Rhinoplasty (Nose Job) in New York
Frequently Asked Questions
How do I avoid getting a “plastic looking nose” if I am going to get a rhinoplasty?
It was very common 20 or 30 years ago for patients to have similar rhinoplasty results, typically with an over resected nasal dorsum that left a “scooped out” appearance and an over resected nasal tip which left a “pinched” look. The nose often did not “fit” the face properly and left a very “plastic looking” nose, sometimes with breathing difficulties. Today, most surgeons perform a rhinoplasty that will improve the appearance of the nose but just as importantly maintain adequate function.
I want an improvement in the look of my nose but I would like to maintain my ethnicity. Is this possible?
This is a question that is asked often. Most patients want to maintain their ethnic look but often with “softer” features. Some patients just want a bump on their nose softened or removed, some want a flat nose to be raised, and still others desire slightly narrower noses. A natural result maintaining a patient’s ethnic features is all possible by using subtle maneuvers to achieve surgical goals.
Do you have to break the bones?
Many patients who present for rhinoplasty complain that their nose is too big and they want a bump removed. The bones are gently shaven down to soften the bump. In doing so, the normal pyramidal shape of the dorsum of the nose sometimes becomes flat. In order to restore this pyramid shape, the bones have to slide inward from both sides. This is achieved by precisely cutting the bones and realigning them to recreate this pyramid.
I have a bump on my nose. How do I get rid of it?
A bump on the dorsum of the nose is often due to both bone and cartilage growth. Rasping or shaving the bone down and then delicately trimming the cartilage is how a dorsal hump is usually removed. Because shaving the dorsum will often create a flat appearance or an open roof, lateral osteotomies, or precise cuts in the bones on the side of the nose will allow the open roof to close.
My nose is very wide. How can it be narrowed?
Increased nasal width can be at any level. If it is in the upper one-third then this can be due to the wide bones. Osteotomies of the bones or precise cuts in the bone can narrow this region. In the middle one-third, or middle vault, the upper lateral cartilages can be trimmed to narrow this region. Osteotomies treating the upper one-third will often help to narrow the middle one-third as well. For the lower one-third, this often includes the nasal base, and various alar base reduction procedures can be performed to narrow this region.
My nose is crooked. How can this be corrected?
A crooked nose can be due to curvature of the nasal bones and/or the septal cartilage. Treatment may require a submucous resection (SMR) of the curved component of septal cartilage, and possibly osteotomites of the bones to straighten it. A good nasal exam pre-op will facilitate making the appropriate surgical plan. Sometimes cartilage grafts are used and/or sutures are used to straighten the septal cartilage as well.
What is a septoplasty?
A septoplasty is a procedure to straighten the nose. This can consist of removing a small portion of the septum called a submucous resection (SMR) or even placing sutures or scoring the cartilage to straighten it. Sometimes internal splints are placed temporarily to support the correction.
What is an SMR?
The letters, SMR, stand for submucous resection. This refers to the removal of a portion of the septal cartilage to improve curvature or it is used to harvest cartilage for graft material.
What is an alar base reduction?
An alar base reduction is sometimes referred to as a Weir excision depending upon the technique. An alar base reduction can be performed to treat flare of the nostrils, and/or width of the nasal base. Small crescents of tissue can be taken out along the nasal vestibular floor, along the crease of the nostril sill rim, or used in a combination of both.
My nostrils flare, how can this be improved?
Flaring nostrils can be treated with an alar base resection usually along the nostril sill. Fine sutures are used to repair this treated region. The sutures are usually removed within one week after surgery.
My nose is flat. How can I increase my bridge?
A flat dorsum can be augmented with autologous tissue or non-autologus tissue. Autologous tissue (tissue from one’s own body) includes cartilage grafts that can be harvested from the septum, the ear, or the rib. If the nasal bridge is very flat, often rib graft is the best choice. Non-autologous tissue includes irradiated homograft costal cartilage (IHCC) which is cadaveric rib cartilage, or an implant like silicone or medpor. My preference is usually rib cartilage, followed by IHCC.
How is diced cartilage used in the nose?
Diced cartilage is usually made from either septal or rib cartilage. This is literally chopped up cartilage that is then wrapped within a tube of either temporalis fascia or even Alloderm and then secured on the nasal dorsum and used for augmentation.
I am African American and want my nose improved. What are some common issues that need to be corrected?
Commonly the dorsum is flat, the base is wide, and the tip often does not have enough projection. Cartilage grafts are used to provide dorsal height and can add tip support. A columella strut with tip grafts can improve the tip projection for many patients. A base excision treating alar flare or base width can be performed as well.
I am Asian and my nose is flat. How can you improve my dorsal height?
Commonly in this patient population, the nose is flat and wide. A dorsal onlay cartilage graft is a good option to augment the dorsal profile. Modifications of the alar base can be performed using various techniques to narrow the base or treat nostril flare.
My nasal skin is thick. How can I get definition in my tip?
Thick skin can minimize the risk of seeing irregularities in the nasal tip or other structures after rhinoplasty. However, tip definition may be difficult to achieve for some when the tissues are very thick. Sometimes cartilage grafts are beneficial and occasionally skin flap thinning may be performed.
What is a tip plasty?
A tip plasty is a procedure performed on the nasal tip to refine it. It is often requested by patients who are unhappy with a boxy or bulbous tip. This is not as involved as a standard rhinoplasty because no bony or cartilaginous septal work is done on the dorsum. The recovery is often a bit easier, and bruising is not as significant as in a standard rhinoplasty. This can be performed using an open or a closed approach.
I have columella show, how can this be corrected.
Columella show is sometimes misconstrued by the patient. This is because of the delicate relationship between the alar rim and the columella. Sometimes the columella show is due to a retracted alar rim which can result from weak alar rims or over aggressive excision of alar cartilage during a rhinoplasty. A hanging columella is one in which the columella is pushed down and “shows” more than normal. Treatment of columella show due to alar retraction can be performed using alar grafts to strengthen the alar rim cartilages. Sometimes if there is severe retraction, a composite graft of cartilage and skin can be placed internally to lower the alar rim. If there is a hanging columella, this is often due to a prominent caudal septum pushing the columella downward. Treatment of a hanging columella can be as simple as trimming the caudal septum.
If I need nasal grafts where can you get them?
Nasal cartilage grafts are obtained most commonly from the septum. Performing an SMR (submucous resection) to harvest septal cartilage is common. Other sources of cartilage include the ear and the rib.
When is rib graft used?
A rib graft is harvested when a large piece of cartilage is required for dorsal augmentation or septal cartilage is not available. Usually septal cartilage will not provide adequate augmentation in these cases.
What options for dorsal augmentation are there?
When the nose is flat and dorsal augmentation is requested, options for augmenting the nose include use of autologous tissue (the patient’s own) such as the septal cartilage, ear cartilage or rib cartilage. Non-autologous sources include silicone or medpor implants. Another great option, in my opinion, is irradiated homograft costal cartilage which is a cadaveric rib cartilage graft.
What is an open rhinoplasty?
An open rhinoplasty is one technique used for performing a rhinoplasty. It uses the same incisions as a closed rhinoplasty but also incorporates a small incision across the columella skin. This additional one centimeter incision allows the soft tissue envelope over the tip and dorsum to be raised so that the surgeon can directly visualize the underlying cartilaginous and bony structures while performing a rhinoplasty.
What is a closed rhinoplasty?
A closed rhinoplasty is a technique employing incisions internally in the nasal vestibule to provide access for performing a rhinoplasty. This can include either an inter or intra-cartilaginous incision as well as a septal or transfixion incision.