Louisville 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.

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.

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.

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.

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

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.

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.

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.

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

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

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.

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.

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

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.

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”.

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

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.

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

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.

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

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.

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

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

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

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.

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.

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

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

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

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.

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.

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

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

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

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

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

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.

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.

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.

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.