Open vs. Closed Rhinoplasty

If the definition of beauty is subjective then the definition of a “perfect profile” is even more subjective.   Some celebrities, such as Angelica Houston, Barbara Streisand and Jessica Sarah Parker have made their prominent noses their signature feature. These three ladies are considered women of style, fashion and beauty. Other celebrities have tapered their noses for a more traditional look.

There are people, like yourself, maybe who are considering a subtle enhancement or more obvious change to your nose.  Refining your profile, narrowing the tip, or building up the bridge of your nose can make a big difference.

Nose reshaping is the third most popular procedure in the United States.  The American Society of Plastic Surgeons reports that 223,018 people reshaped their noses in 2016.  More than 30,000 teenagers between the ages of 13-19 years old, chose to change the shape of their noses. Most surgeons recommend that a patient wait until they are over 18 to undergo rhinoplasty because their nose is less in the developmental stage. However, there are always exceptions to this rule.

Who’s the Right Candidate for Rhinoplasty?

There are several characteristics that define the right candidate for rhinoplasty:

  • Want to refine the shape of their nose
  • In good health, no serious health conditions
  • Has realistic expectations for a rhinoplasty can do
  • Has a support network that can help them during their recovery from rhinoplasty
  • Able to quit smoking for a few weeks before and after treatment

Patients who previously had an operation on the nose or happen to have thin, scarred tissues are better candidates for a procedure called open rhinoplasty, while patients who don’t want any scarring to appear on the outside of the nose are better candidates for a closed rhinoplasty.

Definitely Not for Ladies Only

Plastic surgery for men is being viewed as more acceptable and the men who have undergone the knife feel they are happier with and more confident about their looks. Techniques for male rhinoplasty vary from those used in rhinoplasty for women. Nose reshaping represented 25% of all cosmetic surgeries (55,000) for men in 2016.

It takes a great deal of expertise to correct a male or female nose, but re-sculpting a male nose presents an even greater challenge than the female nose.  The surgeon must take care not to feminize the nose too much and male skin tends to be thicker.

Choosing the Right Surgeon for Your Rhinoplasty?

So, thinking about tweaking your nose? Dr. Ali Sajjadian is a triple board-certified plastic surgeon with a highly developed aesthetic sense. Dr. Sajjadian is board certified by the American Board of Plastic Surgery, the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology, which translates into a very deep knowledge of the function and reshaping of the nose.  This is a very important consideration as the nose is the prominent feature of the face. Just as a pleasing appearance to the nose impacts facial symmetry, a nose that has been incorrectly reshaped can create a negative impact, destroy confidence and affect breathing processes.

Just as no two noses are ever alike, no two rhinoplasties are ever alike. There is a common thread involved with nasal contouring, which is getting the nose to look harmonious, symmetrical and attractive on the face.

It is all about that nose

The ability to breathe clearly through our nose and enjoy fragrances around us is all part of enjoying our lives to the fullest.

Bone comprises the upper 1/3 of the nose and the remaining area of the nose is made up of cartilage, which is referred to as upper lateral cartilages and lower lateral cartilages. Cartilage is bendable and flexible. Cartilage can be carved with a knife and bone is contoured with a file, rasp or inset with a chisel. Another important part of the nose is the septum. The septum divides the nose into two chambers. When the septum is bent or deviated it will prevent unobstructed breathing.

Why Fix it if it is Not Broken?

There are several reasons that nasal surgery is performed.

  • There is nose reduction, which can be the case if the patient feels their nose appears too big for their face or if the patient wants to remove humps, bumps, narrow the nostrils or correct symmetry.
  • Some patients require nose augmentation if the bridge is too small. This can require moving cartilage to the area, typically from one part of the nose to the bridge. If there is not enough cartilage then the surgeon will use cartilage from another part of the body.
  • Facial rejuvenation is another reason people are looking to correct their nose. As we age the tip tends to enlarge or breathing is interrupted.
  • There is also ethnic rhinoplasty, which requires the surgeon to correct the nose but still keep it harmonious with the rest of the face.

The most sought-after nasal corrections are the nose being too large for the face, a hump on the bridge of the nose, droopy nasal tip, flared nostrils, off center nose, the angle between the nose and upper lip, nostrils are too wide and a bulbous nose.

There’s also another subset of rhinoplasty called “ethnic rhinoplasty,” a procedure that creates a more balanced nose without changing the unique characteristics that certain ethnic group has. Only the most highly trained, discerning plastic surgeons are able to perform ethnic rhinoplasty, because there’s so many considerations they need to make.

The Nose RX. Open and Closed Rhinoplasty

There are two ways a plastic surgeon can correct a nose. The first option is closed rhinoplasty. What this means is that all incisions are performed inside the nose and there are no visible scars. The operation is performed within the nostril. This is a delicate procedure as it is challenging to work without visibility.  Some plastic surgeons find closed nose rhinoplasty a useful technique for bridge augmentation or refinement.

