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Rhinoplasty (Nose)

Nasal Surgery: Rhinoplasty / Septorhinoplasy / Septoplasty

General Information 

Miami’s facial surgery expert, Dr. Sam Gershenbaum, brings state-of-the-art techniques and experience to every nasal surgery procedure at the Brickell Riverfront Surgery Center in Miami, Florida. Nasal surgery, or rhinoplasty, is popular among men and women who are dissatisfied with the size and/or shape of their nose. Being such a prominent feature, the nose may be the most defining characteristic of one’s face. Septorhinoplasty corrects both cosmetic concerns and septal deformities causing airway obstruction. Septoplasty, alone, may be performed to correct a deviated septum causing airway obstruction. Dr. Sam Gershenbaum routinely performs rhinoplasty, septorhinoplasty and septoplasty at Brickell Riverfront Surgery Center in Miami.

Typical reasons for rhinoplasty include:

  • Decreasing or increasing the size
  • Removing a hump
  • Narrowing the nose and tip
  • Increasing or decreasing projection
  • Correction of a crooked nose or deformity
  • Correction of a hanging or drooping tip
  • Correction of airway obstruction

Conditions requiring rhinoplasty may be a result of natural genetic causes, birth defects or traumatic causes. Dr. Gershenbaum also routinely performs corrective rhinoplasty and septorhinoplasty for patients unsatisfied with their surgery performed elsewhere. Frequently, patients who desire rhinoplasty are concerned that their nose appears too large or out of proportion to their face. The nose and chin are important balancing features of the profile, and can often affect one’s appearance. A small, flattened or receding chin may also be a contributing factor to a patient’s unbalanced or “unattractive” profile. Chin augmentation or a chin implant may be considered and discussed at the time of the nasal surgery consultation as this procedure is frequently performed at the same time as rhinoplasty to improve and balance facial proportions.

Before

After rhinoplasty with chin implant

Cosmetic improvements and correction of deformities of the nose can be corrected by adding to, removing, reshaping and/or rearranging bone and cartilage. Each person’s nose is different requiring a complete understanding of nasal anatomy, along with a full armamentarium of procedures and techniques to formulate a specific surgical plan. Bone and cartilage can be filed, shaved, cut and trimmed along with a vast number of suturing techniques to reshape cartilages of the nostrils and tip. More often, precise cartilage grafts are trimmed and shaped to provide added contour and support to the dorsum, tip and nostrils for cosmetic as well as functional repairs. Cartilage for repairs are most often harvested from the nasal septum, however, can also be taken from ear and rib cartilage as well. At times, soft tissue fascia and/or dermal-fat grafts can be used as well for corrections along the dorsum. On occasion, allograft donor dermis and cartilage can be used as well.

Techniques

Dr. Gershenbaum routinely performs both closed rhinoplasty and open rhinoplasty procedures depending on the needs of the patient. Rhinoplasty and septorhinoplasty can be accomplished through a closed technique, where incisions are made inside the nose only. Dr. Gershenbaum performs closed nasal surgery with more minor rhinoplasty procedures, such as removing a nasal hump, narrowing the nasal bridge or adding simple cartilage grafts to support the nostrils or add conservative projection to the tip. 

For more extensive rhinoplasty and septorhinoplasty procedures, Dr. Gershenbaum prefers an open approach, in which an incision is also made across the columella (the skin bridge between the nostrils), which connects the internal incisions. The open approach provides unparalleled exposure and accuracy with greater predictability in results.  The performance of each suture technique, cartilage shaping and graft placement is visualized. The resultant scar is near imperceptible. Dr. Gershenbaum has never had an issue or complaint about the few millimeter columellar scar in all his years of practice.

Marking for columella incision

Dorsal preservation rhinoplasty, sometimes called “push down” or “let down” preservation rhinoplasty is gaining popularity in reducing a nasal hump. Instead of cutting, trimming or filing the anterior nasal hump, this procedure entails removing precise cartilage strips and incising bone or removing precise strips of bone below the natural untouched nasal dorsum. This allows the “impaction” or “push down” of the nasal dorsum while leaving the normal dorsal nasal anatomy intact. In patients who are candidates for this procedure, it can reduce potential deformity or irregularities in the nasal dorsum that may occur from the more common direct filling and trimming of nasal bone and cartilage to reduce the hump.  

The Consultation

The initial consultation is extremely important to review the patient’s medical history, goals and expectations as well as develop mutual trust and rapport. Numerous before and after photos are reviewed, the procedures and alternatives are discussed.  A physical examination of the internal and external nose is performed to evaluate the cosmetic appearance as well as the functional airway. Discussion continues to insure that expectations can be met as well as to determine the best choice of procedures. The objectives and plan of every nasal surgery varies with each patient, and the ideal nose varies from face to face depending on facial shape and proportions, nasal structure, skin type and ethnic background. The result of rhinoplasty should reflect the agreed upon plan, and the nose should look natural without any signs of an “operated” appearance. Rhinoplasty can generally be performed after the mid-teens, when the growth spurt has ended. Prospective patients are encouraged to speak with previous patients about their surgery and results. Dr. Gershenbaum and his staff are always available for questions. Following the initial consultation and after appropriate time for reflection and decision making, an appointment is scheduled for routine preparation and informed consent. Additional questions and concerns may also be addressed. Routine blood analysis and medical clearance are required prior to surgery.

