Facial Plastic Surgeon / Procedures / Nose / Rhinoplasty
Overview
Rhinoplasty is a surgical procedure to reshape and improve the appearance of the nose. Commonly rhinoplasty is performed to reduce or increase the bridge of the nose, change the shape, size, and angle of the tip; change the shape of the nostrils, straighten a crooked nose and improve breathing, shorten or lengthen the nose, and alter the projection of the nose. Also the nose is commonly involved in trauma, thus rhinoplasty in San Francisco is often necessary to correct post-traumatic deformities. Dr. Dino Elyassnia is highly skilled and delivers some of the best rhinoplasty the Bay Area has to offer.
Based on the American Society of Plastic Surgeons (ASPS) 2017 Plastic Surgery Statistics Report, rhinoplasty is the third most popular cosmetic surgery in the U.S., with 218,924 procedures performed in 2017. It is also one of the most difficult surgeries to perform, necessitating the absolute best rhinoplasty surgeon you can get.
More so than any other surgical procedure, nose jobs must be tailored to the individual because each person has unique features to their nose and commonly their own concept of nasal aesthetics. It is also important to evaluate the rest of the face when planning rhinoplasty surgery in order to create a balanced look. The chin especially has a major impact on facial aesthetics and the appearance of one’s nose.
Rhinoplasty techniques can be divided into two major categories, “open” and “closed,” based on the incisions used. The goal of both surgical techniques is to separate the skin of the nose from the underlying bone and cartilage framework. This is then sculpted to create the desired shape.
In open nose job surgery, the incisions are made inside the nostrils and connected with an incision at the bottom of the nose across the tissue that separates the nostrils (columella). This allows the skin envelope to be lifted completely off the framework which offers the best visibility. The disadvantage is a small potentially visible scar across the columella.
In closed rhinoplasty surgery the incision across the columella is not made; incisions are only made inside the nostrils. This produces invisible scars but visibility for the surgeon during the operation can be limited and some techniques are not possible. Often the decision depends on your surgeon’s preferred technique and the nature of the changes that need to be made. Often surgeons can perform either technique and will choose the best one for you for your rhinoplasty in San Francisco.
If you have flaring of the nostrils, this may require additional incisions on the outside at the base of the nostrils. If you have breathing problems, your nose is crooked, or cartilage is needed to build up your nose, the surgeon may also perform a septoplasty in San Francisco. The septum is the vertical cartilage that separates the two nasal cavities inside your nose. Any incision for a San Francisco septoplasty is made inside the nose. In some circumstances like revision rhinoplasty procedures, this cartilage from the septum is not enough to build up the nose and cartilage may also be needed from other locations like the ear or ribs, which requires additional scars.
Rhinoplasty in San Francisco and the Bay Area can improve your appearance and self-image but it can’t necessarily change your look to meet your ideal. The best candidates for this surgery are healthy mature individuals who are unhappy with the appearance of their nose and are looking for an improvement not perfection.
Variety in each person’s anatomy limits the degree of changes that are possible with rhinoplasty in San Francisco. For instance, very thick nasal skin limits the amount of definition that can be achieved when sculpting the nasal framework. Rhinoplasty is often appropriate for patients as young as 15 or 16 if they have completed their growth spurt and can also be suitable for any ethnicity with ethnic rhinoplasty.
A nose job is performed to fix deformities due to trauma or birth defects. It is commonly but not always indicated for breathing problems. For instance people with significant obstruction from nasal allergies would not benefit from rhinoplasty. Also, anyone who has had a nose job within the past year is not a good candidate for another procedure.
“I am so happy to have chosen Dr. Elyassnia as my rhinoplasty surgeon. HE IS AMAZING. He gave me exactly what I wanted and I would highly recommend him for Rhinoplasty. I love my results!!”
N.B
During the first meeting, your surgeon will determine if you are a good candidate for rhinoplasty surgery while at the same time you will decide if he or she is right for you. This starts with a full health history review with a focus on any previous nasal trauma, breathing problems, allergies, or any major illnesses that can cause problems during your rhinoplasty surgery. It is important to tell your surgeon if you smoke or take any medications, supplements, or other drugs as these can have a big impact on your surgery. An example is aspirin or ibuprofen which can lead to bleeding after your procedure.
During the exam, your rhinoplasty surgeon will do a general evaluation of your facial proportions relative to your nose. He or she will then do a detailed exam of your nose both from the outside and the inside with the use of a speculum. Finally photographs are taken of all patients; these assist with the planning and evaluation of your surgery. These photos can also be used to create modified images of how your nose will look after your rhinoplasty surgery. These images help patients and surgeons communicate and plan surgery and should not be viewed in any way as a guaranteed result.
Based on this thorough assessment and a discussion of your goals, the surgeon will describe not only what approach is best for you but also the various alternatives and all of the risks and limitations associated with each of these.
