Rhinoplasty


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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Rhinoplasty for small nose can mean a lot of things. Does the patient want to augment the bridge of his/her nose? Or does he/she want to correct the upturned tip, a feature that can make the nose appear too short or small in relation to the face?

 

rhinoplasty for small nose

The before photo shows the patient having very visible nostrils due to her over-rotated tip. By counter-rotating the tip with the use of cartilage graft, the nose now appears more proportionate to her face as shown in the after pic.

 

To achieve results that will satisfy the patient long term, leading Los Angeles plastic surgeon Dr. Tarick Smiley highlights the importance of candid discussion with a rhinoplastic surgeon.

 

Dr. Smiley says the right candidate for rhinoplasty, or nose job in layman’s term, is someone who can explain his/her goals in detail, adding that vague or generalized description is a big no-no for this surgery in which the success or failure is determined by a few millimeters.

 

To further shed light on the issues involving rhinoplasty for small nose, the renowned plastic surgeon explains the two most common goals of patients.

 

  • Augment the dorsum or bridge

 

Some ethnic patients ask for rhinoplasty augmentation to make their nose appear more proportionate to their face. The goal is to create results that are ethnically consistent with the face and so over-augmentation must be avoided.

 

To augment the dorsum, most surgeons prefer autologous cartilage graft, meaning the patient’s own tissue is used instead of synthetic materials such as silicone or silastic. Possible “sources” include the nose itself, ear, hips, and ribs.

 

Patients having their primary rhinoplasty (no previous nose surgery) and are only seeking for a conservative amount of augmentation are generally good candidates for autologous cartilage graft, therefore avoiding the potential risks that come with artificial implants.

 

  • Correct the over-rotated [upturned] nose

 

Sometimes referred to as Miss Piggy (in reference to the Muppet character), an overly rotated or upturned nose can make it appear too short for the face. Some people have this as an inherited feature, while in some cases it occurs from trauma or a botched nose surgery.

 

To correct the short and over-rotated appearance, the most important thing is to create a strong support to the tip, allowing it to maintain its counter-rotated position.

 

Because the tip requires significant reinforcement, most surgeons use septal cartilage, which is collected from the nose itself. Rib cartilage is also a good option to create a strong support and to lengthen “visible” wall of tissue between the nostrils. Ear cartilage, meanwhile, is rarely used in this surgical maneuver due to its insufficient strength.

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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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