessive bleeding.
  • Stop smoking and using nicotine. Both of these habits can slow down your healing process. They should be stopped at least two weeks prior to surgery.
  • Purchase post-operative supplies. In addition to the few medical supplies and prescriptions you may need, you may also want to stock up on lip balm and small ice packs or a few bags of frozen peas.
  • Arrange to have a loved one stay with you. It's helpful to have assistance at home for at least 24 hours following rhinoplasty. This can give you peace of mind and also ensure that you take your medication as directed and aren't overdoing it when it comes to physical activity.

How Much Swelling is Normal after a Nose Job?

Swelling is one of the most notable side effects for rhinoplasty patients. We do our best to prepare you for this as we move toward your surgery day. However, post-op swelling can still feel surprising. The degree of swelling that you experience will relate to the extensiveness of your surgery. The more resizing and reshaping that occurs during your surgery, the more swelling may occur afterward. This can obscure the results of your surgery for a week or so. Initially, your nose may not only look "fat," but may also look more lifted than you'd anticipated. The swelling may also worsen before it gets better. This all relates to the constriction and swelling within the tissues and skin. It's important to see this side effect as a normal part of the healing process and not a cause for alarm. That said, if you have questions about swelling or any other post-operative side effects, please don't hesitate to contact the office. We're here to support you throughout your recovery!

When Will My Final Results from Rhinoplasty Appear?

Like swelling, we do our best to prepare you for your overall timeline for full recovery as we prepare you for your rhinoplasty surgery. The majority of the swelling that prevents you from seeing your new nose resolves in the month that follows your procedure. After three months, you can expect about 90 percent of your swelling to be gone. That last 10 percent, though, can take up to 18 months to resolve. This is important to recognize because it is that last little bit of swelling that affects the overall definition of your nose, especially the bridge.

Your final rhinoplasty results will be confirmed 12 to 18 months after surgery. However, you can expect to feel comfortable with your appearance, enough to pose for pictures or attend special events, around the three-month mark after surgery. Most patients are very happy with their appearance as soon as one month after rhinoplasty.

When Are Stitches Removed After Rhinoplasty?

All of the internal stitches dissolve but any stitches in the exposed skin are idealy removed within six days to minimize visible scarring.

Rhinoplasty Variables and Realstic Expectations

There is a limit to how much smaller the new nose can be, based on its starting size. The skin “envelope” can only shrink within a certain range to fit the newly reduced bone and cartilage framework. If the nose is reduced in size excessively, the skin can “bunch up” and leave an unattractive fullness to the tip of the nose. Removing skin would require visible scars which can be very unfavorable. In addition, the tip cartilages can only be reduced and reshaped within certain limits since there is a minimum which must be left to adequately support the tip of the nose. Thus, in a sense, there is a certain non-negotiable degree to which the nose can be reduced in size. We try to demonstrate this using computer imaging to modify your nose and demonstrate realistic outcomes.

Certain aspects of the healing process vary from individual to individual and are not entirely in the control of the surgeon. When the bones heal back together they can thicken (called a bony “callus”) and result in slight bump which can show as a minor imperfection in a nose that is still beautiful. Also, scar tissue forms under the skin as part of the normal healing process that fuses the skin back to the reshaped bone and cartilage. If the individual forms thin, delicate scar, the nose will be slightly more refined and smaller. If the scar tissue is somewhat thicker (say the thickness of a slice of lunch meat instead of a tissue) the tip of the nose will be slightly rounder, fuller and less defined, although the nose is still typically nicely improved. Because of these physiologic variables, we like to use computer imaging to show a subtle range of outcomes that must be accepted to be a good candidate for rhinoplasty. If an individual is excessively picky with the computer imaging when realistic results are shown, they are usually not considered a good candidate for surgery since that type of patient has been shown by studies to be unhappy a very high percentage of the time even with an appropriate improvement in appearance.

We will always strive to demonstrate honestly what can and cannot be achieved and show a realistic range of outcomes as well as before and after pictures of our patients to help you decide if rhinoplasty is a good choice for you.

Click to learn about Pain Management Options.

Click here to learn more about our innovative simulator tool, Vectra 3D, to further assist you and the doctor during your consultation.

Schedule a Rhinoplasty Consultation in Dallas

To learn more about Rhinoplasty and other cosmetic surgeries offered at The Plastic Surgery Center of Dallas, please contact our practice at (972) 661-5077. We look forward to hearing from you! You can learn more about Dr. Walker here.

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