Rhinoplasty

Ethnic Rhinoplasty     Candidates for Rhinoplasty     Techniques     FAQ

Rhinoplasty essentially means “nose change.” While many Rhinoplasties are done for cosmetic purposes, some functional cases require correction of an external deviation in order to achieve a more balanced nasal airway.

Independent of the reason for surgery, cartilage and bony parts of the nose may need to be modified in order to achieve the desired result. Internal work may be needed for an external change and vice-versa. Each case is unique and each surgery can be tailored to an individual patient’s needs. Some operations are relatively simple while others can have a high level of complexity.

Dr. Westreich’s practice is devoted to cosmetic and reconstructive procedures on the face and neck. Because of his background in Otolaryngology (ENT), he has a special interest in functional nasal preservation and correction. A practice emphasis is on nasal surgery of all varieties and surgery for facial rejuvination.

Consequently, he is able to offer a wide array of nasal surgery options, including closed approach rhinoplasty (endonasal), open rhinoplasty, revision rhinoplasty, profile- plasty and tip-plasty, deviation correction, and subtle polish procedures.
Dr. Westreich has originated many Rhinoplasty and septoplasty techniques, such as Foundation Rhinoplasty and Rhinosculpting which have been published in medical journals and textbooks on facial plastic surgery.

Dr. Westreich has previously been recognized as a leader in facial plastic/ENT surgery and was most recently listed in NY Magazine’s Best Doctors for 2014.

Ethnic Rhinoplasty

While Rhinoplasty surgery is not based on ethnicity alone, patients can look at these categories and gain some insight into what their nose may require based on their individual background. At a consultation, your specific anatomy and desires will be taken into account throughout the decision making process. Your ethnicity may provide hints as to what you may need, but Dr. Westreich treats these as general guides and not predetermined answers. That way, patients can avoid ‘cookie-cutter’ noses and get the outcome that best suits them.

Before After

In general:

  • Causasian noses: Reduction techniques are common in this group. Noses tend to require less grafting, as the cartilage is typically strong. Profile-plasty without tip work is common. Tip-plasty is recommended for position changes (lifting or dropping a tip) or more substantial narrowing in that region. Septoplasty and nasal valve surgery is very important for breathing restoration or retention.
  • Asian Noses: Tend to have small and soft cartilage elements, as well as short nasal bones and moderately thick skin. These cases often require grafting in both the bridge and the tip for comprehensive narrowing. Profile grafting alone may be appropriate for some patients of Asian descent. Septal cartilage grafts are limited by size and ear or silicone is often recommended for bridge Augmentation. Septoplasty tends to be less relevant and inferior turbinate surgery is more likely to achieve breathing improvement.
  • African American Noses: These are typically very similar to asian noses in the need for grafting of the bridge and tip. The cartilage tends to be very soft and the skin can be severely thick in certain patients. Turbinate surgery, rather than septal surgery, is also the main functional intervention. Skin thinning is often recommended as part of the surgery. Augmentation using septal, ear, or rib cartilage and/or silicone is typically required in order to ‘push through’ the thick skin and allow the nose to look narrow on front view. Alar base or nostril reduction, is also commonly recommended.
  • Hispanic or Latino Rhinoplasty: There is a great deal of variation among Hispanic noses. Elements of Caucasian, Asian, and African American nasal anatomy can be seen and the surgery needs to be tailored to the specific patient’s anatomy. Typically tip-plasty with limited cartilage grafting is the most common recommendation. Limited profile polishing for a small bump is commonly suggested. Septal surgery, valve surgery, and turbinate surgery can be suggested as functional strategies.

Candidates for Rhinoplasty

The best candidates for rhinoplasty are patients who have specific goals in mind and are motivated to achieve these goals over a 6-12 month period. (Noses heal slowly, just like knees; both areas are made of bone, cartilage, and soft tissue). The simpler the surgery, the more predictable the result, so patients should be clear about what is bothersome. Patient should also realize that their original shape may determine the types of changes that are possible. If patients are unsure of their goals, Dr. Westreich will recommend a custom tailored course of treatment.

Simpler Rhinoplasty surgery involves smoothing out a bridge or narrowing the bridge from front view. Tip surgery can be simple or complicated, depending on the amount of change desired and the tissues a patient has to begin with. Internal surgery (septoplasty for a deviated septum) should be considered if crookedness is present internally or externally. Deviation correction can be simple or complicated, just like tip surgery, depending on which elements of the nose are off the midline. Revision surgery is often the most complicated type of Rhinoplasty. Small contour adjustments are most likely to be successful in revision surgery, but more complicated reconstructions can also provide a high level of patient satisfaction.

