Plastic Surgeon • Newport Beach • Orange County
Rhinoplasty - Nose surgery - Nose job:
One can consider a Rhinoplasty ( Nose Surgery / Nose Job) procedure to beautify the nose, correct breathing problems or both. Often, breathing problems are improved by straightening a crooked nose. Snoring can often be cured with nasal surgery, as well as sinus problems. Dr. Bandy uses the most current techniques and designs the surgery specifically to each person's needs and desires.
Before and After
What is rhinoplasty?Rhinoplasty typically refers to a cosmetic change to the nose. The procedure is done to change the shape of the nose. Reconstructive nose surgery, on the other hand, is generally a procedure to correct breathing difficulties (from injury, from birth, or complications from a prior rhinoplasty).
Rhinoplasty ranges from working on a small area of the nose (such as the tip of the nose) to performing a Complete Rhinoplasty (nose, bones, cartilage, and mucosa). Not only can rhinoplasty involve the external nose, it can involve correcting the internal nose as well, such as the septum and turbinates.
How long is the rhinoplasty surgery?A short surgery can be as quick as forty-five (45) minutes, and a more detailed surgery can be as long as three (3) hours. Primary Rhinoplasty (first time a patient has the procedure done) is typically a bit quicker than re-operations. Re-operations (subsequent rhinoplasties) typically take longer to perform, because there is more scar tissue; the length of the procedure is typically longer because it is a more involved surgery.
Who is rhinoplasty recommended for?Rhinoplasty is recommended for anybody looking to improve the cosmetic nature of their nose. Typically, rhinoplasty for cosmetic reasons is not recommended for young ladies or young men before the age of sixteen (16), because you can continue to develop more bone and cartilage as you age. Therefore, people between the ages of sixteen (16) to eighteen (18) would be the youngest that would be recommended for considering rhinoplasty.
What is Septoplasty?Septoplasty, on the other hand, is indicated for dysfunction of the nasal septum cartilage and/ or bone that separates the two nasal vaults (right side from the left side) and contributes to breathing difficulties. Such dysfunction can create breathing difficulties and sinus problems. Septoplasty can be performed at an earlier age if severe enough and if medically indicated. However, if it is a mild dysfunction, it is recommended that you wait until you are sixteen (16) years old.
A Septoplasty procedure operating time can vary depending depending on whether the septum is just being scored and straightened or if a wedge of the septum needs to be removed and how deviated the septum is. However, if it involves doing the nasal septum strictly for breathing purposes, that surgery can be as quick as forty-five (45) minutes or as lengthy as an hour and 1/2.
What type of surgery should I get for an injury to the nose?Reconstructive surgery is helpful for people who have any kind of injuries to the nose. This includes trauma to the nose resulting in a fracture to the bones and or septum or deviation of the septum.
What is a deviated septum?A deviated septum is in irregular shape to the cartilage and or bones that seperate the two nasal vaults and lies in the midline of the nose. Often times, a nose injury that causes a deviated septum will also have pathology with the nasal bones and or cartilage. To correct this, a "septo-rhinoplasty" is required to fix both the internal and external nose. not only is the septum being corrected, but also the nasal bones need to be straightened out to be able to have a straight septum and nose so you are able to breathe properly through your nose. Sometimes a deviated septum is caused by injuries. With an injury, you often would need the complete nasal framework reconstructed to be able to have good functional breathing through both sides of the nose.
Patients are recommended to come in immediately after an injury to the nose for a complete evaluation. Sometimes you will not need a complete surgery if you come in sooner; you might still be able to reset the nose from a fresh injury.
What is septoplasty with submucous resection of the turbinates?Another type of rhinoplasty is "septoplasty with submucous resection of the turbinates." Turbinates are bones inside the nose that help regulate the airflow. Often times when you have a deviated septum and or allergies, you will get hypertrophy or growth of the turbinate bones. Such growth would make it more difficult to be able to have enough adequate airflow through the nose. In that case, the turbinates are worked on as well as the septum. If you have had a previous injury, then a septo-rhinoplasty may be required to repair the entire bony framework as well as the septum in order to get adequate air flow on both sides.
What type of rhinoplasty is popular?Out of the various types of rhinoplasty, the most popular type that people generally come in for is a Complete Rhinoplasty. Complete Rhinoplasty is more than a Tip Plasty (procedure on just the cartilage on the tip of the nose), and may require removal work on the hump of the nose (dorsum) as well as fracturing the bones to narrow the width of the nose.
What is the recovery time and the healing process? (Tip Plasty)Typically, no external splint is required if you do not need to break the bones of the nose, and are just working on the cartilage of the tip. Only tapes are required to support the cartilage. The tapes can typically be removed within three (3) to five (5) days. You will experience some mild soft tissue swelling. Patients are able to return to work as soon as they feel comfortable with their appearance. Often times, surgeries can be performed on a Friday and you can be back to work on a Monday or Tuesday. What is the recovery time and the healing process? (Complete Rhinoplasty) A Complete Rhinoplasty is a procedure where all the tissues of the nose are addressed. For proper healing after the procedure, an external nasal splint would be required and possibly nasal packing. If the packing is necessary, then the packing will be removed on approximately the third to fourth post operative day. The splint will be removed around the fifth (5th) to seventh (7th) post operative day. The majority of people having a Complete Rhinoplasty will require approximately a week downtime prior to returning to normal activities. Again, for a simple Tip Plasty, you only need a few days. For a Complete Rhinoplasty, you typically need a week off.
What activity should I refrain from after rhinoplasty?You should refrain from any kind of contact sports from the first 6 weeks after a rhinoplasty surgery and high impact work outs that elevate the blood pressure.
