The main goal of a nose is to look normally human and to function as an inhaler and exhaler of air. The goals of Rhinoplasty are to improve the appearance and to improve and/or preserve the function of the nose. Any kind of problem of the external and internal nose, including even its absence, can be called Rhinoplasty. It is common that the nasal bones and major cartilage, the septum, need surgical alteration. Septoplasty can be performed independently or as part of a Rhinoplasty. Septoplasty is usually a purely functional procedure and should be considered as a non-cosmetic procedure by insurance companies. Rhinoplasty for cosmetic or aesthetic improvement is not usually a covered insurance procedure in the U.S.

I perform Rhinoplasty as an outpatient procedure in the hospital or in the accredited surgery center. The anesthetic is commonly by conscious sedation and local injection of anesthetic, but could also be under general anesthesia. Most elective Rhinoplasties can be completed within 1 hour in my hands. The key point a prospective patient should know is that what separates one surgeon from another is not so much their operative ability, but their diagnostic acumen and judgment with each unique patient. All surgery requires skill, experience and judgment, but among elective, cosmetic procedures, Rhinoplasty probably demands the most of these talents. Some surgeons, either due to their training or their uncertainty, perform Rhinoplasty through an “open” technique (an incision through the skin) so that they expose the internal cartilages and bone of the nose. I am of the opinion that this approach is rarely, if ever, required to perform precise Rhinoplasty, that it actually can distort what the real end result will look like, and that the external scar has been a problem in some cases. Rhinoplasty by me is done through internal, mucosal incisions. Maneuvers to reshape, excise or add to cartilages are done so under direct vision. A natural appearing nose with no sign of surgery is the usual and intended result.

Rhinoplasty consultation and examination includes a lengthy discussion of the patient’s history, perception of their problem and their goals. Our discussion also includes the patient’s ethnicity and how their goals may be influenced by it. Persians, Indians, Chinese, Poles, Italians and Africans do have quite different issues with their noses that deserve individual attention. Finally a detailed diagnosis and plan of surgery, if indicated, is presented for consideration. A second office visit is encouraged.

Rhinoplasty may include augmentation of the nose with grafts, usually of the patient’s own cartilage, bone or fat. I do not recommend placing artificial implants into the nose due to their risk of infection, extrusion, displacement and scarring. Rhinoplasty should also take into account the harmony or disharmony with other facial features, especially the chin. Rhinoplasty and alteration of the chin (by intra-oral incision) is often performed simultaneously. Chin surgery (Genioplasty) is done under general anesthesia (see Genioplasty).

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rhinoplasty patient 2 after right

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rhinoplasty patient 2 before front 1

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rhinoplasty patient 2 after front 1

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