Rhinoplasty


Augmentation rhinoplasty procedure is a general term to describe a nose-reshaping surgery in which the goal is to increase the height of the nasal bridge. Oftentimes, the surgery also involves the tip and/or nostrils to create a smoother and more natural result.

 

A good number of augmentation rhinoplasty is performed in ethnic patients (e.g., Asian and Hispanic descent). The vast majority of them want to enhance the appearance of their nose without making it look out of sync or “ethnically inconsistent” with the rest of their facial features. Hence, patient satisfaction is closely tied to “how natural the nose appears.”

augmentation rhinoplasty procedure

Leading Los Angeles plastic surgeon Dr. Tarick Smiley explains what augmentation rhinoplasty can accomplish.

 

  • Increase the height of the nasal bridge

 

Aside from ethnic patients, augmentation rhinoplasty is also commonly sought by people with nasal collapse and other deformities (due to congenital, disease, or injury). Nonetheless, their appearance can be improved when their nasal bridge receives additional height.

 

Despite the reasonable safety and proliferation of alloplastic and other synthetic materials, Dr. Smiley believes that using natural material (i.e., derived from the patient’s body such as the nose itself, ear, and rib) remains the most ideal method as it has the least chance of extrusion, rejection, infection, and unnatural results.

 

  • Improved definition of the bridge when viewed from the front

 

Patients seeking augmentation rhinoplasty typically have flat and undefined (or even excessively wide) bridge on front view. While the surgery can improve this “feature,” it should be done within the confines of the underlying anatomy and facial harmony to achieve natural-looking results that can last a lifetime.

 

In general, augmentation rhinoplasty should not raise the bridge all the way to the radix (i.e., it defines the nasal root or the nose’s origin from the forehead area) in female patients because of the too masculine effect, and in ethnic patients due to the unnatural appearance.

 

Meanwhile, men and patients with a prominent or strong jawline can generally tolerate a stronger nose.

 

  • Tip and nostril refinement

 

By taking into account the appearance of the tip and nostril, doctors are able to create a smoother, more natural result. Oftentimes, increasing tip projection is enough to improve the nostril and alar base (or width of the nostrils) without using incisions to narrow them.

 

Again, when doing tip refinement and nostril reduction, it should be done in a way that respects the underlying anatomy (to prevent nasal collapse and breathing problems) and the patient’s ethnic features, gender, and personal goals.

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Reducing the amount of rhinoplasty bleeding is one way to promote shorter social recovery. Hence, plastic surgeons who use precise and gentle dissection during surgery have patients “socially” and “professionally” ready at 1-2 weeks.

 

Aside from meticulous dissection during rhinoplasty, or in layman’s term “nose job,” leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that bleeding can also be minimized with careful patient selection. The idea is to reserve this cosmetic surgery to people with no chronic medical condition such as bleeding disorder, heart problem, etc.

 

rhinoplasty bleeding

Because the patient’s health status is closely tied to the success of rhinoplasty, Dr. Smiley highlights the importance of lab screening whose “details” will depend on the information gathered during the initial consultation. For this reason, he says that patients must fully disclose their medical history and drug use to prevent complications.

 

Once they pass lab screening, Dr. Smiley says “preparation” is the next step to further reduce bleeding and risk of complications. There are generally agreed upon guidelines such as complete cessation of smoking (minimum of three weeks); discontinuation of drugs and supplements with blood thinning properties (at least two weeks); and controlling medical condition, if there is any, through lifestyle changes and/or medications.

 

After surgery, a very small amount of bleeding can be expected (and is normal) in the first few days. Severe bleeding in which blood is pouring out or down one’s throat, meanwhile, is extremely rare and requires immediate treatments, says Dr. Smiley.

 

To prevent bleeding and healing problems, Dr. Smiley says he requires all his patients to avoid nose-blowing, rigorous activities, blood-thinners such as aspirin and ibuprofen, and alcohol for a certain period of time (usually 2-3 weeks, although the specific instructions may differ from patient to patient).

 

To further promote healing, keeping the amount of bruising and swelling to a minimum can also be a huge help, says. Dr. Smiley who advocates head elevation and cold compress (around the cheeks and eyes for the bruises).

