Nose Surgery/ Rhinoplasty

RHINOPLASTY

THE GOAL: TO REFINE, REPAIR OR RECONSTRUCT THE SHAPE OF THE NOSE TO SUIT THE FACE AND/OR TO ALLIEVIATE BREATHING PROBLEMS.

SIMPLIFIED NASAL ANATOMY

TERMINOLOGY NOTES

Rhinoplasty, that is, surgical nose reshaping, can accomplish a number of different things including:

Hump reduction of either cartilage and/or bone, osteotomies to reduce the size both in profile and frontal view
Cartilage, bone and fascia grafts to build up a nose
Septoplasty, turbinectomies, spreader and batten cartilage grafts to correct breathing problems

SPREADERGRAFT PLACEMENT:

ALAR BATTEN GRAFTS :

LATERAL CRURAL STRUT GRAFTS:
Cartilage grafts and suture techniques to modify the shape of the nasal tip

(e.g., to improve a bulbous,boxy, drooping, hooked or upturned tip)
Cartilage strut grafts and suture techniques to change the angle between the nose and upper lip
Weir excisions to narrow the nostril span
Modified techniques to correct a birth defect
Rib, ear or cranial bone grafts to reconstruct after an accident or a previous rhinoplasty

Depending on the individual’s case, Dr. Haworth may apply a few or many of these surgical concepts during the same surgery.

THE MOST APPROPRIATE CANDIDATES FOR RHINOPLASTY ARE :

At least 14 years old for young women, 16 for young men
Older patients with a nose that has started to hang or with an increasingly drooping tip
Patients who have a congenitally crooked nose or one that has been deviated because of trauma
Those who suffer from nasal obstruction from a anatomical problem of the nose
Those who need to correct a cleft lip-nasal deformity
Patients with realistic expectations about how they want their nose to be changed in shape and size to compliment theirother facial features
Needing to get the results of a previous rhinoplasty improved while having realistic expectations of the results
Those with nasal skin which is neither too thick or too thin

WHAT A PRIMARY OR REVISION RHINOPLASTY CANNOT DO IS :

Create an exact replica of another person’s nose, celebrity or otherwise, from your preexisting nose
Completely correct severe deformities of the nose from either trauma or past surgery 100% of the time.
Narrow a nose to an unrealistic or unattractive degree
Alleviate personal problems (social or psychological) in your life

RELATED PROCEDURES

Patients may choose to do one or all of these at the same time or in conjunction with other procedures such as:

Chin augmentation
Sinus surgery (Performed in conjunction with a qualified head and neck surgeon)
Jaw or cheek augmentation
Augmentation of the premaxilla or upper jaw
Upper lip lift and other lip procedures
Facelift

OLD THINKING VS. NEW TECHNIQUES

Dr. Haworth is renowned for his rhinoplasty results because he is one of the few to meld beauty with simplicity. Firstly, he analyzes a nose to formulate a surgical plan. Secondly, in the operating room, he strives to not only reshape it into a beautiful feature but also artistically scale it to the rest of the face. Dr Haworth understands that this takes extra time and sensitivity. His goal is to impart the impression one was actually born with the ideal nose others would envy. Consequently, his rhinoplasties take longer to perform than in years past. Not only does he build the ideal nose in terms of projection, angles, shape and size but then he methodically erases most evidence that surgery has been performed in the first place via advanced surgical maneuvers. In general too, nose surgery has become significantly more sophisticated than in generations past, resulting in a far more subtle, natural outcomes than ever before.

These breakthroughs include:

ONE SIZE DOES NOT FIT ALL: Modern suturing and grafting techniques are employed in accordance with patients’ goals and particular anatomy. Not only is the placement of each suture critical but also is the force with which it is tied. According to Haworth, "Great surgery is measured in millimeters, not centimeters", but in the case of rhinoplasty surgery it is more accurately measured in fractions of a millimeter!

GREATER APPRECIATION OF POTENTIAL PROBLEMS: which may arise after certain surgical methods (such as nasal obstruction). As a result, the modern rhinoplasty surgeon takes into account such possibilities and consequently "goes the extra mile" to avoid them with specific surgical moves.

THE OPEN TECHNIQUE: as opposed to the closed. Dr Haworth used to perform 80% of his rhinoplasties closed to avoid the theoretical scar across the columella (the narrow strip of tissue that separates the nostrils) as well as prolonged swelling. However, he found that these supposed advantages to the closed method did not borne out to be true. The closed method tended to result in less accurate suture placement, shifted cartilage grafts and less consistent results; therefore, Dr Haworth has shifted his approach to an open one in over 85% , based upon practicality, reliability, safety and ultimately, patient satisfaction.

STATE-OF-THE-ART TECHNOLOGY: to eliminate or minimize the need for "packing the nose" after surgery. Patients’ postoperative experiences are better than ever in terms of comfort and healing.