The Rhinoplasty / Septoplasty Operation

The surgical procedure is performed in our state-of-the-art outpatient facility Brickell Riverfront Surgery Center in Miami, Florida. General anesthesia is used for most cases. This surgical procedure time will vary greatly depending on the extent of the procedure. A simple hump reduction may take one to one and a half hours while a dorsal hump and tip reshaping may take from two to three hours. More involved airway and reconstructive procedure can take longer.  In the holding area, the surgical plan is reviewed with the patient prior to surgery and all skin markings made. For general anesthetic cases, after speaking with the anesthetist/anesthesiologist, the patient is brought back to the operating room. After asleep, local anesthesia is injected into the areas to be worked on which also and shrinks blood vessels and capillaries to reduce bleeding. If cartilage or soft tissues are to be harvested, this is completed first. Dr. Gershenbaum typically works on the dorsum first, then the septum if planned and lastly the tip. The results are carefully inspected multiple times along the way. A wet finger courses along the dorsum to ensure a smooth contour. Different techniques can be used to reduce enlarged or flared nostrils, which would be performed at the end of the procedure.

Before

After nostril reduction and rhinoplasty

All incisions are closed with sutures. Dr. Gershenbaum most often avoids nasal packing by placing multiple dissolvable sutures in the septum to avoid blood and fluid collection. Packing, at times, may be needed. Tape and a nasal splint are most often applied. 

Any ancillary procedures, such as a chin implant, may lastly be completed. The patient, after awake, is transferred to the recovery area, where they will generally spend one hour in preparation for discharge.

The Recovery Period

Following the surgery patients generally report minimal discomfort which is easily controlled with medication. Most nasal surgery patients really do not complain of pain. Varying degrees of swelling and bruising, generally mild, depending on the extent of the procedures subside over the first few days and the remainder over the next week or two.  Generally, the patient is seen for their first follow up appointment the next day after surgery. If packing is placed, it is generally removed from one to three days, depending on the extent of surgery. The internal sutures are dissolvable while the external sutures and the nasal splint are removed one week after surgery.  Dr. Gershenbaum generally replaces tape on the nose to be kept on for an additional week to reduce swelling.  Depending on the extent of the procedure, routine activities may resume a few days to one week after surgery and light exercise started at four to six weeks after surgery. Recovery and healing will vary from patient to patient. It must be remembered that complete healing takes time and patience. Swelling in the tip is last to resolve taking several months and even up to one year before realizing the final results of surgery. Some numbness may be present for weeks or even months following the surgery and optimal breathing may take weeks or months following surgery as well.

What does rhinoplasty cost in Miami?

The cost of rhinoplasty in Miami will vary depending on many factors including the practice, the surgeon, the surgery center and the anesthesia provider whether physician or nurse anesthetist. The price of a rhinoplasty will also vary greatly depending on the extent of the correction required for each individual patient. Some patients may require a hump reduction only. Other patients may require hump reduction and tip work. Many patients with require dorsal hump corrections along with tip work, septal deviation corrections and cartilage grafts. There are also those who require reconstructive procedures for  previous surgery or traumatic injury. Please check out the article on my website under patient education, What’s In A Surgical Fee to help better understand why prices vary. In general, the full cost of a rhinoplasty will range from $5,500 to $15,000.  For more information on rhinoplasty, or to schedule your appointment, click here to our Contact Form, or simply call 305-933-1838…….. Because YOU deserve the best!

Complications

 As with most cosmetic surgical procedures, complications are unlikely when performed by a skilled and competent surgeon.  Complications include, but are not limited to anesthesia risks, bleeding, infection, poor healing, poor scaring, persistent or increased deformities or irregularities, breathing problems and the need for revision surgery.

Rest assured that Dr. Gershenbaum will do everything he can to make your procedure(s) and experience truly rewarding. In the unlikely event of a complication or result that is less than desirable, we will do all within our power to work toward a result that you can be proud of. Venodyne calf compression devices are used for every surgery. Venodynes are pressure cuffs that fit over each lower leg from the ankle to the knee circulating every one to two minutes to reduce pooling of blood in the lower extremities and further reduce the possibility of blood clots or emboli. In addition, smokers must stop smoking well in advance of surgery. Smoking seriously decreases blood circulation in the skin which increases the risks of complications and poor healing.

If you reside in or plan to visit South Florida and you are interested in learning more about nasal surgery and/or a chin augmentation, contact Dr. Sam Gershenbaum at 305.933.1838 or via our online contact form. Dr. G’s dedication to his patients, experience and perfectionism has made him one of the top, award-winning plastic and reconstructive surgeons in Miami.

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