Rhinoplasty
Dr. Randal Haworth is considered one of the world’s foremost rhinoplasty specialists, dealing with both primary rhinoplasty and rhinoplasty revision. Located in Beverly Hills, Dr. Haworth brings his artistry and experience to the practice of facial plastic surgery. Among the traits possessed by the world’s top rhinoplasty specialists is an advanced understanding of the nasal anatomy and functionality as well as an exceptional surgical skill to perform both primary and revision procedures properly.“Even though a high level of technical skill is needed to translate intention into form with rhinoplasty surgery, an artistic vision with keen aesthetic sensibility is necessary to allow a result to transcend from good to great. This is why I am so passionate about performing rhinoplasty – I consider it a constant challenge, prompting me to always critically evaluate myself and become better at what I do.”All rhinoplasties are generally performed on an outpatient basis using sedative or general anesthesia. To gain access to the nasal bone and cartilage, Dr. Haworth creates hidden incisions inside of the nose where they cannot be seen. He then reshapes and resizes the nose after a detailed consultation with the patient to determine their individual goals and what may look best to suit their overall facial appearance.
Terminology
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RHINOPLASTY TERMINOLOGY NOTES
Video


Hump reduction of either cartilage and/or bone, osteotomies to reduce the size both in profile and frontal view. This image describes the region typically reduced using this technique
- Modified techniques to correct a birth defect
Rib, ear or cranial bone grafts to reconstruct after an accident or a previous rhinoplasty
- Cartilage, bone and fascia grafts to build up a nose
- 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. The image to the right displays regions typically reduced or removed using this technique
- Septoplasty, turbinectomies, spreader and batten cartilage grafts to correct breathing problems



Candidates & Expectations
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RHINOPLASTY CANDIDATES
Dr. Haworth makes a point of serving each individual patient’s needs and defining overall expectations from any plastic surgery procedure. As Dr. Haworth states in his blog, “Plastic surgery will not make you happy, but it can make you happier. In simple terms, this allows me to assess whether a patient is fundamentally happy and balanced prior to operating on them.” The best 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 their other facial features
- Those with nasal skin which is neither too thick or too thin
- Those with unsatisfactory, unnatural-looking results from a previous rhinoplasty that may include (but are not necessarily restricted to) a pinched tip, irregular profile, collapsed sidewalls (“Inverted V Deformity”), “Saddle Nose deformity”, crooked appearance, asymmetrical retracted nostril shape, etc.
- Those with unsatisfactory functional results in breathing or nasal airflow due to tissue damage or undesirable healing
- Those needing to get the results of a previous rhinoplasty improved while having realistic expectations of the results
- 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
Pre-Op Planning
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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.PRE-OPERATIVE CONSULTATION
Your successful rhinoplasty surgery will require a number of appointments to ensure maximum health and safety. 1. 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. 2. Medical Records- 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
- For patients over 45, we may also require that you provide the following:
- Full medical clearance
- EKG
Post-Op Course
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OPERATION AND RECOVERY LOGISTICS

- 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.
POST-OPERATIVE 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.
- 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 exercise, 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
Risks & Challenges
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RISKS & 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
- 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)
FAQS
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FAQs
View frequently asked questions from patients considering Rhinosplasty & Revision Rhinoplasty facial procedures. 1. IS NOSE SURGERY PAINFUL? No. It is uncomfortable at times because you will not be able to breathe through your nose for a couple of weeks after the surgery. 2. DO YOU NEED TO BREAK MY BONES DOCTOR? Only if aesthetically advisable. Remember, “breaking the bones” doesn’t add any pain to the procedure postoperatively and only augments the result. “Breaking the bones” is, in fact, a very controlled maneuver using delicate instruments; indeed, “controlled infracture” is a more accurate term. 3. DO I NEED A CAST AND IF SO, FOR HOW LONG? Most rhinoplasty patients will require casting for up to 1 week postoperatively to allow the bones to set. After 1 week the cast is removed. 4. WHEN CAN I GO BACK TO WORK AND SEE MY FRIENDS? Most patients feel confident to see other people at 7-10 days after surgery. 80% of swelling takes 2-3 weeks to resolve while the remaining 10-20% takes 6 months to a year to go away. Bruising takes about 7-10 days to fade away. At 2 weeks postop, I administer a minute shot of cortisone that “turbo-charges” the disappearance of the swelling, so that most feel really great about their result at 3-4 weeks. It is only the very rare patient who experiences prolonged postoperative inflammatory swelling lasting many months. 5. MY NOSE FEELS HARD AND STIFF AND NUMB. IS THIS NORMAL? Yes. These sensations last about 3 months and are par for the course. 6. WHEN CAN I PLAY SPORTS? Your nose will be quite fragile for up to 8 weeks after surgery, so it is important to avoid all contact sports for this time. This also includes free bicycle riding (you can fall off), tennis water sports, etc. Murphy’s Law dictates that if something bad can happen, it will. Be forewarned. 7. MY NOSE IS STUFFY. WHEN WILL I NOTICE AN IMPROVEMENT IN BREATHING? This depends on the individual, the extent of the surgery and how bad your breathing was in the first place. It will take several weeks to notice improvement in nasal inspiration, so before that time, you will be breathing mainly through your mouth. Consequently your mouth can get very dry especially while sleeping. Therefore, it is advisable to utilize a humidifier while sleeping to help alleviate the discomfort associated with a dry mouth. Nasal stuffiness after rhinoplasty results from normal postoperative swelling and obstructing crusts. Occasionally, I will prescribe a nasally inhaled steroid to help reduce the postoperative inflammation and associated blockage. Avoid vasoconstrictors such as Afrin™ after surgery since this may have a deleterious effect upon healing and long term breathing. Nasal saline sprays, such as Ayr™ and Ocean™ are very useful to clean out the nasal passages of crusts as well as the careful use of Q-Tips soaked in hydrogen peroxide. Honey dissolved in a small amount of warm water is quite effective in dissolving crusts, by either carefully sniffing the mixture through the nose or through applying it with Q-Tips. Honey also possesses some antibacterial activity. 8. IF I NEED A MINOR REVISION, WHEN CAN I GET IT DONE? This is infrequent (under 4% with my patients), but if necessary, it is advisable to wait a minimum of 6 months after the original surgery. Very minor asymmetries can be corrected under local anesthesia (like the dentist) utilizing a permanent fat transfer technique, before 6 months. 9. WHY DO YOU PLASTIC SURGEONS RECOMMEND CHIN IMPLANTS AT THE SAME TIME AS RHINOPLASTIES? We only do if the chin is small in relation to the other facial features. Both the nose and chin are the most prominent features when the face is viewed in profile. Consequently, they should be aesthetically balanced. However, the patient will be the ultimate judge of this. 10. HOW DIFFICULT ARE CHIN IMPLANTS? WHAT IS THE RECOVERY TIME? Chin implant surgery is relatively easy surgery to perform for the surgeon and to recover from for the patient. Swelling is minimal and once the surgical tape is removed after a few days, patients feel comfortable going in public-even making television appearances! The implant will feel like your regular bony chin and should not move or shift. Infection is exceedingly rare. Liposuction under the chin and of the neck to highlight the jawline can be performed at the same time through the small small incision (about 1 cm long).
*Plastic & cosmetic surgery results may vary significantly between patients