Rhinoplasty

AM I A GOOD CANDIDATE FOR NOSE SURGERY?

If you suffer from one or more of the above conditions, rhinoplasty might be right for you. Patients should be realistic in their expectations of what nose surgery can achieve and understand that the same nose on someone else will not look the same on their face. Ideal rhinoplasty candidates have no serious medical issues and do not smoke or are willing to quit for an extended time before and after surgery. Teenagers interested in rhinoplasty should have fully developed nasal tissues, as this procedure should not be performed if the nose is still growing. 

Schedule a consultation at our St. Louis plastic surgery practice to find out if you’re a candidate for nose surgery. Call us at 314-878-8600 today!

THE RHINOPLASTY OPERATION

The upper nose is composed of bone (the nasal bone), and the lower structures of the nose are made of cartilage (upper lateral cartilage and lower lateral cartilage). Nose surgery can adjust the cartilage, bone, skin or all of these structures. They can be trimmed, bolstered, augmented, shortened, lengthened, replaced or repositioned. 

In the past, rhinoplasty was largely designed to reduce the size of the nose. This means bone and cartilage were taken out to alter the shape of the nose, making it smaller. Over a long period of time, many of these older rhinoplasty patients developed complications from over-resection of bone and cartilage. They developed the telltale signs of reductive rhinoplasty that we all recognize, such as pinched nostrils and pointed, turned-up tips.

DR. RIDENOUR’S APPROACH: STRUCTURE RHINOPLASTY

Today’s rhinoplasty operation is much different and much more natural in appearance. Dr. Ridenour believes in the principle of structure rhinoplasty. In structure rhinoplasty, there is minimal excision of bone and cartilage. Instead, the nasal cartilages are contoured with sutures and additional pieces of cartilage to create the desired shape. Soft tissue grafts are used more frequently to prevent visible irregularities from occurring beneath the skin. The result is a nose with an improved shape that looks natural but is strong enough to resist change over time.

OPEN VS. CLOSED RHINOPLASTY TECHNIQUES

Your rhinoplasty procedure may be performed using the open (external) or closed method. The techniques used for both options are generally the same; it is the placement of the incisions that differs. Open (external) approach is usually preferred in revision rhinoplasty, and for more complex or challenging cases, or when the nose is crooked or twisted. The external approach allows superior visualization and the precise placement of sutures and grafts.

OPEN RHINOPLASTY

With the open technique, an incision is made along the thin strip of tissue between the nostrils, which is used to peel back the tissues to open the nose and give your plastic surgeon full access to make the needed adjustments. This option is often used for patients who require significant changes to their nose.

CLOSED RHINOPLASTY

With closed rhinoplasty, your surgeon operates through incisions within the nostrils, meaning the surgeon has less visibility. This option is best for more modest alterations of the nose. However, rather than being concerned with the surgical options, both of which result in inconspicuous scarring, patients should focus on choosing an experienced rhinoplasty surgeon, and allow the surgeon to select the approach that suits them best.

Rather than being concerned with the incision options, which both result in inconspicuous scarring, patients should focus on choosing an experienced rhinoplasty surgeon, as the ability of the plastic surgeon will have the greatest impact on the results. 

WHY SHOULD I CHOOSE DR. RIDENOUR AS MY RHINOPLASTY SURGEON?

With rhinoplasty, it’s critical to choose a surgeon who is experienced, comfortable and confident in performing this procedure. Dr. Ridenour is a double board-certified surgeon with vast experience in primary and secondary (revision) rhinoplasty. He performs both open and closed rhinoplasty techniques depending on the needs of the patient. He is fortunate to have been mentored by some of the great rhinoplasty surgeons of the modern day, and he is known for his natural and realistic results. Dr. Ridenour also participates in continuing medical education to further develop his skills and stay knowledgeable of the latest rhinoplasty techniques. 

The entire staff at Ridenour Plastic Surgery is committed to excellence, providing a positive experience for all patients and maintaining a safe, quality facility. 

WHAT TO EXPECT AFTER NOSE SURGERY

WHAT IS RHINOPLASTY RECOVERY LIKE? 

After surgery, you will have a splint and packing inside your nose and bandages covering the outside. The packing will be worn for two days and removed at your follow-up visit. The splint will be removed after one week. You will experience bruising and swelling of the nose for a few weeks, after which the swelling may occur intermittently, often in the mornings. 

We recommend that patients follow these directions for the first few weeks while they recover:

• Sleep with your head elevated to help reduce swelling 
• Avoid blowing your nose so as not to disturb your healing nasal tissues
• Wear loose-fitting or button-up shirts to avoid bumping your nose as you get dressed or undressed 
• If you wear glasses, tape them to your forehead or use cheeks rests to avoid putting pressure on your nasal bridge
• Avoid sun exposure or use sunscreen with at least SPF 30 when outdoors to prevent skin discoloration

HOW MUCH DOWNTIME WILL I NEED?

Patients are encouraged to take a full week off from work and other responsibilities. You can resume everyday activities after this initial recovery period, but do not engage in activities that require a lot of exertion for another two to four weeks. If your job has a lot of physical demands, you may want to take two or three weeks off. 

WHEN WILL I SEE MY RHINOPLASTY RESULTS? 

You will be able to see most of your rhinoplasty results once the initial swelling and bruising resolve after a few weeks. However, residual swelling may last for several months, and it may take a year for your nasal tissues to fully settle into their new positions and reveal your final results. 

ARE THE RESULTS OF RHINOPLASTY PERMANENT? 

