The Different Types of Nose Jobs

If you’re unhappy with your nose you can take heart in the fact that getting a nose job, or having a rhinoplasty procedure, is one of the most common and most complication-free forms of cosmetic surgery you can elect to have. In 2007 alone the American Society of Plastic Surgeons reports that there were approximately 285,000 people who had their nose reshaped either for cosmetic or health reasons.
Because the nose is such a prominent and always visual part of the body no one wants to have scarring or deal with breathing complications due to swelling. If you’re consider any sort of nose reshaping or rhinoplasty then you should be aware that there are actually two different types of rhinoplasty procedures which are generally performed.
Closed Nose Rhinoplasty – This is the least invasive type of nost job and it involves your plastic surgeon making an incision on the inside of your nose and working entirely beneath the skin of your nose with limited visual access. Not all nose reshaping procedures can be done this way due to the limits of what can be seen. Recovery is quick and generally easy, though there will still be some initial discomfort.
Open Nose Rhinoplasty – This type of rhinoplasty involves removing the nose of the skin and allowing the plastic surgeon to have full access to the underlying cartilage and tissue of the nose. There is a small incision made across the columella (between the nostrils) to perform this procedure and some scarring can occur. The open nose rhinoplasty procredure allows for greater shaping of the nose and gives the surgeon the most access. This can be a fairly complex procedure though some surgeons prefer it because of the results it can yield. There is a little more discomfort and recovery time is a little bit longer with open nose rhinoplasty, but again, the results may be worth it.
With either the open nose or closed nose rhinoplasty procedures there will be consideral discomfort and recovery times, though serious complications rarely occur. The most common types of discomfort are swelling and bruising, moderate pain, nasal discomfort and trouble breathing while recovering. In some cases you may also experience numbness, though that often goes away with time.
Pain medication is often given and people who undergo any sort of nasal surgey are generally advised to sleep in an upright position for several days to several weeks.
The choice of what type of procedure you will have will be depend upon the type of changes you wish to have made to your nose and the preferences of your surgeon.

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Rhinoplasty: Saddle Nose Deformity

Saddle nose deformity is due to loss of nasal dorsal height and support, leading to a collapsed and short nose.  Dr. Vartanian has used a number of techniques to repair such nasal deformities.  Here is Dr. Vartanian’s classification system for saddle noses:

Classification

Regardless of the etiology, categorizing the severity of the saddle nose is helpful. Dr. Vartanian uses a simplified system that classifies saddle-nose deformities on the basis of the anatomic deficits as follows:

Most patients with a type 2, 3, or 4 saddle-nose deformity have functional nasal airway obstruction.

A practical classification method described by Tardy divides saddle-nose deformities into 3 categories, as follows:

Indications for nasal reconstruction must be tempered by patient selection, the surgeon’s experience, and the etiology of the deformity. Indications for surgery can be functional, aesthetic, or, most commonly, both. Examples are as follows:

Persons with contraindications for repairing a saddle-nose deformity include the following:

Patients with relative contraindications include the following:

Dr. John Vartanian prefers the use autogenous cartilage grafts from the septum, ear, and if need be, costal (rib) cartilage for reconstructing saddled noses.  Usually an external rhinoplasty approach is chosen.  For more details please refer to the author’s website:   http://www.facial-plastic.com/

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All About Rhinoplasty

No matter if you were born with a crooked nose, a nose that is too big for your face proportions, if your nose is too long, if you broke your nose, or anything else you might think of, you can fix your nose, feel better about your looks and breathe better by performing a nose job surgery.

Nose job plastic surgeries, also known as Rhinoplasty are very common these days, people don’t settle for a look they don’t like any more but correct it. In some cases the defect in the nose might cause the patient breathing problems then the nose job plastic surgery is also a matter of health aid.

The patient must be at least 16 in order to have the surgery; the patient should be examined before having the surgery in a professional medical clinic. If the patient is compatible for the nose job surgery he then can decide if he wants to have it.

