Louisville Rhinoplasty

Dr. Jarrod A. Little is Louisville’s premier Rhinoplasty specialist.

 

Dr. Jarrod Little

A native of Texas, Dr. Little obtained his undergraduate degree at Baylor University in Biochemistry, followed by medical school training at the University of Texas-Houston. In 2002, Dr. Little joined the University of Louisville residency program in Otolaryngology-Head and Neck Surgery. After completion of his residency, Dr. Little was invited into the Plastic and Reconstructive Surgery Fellowship Program at the University of Louisville, which is one of the top programs in the country.

Dr. Little serves as an Assistant Professor of Plastic and Reconstructive Surgery, as well as Otolaryngology-Head and Neck Surgery, at the University of Louisville. Dr. Little’s specialized training has provided him with extensive knowledge of the head and neck area, which he applies to his work in facial plastic surgery. Dr. Little is part of University Surgical Associates Plastic Surgery. He is certified by the American Board of Plastic Surgery.

Louisville Rhinoplasty

What Is Rhinoplasty?

Also known as a nose job, or nose reshaping, rhinoplasty is a cosmetic surgical procedure to improve the appearance and/or function of the nose.

Aesthetic concerns that can be potentially fixed through rhinoplasty are:

  • Crooked nose
  • Drooping or prominent nasal tip
  • Nasal tip asymmetry
  • Excessive nasal width, length, or size
  • Prominent bridge hump
  • Initial failed rhinoplasty correction

The nose is made of bone (upper), cartilage (lower), and skin. Rhinoplasty can change any combination of the three, including all of them together. By operating on deformities or insecurities in the nasal region, Dr. Little can improve the appearance of your nose, thus increasing your confidence and well-being.

Additionally, rhinoplasty can help restore nasal function. By correcting issues such as airway obstructions, often caused by a deviated septum, rhinoplasty can help you achieve normal, comfortable breathing. An unobstructed passageway is a great added benefit to your new, aesthetically pleasing nose.

Types of Rhinoplasty

Open Rhinoplasty
This type of procedure has historically been the most common amongst plastic surgeons. In this type of rhinoplasty, the surgeon creates an incision on the underside of the nose on the columella, or the area between the nostrils. The tissues are then lifted to give access to the underlying structures of the nose.

Now, open rhinoplasty is usually recommended for individuals who require significant adjustments to the nasal tip or extensive precision within the nasal structures. Due to this incisionary necessity, you should expect a small scar at the point of the incision. Recovery is also a longer process with this type of rhinoplasty.

Closed Rhinoplasty
A closed rhinoplasty is recommended for those that do not need significant adjustments of the nasal tip, or extensive revisions within the nasal structure, because there is limited access to these structures. Incisions here are placed within the nostrils, and alterations in the nose are made without lifting any tissue.

In a closed rhinoplasty there is generally no visible scarring, which makes it the preferred method when appropriate. Additionally, there is less recovery time using this method.

Other Considerations

Dr. Little will take into account the overall look and proportions of the face as a whole when deciding the appropriate action of your cosmetic nasal procedure. Considerations will be made concerning facial proportions, as well as the nose’s proximity and aesthetic relation to the eyes, mouth, and chin.

As with any surgical procedures, there are risks to rhinoplasty. These risks include:

  • Reactions to anaesthesia
  • Breathing difficulty
  • Skin discoloration
  • Infection
  • Scarring
  • Nasal septal perforation
  • Dissatisfaction with nasal appearance

Schedule a consultation with Dr. Little today and discuss these risks before deciding to participate in your rhinoplasty.

Rhinoplasty Recovery

You will be given a nasal splint that should be worn at all times for about a week. During this time you can expect some bruising or swelling in the nasal region, as well as around the eyes.

The majority of rhinoplasty patients can expect to return to normal daily activity within 1-2 weeks of the procedure. Keep in mind that if your job consists of strenuous activity, it may be a few weeks before you’re able to return to work.

After two weeks or so your bruising and swelling should subside to a point where most people will no longer notice. Mild exercise can potentially be resumed, but discuss this first with your surgeon to be sure.

After 4-6 weeks most patients will feel great about the results of their surgery. However, some individuals with thicker skin, or those that have undergone a second surgery to fix a previously botched procedure, may still have significant swelling.

The key from this point forward is to be patient with your results. Your nose will continue to be refined over the next 3-6 months. You may even find that after a year and a half you notice that your nose looks even better than it did at the 6-8 month point! Everyone heals differently, and swelling may last longer for certain individuals. Again, the key is to stay resilient and continue communication with your surgeon to confirm that everything is healing as it should.

