Rhinoplasty by Dr. Cory Goldberg

Rhinoplasty is cosmetic nasal enhancement and is frequently combined with functional nasal airway work. At the same time, the goals that people have for their nose vary widely. The first thing I established with the patient is what their concerns are and the things that they would like to try and address. This may include things such as a bump on the top of the nose or refinement of the tip. When they've given me their goals and I do my assessment, I make recommendations to improve all the different portions of the nose that I see could be improved upon and after surgery would result in a consistent, balanced appearance to the nose. And also trying to balance the appearance of the nose with the remainder of the face. It's common that patients will come to me and ask for one specific change to be made to their nose, such as removing the bump on the top of the nose. It's rarely possible to do one small part of a nose in isolation, and the reason is is that once you change one part of the nose, the other parts need to be changed in order to balance with it. A nose needs to have all of its parts fit together in a coherent fashion. Additionally, the nose needs to fit with the rest of the face to have proper facial balance. And so addressing a single small part of the nose, such as a bump, is rarely possible. And it usually requires at least some amount of work to be done on all parts of the nose in order to make sure that it's consistent with itself and the nose looks appropriate and and that the nose is balanced and fits with the remainder of the face. Nose surgery can be done either as an open or closed procedure. Open is the more common procedure and involves an incision under the nose as well as on the inside. Closed rhinoplasty is surgery done with incisions just on the inside of the nose without any external scar at all. I do perform closed rhinoplasty, but but I offer it to patients only when their goals can be met. With closed rhinoplasty, most often, if any work needs to be done to the tip of the nose, such as refining it, reshaping it, or changing the nostrils in any way, it requires an open rhinoplasty to be performed. The recovery for nose surgery is around five to seven days. Usually patients return to me after only two days. If there's any kind of airway work being done, which frequently requires some amount of packing or things to be inserted on the inside of the nose at that two day mark, the packing in the nose would be removed. If no functional airway problems are present, Then that may not be necessary. Patients return to me at the one week mark, at which point I take the cast or splint off the top of their nose and at the same time take the stitches out from underneath if they're present. The recovery time for a closed rhinoplasty and an open rhinoplasty, in fact, are nearly identical. And so really, the only small benefit of the closed rhinoplasty is the lack of scar under the nose. Open rhinoplasty incisions heal extremely well, and in fact, years later, it's impossible to find that scar in many patients. And even when I know that it's there most often I'm not able to see it. The early recovery is five to seven days, after which most patients are ready to return to regular work in an office or administrative setting. At the one week mark, there may be some bruising present and some swelling, and it might be possible that people would be aware that you've had surgery or something done. If a patient prefers to keep it secret and not have anyone know that they've had surgery, I usually recommend taking two weeks off. At the end of two weeks, usually any bruising is gone and the swelling has reduced enough that it's not really visible at that two week mark. Patients can also return to light exercise, such as a treadmill or stationary bike, and by four weeks, they're ready to return to regular exercise, including weightlifting, running and other types of training. At the one month mark, usually about 80% of the swelling has resolved. That means that about 20% is still present. And while at that point the result is quite notable and the cosmetic benefit can be seen immediately, the small amount of swelling that's still there is something that I would be able to perceive as well as the patient. It's not perceptible to other people and it resolves very slowly over time. So while things are very presentable and the result looks excellent at the one month mark, the final result for a rhinoplasty takes about nine months or even up to a year. Frequently during that time, the swelling, as it's coming down, down, may come down in an irregular fashion, so that swelling may be more prominent on one side or the other and may give the appearance of asymmetry or other irregularity. That's why it's important to wait until the 9 or 12 month mark before judging a final result after nose surgery.