The surgery takes about one hour but the patient needs to rest for a few days afterwards because the nose will be swollen, there might be hemorrhoids around the nose, and the patient might feel nauseas and weak and have troubles breathing since he can only breathe through the mouth. The swelling can stay up to several months until the nose is back to its original but corrected size.

The surgery can be made with a local anesthesia or general anesthesia. The surgery is made from the inside of the nose so the cuts and scars won’t be visible afterwards.

The patient needs to be ready for the changes he is going to experience. For a start, he is about to have a swollen nose for quite a while after the surgery which might make him feel uncomfortable; he would also need to wear a bandage for a few weeks or days, depending on the surgery.

And last but not least he will need to get used to the new look which might be a little funny at first.

For many people the nose job plastic surgery is a life changing procedure, before you consider having the surgery it is best to talk to people who had this surgery and ask them anything you can think of about how they felt before the surgery, while having it, and after the surgery; learn how it changed their lives in a good or bad way, and also ask where they performed it and if they can recommend you on a good clinic or a specific surgeon.

You need to ask as many questions as you can before having this life changing surgery. Also ask the doctor about the complications and what you can do in order to prevent having any problems.

Make sure you know exactly how you want to look after the surgery and make sure you get the best surgeon you can find in order to perform the surgery and get the best results.

It is very hard to correct a “bad surgery” therefore make sure you have the best surgeon and that you know what you want before you perform it.

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The Delicate Nose

Cosmetic surgeons who are faced with a patient who is unhappy with a large nose and wishes to minimize the size and revise the shape, can design a new size and shape to fit his or her ideals of nose beauty. However, a person with a small or petite nose who would like to accentuate or maximize the size and shape faces unique limitations. For the majority of men who desire rhinoplasty surgery, the surgeon can start with a larger “piece of clay” and then sculpt down. For women with petite noses who desire a dramatic change must realize that the limitations are set based on factors like surgeon skill, technology, and experience.

Some cosmetic surgeons offer the practice of nose augmentation, the use of safe augmentation materials to add shape, size or form to a “too-delicate” nose. The standard of beauty in Hollywood and magazines today says “less is more,” and surgeons are not usually faced with this dilemma. Most women who do go in search of a change want to minimize their nose shape and size for a delicate-looking nose.

While a delicate nose of small proportions may seem like the perfect nose, this type of nose may only fit certain faces. It is your surgeon’s job to assess and evaluate your facial features to decide what the ideal nose proportions for your rhinoplasty may be. While a particular nose may appear attractive in a magazine or on television, there is a good chance that it may not work well on your face.

If you have a stronger chin and higher cheekbones, a thin, delicate nose may look out of place or odd. The quality and thickness of the skin is also taken into account when deciding on an overall nose style – a surgeon may be able to reduce the size of the nose, removing bone and cartilage, but if the skin is too thick, a nose may never be able to achieve a delicate quality. Also, your body type, size, and stature should be taken into consideration. A delicate nose on a larger person may seem unnatural.

The best thing to do is take a few samples of noses you find attractive into your cosmetic surgeon. Your cosmetic surgeon will be able to use computer imaging to show you what nose shape and size will look best on your face. The goal here is balance – you don’t want too much or too little emphasis on the nose, the central facial feature. Achieving facial symmetry should be as important as the new nose structure itself. After rhinoplasty surgery, you should see an improvement not only in the nose, but also a more attractive quality in the entire facial appearance.

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Revision Rhinoplasty

Revision rhinoplasty can be performed if you are unsatisfied with the results of a previous rhinoplasty procedure. Revision rhinoplasty requires a very experienced cosmetic surgeon who is able to address patient issues successfully while creating results that improve the patient’s overall appearance and provides them with results they are happy with.

