What is Nose Surgery?

Nose surgery, also known as Rhinoplasty, in Boston and Worcester, Massachusetts, is a procedure that improves the proportion and harmony of the face through correcting the size and/or shape of the nose. This procedure can also be done to correct medical issues, such as impaired breathing due to structural defects like a deviated septum.

Am I a good candidate for nose surgery?

Ideal candidates for nose surgery are physically healthy men and women whose nose is completely done growing, and individuals that have realistic goals for the surgery. Individuals who smoke may not be ideal candidates for any surgical procedure.

Liquid Rhinoplasty #60

A woman in her early 60s who had had a rhinoplasty more than 40 years ago.  In the last few years, she has noticed a “bump” on her nose.  She had a history of several silicone injections to her nose after surgery.  On exam, she has a palpable septal edge with an open roof deformity and a drop-off below, where the septum has appeared to settle.  We could consider returning to the operating room for rasping of the cartilage hump and placement of the R temporalis fascia graft.  But we offered a simpler solution in her case of placement of some Restylane in the area in the office.  She is shown before and again, 4 weeks later with a good result.  This is not a permanent solution but can be repeated every few years as needed. Sometimes called a “nonsurgical rhinoplasty.”

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Non Surgical Rhinoplasty #60

A woman in her early 60s who had a rhinoplasty more than 40 years ago.  She has developed some settling of the mid-dorsum and a palpable septal cartilage bump in the “open roof” area between the reduced nasal bones.  We could consider returning to the operating room to rasp down the bump and add some additional tissue such as a temporalis fascial graft.  But we elected to try the much simpler option of augmenting the area with 0.6 cc of Restylane.  At two weeks she has an excellent result.  This can typically last for 2 years or longer in this area and is relatively easy to repeat as necessary.

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Rhinoplasty Patient #24 – Follow Up (7-year)

A 7-year follow-up on a patient with an extremely severe nasal obstruction with total blockage of the right nose and near total blockage of the left nose, with a right angle bend of his septum. An extracorporeal septoplasty was performed at the age of 17.  In this case, the septum is completely removed/ reshaped on the back operating table, stabilized with a resorbing plate, and placed back into position, stabilizing with sutures and drilling holes through the nasal bones.  The nasal dorsum tends to “settle” a few millimeters so it is often best to leave it a little prominent so that when it settles it is in the right position.  In his case, we were fortunate and obtained an excellent result with a straight nose, correction of his dorsal hump, and clear nasal passages.

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Rhinoplasty Patient #23

A woman in her late teens who was bothered by the shape of her nose.  Her main concern was a dorsal hump and her second concern was the shape of her nasal tip.  The third concern was her nose being crooked.  She is shown before and again, one year after an open rhinoplasty. Discussion: Studies show that the happiest patients after rhinoplasty are those with a dorsal hump, possibly because the correction is seen more quickly.  Tip refinement continues to improve for 3 years after surgery and is impacted by the thickness of the nasal skin- if the skin is thick it is difficult to see any detailed shape changes.  Her skin is relatively skin and as the swelling diminishes the created shape is better revealed. It is difficult to fully correct a deviated nose because of residual forces in the nose that want to return to the original bend of the cartilage.  We were fortunate in her case to make the nose dramatically straighter, but this is not always predictable or possible. Her chin is “weak”, falling behind an imaginary line dropping down from the lips (“Riedel’s line” which connects the most prominent points of the upper and lower lips and is a good guide to the most aesthetic projection of the chin) and her facial balance could be improved even further with a chin implant.

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Rhinoplasty – Patient 133

A woman in her early 20’s who is bothered by a dorsal hump and drooping of the tip when she smiles. She also has some deviation of her nose. She is shown before and again, 4 months after an open rhinoplasty. The open rhinoplasty places an incision across the base of the nose that fades with time and allows us to open up the nose more completely for surgery and add more structure and precision to the nose. She is thrilled with her improvement and we can expect the tip to continue to gain in refinement over the next 3 years as the swelling continues to resolve.

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What are my options for nose surgery?

There are two main techniques used for rhinoplasty today: the open procedure and the closed procedure. A closed procedure involves hidden incisions made inside the nose, while an open procedure entails an incision outside of the nose, or along the slim strip of tissue that separates the nostrils, called the columella.

Depending on the patient’s goals for the outcome of the surgery, bone or cartilage can be removed to reduce the size of the nose, while cartilage grafts may also be required.

What should I expect during recovery?

Typically, it takes about 10 to 14 days for most of the swelling and bruising to heal following nose surgery, and a nasal splint is often placed for the first week. Bruising under the eyes and brief nausea from anesthesia are normal side effects. Patients are advised to avoid straining, bending and lifting, as well as wearing eye glasses immediately after the procedure.

In most cases, patients return to work within two weeks, once the bruising has depleted. However, more strenuous activities should be avoided for about six weeks. Although the results are immediate after surgery, the overall contour continues to improve for two to three years. As with any invasive procedure, there are risks involved with nose surgery. Ruptures of small surface vessels on the nose, infections, and poor wound healing are all complications that can arise.

How long will results last?

Rhinoplasty results are permanent. However, rhinoplasty revision surgery is also an option.

“Dr. Hall and his staff are great. They are friendly and made me feel comfortable. Dr. Hall is very knowledgeable and put me at ease regarding my surgery.”

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