While no plastic surgery procedure can halt the aging process, rhinoplasty results are considered relatively permanent. The structural support should maintain your new nasal shape over time, even as your skin and tissues become lax with aging. Dr. Ridenour makes sure his patients’ noses are well-supported to avoid the complications and obvious signs that previous rhinoplasty techniques resulted in over time.

WILL I HAVE SCARS AFTER NOSE SURGERY?

Whether you underwent open or closed rhinoplasty, you should not have noticeable scarring. Closed rhinoplasty scarring will be completely concealed within the nostrils, and the small scar resulting from open rhinoplasty will be on the underside of the nose. 

FREQUENTLY ASKED QUESTIONS ABOUT RHINOPLASTY

HOW MUCH DOES RHINOPLASTY COST?

The cost of rhinoplasty varies based on the techniques used for your operation, the experience and geographic location of your plastic surgeon, and facility and anesthesia fees. During your consultation, we will be able to provide you with specific rhinoplasty pricing based on your personalized surgical plan.

WHAT HAPPENS DURING A RHINOPLASTY CONSULTATION? 

During your consultation with Dr. Ridenour, he will review your medical history, evaluate your nasal structures and the thickness of your nasal skin, and listen to your concerns and goals. He will take into account your gender, ethnicity and other facial features to determine the best way to improve your facial harmony with rhinoplasty. He will also help you set realistic expectations based on what nose surgery can do for you.

WHAT TYPE OF ANESTHESIA IS USED FOR RHINOPLASTY?

Rhinoplasty is often performed with the patient under general anesthesia, meaning they are in a deep sleep-like state for the duration of the procedure. This type of anesthesia requires a ventilator to breathe for the patient during the procedure. At Ridenour Plastic Surgery, we use conscious sedation, which is also known as Monitored Anesthesia Care (MAC). In this type of anesthesia, the patient can be lightly sedated, moderately sedated, or deeply sedated to the point that they’re completely unaware of the procedure and will not even remember any events that occurred during the procedure. The level of sedation administered depends on the health of the patient and the type of surgical or diagnostic procedure being done. This type of anesthesia is typically used for outpatient procedures where the patient will be going home once the anesthesia wears off. 

HOW LONG DOES NOSE SURGERY TAKE?

Your surgery may take anywhere from one to three hours. The duration of surgery will vary based on the amount of adjustments needed, including whether or not corrections are being made to improve breathing and if cartilage grafts are used. Revision rhinoplasty generally takes longer than primary nose surgery. 

IS NOSE SURGERY PAINFUL?

Most people report that rhinoplasty is not painful. Since anesthesia is used during nose surgery, you will not feel any pain throughout the procedure. You may experience some pain and discomfort during the first couple of days as you heal from rhinoplasty. These concerns can be alleviated by taking over-the-counter pain medication. 

CAN RHINOPLASTY IMPROVE MY BREATHING?

Nose surgery can be performed to unobstruct your nasal airway, as the structure of the nose can have a major impact on breathing. If you have a deviated septum that reduces airflow through the nose, septoplasty techniques can be performed during rhinoplasty to straighten your septum (a combination procedure known as septorhinoplasty). This allows the air to flow through your nose more easily and improves your ability to breathe.

WILL I NEED A CARTILAGE GRAFT FOR MY RHINOPLASTY?

Patients who have a small nose, are undergoing revision surgery, or have with insufficient septal cartilage to create volume often need a rib or ear cartilage graft. The cartilage can be used to lengthen and support the tip of the nose, strengthen the nasal bridge and bolster the nasal sidewalls. Grafts are often used in revision rhinoplasty if too much bone and cartilage were removed from the nose during a primary reductive rhinoplasty.

CAN I PLAY CONTACT SPORTS AFTER NOSE SURGERY?

Sports and activities that risk your nose coming into contact with someone or something (such as wrestling or water polo) should be avoided for several months to a year after rhinoplasty. Patients should be aware that their nose will be more delicate during the first year after rhinoplasty, and they should be careful to allow for the nasal tissues to stabilize. It can negatively affect your results if the nose is subjected to excessive physical force.

CAN I HAVE REVISION RHINOPLASTY IF I’M UNHAPPY WITH MY PRIMARY SURGICAL RESULTS?

Nose surgery is a very complex procedure, and the nose can occasionally heal in a way that compromises the intended results. If you are dissatisfied with the results of your rhinoplasty, Dr. Ridenour can evaluate your nasal tissues to see if revision rhinoplasty can achieve your goals. 

Revision rhinoplasty procedures sometimes require recreating a strong nasal framework, which may require a cartilage graft from the ear or rib. It also takes a bit longer to recover from revision rhinoplasty compared to a primary rhinoplasty, but the results are generally very rewarding.

CAN I CHANGE THE SHAPE OF MY NOSE WITHOUT SURGERY? 

Non-surgical fillers can be used to increase the size of the nose in certain areas to make it more proportionate. These injectables can fill indentations for a smoother profile, widen the bridge and create a straighter nose. However, injectable fillers cannot be used to reduce the size of the nose, which is a concern that requires surgery to address.

CAN I COMBINE OTHER PLASTIC SURGERIES WITH MY RHINOPLASTY?

Some patients would like to correct other aspects of their appearance along with their nose. Procedures such as eyelid surgery (blepharoplasty), facelift, neck lift and cheek or chin augmentation with facial implants may be able to be performed at the same time as your rhinoplasty. The total length of time needed for all of your desired procedures will play a part in whether they can be performed together, as there are limitations on how long patients should be kept under general anesthesia.