Why do many rhinoplasty procedures fail to turn out the way patients had hoped? First of all, rhinoplasty is one of the most complex plastic surgery procedures. The number of surgeons who have completely mastered the techniques used and have the artistic talent to deliver personal results with success is comparably small. Secondly, marketing and advertising may mislead patients, giving them unrealistic expectations of their results, it is up to the cosmetic surgeon to make sure the patient understand exactly what to expect from their procedure. Also, many patients have no experience searching for a cosmetic surgeon, and are not sure how to dig deeper before deciding on a doctor.

Some of the most common causes for a patient having revision rhinoplasty include:

· Original rhinoplasty efforts that were too ambitious, an overwhelming amount of changes that simply should have been scaled down by the surgeon

· The physical and aesthetic results were achieved, but there are breathing and other functionality problems

· Revision rhinoplasty may be part of the comprehensive plan to reduce the size and alter the shape of their nose

Prior to committing to revision rhinoplasty, you need to think carefully about what you would like to accomplish with this second procedure, and get specific about what you do not like about your current results. In few instances, it may not even be surgically possible to change certain aspects of your nose.Cosmetic surgeons spearheading revision rhinoplasty must be sensitive to the needs of patients who’ve been through the rhinoplasty process before, only to encounter disappointment. They should be not only skilled and have extensive training and a diverse cosmetic surgery background; they should have a comprehensive portfolio that accurately represents their abilities. Remember never to choose a cosmetic surgeon based solely on price, especially when dealing with a procedure as specialized as revision rhinoplasty.

It is important that rhinoplasty patients have realistic expectations before surgery, and that revision rhinoplasty patients understand also that factors like surgeon skill, technology, and personal care can affect your outcome.

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Cosmetic Rhinoplasty and Reconstructive Rhinoplasty – There Is A Difference

Cosmetic surgery is performed in order to “improve” the appearance and self-esteem. Even though it is not always deemed medically necessary it is most effective in improving and enhancing appearance. It always improves self-esteem as well.
Reconstructive Surgery is performed to correct abnormal structures of the body which are caused by congenital birth defects, trauma, developmental abnormalities, infection, tumors or disease.
Rhinoplasty Plastic Surgery A Brief History
Plastic surgery is a surgical specialty dedicated to reconstruction of facial and body defects due to birth disorders, trauma, burns and disease. The word “plastic” comes from the Greek word plastikos, which means “to mold or shape.”
This dates back to ancient Egypt around 3,000 B.C. and India since 800 B.C. Soldiers wounded in battle incurred many gaping wounds including facial wounds – that surgeons were forced to deal with. During the Renaissance, Rhinoplasty was studied for aesthetic purposes and by the middle 1800s doctors in Europe were using different surgical procedures to enhance the shape, appearance and functionality of the nose.
Two of the most noted pioneers were Jacques Joseph and John Orland who began to explore the benefits of “reconstructive” and “functional” repairs and developed successful surgical techniques to perpetuate this area of modern surgery. During World War I, surgeons were forced to create major advances, quickly, in technologies, reconstructive procedures, anesthesia and techniques. Rhinoplasty was one of the most common surgeries needed and wonderful advancements were made in technique and reduced risk.
So the “art” and “science” of plastic surgery was born out of necessity and has evolved into cosmetic and reconstructive plastic surgery as we know it today.
Common problems of the Nose
Rhinoplasty surgery is one of the most common cosmetic surgeries performed today. People choose to have their nose reshaped for many reasons. If you can identify with any of the following then lets talk about your needs:
Its too big is the most common problem
Its too wide – too broad between the eyes
Its crooked – from an injury such as a fracture
Its too large or “bulbous” at the tip of the nose
Its not well “defined” the tip is poorly defined
Its flaring in the nostrils the wings can be narrowed
Its too narrow the nostrils can be widened & elevated
Its rim is too thick the nostrils can be slimmed in this area
Its tip hangs down the tip can be trimmed to proportion
Its a “ski jump” or “Saddle” the middle appears caved in or crushed
Its crooked from injury (a fracture) you cant breathe well
Rhinoplasty can reduce or increase the size of your nose or change the shape of the tip or the bridge. It can narrow the span of the nostrils or change the angle between your nose and upper lip or correct a birth defect or injury to relieve breathing problems.

