Rhinoplasty


Rhinoplasty, or nose job in layman’s term, is either performed through an open or closed technique incision; this allows the surgeon to reshape the cartilaginous and bony framework of the nose to improve its “outside appearance.”

 

Renowned Los Angeles plastic surgeon Dr. Tarick Smiley says he prefers the closed technique in which the incisions are limited inside the nostril, thus reducing any risk of visible scar. The open rhinoplasty, meanwhile, cuts the columella or wall separating the two nostrils to lift the “roof” of the nose before reshaping the underlying framework.

 

benefits of closed rhinoplasty

The female patient receives the closed rhinoplasty technique known for its shorter recovery or social downtime.

 

“About 95 percent of my rhinoplasty is done through closed technique,” Dr. Smiley said in his recent posts on Snapchat that demonstrated two female patients who have had nose-reshaping surgery.

 

The celebrity plastic surgeon has explained the “core” benefits of closed rhinoplasty:

 

  • More control and increased predictability over the final results

 

Some surgeons argue that the open technique provides more control over the final results due to the improved visibility since it allows them to raise the roof of the nose. However, Dr. Smiley says it comes with one major caveat: They do not see the “outside appearance” of the nose while they are reshaping the underlying framework.

 

Meanwhile, the closed rhinoplasty technique allows the surgeon to reshape the underlying framework and see and examine the outside appearance of the nose in “real time.”

 

“Just like you’re molding a piece of clay it is better to see it every time you do it step by step,” he explained in the videos.

 

 

  • Shorter recovery

 

Compared to the open technique, closed rhinoplasty causes less disruption and injury to the soft tissue, leading to less bruising, pain, and swelling, which in turn contributes to shorter recovery.

 

Contrary to popular belief, most patients are concerned about the “social downtime” than the pain (which in most cases is well controlled by medications). With closed technique, many patients can expect to look presentable after a week, versus 10-14 days when open rhinoplasty is performed.

 

  • No risk of visible scar

 

With closed rhinoplasty, there is no external scar across the columella. It is important to note that open rhinoplasty often results in barely detectable scar, although a small percentage of patients have experienced less than optimal scar.

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Rhinoplasty for ethnic nose has one primary goal: improve the nose in a way that it will remain consistent with the patient’s ethnicity and facial features. Meanwhile, any attempt to reshape it using a set of highly restrictive beauty ideals will lead to unnatural results.

 

Dr. Tarick Smiley, who is the medical director of the California Surgical Institute, says the success of rhinoplasty, or nose job in layman’s term, boils down to acknowledging the great variations of beauty as well as respecting the patient’s underlying anatomies, ethnicity, gender, and aesthetic goals.

 

The vast majority of successful rhinoplasty for ethnic noses performed on women delivers “finesse” results. On the other hand, over-narrowing of the tip, over-augmentation of the bridge or dorsum, and over-tapering of the nostrils almost always lead to ethnically inconsistent results.

 

“Finesse” rhinoplasty generally means creating a result that is a more refined version of the original nose.

 

Respecting the patient’s ethnicity and underlying anatomies also entails the use of conservative surgical maneuvers, meaning the surgeon avoids over-resection of the tissue. In a way, this preserves the structural integrity of the nose and thus it is less susceptible to aging, deformity, and contour irregularity.

 

rhinoplasty for ethnic nose

Before and after photos of ethnic rhinoplastic patient

 

One good example are patients of Middle Eastern and Indian descent who typically require dorsal hump reduction, a rhinoplastic technique in which the excessive fullness along the bridge is corrected by removing a piece of bone and cartilage, which is often re-used to improve the structural integrity of the tip.

 

In many cases, ethnic rhinoplasty deals with a tip that has weak support, causing it to droop and the nose to appear oddly elongated.

 

Reinforcing the tip has some auspicious effects on the femininity of the face. According to studies, the ideal female nose has an angle of tip rotation between 95 and 110 degrees, resulting in a slightly upturned appearance.

 

Again, raising the tip should be done in a conservative, finesse manner lest an error of just a few millimeters can lead to unusually short nose and excessive visibility of the nostrils, a deformity colloquially called as “Miss Piggy” in reference to the popular Muppet character.

 

The slightly upturned tip might be further enhanced with the small suptratip break, a slight indentation along the bridge just above the nasal tip. However, this “subtle” feature is avoided like a plague in male rhinoplasty due to its feminizing effects.

 

And lastly, female rhinoplasty for ethnic nose should take into account the patient’s aesthetic goals—which are largely influenced by social and cultural ideals of beauty—down to the last detail.

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Male ethnic rhinoplasty is a broad term used to describe nose-reshaping surgery performed in men of ethnic descent. It is important to note that even within the same ethnicity variations do exist in terms of nasal anatomy, facial features, and aesthetic goals.

