Rhinoplasty in Denver
Rhinoplasty, or nose surgery (nose job), is one of the most common plastic surgery procedures performed in Denver today. Rhinoplasty can reshape, reduce or even augment a person's nose in order to achieve facial harmony and boost self-confidence. It is almost always performed as an elective, cosmetic procedure but rarely is done for birth defects, such as a cleft lip rhinoplasty. Dr. Bershof is generally considered one of the top rhinoplasty surgeons in the country, and is a 5280 Top Doctor Rhinoplasty.
With rhinoplasty, functional procedures might also be performed, such as a septoplasty (deviated septum), sinus surgery or other procedures to improve airway breathing. A cosmetic rhinoplasty by Denver plastic surgeon, Dr. Bershof, can also be performed at the same time as an endoscopic sinus surgery performed by an ENT surgeon. Nasal airflow is the primary benefit to getting a rhinoplasty for function but for many patients the procedure may also improve the appearance by straightening the shape of the nose and repair post-traumatic deformities.
Goals of Rhinoplasty
Rhinoplasty is an excellent procedure for achieving the following:
- Balance the size of the nose with the other facial features
- Modify the width of the nose at the bridge and tip
- Improve the nasal profile, including removing humps or depressions
- Contour a nasal tip that is too large, "boxy", drooping or upturned
- Change the angle between the nose and the upper lip
- Narrow and reshape the nostrils
- Correct asymmetry or deviation
Candidates for Rhinoplasty
The best candidates for rhinoplasty:
- For females, at least 13 years old or past menarche; for males about 16-18 years old
- Have finished facial growth
- Are generally healthy
- Do not smoke
- Are seeking rhinoplasty for personal reasons, not pressure from others
- Have realistic goals for the procedure
Rhinoplasty is usually an outpatient procedure performed under IV sedation or general anesthesia.
Surgeons use one of two techniques when performing nose surgery. In a closed rhinoplasty also called the endonasal technique, incisions are made completely inside the nose, which is the preferred technique of Dr. Bershof. In an open rhinoplasty, the incision is made inside the nose but also outside the nose where it crosses the columella, the tissue between the nostrils. Dr. Bershof generally uses the open technique for revision rhinoplasties which are often referred to him from other plastic surgeons. With either method, the skin covering is gently lifted off the underlying nasal anatomy and the underlying cartilage and bone are sculpted. In rhinoplasty, it is the underlying anatomy that is changed and the overlying skin redrapes to its “new” anatomy. Although most rhinoplasties are considered reduction rhinoplasty, that is, structure (cartilage and bone) is removed so the nose is smaller, occasionally structure is added such as a cartilage graft from the septum or the ear.
If the patient has a deviated septum, Dr. Bershof usually performs the septoplasty first, then the rhinoplasty on the same day. Dr. Bershof often works with otolaryngologists (ENT surgeons) who perform functional endoscopic sinus surgery first followed by Dr. Bershof's cosmetic rhinoplasty.
Primary rhinoplasties generally take 2 hours or so to perform, but can take longer if functional airway and sinus procedures are included.
Recovery and Results after Rhinoplasty
For a short time after surgery, patients may experience puffiness, nose ache or a dull headache, some swelling and bruising, bleeding and stuffiness. Most patients feel like themselves within a few days and return to work or school after 1-2 weeks recovery time. Dr. Bershof changes the surgical splint at one week to tape for the 2nd week, so patients have some type of dressing for 2 weeks.
Even though the new shape of the nose is evident on the operating room table, ensuing swelling sets in, so the results of rhinoplasty become gradually apparent as the weeks and months pass after surgery and the swelling recedes. Swelling may reappear from time to time in the first year after the procedure. It is typically more noticeable in the morning and fades during the day. The tip of the nose takes the longest to resolve swelling.
Contact lenses can be worn soon after surgery unless there is some retrograde eyeball swelling which may take several more days to resolve. Eye glasses cannot be worn for at least 6 weeks unless the glasses are taped to the forehead.
Patients with realistic goals for rhinoplasty are generally very happy with the new shape of their nose. The exact results depend on the patient's nasal bone and cartilage structure, facial shape, skin thickness and age, as well as inherent facial asymmetry which cannot be corrected with rhinoplasty.
Risks of Rhinoplasty
Complications associated with rhinoplasty are rare and, when they occur, are minor. These may include infection, nosebleed, or a reaction to the anesthesia. Some patients breathe through their nose better after rhinoplasty, most the same (once the internal swelling has subsided), and occasionally some breathe worse through their nose. Although the reported redo rate (needing a 2nd rhinoplasty because the appearance isn’t what the patient had hoped) is reported in the literature as high as 20% (1 in 5), in Dr. Bershof’s hands, the redo rate is less than 1% and is always a minor touch-up, not a complete redo of the entire nose.