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When is Rhinoplasty Covered by Insurance?

Having rhinoplasty surgery can be a big cost with many fees incurred. However there are a few instances when insurance will pick up a portion of the rhinoplasty costs. Most plastic surgery is considered done for cosmetic reasons and therefore your insurance will not cover any of the rhinoplasty procedure if you are merely hoping to gain a better-looking nose. Most insurance companies will however what they deem medically necessary.

Rhinoplasty as a Medical Necessity

Only your physician or surgeon can submit to the insurance company the reasons why you are having rhinoplasty surgery. As mentioned before, those procedures which are not deemed necessary by your insurance company will not be covered. If your physician feels that your rhinoplasty procedure is necessary to improve your health or quality of life they can file the forms required to in order for the insurance company to allow the surgery.

For instance, your insurance will not allow your claim if your primary reason for surgery is improving a nose that is unattractive, too large or crooked. These are considered cosmetic reasons. That is not to say that the rhinoplasty to correct the crooked nose won’t ever be covered. If the main goal of the surgery is to reconstruct the nose from a trauma or developmental abnormality, then it is possible that your insurance company will cover some of the cost. This is most commonly referred to reconstructive surgery and some rhinoplasty procedures are covered when they are considered not merely to improve appearance but to reconstruct a necessary problem. If you are seeking rhinoplasty surgery, there will be prior authorizations and a review period, which must be completed before you can continue.

Rhinoplasty for Severe Medical Problems

Your insurance will not only cover for some reconstructive issues but they may also cover rhinoplasty surgery in which there is a severe medical condition or congenital defect which threatens the patient’s ability to normally function. The most common occurrence of this is those people that suffer from migraines and breathing problems. A deviated septum is a possible cause but other factors such as a misshapen nose can also cause extreme pain and headaches. In some cases the breathing problems associated can be partially attributed to or complicate sleep apnea and the overall function of the nostrils. Check with your insurance provider to find out exactly which types of procedures are covered and to what extent.

Denial of Coverage and What to Do

If you are denied coverage and your surgeon and you believe your procedure is medically necessary, you can begin an appeals process. A thorough look through your policy is the first step in appealing the insurance company’s decision to pay none or only a small percentage of the rhinoplasty surgery. Next you will want to write a letter to the claims supervisor stating your case and why you believe this procedure should be covered. Don’t be surprised if you have to supply them with test results, X-rays and other testing to help prove your case.

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Having a Nose Job Done for the Second Time