 

Hence, leading Los Angeles plastic surgeon Dr. Tarick Smiley says successful nose surgeries are highly customized procedure, respecting the “starting” anatomy of the nose, the unique facial features of each patient, his aesthetic goals (which are partly influenced by his culture), and even his body-frame and height.

 

male ethnic rhinoplasty

 

While the ideal male nose is not defined by highly restrictive standards, the renowned facial plastic surgeon says there are definite philosophies and universal aesthetic guidelines that help doctors achieve more attractive and natural results from rhinoplasty.

 

  • The attractive male nose has a strong appearance.

 

Several aesthetic variables that determine a strong, attractive male nose include a slight hump or fullness along the dorsum (bridge), an angle of tip rotation between 90-95 degrees, and a bigger size compared to women (of the same height).

 

The tip rotation, or the angle between the upper lip and nasal tip, is one of the most critical aspects of male rhinoplasty. It should appear straight or sometimes even slightly droopy to look gender appropriate; in no way it should be over-rotated since even the slightest upturned appearance can make the results look delicate and feminine.

 

  • The patient’s face should be taken into account.

 

A good number of male ethnic rhinoplasty surgeries are performed to reduce the width and/or height of the nose, making it more proportionate to the face. However, over-reduction is avoided like a plague because a male nose is naturally bigger than a female nose.

 

  • His height and body frame will partly determine the ideal nose size and appearance.

 

In general, a taller, more muscular male may benefit from a stronger and more elevated bridge and a longer nose than a shorter, leaner man.

 

  • Consideration of some shared anatomies and features.

 

Respecting the patient’s anatomy is one of the keys to preserve natural-looking, long-lasting results. While “strict” generalization does not give justice to the wide variations of ethnic male noses, it is important to note that they have some shared traits such as thicker nasal skin, more bulbous tip (compared with Caucasians), and less supportive cartilage.

 

Markedly thick skin does not show all the details of rhinoplasty, although they are more forgiving compared to very thin skin which can show even the smallest contour irregularity.

 

Patients with markedly thick skin should not have their tissue over-resected because the overlying skin may not drape well especially around the tip, leading to its amorphous appearance.

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Rhinoplasty, or nose job in layman’s term, is generally performed to improve the “outside” appearance of the nose, which is accomplished by reshaping the underlying bone and cartilaginous framework. Hence, the skin must be able to shrink-wrap around the new contour to show the details and improvements brought on by the surgery.

 

Occasionally, rhinoplasty has inadvertent but favorable effects: improved airflow. This is particularly true when the surgery is combined with septoplasty, a surgical technique in which the crooked or deviated septum (wall of tissue between the nostrils) is straightened, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.

 

Some athletes have sought rhinoplasty combined with functional nose surgery to improve their breathing, which can have a large influence on their performance and endurance.

 

People with deviated septum have poor airflow, which interferes with their oxygen intake. As a result, they find it difficult to train in high-altitude environment and they cannot increase the intensity of their exercise routine without feeling wipe out.

 

And because of suboptimal oxygen intake, people with deviated septum also have poor quality of sleep. In fact, their heart and lungs work harder during sleep, instead of being at a more relaxed state, to compensate for the reduced oxygen level.

 

More often than not, athletes seeking nose-reshaping surgery ask for subtle and natural results. This is one of the most critical rhinoplasty guidelines that will influence patient satisfaction.

 

While the surgery involves hump reduction, the patient benefits from minimal fullness along the bridge to complement the stronger nasal tip.

For instance, some male athletes who ask for hump reduction specifically instruct their surgeons to preserve some minimal “fullness” along their bridge. Hence, the success of rhinoplasty also boils down to good patient-doctor communications.

 

Others seek rhinoplasty to correct the deformities that stemmed from previous trauma. Oftentimes, these patients simply want the appearance of their “original” nose.

 

It is important to note that the surgery’s success also relies on patient commitment and cooperation. For instance, strenuous physical activities, especially contact sports, must be avoided for at least six weeks to prevent nose bleeding, persistent swelling, and injuries that can compromise the results.

 

Meanwhile, the frequency of nasal trauma and the kind of sports patients are engaged to are taken into account during patient selection process. Hence, professional boxers who seek aesthetic rhinoplasty are generally considered poor candidates for the surgery.

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It may come as a surprise that rhinoplasty, or nose job in layman’s term, could make someone look younger, an effect more commonly attributed to neck lift and facelift surgery.

 

An aging nose has some archetypal traits: more prominent hump along the dorsum or bridge, and drooping tip, which contributes to the elongated appearance.

 

rhinoplasty

When these before-and-after photos were posted on Dr. Smiley’s Instagram account, some followers pointed out the youthful effects of the surgery on her face.

 

Aging causes the skin to lose its elasticity and the cartilaginous framework of the nose to weaken, leading to the drooping nasal tip, which could create an illusion of a more acute nasolabial angle and a longer looking nose.

 

Sometimes, the aged-related drooping of the tip causes breathing difficulty and abnormal airflow, which are considered medical conditions and thus some insurance may agree to cover the cost of rhinoplasty surgery.