EXPECTATIONS:

Nose surgery will deliver a refined look that is permanent. However, as time goes by and gravity takes its toll, the face will still age.

CHALLENGES

Conditions that make nose surgery of a challenge and may require additional consent/consultation include:

Thick, sebaceous or very thin skin
Past nasal surgery
Severely crooked nose
Presence of a septal perforation
Preexisting scars or a tendency to form excessive scars
Active sinus infections
Cocaine abuse
Uncontrolled high blood pressure
Blood clotting problems
Smoking

RISKS

No surgery is entirely risk-free. However, both our staff and facilities have the highest possible qualifications to produce a happy outcome. While risks and complications are extremely rare, be aware that those for nose surgery can include:

Missed aesthetic expectations
Worsening of nasal breathing
Persistent septal deviation
Altered sense of smell (uncommon)
Prolonged pain (very rare)
Numbness or stiffness despite a great aesthetic outcome
Infection (rare)

Additional treatment of either a surgical or non-surgical nature may be required to alleviate these problems and additional costs may apply.

PRE-OP CONSULTATION

The pre-operative consultation is where you meet with Dr. Haworth and our staff to review your health, finalize the details of your procedures, order appropriate tests, prescribe medications, discuss your aftercare and answer any questions you may have.

Any appropriate health records related to the list of conditions noted above.
Any radiological test results including regular Xrays and CAT scans that may have been taken.

For patients over 45, we may also require that you provide the following:

Full medical clearance
EKG

Alternatively, we can coordinate this for you.

CRITICAL PRE-OP CAUTIONARY NOTE

It is absolutely essential that that you avoid all aspirin, aspirin-related, ibuprofen or blood-thinning medications for 2 full weeks prior to your surgery. In your pre-op consultation, we will give you a complete list of these drugs. For our patients, we also provide a password-protected link allowing you to download the list onto your computer. If in doubt about a specific medication, do not take it, call the office first and ask if it is on the forbidden list.

LOGISTICS AND SPECIFICS

SURGERY DURATION: 1.5 – 4 hours. Rhinoplasty, especially if revisional in nature, may take longer than anticipated due to the deformity encountered and the complexity of surgery needed to correct it.

ANESTHESIA: Sedated.

SUTURES AND CAST REMOVED: 5-7 days

As you wake up from surgery, you will feel mild pressure in your nose similar to what you feel when you have a cold but without the total body symptoms which normally accompany it. However, prescription painkillers will easily control the discomfort. You will most likely have a cast or tape over your nose to control bruising and swelling, while stabilizing the new shape of your nose in the immediate postoperative period.

POST-OP CARE

You will need to keep your activities to a minimum for at least 7 days.

In person and in your post-op information packet, we shall explain everything you need to know for your aftercare at home that will include:

Medications (prescription and homeopathic)
Cleaning incision sites
Utilizing a humidifier in your room while you sleep.
Employing nasal saline rinses (Neil Med) to accelerate the healing process while minimizing complications.

Expect to tire easily for awhile. To aid your recovery you’ll want to rest as much as possible and:

Avoid wearing eyeglasses and sunglasses for 6 to 8 weeks. The pressure and weight of the frames on your nose could distort your final results and interfere with your healing if you wear your glasses too soon after surgery. If you absolutely must wear prescription eyeglasses to function, tape them securely to your forehead with surgical tape.
Treat your face and hair gently, since your skin will be both tender and numb
Keep your head elevated above the level of your heart – even while sleeping – for about 2-3 weeks after surgery
Avoid strenuous activity – including exercize, sex and heavy housework – for at least 2-3 weeks.
Avoid steam baths, and saunas for at least 6 weeks or until the doctor gives you the OK
Avoid alcohol and aspirin products for 2 weeks after surgery
If you don’t feel dizzy, slow walking and mild stretching are fine as long as you keep your head above your knees

To optimize and accelerate healing, we also recommend coming into the office for hyperbaric oxygen treatments and Bioptron™ polarized light therapy. Both of these modalites can reduce swelling and bruising by up to 5-7 days. Addtionally, these exhibit signicant healing properties upon slow-healing incisions and injured skin.

RECOVERY

By the end of the second week, you'll look and feel much better. Most patients are back at work about one to two weeks after surgery. If you need it, special camouflage makeup can mask most bruising that remains.

Gradually, you will be able to resume to your normal activities:

1-3 DAYS read or watch television
7 DAYS resume wearing makeup (most bruising will be gone). However, you will most likely still be swollen.
7-14 DAYS be out in public, back to work and take long strolls
2-3 WEEKS begin moderate and work up to vigorous exercise.

MINIMIZING SCARS

Scars resulting from a rhinoplasty are minor and generally hidden. Scar Gard, Kelocote or similar silicone gel treatments can be somewhat effective in decreasing scar visibility sooner.

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Procedure Descriptions