More and more rhinoplasty patients from the 80’s and early 90’s have requested revision rhinoplasty to meet today’s trend for a prominent nose profile and defining nose tip. Alternatively, rhinoplasty patients of the past may wish to otherwise improve the aesthetic appearance of the nose or increase functionality that has been compromised years after surgery.
Functional complications that have arisen from rhinoplasty procedures of the 80’s to the early 90’s include: ill-defined cartilage, unbalanced sidewalls of the nose, reduction in nose tip protrusion, and breathing impediments.
Today’s Options
There are often several reasons for a previous rhinoplasty patient to request a second revision procedure. This makes revision rhinoplasty surgery more complex than the initial surgery. By the same token, the advantage of secondary rhinoplasty today is that there are improved techniques available for patients to benefit from, including:
Grafting Techniques: There are several grafting techniques to improve functional and aesthetic concerns. Cartilage from the ears or ribs may be grafted to recreate a supportive structure for the bone and cartilage of the nose. The procedure requires up to 3 times the amount of time required for an initial rhinoplasty. In addition, recovery is much longer. Yet, the results can be quite complimentary from both an aesthetic and functional point of view.
Injectibles: Aesthetic issues can be improved through artistic techniques utilized through injectibles. Hyaluronics (Restylane and Hylaform) as well as calcium hydroxyapatite (Radiesse or Radiance) help to create a smooth profile and can improve depressed cartilage areas on the nose. Botox may be used to curve the lip upward, bringing balance to the features of the nose and face. Injectibles can be appealing because of the lack of downtime, immediate results that last 6 months to a year, and nominal fees when compared to grafting techniques.
Both grafting and injectible approaches are highly technique driven. They require the skill of a plastic surgeon with great expertise. It is important to select a plastic surgeon that has extensive experience in the procedure of choice for secondary rhinoplasty procedures.
Because of the special nature of the blood supply to the nose and surrounding area, it is possible for retrograde infections from the nasal area to spread to the brain. To reduce the risks follow the doctor’s advice both before and after the surgery.
Surgical procedure:
Surgery can be performed under general anesthesia with local anesthesia depending on patient or doctor’s preference. Incisions are made inside the nostrils sometimes; tiny incisions are also made on the columella, the bit of skin that separates the nostrils. The surgeon first separates soft tissues of the nose from the underlying structures, then reshapes the cartilage and bone which causes the deformity.
In some cases the surgeon may shape a small piece of the patients own cartilage or bone to strengthen or increase the structure of the nose. This is done for cosmetic reasons or to improve breathing and function of the nose. In rarer cases a synthetic implant may be used to reconstruct the nose if the normal structure of the bone and cartilage is badly damaged or weakened. Alloplastic synthetic are often associated with long term complications alternatively, cartilage from the septum, ear on rib may be used.
Recovery:
A tape dressing will cover the nose for one week, there may be some discoloration and swelling around the eyes which will improve over 5-7 days. One week is usually enough time for returning to work and social activities

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A (Nose) Job Well Done Is A Thing Of Beauty

Rhinoplasty can help change unwanted characteristics of your nose and change the look of your entire face.
The nose is the center of a person’s face, and therefore it acts as the most prominent attention-grabber when people look at you. A beautifully shaped nose can help create overall facial harmony and better appearance for a person, as well as change the entire look of the face. Unfortunately, some people, especially Asian people, are born with flat nose. But still fortunately, they do not necessarily have to get stuck with it for life.
Rhinoplasty, also commonly known as a “nose job”, has been introduced more than a hundred years ago. Rhinoplasty is a nose-reshaping surgery that helps correct deformities or makes subtle aesthetic changes for cosmetic purposes. In most cases of rhinoplasty performed on Asian patients, the bridge of the nose is raised and narrowed and the nasal width at the nose-cheek junction narrowed. It is precise surgery in which the margin of error is measured in millimeters, thus the surgeon must have a full knowledge of nasal anatomy and the basic principle of surgical procedures.
The most common nasal augmentation rhinoplasty is by inserting fabricated silicone implant which comes in three textures: hard medium and soft. The silicone for the nose is the solid silicone with Hydroxyapatite which is the artificial bone to help adherence to the natural bone. Incisions are made inside the nostrils. In some cases, the surgeon may shape a small piece of the patient’s own cartilage or bone to strengthen or increase the structure of the nose.
There are two major ways to perform a rhinoplasty: the closed and the open techniques. The open technique includes an incision across the colummella, the small skin between the two nostrils. One major advantage of this technique is the ability to completely visualize the internal structures of the nose, and place sutures precisely where they may be required. With this type of rhinoplasty, the swelling takes significantly longer to subside and some of the tissues may be unnecessarily disrupted. The scar is most often quite small and fades rapidly. The closed technique does not require an external incision, heals more quickly and does not disturb the tissues as much as the open technique.
Rhinoplasty should wait until after the teenage growth period that occurs in the mid-teens. This growth period normally occurs from ages 14 to 15 for girls and somewhat later for boys and your nose is generally fully developed by the age of 16. Once you are done with the growth spurt of puberty – which is when you stop getting taller – it is fine to have a rhinoplasty.
Rhinoplasty can be performed as a day case, which means that you can have the operation and go home the same day. Pain, bruises and some swellings are expected after the procedure and there might be some minor bleeding for a day or two. Alloplastic synthetic materials are sometimes associated with long-term complications such as migration and extrusion. The swelling, which will reside mostly around the eyes and the nose itself, will be very noticeable at first, but will begin to subside around the third day and should be largely gone within two weeks. Some minor swelling will remain for up to six months afterwards, and the final, long-term rhinoplasty results can be evaluated and enjoyed about a year after the surgery.