The second option is the open approach. Your plastic surgeon will make a hidden incision across the columella. The incision will be either” v “shaped or can be a stair step shape. The skin can then be lifted to give the surgeon better visibility of the nose and its structures. This provides direct access but also leads to more swelling and tip numbness for eight to nine months following surgery. On healing there is only the slightest visibility.

The surgeon you select must also have an artistic sense and a sense of balance. Proportionality is key to this potentially life changing surgery. You should have reasonable expectations and because every individual as a nose unique to their face, your surgeon can make a strong improvement and capture the essence of the nose you like, but it may not be identical to the image you have in your mind.

Talk to Your Doc

So, you’ve made up your mind to have the surgery, what happens next? Research, research, research!  Seek out a doctor who is an expert at cosmetic and reconstructive surgery and who has had experience performing rhinoplasties. Browse through the photo galleries on the surgeon’s website.

Once you have made a decision about which surgeon you would like to perform your procedure, look for types of noses that appeal to you and that you think might complement your face.  A surgeon cannot get an exact replicate, but the pictures will assist your surgeon in envisioning the look you prefer. Your surgeon will also let you know why the photos you brought in will either work for you or not. Bring a list of medications with you, so you can discuss them with your doctor during your consultation.

During your consultation your plastic surgeon will determine if you are a candidate for nasal surgery.  You will be examined as to the thickness of your skin and to see if you have any underlying problems, such as a deviated septum. Let your surgeon know if you smoke or if you have any other health concerns. If you would like to see more pictures of your surgeon’s work, just ask.

Depending on the revisions you would like to make, your doctor will let you know which type of approach is more efficient for you to reach your goals.

Your surgeon will either provide you with a preview of your new look with either a hand drawn example or one generated by computer software. It is also likely that the plastic surgeon will take photographs of you for their records. Your doctor will also explain the differences between general anesthesia and IV sedation. With general anesthesia you are completely asleep, with IV sedation you are given local anesthesia and put into a twilight sleep.

Preparing for surgery

If you work out of the house prepare to take two weeks off from work. It will take about that amount of time for bruising and swelling to become manageable. Buy soft foods and a gentle toothbrush for your first few days of recovery. Make sure you have someone to drive you to the surgical center, surgical suite or hospital where the procedure will be performed.  This is done as an outpatient surgery, so you will not need to spend the night.

To ensure your surgery goes smoothly, follow these easy rules:

  • Quit smoking at least two weeks prior to your surgery. Smoking inhibits the healing process.
  • Refrain from taking vitamin E, herbal supplements, such as ginseng, ginger and others.
  • Confirm your ride to and from the surgery center.
  • Avoid sodium to limit or reduce swelling.
  • Do not drink alcohol before surgery.

Day of Surgery and Recovery

The surgery should last only one to two hours. When you are awakened from surgery, you may feel groggy and you will find packing across your nose to keep the new shape and perhaps in your nose to control bleeding. There will be bruising and swelling and more discomfort than pain, which can be relieved with prescribed medication. Don’t expect to get too much accomplished the first one or two days following surgery. Keep your head elevated and ensure your head doesn’t experience too much movement. Do not pull your clothes over your head, rather slip them on over your legs and pull up.  Use a gentle tooth brush and brush gently. Apply cold compresses to reduce swelling and bruising. Take baths not showers.

The packing should be removed within two days and you will feel more comfortable. After about a week all bandages should be removed. You will still be swollen but you will be ready to return to your daily activities.

Following your return to work, you may be feeling well but you must make sure that you attend your follow-up appointments to ensure that you are healing correctly.

The new shape of your nose will be visible almost immediately, but it will continue to settle for up to a year’s time and possibly more. This is great news because you can continue to see improvement.

For the best results, always consult with a board certified plastic surgeon. Or better yet—a surgeon who holds a triple board-certification like Dr. Sajjadian. Dr. Sajjadian is one of the few plastic surgeons in the U.S. to hold this distinction, but he’s also considered one of the utmost experts in open rhinoplasty, closed rhinoplasty, ethnic rhinoplasty, and he’s a surgeon that many other doctors refer patients to in cases of revision rhinoplasty. But what matters to most patients is Dr. Sajjadian’s impeccable artistry and incredible ability to create balanced, natural-looking results.

With every rhinoplasty he performs, Dr. Sajjadian ensures that the results are tailored to the patient’s unique characteristics, and that he never sacrifices function over aesthetics. His board-certification in plastic surgery, otolaryngology, and plastic and reconstructive surgery is further proof that Dr. Sajjadian has the training to ensure the patient’s nose is improved structurally and functionally. In addition to his incredible skill as a surgeon, Dr. Sajjadian also makes sure to use the most advanced techniques and technology when performing his rhinoplasty.

To find out which rhinoplasty technique is right for you, we invite you to contact us at 949-515-0550.

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