1. At what age can rhinoplasty be performed?

Rhinoplasty, is more commonly referred to as a "nose job." Rhinoplasties are one of the most common plastic surgical procedures. Extensive nasal surgery is generally avoided in children with the exception of severe disfigurement due to accidents or congenital deformities. For lesser deformities surgery is deferred until after the child stops growing. Rhinoplasty is performed at the earliest, from 16 to 18 years of age. Rhinoplasties performed on teenagers and young adults has been shown to be beneficial to the social development and self confidence of the individual.


2. What does a typical rhinoplasty consultation entail?

Rhinoplasty can reduce or increase the size of your nose, change the shape of the nasal tip and nostrils, remove a hump, or change the angle between your nose and your upper lip. The initial consultation establishes the relationship between the patient and physician. This will allow the surgeon to determine whether the patient is an appropriate surgical candidate for the procedure. The patient' s history should establish whether the patient is physically and emotionally ready for a rhinoplasty. An individual' s ethnicity, facial features and bone structure all contribute to the techniques used in a rhinoplasty. There is no "one size fits all" when it comes to this procedure. The physician will discuss your aesthetic concerns with you and will explain what can be achieved realistically.


3. What should I expect postoperatively?

There is a nasal packing that is removed the next day and a splint that is removed in a week. Swelling and bruising is present for about 2 or even 3 weeks in most patients. The majority of the benefit is seen at this time. There is more subtle swelling that continues to improve and mature over the course of 9 to 12 months so that the true final result can really only be appreciated after a full year.


4. What is a "hanging columella"?

A nasal columella is the external, and sometimes partial internal, fleshy section of the nose which separates the nostrils. When it is referred to being a hanging columella this section is often prominent or hangs down. In the ideal nose, actually 2-4 millimeters of this skin bridge should be visible from the side view and therefore, a very small amount of the inside of the nostril should be visible from the side. If there is too much columella show then one can see too much into the nose and in front view it may look like the columella hangs down. Sometimes the columella isn' t really hanging down but only appears so because the side rim known as alar margin is pulled upwards too much. There are a variety of causes such as prior trauma, old techniques in rhinoplasty, or an inherited tendency. A number of surgical techniques can reduce the visibility of the columella or the amount one can see into the nose


5. Is it possible for someone to be allergic to dissolvable stitches? And if so, what is the reaction like?

Yes, it is possible for someone to be allergic to dissolvable sutures. There are two types of absorbable sutures that can promote a response in those who are sensitive to these sutures. The two include absorbable material such as vicryl suture or gut suture material. An allergic reaction may cause redness, itchiness and sometimes pus formation. The symptoms may not show up until about several weeks after surgery. Antibiotics can be given but it usually re-occurs. The best thing to do in some cases is to remove any of the left over material and replace it with non absorbable suture such as a Nylon or Prolene suture. These sutures are usually removed in 10 days. Another option can be tissue glue adhesive such as Dermabond. Your physician can distinguish the difference between normal healing, typical irritation and an allergic reaction. The type of suture material used is strictly up to your surgeon. If you have a history of a reaction to an absorbable suture, be sure to mention this to your physician. Using a non-absorbable material can also be an option, if you prefer.


6. Are there any new techniques to repair a deviated septum? Is cauterization used? Does the nose always have to be packed after surgery?

Endoscopically guided septoplasty is a new technique for correction of septal deformities providing excellent visualization. There is decreased post operative swelling with this technique. It is very useful in difficult revision nasal surgeries in which obstructing septal deviation persists. Endoscopic versus an open septoplasty is strictly up to your surgeon and his or her experience level. I prefer the open septoplasty for repair of the deviated septum. Electrocautery is used only on the turbinates or the initial incision on the columella in open techniques.

Usually after Septal straightening surgery, internal nasal splints are placed for one to two weeks. Nasal packing may also be placed if turbinate surgery was performed.


7. Which approach is preferred? Internal or external?

Some surgeons perform all of their rhinoplasties, open and others perform them closed. It solely depends upon the surgeon. The external rhinoplasty approach is my preferred approach to the nose because it provides maximal exposure of the lower lateral cartilages, upper lateral cartilages, middle nasal vault, and bony nasal vault. These supportive structures can be manipulated in a precise and symmetric fashion. This approach allows for accurate suture placement and fixation of cartilage grafts.