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What Is A Poper Rhinoplasty?

Rhinoplasty is the surgical correction or improvement of the contour irregularities of the nose. The essential parts of the nose include the bony dorsum (hump), the middle cartilaginous dorsum (part of the nose that helps with breathing) the tip of the nose, and the sides. A rhinoplasty may be considered either functional or cosmetic where correction would involve either a breathing problem or be one to improve the appearance of the nose.
What incisions are used?
A rhinoplasty involves either an open or closed approach. Although a closed approach (where the incisions are confined to the inside of the nose) may limit scarring, there are certain circumstances where and open approach (extending the incision across the bottom of the nose) may be beneficial. However, even if an external rhinoplasty approach may be used, the scar virtually always heals without problems and is rarely even noticeable.
How long does a rhinoplasty last?
A rhinoplasty is intended to last a lifetime, and although patients will continue to age, long lasting results are the norm.
Can other procedures be combined with a rhinoplasty?
The face can actually be divided into thirds with the nose being part of the middle third. Traditional face lifts address the lower two-thirds while the upper third includes the areas of the eyes and forehead. These areas can easily be combined with a rhinoplasty itself and actually help to maintain a uniform appearance.
Are there any specifics points to be aware of?
Reshaping of the nose can reveal immediate results but require a significant period of time to achieve the final results – typically up to one to two years. The results require patience but the end result is worth it. In some cases, the septum of the nose is deviated, which may also require correction – a situation where insurance coverage may be applicable.
What type of anesthesia is used?
A rhinoplasty is usually performed with general anesthesia although local anesthesia with IV sedation is also an option. The procedure usually takes 2-3 hours and patients typically go home the same day.
What can I expect after surgery?
Most patients feel that surgery was less traumatic than they expected and many patients stop taking their narcotic pain medication only a few days after surgery. Sutures are removed in five days and nasal packing (if used) is removed in one to two days. Most of the bruising is resolved at 7-10 days, which is easily covered with make-up.
Follow up is very important and patients are encouraged to return to the office at six weeks, six months and the first and second years after rhinoplasty.
Tell me about credentials – Is there a difference?
Yes, Absolutely! A rhinoplasty is a procedure which, unfortunately, can be performed by any physician – whether adequately trained or not. Most states have very little regulation on this matter. Because of this, non-plastic – or so called “cosmetic” – surgeons can perform a rhinoplasty as well. In addition, some physicians who are legitimately board certified in other specialties, such as dermatology and gynecology, for example are performing “cosmetic” surgery even though they often have never had any formal residency training in the specialty of plastic surgery itself. Weekend courses abound and the patient is often confused as to which doctor to see.
Does Hospital affiliation matter?
Again, yes. Although operating in an office setting is not in and of itself inappropriate, it is always possible that an extended hospital observation or additional care might be needed. Indeed, certain procedures or multiple surgeries are usually best treated within the context of a full hospital facility. In addition, hospitals usually require certain standards (credentialing) such as board certification before a physician can have staff privileges. Unfortunately, there are no legal restrictions in most states that prevent physicians operating out of their offices or non hospital associated free-standing surgery suites; so be sure to ask if your doctor does have admitting privileges at a fully accredited hospital facility. If they don’t, their ability to either transfer patients or provide continuity of care is potentially compromised.
Any other helpful hints?
Needless to say, your decision in choosing a plastic surgeon can be a difficult and time consuming task making it even more important that you personally visit with the plastic surgeon that will perform your procedures. Evaluate their results (photos), office, staff, and testimonials and your feelings regarding your overall experience with their practice. You can often ask to speak to other patients who are willing to share their experiences with you.

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