The Top 5 Nose Complaints. Sound Familiar?

While we can often disguise protruding ears with different hairstyles and soften the appearance of our eyes with makeup, the nose is the most noticeable facial feature and is more difficult to hide or disguise. In the 500+ Rhinoplasty procedures that I have performed, I have employed a highly focused individualized approach which avoids the dreaded “operated on” or “done” appearance.

FUNCTIONAL nasal problems usually arise from an injury and result in a disfigurement of the nasal shape with complaints of obstructed nasal breathing.
     Most functional Rhinoplasty candidates  have sustained an injury to the nose that has resulted in a possible nasal fracture and/or displacement of the internal partition of the nose, which separates one nostril from the other. The most common concerns - difficultly breathing through the nose and severe headaches.
     The nose may appear disfigured, often identified by a hump at the mid-portion of the bridge. An internal examination may confirm that there is, in fact, a deviation of the nasal partition resulting in a partial blockage of nasal airflow. We then would develop an operative plan to restore the displaced nasal structures to their original position, and to rearrange the displaced nasal partition in an effort to restore normal nasal airflow. The reconstruction of a functional nasal problem is usually covered by one’s insurance.

COSMETIC nasal problems include the above complaints of “my nose is too large”, “I hate my hump” or “the tip is too large”. These are characterized as cosmetic because their improvements do not affect the function of the nose and the ultimate goal is to produce a better appearance of the nose. I refer to this type as an “aesthetic” Rhinoplasty. It is important to understand that the shape of the nose is dictated by the bone and cartilage framework beneath the skin.  It is therefore the goal of the cosmetic nasal surgeon to reshape the framework beneath the skin to reduce the size and shape of the nose, without producing a result that looks “done”.
     In the case of an aesthetic Rhinoplasty, I feel the most important aspect of the initial consultation is to determine whether the results of the procedure can realistically meet the patient’s expectations.  Difficulties can arise when a patient states, “I want my nose to look exactly like this,” and presents a photo of a celebrity.  This type of result is often not realistic, firstly, due to other facial features contributing to the nasal appearance, and secondly, because the nasal framework may not allow a specific result. However, certain characteristics of someone else’s nose may be incorporated into each individualized Rhinoplasty. A detailed examination of the candidate is performed and an operative plan to address the patient’s concerns is formulated. Because this is a purely cosmetic procedure, it is not covered by insurance.

The Nasal (Rhinoplasty) Procedure:  Both functional and cosmetic procedures are done under a general anesthetic and on an outpatient basis.  Each procedure takes about two hours to perform. Most patients rate the pain on a scale of 1 to 10 as a 4 to 6.  There is a dressing in place for 6 to 7 days, and upon its removal the patient’s result is noted with a moderate amount of swelling.  Patients typically feel comfortable being in public after Rhinoplasty in seven to eight days.

To set up a consultation, call Dr. Rucker’s office at 715.833.2116. Our staff is always happy to assist!

Rhinoplasty: The Two Types

I hate my profile

My nose is too large for my face
I hate this hump on my nose
The tip of my nose is too large

These are the most common patient complaints regarding the appearance of their nose.

Nasal surgery has become more popular in recent years because the nose is the most noticeable facial feature. We can often disguise protruding ears with various hairstyles and soften the appearance of our eyes with makeup, but our unwanted nasal features can’t be hidden or disguised. In the 500 Rhinoplasty procedures that I have performed, I have employed a conservative approach.  This method avoids the dreaded “operated on” or “done” appearance.

There are two types of Rhinoplasty procedures. The first is a reconstruction of the nose that has been disfigured by injury or has become damaged from disease, such as skin cancer.  I like to categorize this type of procedure as a functional Rhinoplasty.  The procedure is performed to relieve such symptoms as a complaint of the inability to breathe through one or both nostrils and the associated complaints of excessive mouth breathing or headaches.

