Rhinoplasty (Nasal Surgery)

Rhinoplasty (Nose Surgery)

 

One of the few operations that requires extensive experience and understanding of the anatomy and sense of aesthetics of the nose is a rhinoplasty (commonly known as “nose jobs”). Most of us have witnessed patients who have had the procedure, and the results have been quite obvious and disappointing. People often remark that they can always tell when someone has had a rhinoplasty. This certainly is not true, and only poor results are obvious. Dr. Sherman has performed countless operations over the past 30+ years of his practice. Our goal is to refine the nose, addressing the individual needs of each patient, in a conservative fashion.

The procedure includes an improvement in the aesthetic appearance of the nose, as well as the restoration of nasal function if required. We treat each patient individually, avoiding the “cookie cutter” rhinoplasty look which was so prevalent in the past.

 

Rhinoplasty overview by John E. Sherman, MD, FACS New York Plastic Surgeon

Operation: Rhinoplasty may be performed in our fully accredited office or in the hospital. The choice of facility depends on your age, your general health, and any additional procedures that may be performed at the same time.

If the rhinoplasty is performed in Dr. Sherman’s fully certified office operating suite in New York City, the surgery is performed on an outpatient basis, You will leave the office approximately 1-2 hours after the procedure. As another procedures, the patient  will leave the office with a friend or relative, and proceed home or to the hotel. It is essential that ice compresses be applied to your eyes to minimize bruising in the early postoperative period.

If performed at the hospital, you have a choice of New York’s finest facilities: The New York Presbyterian Hospital – Weill Cornell Medical Center (Rated the Best Hospital in NY, US News and World Report) or Lenox Hill Hospital, Manhattan Eye Ear and Throat Hospital. Dr. Sherman also operates at The Greenwich Hospital in Greenwich CT.

 

Variations of the Operation: Each individual rhinoplasty surgery is different. The goals of the teen seeking nasal improvement may be very different than that of the 40 year old seeking the same procedure. Obviously, the aesthetics are entirely different from each other. In particular, the nature of the skin envelope and anatomy is entirely different from patient to patient.

In order to reach a satisfactory result, Dr. Sherman will spend considerable time with you to help you define the aesthetic goals of your rhinoplasty. This may include a second visit to the office to further define your goals. We do not use computer imaging to visualize the proposed changes. The computer imaging, which is just a Photoshop program, may convince you to have the rhinoplasty. It will not address your individual anatomy, your skin type, and most importantly, the ability of the surgeon to realize these goals through surgery.

Closed rhinoplasty (endonasal approach): This approach is used in approximately 75% of our patients. Because of Dr. Sherman’s 30 year experience with this operation, he is able to visualize all the structures, and predict the outcome of the procedure. The advantage of the endonasal approach is less swelling and the lack of an external scar. However, there are indications for an open approach (external rhinoplasty).

External rhinoplasty (open approach, or open rhinoplasty): The indications for this procedure in our practice is a complex procedure that requires cartilage grafting, or straightening a nose that has been affected by the severe trauma. A small incision is made across the columella exposing the anatomy below. The advantage of this procedure is that it allows precise placement of cartilage grafts, if necessary, and a better visualization of the underlying anatomy.

Septoplasty: The septum is the wall that is located between the two nostrils. Often, the septum is injured in accidents, causing it to obstruct one or both sides of the nasal passageway. This, may have occurred during adolescence in an athletic event which may not have been appreciated at the time of injury. Dr. Sherman will correct your septum at the same time as he performs the rhinoplasty, thus improving your breathing. If your nose simply has an obstruction and you do not desire a rhinoplasty, the septoplasty can be performed without a rhinoplasty. The advantage of a septoplasty performed alone is that there is no bruising to encounter. However, if the nasal fracture must be corrected at the same time, there will be bruising.

The nasal fracture and septoplasty can be performed restoring your nose to its pre-injury appearance. This is not a rhinoplasty, but is reconstructive in nature.

Anesthesia: As in all of our procedures, the anesthesiologist is a board-certified fully accredited physician. The rhinoplasty is usually performed under a deep intravenous sedation anesthesia or a general anesthesia. Over the past few years, we have realized that the most important aspect of this procedure is maintaining the patient’s airway to minimize any complication. Therefore, most procedures are performed with some type of airway in place: either a laryngeal mask airway (soft tube that goes to the larynx) or endotracheal tube. Dr. Sherman will discuss each of these with you at the time of consultation. The goal is safety as well as maximizing the aesthetic result of the procedure.

Convalescence: Your “down” time may vary according to the complexity of the operation and your goals. Bruising may also vary, but is almost totally gone by 10-12 days after your rhinoplasty. If still present at that time, you may apply a light cover-up makeup to conceal any remnant of the discoloration. We ask that you refrain from exercise for 3-4 weeks after rhinoplasty. Jarring activities such as running should be avoided for at least 1 month after rhinoplasty surgery to avoid displacement of the nasal bones.

Insurance Information: Reimbursement after a rhinoplasty or septoplasty may vary depending on your insurance carrier. Generally, each company will provide some type of reimbursement if there is a degree of difficulty breathing, and is clearly documented. Each area may require different documentation. We will work with your insurance carrier to determine the precertification that may be necessary. The procedures that are often covered by insurance are:

  • Septoplasty surgery
  • Correction of nasal fractures (either early or late)
  • Reconstruction of nasal deformities with cartilage grafts to correct breathing problems.

It is our policy to help you contact your insurance company to help you predetermine your benefits, and pre-certify your surgery if it is non-cosmetic.