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Male rhinoplasty for large nose is a highly customized procedure in which the patient must be able to describe his goals in the most exact detail. Furthermore, the surgeon must conduct a comprehensive physical exam to evaluate skin thickness, underlying structures of the nose (cartilaginous and bony framework), and even the entire face to achieve proportionate, natural-looking results.

 

Rhinoplasty, or in layman’s term nose-reshaping surgery or nose job, is one of the most technically challenging plastic surgery procedures that its success is determined by minute changes measured in millimeter. Hence, it requires deep understanding of the anatomy and respect of the patient’s ethnicity, gender, and facial and nasal anatomies.

 

rhinoplasty for large nose

Leading Inland Empire plastic surgery expert Dr. Tarick Smiley has recently posted a series of videos on Snapchat to demonstrate a male patient who required rhinoplasty for large nose.

 

Aside from having a hugely disproportionate nose (relative to his “small” face), Dr. Smiley said the patient also complained of the following cosmetic issues:

 

  • dorsal hump or excessive fullness along the bridge of the nose
  • hooked or drooping tip
  • bulkiness of the tip

 

For this patient, Dr. Smiley performed the closed rhinoplasty, meaning all the incisions were made inside the nostrils, specifically within their inner lining. Aside from eliminating the risk of visible scar, the technique is also known to result in shorter “social” recovery because of the minimal postop bruising and swelling.

 

The incisions allowed Dr. Smiley to access the cartilaginous framework of the nose and to remove the piece of cartilage causing the dorsal bump along the bridge. But instead of discarding this tissue, he resized and reshaped it so it could be used to support the tip and refine its appearance at the same time.

 

With additional tip support, Dr. Smiley was also able to address the excessive bulkiness of the tip.

 

Afterwards, the celebrity plastic surgeon rasped or shaved down the bone (the upper one-third of the nose is made up of bony framework, while the lower two-thirds is made up of cartilage that is relatively flexible) to further reduce the fullness along the bridge. This was done with the use of a device closely resembling a nail file.

 

Because the patient has thick nasal skin, the amount of reduction must be on the conservative side. The idea is to allow the overlying skin to redrape beautifully around the new contour, as opposed to looking bulbous or amorphous, which could happen after an over-aggressive tissue resection.

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Rhinoplasty hump reduction, aka, nose-reshaping surgery to eliminate or reduce the fullness along the bridge, entails a set of meticulous surgical techniques to achieve proportionate and natural results, which are primarily achieved when the patient’s gender, ethnicity, and facial features are all taken into account.

 

Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a series of Snapchat videos involving a female patient who asked for rhinoplasty hump reduction. But to achieve a smoother, more proportionate nasal profile, he also performed a simultaneous tip refinement.

rhinoplasty hump reduction

The patient, who had been involved in an accident that left her nose broken, had visible hump along her nasal bridge that looked incongruous with her feminine features.

 

Dr. Smiley was able to improve her nose—i.e., remove the hump and refine and slightly elevate the tip, ultimately resulting in a more feminine appearance—with the use of closed rhinoplasty technique, which basically means that all incisions are made inside the nostril; hence, the risk of visible scar is almost eliminated.

 

During a closed rhinoplasty technique, incisions are made within the lining of the nostril, which in turn exposes the cartilage that comprises the lower two-thirds of the nose. The upper one-third, meanwhile, is made up of bone.

 

In the video, Dr. Smiley is seen removing a small piece of cartilage to refine and narrow the tip. Afterward, he trimmed the offending nasal bone that was causing the excessive fullness or hump along the bridge.

 

Instead of the discarding the cartilage collected during surgery, the celebrity plastic surgeon reshaped it so it could be used to reinforce the tip, a technique that allows the results to persist long term and to prevent collapsed or pinched appearance.

 

To further create a gender-appropriate nose during rhinoplasty hump reduction with a simultaneous tip refinement, Dr. Smiley slightly raised the tip. According to studies, the ideal angle between the upper lip and nose is 105-110 degrees for women, while in men it should be 90-105 degrees.

 

The amount of reduction that can provide the most natural results, Dr. Smiley said, is largely determined by how much skin shrinkage is expected to occur. In general, markedly thick nasal skin does not redrape as good as thin skin.

 

However, thin skin is less forgiving as it shows even the tiniest contour irregularities.

 

Hence, patients whose skin is considered “medium thickness” enjoy certain advantage: Their skin shows the “details” and improvements without the increased risk of contour irregularities.

