RHINOPLASTY IN NEWPORT BEACH

 

Dr. Horowitz and Dr. Nichter have been performing rhinoplasty surgery and functional nose surgery for over two decades. Their attention to detail, eye for aesthetic balance, and surgical expertise have gained them the reputation of being two of the best rhinoplasty surgeons in Newport Beach, CA. They perform rhinoplasty surgery on all ethnicities and address each patient individually based on their surgical goals. Some patients wish to maintain their ethnic appearance, while others prefer a more westernized nose. It is important for any rhinoplasty surgeon to listen to the needs of their patient to ensure the optimal result is achieved.

Our doctors categorize nose surgery by the following:

  • Primary Rhinoplasty: This is the first surgery performed on the nose for cosmetic reasons. The procedure reshapes the nose to create better balance of facial features. It is often times combined with chin augmentation or functional nose surgery.
  • Ethnic Rhinoplasty: Still considered a first nose surgery, but for ethnic patients who wish to fix aesthetic issues with or without maintaining their natural cultural look. Ethnic rhinoplasty includes Hispanic, African-American, Asian, Middle-Eastern, Eastern European. There are common traits seen in the nose for each ethnicity mentioned. Skin thickness plays a major role with certain ethnic noses and can impact the amount of visible improvement which can be achieved.
  • Revision Rhinoplasty: One of the most technically challenging procedures in all of cosmetic surgery. Not to be left in the hands of a plastic surgeon with little experience in revision nose surgery. Revision rhinoplasty can address issues not corrected to the patient’s liking or complications from the first surgery.
  • Functional Nose Surgery: Correction of internal issues not cosmetic in nature. Used to improve breathing, headaches, facial pain, snoring, postnasal drip, and more.

The three most common functional issues addressed with surgery are:

  • Deviated Septum
  • Enlarged Turbinates
  • Internal Valve Collapse

Some patients have rhinoplasty to address both cosmetic concerns and functional issues.

WHO IS A CANDIDATE?

Any patient who is in good health who wants to improve the appearance of their nose and/or internal functional issues. This includes patients who have experienced a traumatic injury to their nose (broken nose) or require a revision surgery due to a botched rhinoplasty.

COSMETIC RHINOPLASTY CAN CORRECT:

Dorsal Hump: This by far the most common reason for having nose surgery. A dorsal hump refers to the bump or prominence of the bridge of the nose. While the front view may be acceptable, patients are usually very unhappy with their appearance from the profile view. Correcting a dorsal hump may seem quite easy, but it actually requires a great deal of technical skill.

Long Nose: In many cases, the nose may appear longer due to the presence of a dorsal hump or a droopy tip. In either situation, Dr. Horowitz or Dr. Nichter will perform an examination to determine what exactly is causing the longer nose and what should be done to fix it. The objective is usually to reduce or flatten the bridge, and may require elevation of the tip. The importance with long nose correction is to not over correct.

Wide Nose: A wide nose can be a result of the dorsal bridge, dorsal base, nostril flare or tip. Each one requires a different approach. The structure of an individual’s nose can limit the amount of narrowing that can be done.

Droopy Tip: A droopy tip is often times caused by a long septum or long cartilage. Either one essentially pushes on the tip causing it to hang downward. Patients often complain that smiling makes it look worse, so they avoid taking pictures. The first step is to determine what is causing the tip to droop and then treating the underlying cause/s.

Other: Noses which are crooked, pointy or flat can also be corrected with rhinoplasty surgery.

FUNCTIONAL RHINOPLASTY CAN CORRECT:

Deviated Septum: Frequently, the nasal septum (the cartilage separating the right and left nasal passages) is deviated and needs to be corrected. A crooked nose can also contribute to septum issues. The procedure performed is called a septoplasty.

Enlarged Turbinates: Turbinates help to add moisture and filter air. When enlarged, they can contribute to airway blockage, and will need to removed as part of the nasal surgery.

Airway/Valve Collapse: Additionally, narrowed passages and airway “collapse” can require placement of cartilage grafts (also called spreader grafts) for structural support. On rare occasions, scar tissue within the nose from previous injury or surgery may block air flow and require correction.

The intended result is to improved breathing and to provide relief from other symptoms

PROCEDURE DESCRIPTION

Cosmetic rhinoplasty can sometimes be performed using a local anesthetic along with I.V. sedation. More often though, general anesthesia is used. Options will be discussed during the consultation. Functional rhinoplasty requires general anesthesia. Both are considered outpatient procedures and are performed in our Newport Beach accredited surgery center.

