Rhinoplasty is one of the most commonly performed operations by Dr. Sherman. Over the past 30 years he has operated on countless patients desiring cosmetic improvement as well as functional improvement of the nose. The result of the operation is dependent on two factors: 1. the anatomy and cosmetic goal of your operation, and 2: the experience of the surgeon and his or her familiarity with all techniques. Just as the concept and goals of rhinoplasty has evolved over the past hundred years, so should the procedures of the surgeon throughout his or her 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.
The goals of the teen seeking nasal improvement may be very different than that of the 40 year old seeking the same procedure. 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.
To help you 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-like program, can show you the potential outcome, should you opt to have the operation. It will not address your individual anatomy, your skin type, and most importantly, the ability of the surgeon to realize these goals through surgery.
Overview of Rhinoplasty in Manhattan by John E. Sherman, MD, FACS New York Plastic Surgeon.
Every nose is different, and every nose surgery is different.
Nasal surgery 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 operation is performed in Dr. Sherman’s fully certified office operating suite in New York, it is performed on an outpatient basis. You will leave the office approximately 1-2 hours after the procedure.
If performed in the hospital, Dr. Sherman is on staff at the New York Presbyterian Hospital-Weill-Cornell University Medical Center (Rated the Best Hospital in NY, US News and World Report), and Manhattan Eye Ear and Throat Hospital.
+ Closed rhinoplasty (endonasal approach)
This approach is used in approximately 50% of our patients. Because of Dr. Sherman’s 30+ years of extensive closed-rhinoplasty 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)
Dr. Sherman prefers an open approach (external rhinoplasty) if there is indication for cartilage grafting, or if the nose needs straightening, or if there is a significant airway problem. A small incision is made across the columella, exposing the anatomy below. The advantage of this approach is that it allows precise placement of cartilage grafts, if necessary, and a better visualization of the underlying anatomy.
Septoplasty may be performed at the same time as a cosmetic rhinoplasty. 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 has been performing functional airway correction throughout his career, emphasizing both function and aesthetics.
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 it. 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 by restoring your nose to its pre-injury appearance. This is not rhinoplasty, but is reconstructive in nature. (Click here for more info.)
Our anesthesiologist is a board-certified fully accredited experienced 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.
If you are traveling to New York for surgery from outside the city, we can help schedule your hotel reservations and care.
+ What to Expect During Recovery
As other procedures, the patient will leave the office with a friend or relative and return home or to the hotel. It is essential that ice compresses be applied to your eyes to minimize bruising in the early postoperative period.
Your downtime 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. When you leave the office, a splint will be placed over your nose which will be removed at roughly 6 or 7 days after surgery. This minimizes the chance of the nasal bones to move during healing. Equally important, you may not put eyeglasses over your nose for 3 weeks after surgery, after the splint is removed.
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 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 in breathing, and is clearly documented. Each area may require different documentation. We will work with your insurance carrier to determine the pre-certification that may be necessary. If your insurance company does give precertification, you receive reimbursement direct from the insurance company for both the surgeon’s fee, and anesthesia. However, it may not cover the entire cost of these fees.
+ Types of Procedures Often Covered:
- 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.
In order to produce the best results for each patient, Dr. Sherman utilizes his extensive surgical knowledge and decades of experience. For more information about rhinoplasty or other plastic surgery procedures, please feel free to contact our office today.
+ Am I a good candidate for rhinoplasty?
If you are unhappy with the general appearance of your nose would like to refine or improve its appearance you would benefit from a rhinoplasty. If you have been injured in the past, and the appearance of your nose has changed, rhinoplasty can also be beneficial.
+ It is the procedure painful?
Rhinoplasty is performed under a deep intravenous sedation anesthesia or occasionally with a general anesthetic. During recovery process, swelling and bruising are to be expected, and the 1st night after surgery is often uncomfortable. On the pain level scale, the pain level is a 2 out of a total score of 10. Most patients are easily managed with one night of pain medication, returning to simple Tylenol the next day.
+ What if I have breathing problems for nasal obstruction?
Strictly speaking, a rhinoplasty is used to enhance a cosmetic appearance of your nose. In a significant percentage of patients, breathing abnormality’s and nasal obstruction are also present. In these patients, the correction of nasal obstruction will also be performed. This nasal obstruction can result from previous trauma causing septal obstruction “deviated nasal septum” or from allergies causing hypertrophy of the turbinates. This relief of nasal obstruction can be performed separately if you do not want the appearance of your nose change, or at the same time as a rhinoplasty.
+ How long will the procedure take?
If there is a simultaneous need for correction of breathing problems, it will take slightly longer. The time varies with the extent of structural and aesthetic changes being made to the nose.
+ How long will it take to recover my rhinoplasty?