 

Leading Los Angeles plastic surgeon Dr. Tarick Smiley, who has performed over 3,000 rhinoplasties as of this writing, says the “inadvertent rejuvenating effects” of the surgery can be achieved when the drooping tip is de-rotated.

 

However, the amount of de-rotation should take into account the patient’s ethnicity, gender, nasal anatomies, and cosmetic goals, he says.

 

For instance, women of short stature in general can have more angle of tip rotation (i.e., angle between the tip and upper lip) with studies suggesting that they can tolerate up to 110 degrees angle.

 

The ideal angle of rotation of the nasal tip for men, meanwhile, is close to 90 degrees giving it a stronger, straighter profile. The upturned appearance is avoided like a plague during male rhinoplasty due to its feminizing effects.

 

De-rotating the tip entails improving its structural integrity; hence, Dr. Smiley often uses the patient’s own cartilage derived from the nose itself or the back of the ear to raise it a bit. The use of “living tissue” eliminates the myriad of risks associated with artificial implants.

 

Shaving down the prominent dorsal hump can also result in a younger, more feminine appearance. Nonetheless, it might be ideal to preserve some minimal fullness along the bridge when dealing with male patients to ensure a more natural and masculine result.

 

A 2012 study published by Archives of Facial Plastic Surgery has shown that patients who have had rhinoplasty looked 1.5 years younger on average compared with their “before” photos.

 

The researchers enlisted 53 rhinoplastic patients aged between 15 and 61 (35 was the average age) who were photographed before and one year after surgery; 50 “ordinary observers” were then asked to rate their appearance based on the perceived youthfulness.

 

The study noted that the rejuvenating effects were more evident for older patients than younger ones, although regardless of age, individuals who had dorsal hump reduction and greater nasal tip de-rotation appeared to lose more years than other patients.

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Rhinoplasty, or nose-reshaping surgery, is the most challenging procedure in facial plastic surgery due to the nuances that define the ideal nose. Instead of being confined by a strict set of “beauty tenets,” several variables determine the ideal or attractive nose; these include the patient’s gender, ethnicity, face, nasal anatomy, and even height.

 

Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently posted a series of Snapchat videos demonstrating two patients who have had female rhinoplasty.

 

Female Rhinoplasty Before and After Photos of Actual Patients

 

female-rhinoplasty-before-and-after-photos

Notice the small suptratip break, more elevated tip, and improved overall profile of the nose in the after photo.

Prior to surgery, patient no. 1 had a “bulky” tip and an absent supratip break, which is a very subtle dip right before the tip. This is one of the nuances to female rhinoplasty that makes the results more attractive and gender appropriate.

 

Meanwhile, the appearance of supratip break should be avoided in male rhinoplasty due to the feminizing effect.

 

Dr. Smiley performed the closed rhinoplasty in which all the incisions were placed inside the nostrils, specifically within their inner lining. The technique not just results in shorter recovery and but also reduced bleeding and post-op swelling. Another notable benefit is the complete elimination of visible scars.

 

Through closed rhinoplasty technique, Dr. Smiley corrected the bulkiness of the tip by removing the excess cartilage, a framework that supports the lower two-thirds of the nose. This was done in a conservative manner to narrow the tip without compromising its structural integrity.

 

To reinforce the tip and promote near permanent results, Dr. Smiley cut and reshaped the excess cartilage before this was re-used to support the slightly elevated tip.

 

By slightly elevating the tip and making sure that it is “a bit higher than the dorsum or bridge of the nose,” Dr. Smiley said the “aesthetically pleasing” supratip break can be created.

 

Since Dr. Smiley deemed that the patient has a “nice starting dorsum,” it received very minimal change during surgery.

 


 

Patient no. 2 had a large dorsal hump that looked like a “hook,” which appeared incongruous with her feminine features. Further making her nose too big and long was her drooping tip that had insufficient structural support.

 

Notice the slight elevation of the tip, the minimal suptratip break, and reduction of the dorsal hump in the after photo.

Dr. Smiley also performed the closed rhinoplasty technique due to the auspicious results such as shorter downtime and no visible scar.

 

The patient’s dorsal hump was corrected by removing a relatively large piece of excess cartilage. To further create a smooth transition between the three regions of the nose, Dr. Smiley also rasped its bony part (the upper one-third of the nose).

 

The excised cartilage was later reshaped for tip reconstruction; the goal was to raise the drooping tip, reduce its width, and provide a stronger support for the new contour.

 

Both patients benefitted from a conservative elevation of their nasal tip. According to studies, attractive female noses have a tip rotation (angle between the upper lip and tip) that is between 95 and 110 degrees, leading to a slightly upturned appearance.

 

Attractive male noses, meanwhile, have a tip that appears straighter. Hence, rhinoplasty for men aims for an angle of tip rotation near 90 degrees or slightly less.

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