It is very important to listen carefully to the various limitations of each approach and to openly discuss your expectations with your rhinoplasty surgeon. Many times a poorly informed patient or surgeon is the direct cause of an unsatisfactory result even when there are no complications with surgery. The surgeon should also go over the details of the procedure including the type of anesthesia used, the facility where surgery will take place, and the costs involved.
At the end of the consultation you may decide to go ahead with rhinoplasty in San Francisco and schedule a date but if you are unsure or don’t feel fully informed, don’t hesitate to ask your doctor any questions. A second meeting may be necessary and should always be available as an option.
“I had a rhinoplasty procedure done by Dr. Elyassnia in July. The entire experience was amazing and I couldn't be happier with the results. My nose looks very natural and while the "bump" is gone and my nose is totally symmetrical no one can ever tell that I had surgery. The staff and facility are seriously top notch and I felt very well taken care of the day of the procedure. One of the reasons I chose Dr. Elyassnia is because the surgery is done on site and not in a hospital. Thank you!!"
S.V
Preservation rhinoplasty is the latest evolution in nose reshaping surgery. Rhinoplasty has been around in its current form for over half a century and is being constantly refined to create better results with greater predictability and longevity. Preservation rhinoplasty is designed to preserve tissues and structure as much as possible while enhancing nose shape and size.
Preservation rhinoplasty has been developed to reduce the need for revision surgery and to extend the longevity of the results that can be obtained through rhinoplasty. By reducing the amount of surgical change to preserve as much of the natural shape and tissue as possible, better results can be achieved with less risk of requiring revision surgery in the future. The aim of preservation rhinoplasty is to avoid any unnecessary excision or removal of tissue or alteration to the internal nose structure. With this new approach, manipulation of existing tissues is chosen over removal, and advanced suturing and more precise surgical techniques are employed.
The benefits are numerous and include greater likelihood of long-term success, less risk of the need for revision surgery, reduced risk of complications, enhanced longevity of results, and reduced need for grafts from other areas such as the ribs.
The benefits of preserving tissues such as the structural bones and cartilage of the nose are far superior to their removal as they are integral to nasal function. The shape of the nose can be changed in subtle ways that can have dramatic impact on the appearance of your face. The case is always “less is more” when it comes to rhinoplasty, so that your unique identity is maintained while the balance of your face is enhanced.
Through the use of manipulation of the underlying structural tissues of the nose, the desired shape and function can be obtained without the high risk of complications or need for revision surgery. By using precision surgery, the natural structure of your nose can be preserved while enhancing its shape. Similar techniques in either the open or closed surgical approach are used in conjunction with preservation rhinoplasty for greater success in surgery. Recovery from nose reshaping surgery is often easier with preservation rhinoplasty as less damage to the nasal structure has been caused when performing the surgery.
Dr. Dino Elyassnia was one of the first surgeons to perform preservation rhinoplasty in the US, and helped organize the first teaching course on this concept. Dr. Elyassnia has adopted this latest evolution into his practice to ensure that only the most cutting-edge surgical techniques are employed for the benefit of his patients. The goal of preservation rhinoplasty is to create a result that will not need a revision later and requires less extreme tissue removal for greater structural integrity than other rhinoplasty techniques. Dr. Elyassnia has a wealth of knowledge and experience that allows him to stay ahead of the curve, contribute to the development of better rhinoplasty techniques, and to implement advances that lead to far superior surgical outcomes.
You will need to begin fasting 8 hours prior to your procedure which means you cannot eat or drink anything at all during this period including chewing gum or water. If you have been instructed to take any medications in the morning this is permitted with a few sips of water.
Depending on how extensive, a nose job can be done with local anesthesia and sedation which means you are very sleepy but from time to time you may be slightly aware of what is happening. However, many surgeons prefer general anesthesia. The surgery takes about 3 to 4 hours but can be longer in some cases. You will likely have tape and a splint placed over the nose and you may have packing or a soft silicone splint inside the nose. After surgery, you will stay in the recovery suite until you are ready to go home.
Within 1 month of surgery, all patients greater than 50 years old or with medical problems should have a medical evaluation by their physician or a primary care provider. Depending on your health this may require blood tests, an EKG, etc. You will be given a list of medications, vitamins, and supplements to refrain from taking at least two weeks before and after surgery. You should also stop smoking for at least 1 month before and after surgery.
Rhinoplasty is usually an outpatient procedure. If you and your surgeon have decided that you will go home, you will need to arrange for someone to drive you. Your surgeon will give you a prescription for the medications you will need after surgery so these can be obtained ahead of time.
All surgical procedures carry some uncertainty and risk and this operation is no different. Although there are many possible complications, the good news is that the combined risk of having any major complication is still rare as long as your surgeon is properly trained and the procedure is performed in a well-equipped facility. The following represents some of the major complications but is not meant to be comprehensive.