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The Aging Face – Part 1

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Part 5 – Closed Rhinoplasty

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Part 4- Open Rhinoplasty

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Part 3- Mountain Climbing and Noses

What in the world does Rhinoplasty have to do with mountain climbing (besides frequent frostbite on the nose)? Well, the different types of mountain climbing can illustrate the differences between types of rhinoplasty procedures. Just follow me a bit... "Alpine" style...

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Part 2- History of Rhinoplasty

One of the earliest recorded surgical procedures, of any kind, was that of nasal reconstruction in India in approximately 800 BC. During that time, removal of the nose was performed as punishment. Doctors then used the forehead skin to re-create the nose. Amazingly,...

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Part 1- Me and the Nose

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Q & A with Jarrod A. Little,MD

How old do I have to be before I can have rhinoplasty?

Nasal fractures or reconstruction can be performed at any age. Aesthetic rhinoplasty is generally performed after the majority of nasal growth has been obtained. This can be as early as age 12 in girls and 18 in boys.

How long do the changes last?

After rhinoplasty, you will not see your final result for 9-12 months. These changes are generally permanent. However, the nose will continue to experience age-related changes over a lifetime.

How is the chin connected to the nose?

The chin and the nose are intimately related. A prominent chin may cause the nose to look small. An under-projected chin may make a nose appear too large. Therefore, addressing the size of the chin if needed, is critical to the overall appearance of the nose.

What is the difference between an open or closed approach?

An “open” approach involves a scar at the base of the nose. The nasal skin is elevated off of the structure of the nose, then replaced after alterations have been performed. A “closed” approach involves incisions on the inside of the nose. The open approach is easier to learn and perform, but is often associated with longer operative times, duration of swelling, and longer down-time. The closed approach is more difficult to learn and perform, but can cause less down-time, less swelling, and less operative time, as well as avoidance of an external scar.

How long before I see my final result?

It often takes 9 months to see your final result. This time may be longer if previous nasal surgery has been performed.

What if I have trouble breathing before surgery?

Difficulty breathing can be due to many different problems. Some of which may be addressed at the time of rhinoplasty. It is important to fully evaluate breathing issues prior to surgery.

How long does it take to heal?

The majority of healing occurs within the first 2 weeks. If the nasal bones are repositioned, care must be taken to not alter their position during this time.

When can I go out after rhinoplasty?

You can go out and resume non-strenuous activities at any time after rhinoplasty. I generally recommend 2 weeks before heavy exercise. Most patients wear a small splint on the outside of the nose for 3-5 days after surgery.

How long is the surgery?

Operative times vary depending on all that needs to be addressed. In general, however, most rhinoplasty procedures can be performed in 1-2 hours.

How painful is surgery?

Rhinoplasty is generally not a painful procedure. Most pain can be treated with Acetominophen (ie- Tylenol) alone.

Do you use computer simulation programs?

I do not. Rhinoplasty is a very delicate procedure, with many variables. It is impossible to transfer a computer simulation to a real patient. Photos and computer simulations are useful in discussing overall goals, however.

Do you have before and after photos?

I do not. I understand the desire to see them though. I do not incorporate before-and-after photos for 3 reasons: 1) All patients (and noses) are different. One patient’s changes cannot be directly translated to another. 2) I treat all my patients like they were a part of my family. I would not want my sisters photos scattered over the internet for all to see. 3) Anytime photos are presented, you will see the best possible results, not necessarily a reasonable expectation.

Can I have other work done at the same time?

Absolutely. Rhinoplasty can be combined with other facial or body contouring procedures.

Why is rhinoplasty one of the most difficult procedures in Plastic Surgery?

Rhinoplasty is often considered one of the most challenging procedures in Plastic Surgery due to a variety of reasons. The procedure is very delicate and there is little room for error. Additionally, the changes made during the procedure are not fully manifested for 9 months after surgery.

Will it be noticeable?

Your result after rhinoplasty will be noticeable. My goal is to obtain a natural result. Friends and family may notice a change, but the goal is for new acquaintances to not be able to tell that a procedure has been performed. The last thing anyone wants is to go to a party and have someone say (or think), “nice nose-job”.

How long before I can exercise?

I generally recommend 2 weeks before heavy exercise. Low-impact exercise may resume within 1 week.

What if I have thin skin?

Thin skin makes rhinoplasty more difficult because even minor imperfections are easily seen. On the other hand, it often allows more precise changes to be made to the nose.

What about using facial fillers in the nose?

There are no fillers which are FDA approved for use in the nose. Nevertheless, some have tried and severe complications have resulted.

What are grafts used for in rhinoplasty?

Grafts are generally pieces of cartilage that are used for augmenting the structure and appearance of the nose. This cartilage can be obtained from the nose, ear, or ribs.

Am I too old?