Are there any other procedures commonly performed along with rhinoplasty?Rhinoplasty is sometimes performed at the same time with other procedures of the face, such as surgeries involving the eyes or a chin implant.
What is Clean-Contaminated Case vs. Sterile Surgery? (combination of surgeries)Rhinoplasty is considered a "clean-contaminated" case. A clean-contaminated case means that the procedure is not completely aseptic and sterile, because bacteria lives inside the nasal conjunctiva. Similar to intra-oral surgery or vaginal surgery, these procedures are all considered clean-contaminated. Therefore, anytime that you are having another procedure done with a clean-contaminated procedure, it is important to perform the sterile surgery(s) first (ex. breast augmentation, tummy tuck) prior to the clean-contaminated procedure(s). Further, the patient should know that there is a slight increased chance of post-operative infection. This holds true even when everything is done in a complete sterile environment, because you can get some bacterial seeding into the blood stream. Generally, patients can have different types of plastic surgery on the same day (ex. breast augmentation and rhinoplasty) as long as they understand the slight increase in risk of post operative infection.
Are there any new technological advances or medicine for rhinoplasty?Rhinoplasty relies heavily on the artistry of the surgeon. Accordingly, not only should a surgeon be chosen on credentials, but also on his or her artistic abilities. Prospective patients are recommended to review Before and After photo galleries, because they are extremely important in choosing a surgeon to perform this type of plastic surgery. Thus, rhinoplasty is very much an artistic surgery that relies on the training, skills and artistry of the operating surgeon.
What is the ideal nose?Patients will sometimes come in requesting to look like someone popular in the media such as Kate Middleton, Kim Kardashian, Natalie Portman, Britney Spears, or Selena Gomez. However, it is better for patients to focus on the specific changes they want in their nose, because they are not going to get the exact same nose that another person has. Patients are recommended to bring in a photo of what their ideal nose would be, if they could choose (not necessarily celebrities). During the consultation or pre-operative appointment, photos can be taken and computer imaging performed to give the patient an idea of what their nose would look like after rhinoplasty. With this computer imaging, patients can get a realistic idea of what their nose would look like after surgery.
What type of incision approaches are there for rhinoplasty?There are two approaches to incisions for rhinoplasty: 1) Open Approach Incision, and 2) Closed-Approach Incision. For a closed approach, you do not have any external incisions. Thus, scars are well hidden inside the nose. Those incisions are all done in the mucosa inside the nostrils. An open approach is performed in a similiar fashion however a small incision on the fleshy aspect between the nostrils is made to assist in viewing the structures inside the nose.
What is a Closed-Approach Incision for Rhinoplasty?Through closed-approach rhinoplasty, all the changes are performed within the nose, through incisions hidden inside the nose. This includes the septum if necessary.
What is an Open-Approach Incision for Rhinoplasty?For an open-approach, there is an additional small incision along the columella (the small fleshy part that separates the two nostrils). That incision can be done as a V shape or as a "stair -step" type incision. The remainder of the incision carries on into the inside of the nose.
Which type of incision approach is best for my rhinoplasty surgery?The approach that is chosen is dependent on the severity of the deformity. Sometimes, if a severe asymmetry is involved, the open approach will be the preferred method. Depending on the circumstances, even a mild asymmetry may require an open-approach. Often times, you will get a better cosmetic result if you do an open approach, because the approach allows you do more to the cartilage to adjust the way the cartilage is and make them more symmetric. Thus, the incision depends on the individual patient's nose.
Are there financing options for rhinoplasty?The patient has multiple financing options. For example, the patient can pay for the surgery on credit card, and make monthly payments back to their credit card. Additionally, CareCredit is a financing company specific for cosmetic surgery; patients can apply for care credit, and there are multiple options for CareCredit. Sometimes, patients opt to make payments directly to the office. This is a prepayment plan where a patient would pay until he or she pays the entire balance for the surgery; then, they would have their surgery.
What is the average cost for rhinoplasty? Rhinoplasty cost varies depending on the intricacies of the surgery.
What is the average cost for Tip Plasty Surgery?The cost of rhinoplasty varies depending on what needs to be done to achieve the patients goals. Tip Plasty (where just the tip is being operated on) can range from anywhere between $2,500 to $6,500 depending on what type of anesthesia is being performed, and the amount of work that needs to be done to achieve the intended results.
What is the average cost for Complete Rhinoplasty?A Complete Rhinoplasty can range from anywhere between $6,800 to $14,000 depending on the complexity of the case. Complete Rhinoplasty may be performed for a primary rhinoplasty (first time having rhinoplasty done) or reconstructive rhinoplasty that is being performed as a secondary surgery, or in situations where there has been an injury or previous damage. It is normally more expensive with the second or third surgery, because you will likely have more scar tissue and work involved. Sometimes you need to have cartilage harvested from different areas such as the ear or even the septal cartilage to reconstruct the nose.
What is the average cost for Septorhinoplasty?The cost for septo-rhinoplasty typically ranges between $8,500 to $15,000. Although some of it can be considered cosmetic, some of it may also be considered reconstructive. Thus, there may be some coverage through insurance companies for septo-rhinoplasty. Patients are recommended to be aware and take caution with insurance companies, because even if you get prior authorization, it does not mean that the insurance company will pay; they may evaluate it and determine it was cosmetic.
Some patients that have done primary rhinoplasty end up with partial blockage of the airway. Thus, a cosmetic surgery might turn into reconstructive matter. Some of the patients that come in to see Dr. Bandy are patients that have had such blockage caused prior by previous surgery.