Before After

Whether the desired result is subtle or more dramatic, it is important to determine if a high probability of success is present in order to achieve the desired change. If a high probability of success is not present, other potential strategies should be explored.

Your consultation

Our consultation process is thorough and sometimes requires more than one visit. Consultations are typically about 45 minutes in length. Patients routinely arrive and fill our medical forms and then meet with the patient coordinator to discuss their goals. Photographs are taken, which are then used to generate a potential imaging result for you (imaging is not performed for all types of plastic surgery consultations). All imaging in our practice is done by Dr. Westreich. While imaging is only an approximation of your surgical result, Dr. Westreich feels that it is more exact if based on a specific surgical plan, which has to be created by the surgeon, not his or her staff. After the imaging is complete, Dr. Westreich will speak to you and confirm what you are looking to accomplish with the surgery and then perform a medical exam.

Imaging is presented as a tool for the surgeon and patient to agree upon the direction of the surgery and can be refined during the consultation. Alternatives may be presented to you when medically indicated (partial versus full Rhinoplasty, chin implants, skin treatments rather than surgery, fillers, lasers, etc.) and possible surgical outcomes will be discussed. Patients should expect to leave their consultation with a solid idea of projected outcome, cost, potential risk, and scheduling possibilities. In fact, most patients schedule their procedure after their first appointment in our practice. Patients with multiple procedures, complicated surgical plans, or those having difficulty deciding on their goals may be asked to return for a second consultation.

Before After

Techniques by Dr. Westreich

Nasal Tip-Plasty

Nasal tip Plasty involves reshaping the cartilages of the nasal tip. 2 paired horse-shoe like cartilages make up the tip of the nose. The length, width, and bending contour of those cartilages, as well as their symmetry, determine the look of that region. Some nasal tips will narrow with a small amount of cartilage removal, while other tips will need sutures, grafts, or division techniques in order to drastically change their shape. The nasal tip is a very 3-dimensional structure, which should only be modified in order to achieve significant and necessary changes in nasal tip appearance.

Profile-Plasty

Profile plasty involves reducing a bump on the bridge of the nose. Removal of cartilage and bone from the top of the nasal septum and nasal bones can be required for profile reduction. After removal, nasal structures need to be brought together again in the midline with osteotomies. Spreader grafts may also be necessary in patients with weak cartilages. It is important that patients have a nasal tip which will balance well with the new profile, as this area of the nose is not manipulated in profile procedures.

Polish Rhinoplasty

This describes a procedure often used for deviated noses that also have functional blockage. Since all areas of the nose are typically involved in deviation (including bone and cartilage), re-breaking the nose is often required. When crooked structures are moved, it is important to polish and trim them smooth. Camouflage grafts may also be required to give the nose an even appearance.

FAQ

1) How long after surgery can I return to work?

Patients typically can return to work after 7-10 days, depending on the type of procedure performed.

2) Is Rhinoplasty covered by insurance?

Cosmetic surgery is never covered by insurance. If a patient has functional problems and internal surgery is recommended, then insurance may pay for a portion of the procedure.

3) What type of anesthesia is used during the procedure?

General anesthesia is typically used for all nasal and facial procedures. Prior to receiving anesthesia, patients will be required to have a medical evaluation, in order to ensure they do not have additional risk related to the surgery.

4) What are risks and complications that can occur?

All surgeries carry a risk of bleeding, infection, and scar formation. These risks are, fortunately, uncommon in nasal surgery. Other risks, such as temporary lip movement abnormalities, temporary numbness and smell loss, or pain are typically self limited to a few days or weeks after nose surgery. All cosmetic surgery carries the risk of unpredictable healing and a result different then expected. Most busy Rhinoplasty surgeons (actually all surgeons in general) will, on average, revise a small percentage of their own cases due to unexpected results. Dr. Westreich is committed to making his patients happy and will work with any dissatisfied patient looking to improve their result.

5) How do I prepare for my surgery?

The best thing to do is to read and follow the instructions that our office provides you before the surgery. Ask questions at your pre-operative visit or schedule a follow up if new questions come up. Relax as much as possible before the day of surgery. Avoid taking any medication that may decrease your ability to heal after surgery. In our experience, patients that are confident and prepared have an easier time with the recovery process.

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