Cosmetic rhinoplasty have incisions hidden within the nostrils. In some cases, a small “nick” in the skin is placed at the upper nose near the corner of the eye. More complex nose surgeries often require an incision placed at the base of the nose called the columella. This is called an “open rhinoplasty,” because it allows the surgeon to elevate the nasal skin to directly view the interior of the nose and make necessary corrections. This technique is preferred because it greatly increases the surgeons ability to achieve the best possible result and avoiding the need for a revision surgery. The scar heals very well, and overtime is nearly invisible to the eye.

Wide noses may require narrowing of the base, which requires small incisions (Weir incisions) placed in the groove where the nostril meets the cheek. This allows the base to be positioned closer together.

More complex nose corrections may require grafts. Cartilage and bone grafts are often taken from within the nose (septum). Ear cartilage, rib, hip, or outer portion of the skull are other possible grafts. Synthetic nasal implants may be used to build-up portions of the nose.

COMPLIMENTARY PROCEDURES

If your selected surgeon feels an additional procedure would benefit your overall result, he will provide his recommendation The two most common add-on procedures include:

  • Chin Augmentation
  • Neck Liposuction

If you have additional questions or would like to schedule a consultation, fill out the form below or call our office (949) 565-2121

INSURANCE GUIDELINES

We are a cash only business, meaning full payment is required prior to surgery. We are not contracted with any insurance companies, but if your nose surgery qualifies for reimbursement, we can provide you with the documentation needed for you to submit your claim directly.

Surgery necessary to correct functional breathing problems or deformity from an injury may be covered by insurance. The insurance carrier will not cover any of the charges which are cosmetic in nature. If your surgery is part cosmetic, part functional, we can provide you with a breakdown of fees.

After your consultation, if you feel your surgery may qualify for insurance coverage, we encourage you to call your insurance company directly to discuss further.

If you need assistance with filing your insurance claim, we can provide a referral to an insurance billing service.

AFTER SURGERY

WHAT TO KNOW AS YOU HEAL

SLEEPING/LAYING:

You need to keep your head (and nose) elevated to reduce swelling. If possible, sleep on your back elevated using two or more pillows.

SPLINTS:

You will go home with an external splint in place. The splint is usually removed within 7-10 days. Internal splints may be used with septoplasty surgery and remain in place for 1-2 weeks. If septal splints are in place, the use of saline spray for a few days will not be harmful. Prolonged use of drops is not advised.

NASAL PACKING:

Nasal packing is usually avoided. If you have more than normal bleeding during surgery, or if there is another reason, then packing may be used. Packing requires you to breathe through your mouth, and you will have somewhat more swelling than usual. Packing usually remove within 24-48 hours.

DRAINAGE:

Bloody drainage is expected during the first several days. This may require your dressings to be changed frequently. Crusting dried blood will collect in the nostrils. Use Ocean Spray Saline Nasal Spray or arnica gel solution for a few days will help clean the area; debris can be removed with an infant aspiration bulb. Elevation, ice, and pressure (squeezing the sides of the nostrils for 10-20 min.) can help control bleeding.

CONGESTION:

Your nose will be partially or completely obstructed for a few days after surgery. If splints have been placed, some reduced airway will be present. Following removal of splints or packing, the nose will continue to be somewhat congested – usually for 2-4 weeks. The use of over-the-counter or prescription decongestants may decrease symptoms and provide relief.

SWELLING/BRUISING:

The majority of swelling and bruising subsides progressively over 1-2 weeks. Arnika Montana cream is an herbal remedy known to help reduce swelling and bruising. It can be purchased from our office or at a natural health food store. Note: you may have some degree of swelling and firmness of the nose for up to one year or longer.

SENSITIVITY/NUMBNESS:

You will likely experience some sensitivity and/or numbness, which will slowly resolve; the tip of the nose will feel stiff or “woody” and this will improve over the first several months.

ACTIVITY/EXERCISE:

Nasal surgery usually hurts very little. Many people feel quite “normal” within a day or two. Heavy exercise or straining can cause bleeding or swelling during the first 2-3 weeks. Avoid strenuous or aerobic exercise for at least two weeks. Speak with your surgeon before you resume working out.

RETURN TO WORK:

If work is strenuous, wait 7-10 days. If work is sedentary, you may return when feel up to it. If nasal packing has not been placed, this could be as early as 1-3 days after surgery.

OTHER:

Additional temporary conditions may include some airway or sinus blockage, nasal drainage, lumps and irregularities.

RESULTS:

Semifinal result is seen around 3 months. Final result is seen around 12-14 months post-surgery, which is the time necessary for complete healing of the exterior and internal portions of the nose.