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Preventing or at least minimizing the risk of rhinoplasty infection should be one of the most important goals of any prudent surgeon performing nose-reshaping surgery, according to California Surgical Institute website.

 

The list below shows the basic guidelines on how to minimize risk of rhinoplasty infection.

 

  • Strict patient selection

rhinoplasty infection

Anyone with uncontrolled medical condition linked to higher risk of infection and poor healing is discouraged to undergo any elective plastic surgery.

 

Prior to rhinoplasty, judicious surgeons require all their patients to pass lab screening to ensure that they can handle the surgery and the ensuing recovery.

 

  • Achieve one’s optimal health

 

Achieving one’s optimal health generally includes eating healthy, avoiding smoking and too much alcohol and caffeine, and discontinuing aspirin and aspirin-like products for at least 2-3 weeks.

 

  • Accredited surgical facility or hospital

 

This is the safest surgical venue. Being accredited means the surgical facility adheres to the highest patient safety standard.

 

Moreover, an accredited surgical facility has the necessary equipment, building design that promotes sterilized environment, and highly trained staff to reduce risk of infection and contamination.

 

  • Antibiotics

 

Many surgeons today recommend prophylactic (preventive) antibiotics to help ward off infection, which must be taken on time and their full course completed.

 

  • Patient education

 

The patient must be informed of the telltale signs of infection such as elevated temperature, unusual skin changes, and poor healing.

 

If the patient notices anything unusual, he must notify his surgeon right away than wait for his next scheduled appointment. Some individuals might be apprehensive contacting their surgeon thinking that they might bother them over some trivial thing.

 

Furthermore, the patient must understand that his full commitment is necessary to minimize risk of complications. For instance, smoking even just a single stick a few weeks leading up to the surgery or during the initial healing stage is enough to drastically increase one’s risk of poor healing, infection, and less than optimal results.

 

  • Leave the nose alone

 

It is important to leave the nose alone to heal. No picking at the incisions, blowing hard, wearing eyeglasses, or anything that might compromise healing.

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Rhinoplasty bleeding is often minimal provided that the surgeon uses meticulous techniques, which can also lead to shorter social recovery (no outward signs of the surgery), and natural results that can last a lifetime, according to California Surgical Institute website.

 

Rhinoplasty, or nose job in layman’s term, typically results in 1-2 weeks social downtime, which is closely linked to the amount of postop bruising and swelling.

 

rhinoplasty bleeding

The list below shows the “core principles” in minimizing the amount of rhinoplasty bleeding.

 

  • The patients should be in their optimal health.

 

Hypertension, blood disorder, and other chronic medical conditions can lead to increased bleeding. Hence, rhinoplasty or any other elective plastic surgeries require all patients to pass a rigorous lab screening.

 

While some of these conditions can be controlled through medications or healthier lifestyle, it is important to note that some factors are not within the patient or surgeon’s control. For instance, older individuals often have more fragile blood vessels than younger ones and so they may experience more bleeding and postop bruising.

 

  • Preparation

 

All drugs and supplements with blood thinning properties are discontinued for at least 2-3 weeks before surgery and about a week afterwards to prevent bleeding and excessive postop bruising. The same rule may also apply to smoking and alcohol.

 

However, some doctors recommend Arnica montana (homeopathic remedy) and some “special” diet known to promote healing.

 

  • Use of drugs known to constrict the blood vessels

 

The use of local anesthesia combined with epinephrine—a drug that results in the constriction of blood vessels and thus reduces the amount of bleeding—is known to promote healing.

 

Decongestants like Afrin may also minimize the amount of bleeding by constricting the blood vessels.

 

  • Keep blood pressure low at the time of surgery

 

Board-certified plastic surgeons only work with board-certified anesthesiologists to ensure patient safety.

 

Qualified anesthesiologists know that keeping the patient’s blood pressure low during surgery under general anesthesia can reduce bleeding. Also, one of their tasks is to monitor the patient’s vital signs to prevent serious complications.

 

  • Avoid certain activities during the initial healing stage

 

Sneezing and blowing one’s nose should be avoided for 2-4 weeks because doing so can trigger bleeding.

 

It is important to note that despite best efforts, some patients remain susceptible to bleeding and thus they are required to use nasal packing while they recover.

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