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Rhinoplasty ( Nose Job)

Rhinoplasty refers to cosmetic surgery of the nose. Men and women who are dissatisfied with the shape and size of their noses can improve their appearance with nose contouring. The procedure is performed by removing, rearranging, or reshaping bone and cartilage. Typical reasons for this surgery are to improve the angle, remove a bump, or reduce the size of the nose.

What is rhinoplasty plastic surgery?

Rhinoplasty (or nose job) is the operation that changes the appearance of the nose. The size and shape of your nose is determined by heredity and formed by the bones and cartilages that are underneath your skin. The nose's appearance can be altered by trimming and reshaping those bones and cartilages. If you are considering a rhinoplasty you should look at your nose in the mirror carefully and try to determine what parts you find unsatisfactory and what you would like changed. Some common complaints are a bulbous round tip, a hump along the bridge of the nose, or a nose that is off-center, too long, too wide, too droopy, or just generally too big. Here are a couple examples of what a rhinoplasty can do.

Dr. Movagharnia found videos of different parts of a rhinoplasty performed by
Professor. Dr. Gilbert Nolst Trenite' and asked his permission to place them here so that his patients can make themselves familiar with the way Dr. Movagharnia does his Rhinoplasty. Please refer to:

What are the benefits of rhinoplasty?

Benefits of Rhinoplasty can range from improved breathing to enhanced appearance and self-confidence.

What are the risks associated with rhinoplasty?

As with any surgery, a rhinoplasty procedure does carry some risks. Fortunately, complications are rare and usually minor. Nonetheless, complications may include infection, bleeding, and adverse reaction to anesthesia.

Am I a good candidate for rhinoplasty?

Rhinoplasty is ideal for healthy, psychologically-stable men and women who are seeking improvement but not perfection in their facial appearance. Most surgeons also consider age as a factor, preferring young patients who have completed their growth spurt.

What does a rhinoplasty procedure involve?

Surgical techniques for reshaping the nose vary. However, a rhinoplasty procedure generally involves the separation of nose skin from its framework of cartilage and bone. This can be done either from an incision inside the nose or through an “open” procedure that requires an external incision in the tissue separating the nostrils. The surgeon then reshapes the nose, replaces the skin over the new framework, and applies a splint to help the nose maintain its shape.

How long does it take to recover from a rhinoplasty?

Healing after a rhinoplasty is slow and gradual with subtle swelling sometimes persisting for months to a year. However, patients can usually expect to return to work or school within a week or two and to more strenuous activity within four to six weeks.

How long can I expect the results to last?

With the exception of changes associated with aging, results are permanent.

My chin? What does my chin have to do with my nose?

The nose is only one part of the aesthetic profile of your face. A weak or receded chin can make a nose appear more protruded than it is, or a weak chin can accentuate a hump on the nose. A chin implant can be placed at the same time as your rhinoplasty to correct a weak chin.

What else should I look for on my nose?

Review your nasal shape prior to surgery with Dr. Movagharnia and see if you can find any asymmetries in your nose, such as one nostril wider than the other, or the whole nose off to one side. Asymmetries should be identified before surgery because you need to understand that they are sometimes quite difficult to correct. Photos are taken prior to surgery.

During development, the nose and entire face form from two separate halves which merge in the middle. Small differences in the level of the eyes or prominences of the cheekbones can cause asymmetries of the nose which may persist after surgery.

How old do I have to be to have nasal surgery (rhinoplasty)?

Once a young person is beyond the growth spurt of the early teens he is a candidate for rhinoplasty. By that time the nose will have assumed its adult shape, usually after the age of fourteen in girls, and fifteen in boys.

Am I too old to have my nose done?

There is no upper limit to the age at which someone in relatively good health may have a rhinoplasty. Many older adults who have lived with their noses all their lives usually do not want an operation that will markedly change the shape of their noses. However, gravity pulls the nose down just as it pulls on everything else, and the nose tends to droop as years go by. A minimal rhinoplasty can lift the nose and give a subtle impression of youth without a drastic change, making you look the same but better.

What can be accomplished?

A rhinoplasty can address, within reason, most dissatisfaction that people have about the shape and size of their noses. However, the operation is not quite as predictable as carving a new nose from a block of marble or what a computer can generate. Dr. Movagharnia cannot put someone else’s nose on your face. He makes carefully planned changes in the structure of the nose you already have.

How is the surgery performed?

The nose is made up of a firm framework of bone and cartilage that is covered by skin, and during the operation the size and shape of that framework changes. The skin will then conform to the new architecture of the nose and show the changes. Many factors influence the final appearance of your nose. The thickness and texture of your skin, the strength, shape, and symmetry of the nasal bones and cartilages, how your body tissues heal after surgery, and, of course, the surgeon’s skills have an impact. For example, very thick skin can hide rather than display the changes made in the bones and cartilages to a certain extent, and for that reason it is more difficult to make changes in a nose with very thick skin or a “meaty” nose. Because everyone’s tissues react differently to surgery, no surgeon can guarantee the outcome of any operation.

In some cases, especially if your nose has had previous surgery, been fractured, requires extensive surgery, or if there has been poor healing in past, it is possible that a secondary procedure, performed one year after the first, may be necessary to make final adjustments in the appearance of your nose.

The nose must look natural and fit the face. The thickness of your skin, the strength of your facial features, your height, and your sex will influence what can and should be done to your nose.

What else should I consider for rhinoplasty?

