The nose occupies the central portion of the face and, as such, can be a focal point for others when during conversation. Nasal deformities come in many varieties, from the relatively common “bump” on the bridge or a “ball-like” appearance to the tip to more severe and complex deformities, whether congenital or some caused by previous surgery.
Ideal nasal shape typically avoids any features that are extreme, so as to direct attention to the eyes and the rest of the face without distraction. Asymmetries of the nasal tip, bridge or nostril are distracting to the eye and result in noticeable deformity. In addition, with many patients, prominence or of one area of the nose (wide bridge, bulbous tip, droopy tip, etc.) creates a displeasing appearance that can be corrected surgically.
In addition to cosmetic improvements in the nose, impaired breathing can be corrected in nearly all cases. With all rhinoplasty procedures, unimpaired nasal breathing is fundamental to any successful outcome. Prior to surgery, weakness of the sides of the nose can lead to collapse when breathing in, leading to obstruction. Similarly, narrowing or pinching of the nose can occur after previous surgery or in some patients with certain ethnic backgrounds (e.g., Northern Europeans amongst others). These deformities and others will be diagnosed and explained to you during your consultation.
Successful rhinoplasty is one of, if not the most difficult, operation in facial plastic surgery. Due to inherent differences in the anatomy of each patient, the techniques used to correct deformities must similarly vary in order to achieve the desired results. Relatively common problems such as a small “bump” on the nasal bridge or a bulbous appearing tip may be less complicated to correct than the previously operated and severely over-resected nose. However, even the less complicated nasal surgeries require precise technique and meticulous attention to detail. Superior training and comfort with these more complicated procedures are a must in order to ensure success.
Notes on Nonsurgical Rhinoplasty and Synthetic Implants
Some “cosmetic” surgeons have not completed formal training in rhinoplasty surgery and offer “nonsurgical” techniques to correct various nasal deformities. This typically involves the use of injectable fillers to camouflage various defects or asymmetries. The injectable fillers used vary considerably from permanent to temporary. Dr. Pero has seen significant problems with infection, extrusion and long-term pain associated with some of these injections and, for this reason, does not routinely recommend this “off-label” use of these products.
Similarly, the use of synthetic implants (termed alloplasts) such as Gore-Tex™ , silicone and others, contains many inherent risks. Commonly used to obtain lengthening of the short nose or raising of the bridge in many Asian or African-American patients, these carry the risk of migration, extrusion, infection, chronic pain and an unnatural appearance. Although many patients do not have these side effects, the risk of them occurring precludes their use in Dr. Pero’s practice. His alternative is to use the patient’s own tissues (nasal, ear or rib cartilage, perichondrium, etc.) to achieve the same, and often more natural appearing, results while eliminating or minimizing many of these risks.
Dr. Colin Pero has a special interest in rhinoplasty and was trained in primary and revision surgery by world-renowned rhinoplasty expert Dean M. Toriumi, M.D. in Chicago, IL. He is one of the few surgeons in the country to regularly perform rib cartilage grafting when needed for complex or revision cases.
Noses come in all shapes and sizes and patients have a wide variety of other facial features. As such, no set aesthetic standards are used when evaluating a patient for rhinoplasty. Upon consultation, clinical photographs will be taken and computer imaging used to demonstrate the proposed changes. Dr. Pero only demonstrates that which his experience tells him will be able to be achievable. Of course, the computer imaging is not a guarantee of your surgical outcome, but in most cases, results are able to be obtained that are very close to the images. In fact, Dr. Pero prints and takes the photographs and the computer-imaged photographs to the operating room to act as a guide throughout the procedure.
Dr. Pero’s training in rhinoplasty emphasizes adequate support of the nasal structure to resist postoperative scarring forces that result in contracture and “pinching” if inadequately supported. This results in durable, long-term results that avoids the typical “operated-on” appearance characteristic of some traditional rhinoplasty approached.
Removal of excess nasal cartilage and bone, as performed in some older rhinoplasty techniques, can result in a shortened, turned-up appearance to the nose, with pinching of the tip and middle vault areas. Dr. Pero is careful to reshape and support the existing structures of the nose in order to achieve the desired cosmetic changes while avoiding the long-term complications sometimes seen with these other techniques. Cartilage grafts taken from other areas are often used to perform the supporting type of grafts Dr. Pero employs. Nasal septal cartilage taken from the inside of the nose is the most common grafting material used in most cases. For more complex cases or in revision cases where septal cartilage has already been used, ear cartilage obtained via an incision hidden behind the ear or rib cartilage obtained via a small (1-2″ long) incision hidden beneath the right breast (or chest in men) are the most common sites for cartilage grafting.
Chin Implantation is sometimes advocated in patients with overprojected noses or in those with “weak” chins. This can provide a significant improvement in the balance of the profile. Dr. Pero will be happy to demonstrate the prospective changes with and without chin implantation if he feels you are a good candidate. More details on chin implantation can be found here.
Rhinoplasty is a difficult and challenging operation. Dr. Pero utilizes techniques that minimize the risk of long-term complications while ensuring excellent long-term cosmetic results. Each patient is unique and requires a similarly unique approach to achieve patient satisfaction. This approach is a result of careful consideration and conversation with the patient on an individual basis with the aid of computer photographs and computerized imaging. If you feel this approach is right for you, we encourage you to call today to schedule your consultation.
Note–Prospective rhinoplasty patients may need to undergo nasal endoscopy as part of a comprehensive evaluation. The charge for this is commonly covered under your health insurance and we are happy to obtain a preauthorization prior to performing this procedure.
Click here to view our photos of some of our patients “before and after” photos.