Rhinoplasty is a surgical alteration of the nose performed to change its appearance. There are many reasons someone may want to change the appearance of the nose. A trauma or injury can lead to a deviation and a “twisted” appearance of the nose. With aging, the nose can begin to have a drooping appearance due to weakening of the cartilage and cartilaginous supports of the nose. Some of our San Francisco nose surgery patients have a congenital misshapenness with which they were born. As a highly experienced rhinoplasty surgeon, Dr. Jill L. Hessler can correct all of these aesthetic concerns by performing a customized nose surgery procedure.
In the northern California bay area another frequently performed surgery is ethnic rhinoplasty. Although this is fundamentally the same procedure, additional care is taken to preserve characteristic features while refining the delicate nasal structures. The goal is to refine your existing features, not to make you look like someone different. Dr. Hessler will discuss your procedure in detail during your rhinoplasty consultation at her Palo Alto facial cosmetic surgery offices. She will also encourage you to thoroughly describe the changes you are looking to achieve.
- Rhinoplasty can be performed to:
- Straighten the bridge of the nose
- Remove a bony or cartilaginous bump of the nose
- Narrow the nostrils
- Increase the projection of the nose particularly common in Asian Rhinoplasty
- Refine the tip of the nose
- Smooth irregularities of the nose
Primary and Secondary Rhinoplasty
Rhinoplasty surgery can be divided into primary rhinoplasty and secondary rhinoplasty, which is also called revision rhinoplasty. Primary rhinoplasty is nose surgery on a patient who has never had nasal surgery. Secondary or revision rhinoplasty is nose surgery on a patient who has already had a rhinoplasty surgery in the past. Revision rhinoplasty can be performed to improve nasal breathing, to add structural support to the nose due to weakening of the cartilage, or to improve the appearance of the nose due to unfavorable healing or unfavorable surgical result.
Rhinoplasty and Other Procedures for the Face
Some rhinoplasty patients come in to their consultation with Dr. Hessler complaining that their nose is too large when in reality other factors may be contributing. A small chin is one factor which can create the appearance of an overly large nose when in reality it is the disproportion of the chin that is causing the imbalance. Often chin implant surgery alone can correct this disproportion. More commonly, additional refinement of the nose is desired in addition to creating balance in the face with the chin implant. In this case, the two procedures are performed as part of the same surgery. Dr. Jill Hessler also frequently performs other surgical procedures in conjunction with rhinoplasty, such as blepharoplasty, facelift, chemical peel and laser skin resurfacing.
Open and Closed Rhinoplasty in Palo Alto / San Jose
The rhinoplasty surgery can be performed using two major approaches. The first is called the closed approach or endonasal approach. With the endonasal approach there are no incisions on the outside of the nose and all rhinoplasty incisions are on the inside lining of the nose. The approach is very good for people with a small to moderate side bump on the nose, those who wish to straighten their nose or those patients that desire minimal change to the tip of the nose. The advantages of the endonasal approach include less swelling, faster recovery and shorter procedure. The procedure is performed at Dr. Hessler’s surgical center in Palo Alto. Depending on the amount of surgery required the endonasal rhinoplasty can be performed under sedation or under general anesthesia. You will discuss the Rhinoplasty surgery in detail along with the optimal anesthetic with your cosmetic consultation with Dr. Jill Hessler. If you have breathing concerns from a broken nose or deviated septum Dr. Hessler works with many insurance companies in the northern California Bay are and throughout California. Call our office to see if your insurance can help cover your surgery costs. If your surgery is more complicated Dr. Hessler has surgical privileges at Stanford Hospital where you can stay overnight for your comfort.
The second approach used in Rhinoplasty is the open approach also referred to as the external approach. This is the name given to this rhinoplasty because an incision is made on the outside of the nose along the columella. This is the middle portion of the nose that holds the tip up when looking at the nose from a basal view. Although an incision is made in the skin this generally heals very well as Dr. Hessler is very meticulous in her surgery specifically for the nasal incision. Dr. Hessler uses dissolvable sutures for this incision so you don’t have to go through the pain of the removal of permanent sutures. Dr. Hessler has found that the incisions heal just as well but with less discomfort to the patients. She is currently conducting a study evaluating the use of different suture materials in Rhinoplasty incisions.
An external rhinoplasty is best for you if you want significant changes to the nasal tip, need additional support to the nose from weakening of the nasal structures or need additional cartilage grafts such as spreader grafts, lateral crural strut grafts or rim grafts. While some of these grafts including spreader grafts can be performed via and endonasal or closed rhinoplasty approach Dr. Hessler will evaluate your nasal anatomy and listen to your concerns to provide the optimal outcome for you. As with the endonasal rhinoplasty the external rhinoplasty surgery is also performed at Dr. Hessler’s surgical center in Palo Alto. Most cases of external rhinoplasty are performed under general anesthesia although deep sedation can also be used. Discuss your anesthetic concerns with Dr. Hessler to see which method is best for you.
After Your Nose Surgery
Rhinoplasty surgery is generally performed as an outpatient procedure at Dr. Hessler’s surgical center in Palo Alto. Immediately following your surgery we will observe you as you wake up from the anesthesia while making sure you are comfortable and under medical supervision. Once you are feeling better, medically stable and awake enough from the anesthesia you will be released to go home. You will need to have a driver to take you home as you will not be able to drive yourself. If you had general anesthesia during your nasal surgery you will need to have someone stay with you overnight to make sure you are comfortable.
Dr. Hessler will see you back one week after your surgery. An external nasal splint is generally placed at the time of surgery. This is like a small cast for the nose. Dr. Hessler will remove this at your follow-up office visit. Unlike many other rhinoplasty surgeons, Dr. Hessler does not pack the nose following surgery except in very rare circumstances. Frequently, a thin piece of silastic sheeting is placed in the nose which helps create a smooth surface inside the nose as you are healing from your septorhinoplasty. This will also be removed one week after your surgery.
For the first few days after your surgery you can expect to have a stuffy nose with some difficulty breathing out of your nose. This is a due to swelling of the mucosa and lining of the nose as a result of your rhinoplasty. If you have any nasal bleeding following the surgery you can use Affrin nasal spray to help stop the bleeding. You should only use Affrin if you have bleeding and not in an attempt to improve your breathing. The breathing will improve over the week following your surgery as the swelling subsides. It is helpful to keep your head elevated by sitting up as much as possible during your recovery from your nasal cosmetic surgery. If you had an external or open rhinoplasty the suture material will dissolve on its own in 7-10 days. The nasal incision can remain slightly red for an additional few weeks but this will fade to natural skin color. Most of our patients achieve their final results within several months after their rhinoplasty treatments. However, very minor residual swelling might linger, which is why patients should wait at least 12 months before seeking any additional procedures.
Schedule Your Rhinoplasty Consultation Today
Dr. Jill Hessler invites you to explore your rhinoplasty options by scheduling a personal consultation today. You can set up an appointment by calling her practice at (650) 799-9009.