Rhinoplasty is by far and away the most complicated and difficult facial plastic surgery operation. Run away from any plastic surgeon who tells you that your nose would be "easy" to do. It is not hard on the patient, but more than any other operation it exposes the skill (or lack of skill) of the surgeon. You simply must see examples of a doctor's excellent rhinoplasty before allowing him to operate on your nose.

Above all, keep in mind that the goal is an improvement, not perfection. Have realistic expectations, and be ready to accept the minor inconvenience of swelling, bruising, and minimal discomfort after the operation.

This operation is for you. Though a good result may have a pleasing effect on a spouse or friend, do not expect praise or notice from everyone. You are not doing it for them. They are not paying the fees and incurring the inconveniences and risks of surgery. If the results are more subtle than dramatic, other people may not even notice.

Your friends might not be as observant as you are. Cosmetic surgery that is undertaken with the purpose of affecting others almost always fails to produce the desired results.

Why all the attention to the nose anyway?

The nose is the major aesthetic unit of the face, and it is right in the middle of your face. The nose contributes to the face’s strength, its femininity or masculinity, its character. The nose’s importance is reflected in our language. We may look down our nose at someone, or turn it up at something. Sometimes we can’t see beyond it, or we even cut it off to spite our face. We keep it to the grindstone, poke it into other people’s business, pay through it, and lead someone around by it. Someone may follow his nose, win by a nose, guess your age on the nose, rub noses with someone, or just be nosy. It’s as plain as the nose on your face. And your cell phone you are looking for? It was right under your nose.

I have had a rhinoplasty before, but I do not like how it came out

It is almost always possible to improve the appearance of a nose after a previous surgery. Dr. Movagharnia will identify with you the areas that need to be changed, and he will explain what can and what cannot be done. This operation is called a revision or secondary rhinoplasty. It is much more difficult than a first-time operation, but it is certainly a good option for someone dissatisfied with his nose after prior surgery. Rhinoplasty is the most difficult facial plastic surgery operation. It just isn't possible for every plastic surgeon to be an expert in rhinoplasty.

I have heard the doctor will break my nose, and I am afraid

The doctor does not break your nose. A controlled incision is made in the nasal bones, allowing them to be brought closer together to narrow or straighten the nose. Since you have been given the anesthetic at the beginning of surgery, there is no pain during the procedure.

I’m also worried about having the packing removed from my nose afterward

Dr. Movagharnia uses no packing inside the nose, so there will be none to remove, unless it is absolutely necessary.

Will there be any scars from the nose job surgery?

Most of the incisions are well hidden inside the nose and are invisible. A small incision is usually placed across the base of your nose, the part called the columella. Once healed it will not be visible.

When will I be able to go home after rhinoplasty?

If you live out of town, you can go home the day after surgery. Flying is no problem. But remember, if you are from out of town, Dr. Movagharnia will want to see you one week later, to take off the dressing. We try very hard to minimize the time that out-of-towners need to spend in Atlanta, and the number of trips they need to make.

When can I return to work or school?

You may return to school or work in as few as 3-5 days after surgery as long as your activities involve no lifting, no strenuous movement, and no long walks. Most people prefer to stay off work for one week until the splint is removed.

What kind of anesthesia is used?

Your surgery will be performed under general anesthesia. You are given a medicine through your IV that makes you fall asleep and you will feel nothing, and remember nothing about the surgery. It is safer than "twilight sleep" anesthesia.

Do I need to tape my nose after surgery and why?

The primary reason to tape the nose is to encourage the skin to shrink wrap down on to the underlying bone and cartilage. This is particularly helpful in rhinoplasty and revision rhinoplasty patients who have medium to the moderately thick skin. These patients have skin that takes longer than average to shrink down following surgery. Their skin is also more prone to forming denser scar tissue between the bone/cartilage skeletal structure and the skin. If this occurs before the skin actually shrink wraps down, unwanted excess scar tissue will be laid down and inhibit any further shrink wrapping. In some cases, the unwanted scar tissue will contribute to the development of prominent contours and bumps that can distract from the final rhinoplasty result. Taping the nasal skin correctly can minimize the likelihood of these undesirable occurrences. I will usually recommend that my rhinoplasty and revision rhinoplasty patients begin taping 2-3 weeks following surgery. There are cases, however, when I will wait longer before recommending patients begin taping the nose. Once started, it is best to continue taping for several months in order to gain maximal benefit from this exercise. Patients are recommended to tape the nose prior to going to bed every night. The tape can then be removed in the morning before starting your normal daily routine. If you are able to keep the tape on the nose longer than just overnight, all the better. Removing the tape must be done very carefully. You cannot simply grab the end of the tape and just pull it off the nose. This would defeat the purpose of the taping exercise, which is to encourage the skin to adhere further to the nose. In the adjacent photos, I show you how to remove the tape with proper technique. It helps if you can apply an over-the-counter adhesive removal solution that aids in loosening the tape from the skin. Alternatively, you can remove the tape while in a hot shower with lots of soap and lather having been applied to the nose. I recommend using tweezers or an equivalent instrument to grasp the edge of the tape as shown in the adjacent photos. Gently peel the tape off the skin but immediately try and pull the tape back over itself 180 degrees. Maintain this orientation as you remove the rest of the tape so you are essentially pulling the tape off parallel to the skin surface. This helps to minimize any chances of you pulling the skin up and off the underlying cartilage and bone. If you have any questions, call Dr. Movagharnia. Do not assume anything. It is easier to prevent a complication than correct it after it has already happened.

For more information about rhinoplasty, please call CCRS at 770 951 7595.