The disfigurement of the nose is most commonly caused by some traumatic event such as a sports injury.  This can result in a displacement of the partition inside the nose that separates one nostril from the other (nasal septum). The external framework can also be affected leaving the condition commonly called a twisted nose. The functional Rhinoplasty is often covered by insurance.

The second type of Rhinoplasty is cosmetic, with the ultimate goal to produce a better appearance of the nose. I refer to this second type as an aesthetic Rhinoplasty. Because this is a purely cosmetic procedure, it is not covered by insurance.

If a functional Rhinoplasty is to be performed, a preoperative evaluation and detailed history of any injury is taken and the nose is examined to determine the degree of nasal airflow impairment.  The internal nasal partition (nasal septum) is examined for any signs of displacement. The external framework is also examined to determine any displacement of the nasal bones, which can often happen after a nasal fracture. 

In the case of an aesthetic Rhinoplasty, I feel the most important aspect of the initial consultation is to determine whether the results of the procedure can realistically meet the patient’s expectations.  Difficulties can arise when a patient states, “I want my nose to look exactly like this” and presents me with a picture of a celebrity.  This type of result is often not realistic because other facial features contribute to the nasal appearance and the nasal framework may not allow a specific result.   However, certain characteristics of someone else’s nose may be incorporated into each individualized Rhinoplasty.  

The procedure is often done in our office operating suite with a local sedation anesthetic.  It is an outpatient procedure and takes about two hours.  Most patients rate the pain as a 5 on a scale of 1 to 10.  The vast majority of incisions are hidden inside the nose and a nasal splint is left in place for one week.  Recovery time is reasonable and most patients are socially presentable in 8 to 10 days. Eighty percent of the swelling has resolved within ten days, with the remainder reducing over a two month period.  Complications are rare, but may arise. The more common ones are infection, asymmetry, scarring and bleeding.  

The Rhinoplasty procedure can be a positive method to address a twisted nose or concerns about one’s nasal appearance.  It is my recommendation that a less aggressive approach is better and patient expectations must be fully evaluated.

Visit Dr. Rucker on RealSelf for answers and tips to the following Questions:

Tip Revision After 7 Months Post-op?
One Week After Rhinoplasty and my Nose Tip Looks Like Richard Nixon's?
3 Weeks Post Rhinoplasty, and Dark Circles Are Getting Worse. What Should I Do?
Open Rhinoplasty Incision Location?
Rhinoplasty. I Have a Bulbous Nose. What Do You Recommend?
Can Fillers Correct my Nose After Rhinoplasty?

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Q & A with Dr. Rucker: Rhinoplasty Imaging

Q: I have been in for a rhinoplasty consultation and you do not do imaging to show what the nose may look like after surgery. Would you consider doing this? If not, why not? I am going to have it done but would like see something like this.

A: In regard to your question regarding computer imaging in an attempt to better visualize the result of a rhinoplasty.  I have researched this technology extensively and have used the software required for computer imaging.  I have come to the conclusion that this is not a viable option for my practice for the following reasons. 

1. I feel the imaging process does not give an accurate picture of the result in many cases. This has been a concern with this technology throughout the plastic surgery community.  This discrepancy in anticipated results has lead to a significant amount of displeasure with patients seeing one result and in reality not receiving that result.  

2. I feel that those users of the technology tend to over estimate the anticipated result on the computer image, which can also lead to a strain on the patient to physician relationship. This technology I feel is better suited for showing possible results following body contouring but is significantly lacking with trying to show the anticipated results on the face.  I try to present a mental pictures to the patient of the anticipated result.  I emphasize shape, tip reduction, nostril changes and alterations of the bridge of the nose.  In this way I feel that each patient can better understand the anatomy and how we anticipate the changes that we propose for it.  The most common concern that my patients tell me is that I don’t want my nose to be overdone.  We strive to give a result that looks natural and compliments the overall appearance of the face.    

JR