NOSE SURGERY (RHINOPLASTY)
Rhinoplasty procedures create a natural-looking nose that blends harmoniously with other facial features. Alterations may be made to increase or decrease the nasal bridge, reduce the size or width of the nose, narrow the nostrils, change the angle between the nose and upper lip, or reshape the tip. The surgical techniques employed depend primarily on individualized goals that are established for each patient.
There are two approaches to rhinoplasty procedures: open and closed rhinoplasty. Depending on your pre-operative anatomy and your ultimate goal, Dr. Hsu will decide which approach to use and whether to raise or trim the height and width of your nose. After the swelling subsides post-surgery, most patients will notice changes in their appearance in six weeks, but the nose will continue to remodel for up to a year. The healing process varies for each patient so your nose will develop at its own pace.
Patients seeking rhinoplasty might also have a functional complaint -- difficulty breathing. A deviated septum or inferior turbinates are common reasons for obstructed nasal airways. Deviated septums can be caused congenitally or by prior trauma. Dr. Hsu will repair the deviated septum by straightening the midline or removing the curved portion. If you are requesting a rhinoplasty for functional reasons, the surgery may be covered by insurance.
Good candidates for this procedure:
Patients who feel that their nose is too large or too small
Patients who wish to correct facial harmony or a crooked, badly shaped, or misaligned nose
Patients with nasal blockage inside their nose that cause trouble breathing
Patients seeking improvement of a birth defect
Patients seeking improvement, not perfection, in the overall appearance of their nose
What to expect: Consultation
All cosmetic consultations are complimentary and serve as a great opportunity to gain further insight by voicing your concerns and having questions answered. During the initial consultation, Dr. Hsu will ask some questions to get to know you and determine if you are a good candidate for rhinoplasty.
Dr. Hsu will first ask you about your specific goals for the rhinoplasty, including what areas of the nose you would like to improve. These goals may be aesthetic or functional, and both aspects are considered in creating a surgical plan. He will also ask about your general health history, including any existing medical problems, prior surgery, daily medications, allergies, and any smoking habits.
Dr. Hsu will then give you his assessment on whether you would be a good candidate for the procedure, and if so, how the surgical plan should be individualized for your anatomy. Since each patient's anatomy and surgical goals are different, you and Dr. Hsu will work together to reach optimal aesthetic results.
On the day of surgery, arrive early to fill out paperwork, meet the anesthesiologist, and be prepared for surgery. Dr. Hsu will meet you in the pre-operative area before surgery to make markings on the areas planned for surgery and answer any last minute questions you may have.
Rhinoplasty is performed under general anesthesia for a duration of approximately two-and-a-half hours. Dr. Hsu prefers performing open rhinoplasties which only require a small incision between the nostrils. He will bring the incision up into the nostrils and dissect the skin and fat to gain access to the underlying cartilage and bone, where much of the reshaping is done. Then, he will take different steps depending upon your needs. For example, if your primary concern is to remove a nasal hump, a surgical rasp or file is used to shave down the cartilage. If your nasal tip is too large, the cartilage is trimmed and stitches are used to reshape it.
Recovery & Post-operative Instructions:
Immediately following surgery, Dr. Hsu will place a split on the outside of your nose to protect it and minimize swelling. He will also place nasal packing into the nostrils and mustache dressings that will sit underneath your nostrils to catch any excess fluid for a week. After approximately two to four days, Dr. Hsu will remove the nasal packing. The remaining splint and stitches will be removed at your one week follow-up appointment.
In the first 48 hours, use a cold compress or hand towel in 20 minute intervals on the surgical area to minimize swelling.
You must keep your head elevated during recovery periods, making sure to sleep on two pillows at night. For most patients one week after surgery, bruising and swelling has subsided enough for makeup and concealer to cover any remaining bruising.
Most importantly, you should keep the surgical area dry until Dr. Hsu gives his approval to shower. To clean the rest of your body, you can bathe from the shoulders down. Dr. Hsu will usually remove stitches during your first week follow up appointment. Swelling & bruising will peak about 48 hours after surgery but will then decrease significantly in the first two weeks. Most patients can return to work after two weeks, but many patients return even sooner! The biggest limitation for post-operative patients is driving, which should be avoided while taking pain medication. Patients usually stop taking pain medication after five to seven days and plan their work schedules accordingly. Six weeks is usually an appropriate time to gradually return to full exercise and activity.
During the recovery period, we recommend walking within the house several times per day to speed healing and minimize the possibility of developing blood clots. If you have any inquiries, Dr. Hsu is available 24 hours following surgery through his personal cell number. For an extended period of time after surgery, Dr. Hsu will maintain regular contact with you to make sure you are healing well. Most follow up appointments are scheduled one week, two weeks, and several months to a year afterward.
Dr. Hsu's view on Nose Surgery.
Aesthetic nasal surgery (or rhinoplasty) is a large topic -- there are entire textbooks that are written about this one surgery alone. The reason for that is that the variations of nasal anatomy between different patients, as well as the functional and cosmetic requirements of the procedure, make the operation one that requires careful planning and good communication between patient and surgeon in order to maximize the results. I enjoy aesthetic nasal surgery a great deal. I feel that since the nose is centrally located, small improvements in nasal shape can affect the overall appearance of the face.
In the majority of my patients, I prefer an “open rhinoplasty” approach, which means that the nasal skin and fat are lifted up off of the underlying cartilage and bone, so that I have complete visualization and control of the nasal framework. This allows me to be as precise as possible in sculpting the nose to create the final goal. Patients’ nasal frameworks vary quite a bit, so after exposing the area, I will usually use a variety of surgical techniques to do so.
Often times, I will use some of the more complex techniques that I have used for the more difficult reconstructive nasal surgery cases, to be used for aesthetics as well. Not every nose is the same, so the operation is highly individualized for each patient.