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Dr. White uses his background in plastic surgery and otolaryngology (specializing in conditions of the ear, nose and throat) to identify and correct the root causes of medical problems and cosmetic imperfections while maintaining a natural and balanced appearance. During the initial consultation, he will work with you to understand your goals and explain what can be accomplished during surgery. Dr White’s goal is to achieve a beautiful and functional nose that fits within each patient’s unique aesthetic and ethnic ideals.
Top 10 Questions and Answers that EVERY PATIENT SHOULD KNOW ABOUT BEFORE GETTING A NOSE JOB:
1) What is rhinoplasty?
Rhinoplasty, from the Greek “to shape the nose” (also called nose jobs), is a surgical procedure that corrects the form and function of the nose, either for aesthetic purposes or after an injury. It is usually an outpatient procedure, performed in a day with two weeks of post-operative rest. The more common aesthetic changes include:
- Nasal hump reduction,
- Nostril flare diminishment,
- Bulbuous nasal tip shrinking,
- Twisted nose straightening, and
- Droopy nasal tip lifting.
Most of the swelling is reduced after a month, but it often can take a year before one can appreciate the final outcome.
2) Can I get a nose like Kate Middleton or another famous person?
Each person has his or her own unique combination of skin thickness, nasal cartilage strength, and facial features. A nose that looks great on one person might not look nice on another person’s face. Dr. White’s goal in rhinoplasty is to achieve a natural balance between the patient’s nose and the rest of the facial features. This causes an onlooker’s attention to focus less on the nose and more on the person’s eyes. Skin and cartilage exert limitations on a desired result, just like the medium (stone) would do for a sculpture, so one must have reasonable expectations as to what can be accomplished and what should be attempted.
Moreover, sometimes it is necessary to perform adjunct procedures to achieve facial harmony. Someone with a very retruded or small chin may appear to have a much larger nose. Balance between the chin and nose can be restored with rhinoplasty and sometimes the addition of a chin implant. This implant is inserted through a small incision underneath the chin and heals in a well-hidden crease.
3) How should I choose my rhinoplasty (nose job) surgeon?
As with any physician, you should research the doctor regarding reviews and results. In this day and age, much of this information is easily accessible on the internet. The next step, is to meet your surgeon. If you do not feel comfortable with or get along with that surgeon, then you should not use him or her. This is a relationship that you are forming with a doctor and, if you don’t understand each other or like each other from the beginning, this will only be an additional layer of stress on your procedure process.
Rhinoplasty is one of the most complicated and unforgiving operations in plastic surgery. As such, it is important that your surgeon has the appropriate requisite training and experience for nose job surgery. Some important signatures of excellence are board certification by the American Board of Plastic Surgery and membership in the American Society of Plastic Surgeons, which both indicate that the surgeon has gone through the appropriate rigorous plastic surgery training and is well regarded by his or her peers. The American Board of Otolaryngology-Head & Neck Surgery certification indicates that the surgeon has special expertise in functional surgery of the nose. For the best rhinoplasty results, it is often best to choose a surgeon who understands how to manage both the functional (breathing) and cosmetic components of the nose.
4) Which way is better, open or closed rhinoplasty?
This is a highly debated topic! Rhinoplasty or nose jobs can be performed via an “open” or “closed” approach. The open approach involves the usual internal incisions of closed rhinoplasty with the addition of a small incision on the columella (seen underneath the nose), which tends to heal almost imperceptibly. The advantage of the open technique is increased visibility of the nasal structures, which is especially helpful in revision surgeries. The exposure also allows the surgeon to perform certain suture modifications to the nasal tip that would otherwise have been quite difficult to achieve. The downside is that there is more prolonged nasal swelling after surgery, but this does resolve with time. While Dr. White typically prefers the “closed” approach without external scars, the method that he chooses will most likely be determined by the requirements of your unique procedure.
5) Wait a second! My last rhinoplasty consultation didn’t even talk about this “functional” stuff! What does that mean?
First consider this: what good is a pretty nose if you can’t use it to breathe?
Frequently, doing cosmetic surgery on the nose means making it smaller. As such, there is less room to breath in the nose than there was prior to the procedure. There are special techniques that can be performed at the time of rhinoplasty to help preserve and optimize breathing through the nose at the same time as your nose job. Often this means the placement of “spreader grafts,” which help to straighten the nose and keep certain areas of the nose open when the nasal bones are broken and moved inward. This area is called the internal nasal valve and is one of the breathing gateways into the nasal passage.
There is also something called the external nasal valve, which as an area on the nose sidewall that can collapse when a person breathes in. Collapse of this area can occur due to excessive removal of nasal cartilage or can be an inherent problem with the nose prior to surgery. This is addressed with cartilage grafting.
Then there is the part that deals with a deviated septum. This is a very common problem and does not always cause significant breathing problems. However, when you make the nose smaller or take down a bump, these small septum problems can become magnified. The treatment for this is septoplasty, which is a straightening of the septum.
The final component is the pair of inferior turbinates. These bones are covered with a lining inside of the nose and is often swollen in people with chronic allergies. The turbinates are a very common cause of trouble with nasal breathing and can be shrunken at the time of rhinoplasty. There are many ways to accomplish this. I choose to perform “submucous resection,” with a turbinate blade, which is a sort of minimally invasive liposuction technique from the inside of the turbinate that cuts down on bleeding and preserves the naturnal lining of the nose. This technique also helps to prevent the development of “empty nose syndrome,” which happens when a surgeon removes too much turbinate and results in the sensation of inability to breath through the nose, despite there being more space to breathe!
6) Can nose jobs be covered by insurance?
Yes, certain functional aspects of rhinoplasty can be covered by your medical insurance. This relates to procedures that attempt to improve breathing through the nose such as septoplasty, inferior turbinate reduction, and nasal valve surgery. The aesthetic component is not covered by insurance, but by combining the aesthetic aspect with the functional correction many patients are able to significantly reduce their out-of-pocket expenses.
7) How old do I have to be in order to get rhinoplasty?
There is no age restriction on rhinoplasty, per se, although if you are under 18 your parents or legal guardian have to be involved in the consultation. Determining whether someone is a good candidate for a nose job has more to do with nasal development than age. If the surgery is performed before the nose is fully developed, two things could happen: the surgery may partially hinder that development, and/or future growth may affect the finished nose. Nasal growth is usually complete around 16 years old, on average.
8) Is medical imaging / morphing helpful?
Image morphing can sometimes be a helpful communication tool between Dr. White and his patients, but it is in no way a guarantee of a particular result. Real surgery has the limitations of skin thickness, cartilage strength, and a biological healing process that does not occur when simply drawing on a photograph.
9) What kind of anesthesia should I use for my rhinoplasty?
There are two major types of anesthesia for rhinoplasty: “Twilight” (half asleep, no breathing tube) and general (completely asleep with a laryngeal mask or breathing tube). Both can be safe for the right patient. The decision depends on your pre-existing medical conditions and how complex your operation is.
10) What are the risks of rhinoplasty?
Nose job surgery is a very safe operation in the right surgeon’s hands and in healthy patients. Dr. White requires medical clearance prior to the surgical procedure, which means that the patient goes to his his or her medical doctor to make sure that the risks of the procedure are low from a medical standpoint.
Other risks include, but are not limited to bleeding, infection, need for more surgery, changes in voice, changes in the ability to smell and breath through the nose, swelling/bruising, and external nasal irregularities. Dr. White will review this with you in detail and how he plans to minimize these risks prior to your procedure. Rhinoplasty is a safe operation and one of Dr. White’s specialties.