There is no chronological age that precludes surgery. The overall health of a patient may dictate whether surgery is safe or not. This requires a detailed discussion with your surgeon

When can I go back to work?

You can go back to work the following day after surgery. You may have a small splint on the nose for 3-5 days, but this does not affect your ability to work in most instances.

Do you have special training?

The route to Plastic Surgery requires prior surgical training. Most Plastic Surgeons pursued general surgery prior to advanced training in Plastics. I elected to pursue my initial training in Otolaryngology/ Head and Neck Surgery (ENT). I feel that this route is ideally suited for those with an interest in rhinoplasty

Will there be scars?

All procedures produce scars. An open rhinoplasty leaves a small scar on the columella (skin between the nostrils). Closed rhinoplasty leaves the scars inside the nose. For this reason, I prefer closed rhinoplasty, when possible

Do you use packing?

I generally do not use packing within the nose. I usually find it unnecessary and I like to avoid the discomfort.

When do stitches come out?

Stitches are removed between days 3-5, if placed. If a closed procedure is performed, all the stitches are placed within the nose, and will dissolve.

What if I have had a broken nose?

A broken nose can be repaired during a rhinoplasty procedure. It is often helpful to bring photos to know what your nose looked like before the injury.

Will there be bruising?

There may be occasional, mild bruising. This usually resolves in 7-10 days.

What kind of anesthesia is used?

Although general anesthesia is usually used, rhinoplasty can be safely performed with local anesthesia and sedation.

Do vitamins or herbal remedies affect rhinoplasty?

Absolutely. There are many different oral supplements which can adversely affect healing and bleeding risk. This requires a thorough discussion with your surgeon and anesthesiologist. The most common supplements that may affect surgery are: garlic, ginger, Chinese peony, ginkgo, oil of wintergreen, saw palmetto, and gensing

What if I smoke?

All patients are advised to stop smoking for 6 weeks prior and 6 weeks following surgery. Smoking can adversely affect healing and postoperative swelling. It may also increase the likelihood of revision procedures.

What is tip rhinoplasty?

Tip rhinoplasty is a specific focus on changing the tip of the nose, without major changes to the rest of the nose. Tip rhinoplasty can be very challenging and often requires an open approach.

What if I only want a part of my nose changed?

This can be achieved, but to achieve harmony throughout the nose, other parts may have to be addressed as well.

Can I blow my nose?

No nose blowing, picking, or sneezing for 1 week.

Can I wear glasses?

No wearing of eyeglasses for 10-14 days. Wearing of contact lenses is preferable.

What if I have thick skin?

Thick skin presents its own challenges. It requires more aggressive surgery and can make it more difficult to obtain precise changes.

What if my nose is too wide or too narrow.

There are a variety of modifications to the width of the nose that can be changed during rhinoplasty.

Does insurance cover rhinoplasty?

Insurance may cover rhinoplasty for reconstructive purposes, ie- after skin cancer removal. It may also cover a portion if a septal deviation is present, which is causing significant nasal obstruction.

Do you use implants in the nose?

Artificial implants are generally discouraged in rhinoplasty. Although many different implants have been utilized, there is a high risk of complications, such as migration or extrusion. If implants are needed for structural or aesthetic augmentation, I generally prefer using a patient’s own cartilage. This can be obtained from the nose, ear, or rib.

Where is surgery performed?

Surgery is safely performed on an outpatient basis in the hospital or certified surgery center setting. Most of my patients receive their procedure at Louisville Surgery Center or Norton Brownsboro Hospital.

What is Cosmetassure?

Cosmetassure is a program designed to assist in unforeseen medical expenses associated with a complication following cosmetic plastic surgery. Further information may be obtained at www.Cosmetassure.com.

What are the risks?

The risks are minimal, but include the same risks as any surgical procedure: bleeding, infection, scarring, asymmetry, difficulty breathing, unexpected cosmetic result, chronic pain or numbness need for further prodedures, and death. A detailed discussion of risks can be found on the informed consent section.

Selected References:
Berneburg, Mirjam, et al. “Changes in esthetic standards since 1940.” American journal of orthodontics and dentofacial orthopedics 137.4 (2010):450-9; discussion 450.

Wong, Wendy W, et al. “Bleeding risks of herbal, homeopathic, and dietary supplements: a hidden nightmare for plastic surgeons?.” Aesthetic surgery journal 32.3 (2012):332-46.

Locations

EAST END

UofL Physicians Plastic & Reconstructive Surgery
Norton Medical Plaza, Ste. 300
4950 Norton Healthcare Blvd.
Louisville, KY 40241
(502) 588-8516

DOWNTOWN

UofL Physicians Plastic & Reconstructive Surgery
401 E. Chestnut St., Ste. 790
Louisville, KY 40202
(502) 588-8516

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