Every year, over 500,000 people seek consultation for rhinoplasty. Some are not comfortable with noses they were born with, some with the way aging has changed their nose and others with the way an injury may have distorted their nose. From a functional standpoint, some may need change of their external nasal structure to improve breathing. Rhinoplasty has one of the greatest impacts on how a person looks. The nose is the most defining characteristic of the face and even a slight alteration can cause a significant alteration in appearance. Removal of a hump that can be seen on side view, a wide nose or a crooked nose are conditions that are commonly fixed by surgery on the upper bony portion of the nose. Tip refinement, elevation of the nasal tip or shrinking of the nostril are common procedures performed on the lower portion of the nose. Often combinations of these procedures are performed. The goal is to achieve facial harmony or balance. Leonardo DaVinci articulated this concept in his art (as seen by his sketch of ideal facial proportions [European ideal] shown below:

Rhinoplasty Procedure

Cosmetic nasal surgery utilizes concealed incisions inside the nose. Sometimes a small "w-shaped" incision hidden in the skin of the columella (the structure between your nostrils) or the base of the alae (the flaring part of your nostrils) are also used.

Bone and cartilage, which determine the shape of you nose, are carefully sculpted to give the intended result. Equally important is careful reconstruction of the breathing portion of the nose to allow for good breathing as well as a good appearance. The surgery is outpatient and can be done with local or general anesthesia.

Diagrammatic examples of reduction of nasal hump and narrowing of nasal width are shown to the above.

Recovery From Rhinoplasty

After surgery, the nose is taped on the top with a nasal splint to hold the support structures in place. Absorbable sutures are used inside the nose and, if external incisions are made, there may be sutures that need to be removed on the skin. A small sponge is placed in the nose to prevent bleeding. The sponge is removed on the day 1 or 2 and the tape and nasal splint are removed on day 7. Mild to moderate bruising underneath the eye for 1-2 weeks is common. Pain is well controlled with pain medicine.

Intended Results From Rhinoplasty

Since the nose is the central structure on the face, the improvement in appearance brings great satisfaction and improved self-esteem to patients. Dr. Puchalski believes in making each nose "fit" the face of the patient, that is, the resultant appearance should not look artificial or "operated on".