Major bleeding is a rare complication after surgery and usually can be controlled with various medications. Nasal packing is rarely necessary. Infection is also quite rare. Scarring usually is not problematic.
With a closed nose job, the scars are invisible. Even with open rhinoplasty, the very small external scar is rarely noticeable. The scars necessary to reduce the size of the nostrils can be more problematic if not done properly.
Occasionally a second procedure may be necessary to correct a minor deformity or to make small adjustments depending on the case. However this is rarely done prior to 1 year from the time of the original procedure as swelling tends to persist and the nose continues to change during this healing period.
You may feel some discomfort for a few days after surgery but this is well controlled with the medication prescribed by your surgeon. You may have bruising under the eyes which resolves in about a week. For the first few days after surgery you may have some bloody drainage from your nose and feel stuffy; this is normal.
You should feel pretty good in 1-2 days but it is important to refrain from any strenuous activity for at least the first week after nose job San Francisco surgery. Patients are encouraged to begin showering 1-2 days after surgery. You should keep your head elevated at all times for the first week. All sutures (if the open technique is used) and dressings will be removed a week after surgery. Initially, your nose will appear significantly swollen but most of the swelling will be gone in 3-4 weeks.
The majority of people are able to return to work after 1 week but this depends on your job. You will have to refrain from any exercise for 3 weeks but then you may steadily increase your activity. Also glasses should not be worn or taped up to the forehead for 3-4 weeks. You should avoid hitting or aggressively rubbing your nose for two months.
Although you will look close to your final result at 1-2 months, the swelling from this operation can take a full year or even longer to fully resolve. This means that your nose will continue to change slightly during this time but it won’t be noticeable to others.
Nevertheless this slow healing process can be frustrating at times. You must keep in mind that things will improve and you must be patient. No revision procedure should be attempted until this process is complete.
It is important to follow up with your surgeon as directed so that any potential complications can be detected and treated early. For the most part these are rare and you will spend most of your time enjoying your new look.
A rhinoplasty surgery can be performed in two different ways, depending upon what type of correction is needed in your nose structure. In an open rhinoplasty, a carefully-placed incision is made in the columella, the small strip of skin and cartilage between the nostrils. In a closed rhinoplasty, the nose structure is accessed from within the nostrils.
While some patients have a concern about a visible incision in an open nose job, the scar is virtually invisible once healed, as it is hidden beneath your nose. The choice between the two types of incisions is based upon how much access to the nose structure will be needed by Dr. Elyassnia to repair a cosmetic flaw. Generally, a nose tip problem, such as droopy, bulbous, misshapen, or overlarge may be corrected with an open rhinoplasty. Minor corrections to nose structure can be achieved with the closed approach.
In an open rhinoplasty, Dr. Elyassnia can see the entire nose structure, and make all the corrections needed with the highest level of accuracy, and less trauma. An open nose job is often the best approach in nose reshaping, including procedures to address a hump on the bridge, a wide bridge, a flat nose bridge, and other cosmetic issues.
The first step in rhinoplasty is surgical planning. Working closely with Dr. Elyassnia, the nose shape, size, and projection you envision will be discussed. Images of your nose will be taken and can be altered to show you various changes and how they will appear. Once the decision is made about the final appearance, your surgical date is planned.
Prior to your nose surgery, you will be restricted from eating for eight hours (as with any surgery). You will be put under anesthesia, either local, intravenous sedation, or general. The procedure requires about three to four hours to complete and is one of the most complex of all facial surgeries. It could not be more important that you have your nose reshaping surgery performed by a highly-skilled, experienced facial plastic surgeon – a poor result will require revision surgery, possibly with the need for grafts to rebuild the nose structure if it has collapsed. Dr. Elyassnia is often called upon to perform revision rhinoplasty procedures – why not have the surgery performed correctly the first time?
During the procedure itself, you are sedated, and the nose numbed, so you will not feel any pain. After the nose job surgery has been performed, some pain and discomfort can be expected, which can be easily managed with pain medication, typically only needed in the early stages of healing. The swelling and bruising that appears after surgery is typically mild to moderate rather than extreme, although every patient is different in the speed with which the body heals. Most of our patients are surprised to discover that the pain associated with rhinoplasty is far less than they expected – and no pain is experienced during the procedure itself.
After your surgery is completed, you will need to be driven home by a friend or family member. Any pain or discomfort can be managed with the prescription medication, usually only needed for the first few days. It is normal to have bruising beneath the eyes, which disappears after about one week. Your nose will feel stuffy, and you may feel pain similar to a sinus headache, easily managed with medication.
Most patients require one to two days to start to feel themselves again. You will need to keep your nose elevated at all times during the first week, and sleep on several pillows or a wedge. Bandages and stitches (if placed) are removed about a week after the surgery. Most people can return to work after about one week if the job duties do not include any vigorous physical motions.