Nose Surgery Questions & Answers Los Angeles

Is there a minimum age to undergo Rhinoplasty?

The size and shape of a nose change during adolescence. Therefore, plastic surgeons generally recommend waiting until at least 15 years of age to consider Rhinoplasty. Boys should generally wait longer because they complete their developmental phase later than girls.
An exception to this rule is a baby that is born with congenital facial deformity such as a cleft lip. In this child, surgical corrections are made to the nose very early on so that the nose will grow in a normal fashion.

What Facial Features Can Affect the Appearance of the Nose?

The proportion of a nose to that of the rest of the face, especially when viewed from the side, is closely linked to the proportions of the chin. Often times a weak chin can make a nose appear too large for the face, or vice versa.

Attention to this relationship is very important in the assessment of the nose and surgical planning. There are times that surgery on the chin (Genioplasty) is an essential adjunct to a Rhinoplasty. At this time, the chin can be augmented or brought forward (Advancement Genioplasty), or reduced or pushed backwards (Reduction Genioplasty or setback).

The size, angle, and flow of the upper lip can also affect the appearance of the nose. Those with a very deep space between their upper lip and the nose, often appear to have an excessively hanging or drooping nasal tip. Augmentation of this area can change the angle between the nose and the lip, and thus significantly alter the overall appearance of the nose. On the other hand, those with thin and long upper lips can appear to have a short nose. Correction of this can also affect the appearance of the nose.

The shape of the eyes, especially that of the inner corners of the eyes (medial canthus), can affect the appearance of the nasal bridge, and vice versa. For example, a flat nasal bridge can make the eyes appear to be too far apart, as is true for many Asian patients. The medial canthal folds in Asians can also make the nasal bridge to appear too wide and flat.

What are the Goals of “Cosmetic” Rhinoplasty?

The first intranasal Rhinoplasty was performed in the 19th century on a young man whose large nose caused him so much embarrassment, he was afraid to appear in public.

The size and shape of your nose is largely an inherited characteristic. Bone and cartilage create the skeletal foundation of your nose, over which skin is draped.

Rhinoplasty can reduce the skeletal structure of a large nose by removing the nasal hump or by narrowing the bony and cartilaginous structures. On the other hand, in those with lack of nasal projection or flat nasal bridge such as those of African or Asian descent, the nasal framework can be augmented with a graft or an implant. The nasal bony and cartilaginous frame structure can also be straightened in the case of a crooked nose while the shape and slope of the bridge can be made more natural.

Rhinoplasty can also alter the size, shape, projection, and the angle of the nasal tip. A hanging nasal tip can be lifted and the angle between the nose and the lip can be altered. A small pinched tip can be made more natural looking, while an overly projected “Pinocchio” tip can be reduced. A wide, boxy, or bulbous nasal tip can be shaped to a more natural form.

Rhinoplasty can also reduce the size of the large and flared nasal nostril, or open and widen a pinched nostril.

Cosmetic Rhinoplasty is performed by either an “open” or “closed” technique. With the “open” technique, the plastic surgeon reaches the nasal bones through incisions inside the nostrils and across the columella – the tissues separating the nostrils. With “closed” Rhinoplasty, the surgeon accesses nasal bones through an incision inside the nostrils, and then lifts the skin away from the underlying bones and cartilage. Some call this a “Scar-less Rhinoplasty.”

As a rule, surgery performed for purely cosmetic reasons will not be covered by your insurance. However, for many men and women these issues of appearance are very painful, even if they are not physically painful. For many, knowing that they can change their appearance is liberating. Many patients tell me that their only regret is that they didn’t have Rhinoplasty sooner!

“Functional” Rhinoplasty – to Correct Breathing Problems or Injuries

We breathe, smell, and even taste with our nose!

The true function of your nose goes beyond just breathing, and its function is related to that of the sinuses, ear and the throat. When nasal passageways are obstructed, not only does breathing become difficult, but also the sinuses and the pressure balance of the ears are affected. That is why patients with chronic nasal airway obstruction also often suffer from chronic sinus and even ear infections.

Patients with nasal airway obstruction are often complaining of inability to breathe through one or both nostrils at night or during sports, post-nasal drip, dry mouth, sinus headaches, and pressure.

The obstruction of the nasal airway occurs at several levels. Constriction or collapse of the nostrils can present the initial level of nasal airway obstruction. Afflicted patients have learned to use splints or tapes to keep their nostrils open while sleeping. In fact, they often demonstrate improved breathing by just manually pulling away their nostrils. This deformity is often caused by the collapse or the constriction of the external nasal valve as a result of trauma or previous nasal surgery. It can be corrected in a variety of ways with the use of cartilage grafts such as a “spreader graft”, or a “banttens graft.”

The next level of nasal airway obstruction occurs deeper and at the level of nasal septum and inferior turbinates. The nasal septum is a wall-like structure that divides the two nasal passageways. It is made of cartilage and bone that is covered in nasal mucosal lining. There are many people that are either born with a deviated nasal septum or develop it as a result of trauma or surgery. The combination of a deviated septum and enlarged inferior turbinates can severely obstruct the nasal airway. The septum can be straightened and the crooked parts removed in a procedure called Septoplasty. It is not uncommon to also harvest part of the nasal septum cartilage during a cosmetic Rhinoplasty to augment parts of the nasal skeleton.

The inferior turbinates are a pair of three levels of turbinates that help to humidify and regulate the flow of air. Either inherent enlargement and/or inflammation can result in significant enlargement of the inferior turbinates, thus blocking the nasal airway. This obstruction is alleviated by reducing the size of the inferior turbinates by a procedure call Turbinectomy. While some surgeons cut down part of the turbinates, others use electric cautery or radiofrequency energy to shrink them. Turbinectomy is a procedure that must be performed with the utmost care by a skilled surgeon who is highly experienced in the procedure, as the over removal of the turbinate can result in “Empty Nose Syndrome” (ENS). Symptoms of ENS include shortness of breath, chest tightness, breathing problems, abnormal heart rate, and the inability to control breathing. These symptoms are difficult to address as the turbinate tissue doesn’t regenerate.
In conjunction with these procedures the maxillary or frontal sinuses can also be assessed and cleaned through sinus endoscopy.Nasal Injury Repair Surgery corrects injuries to nasal bones and the nasal septum when they are fractured or disrupted. The timing of this surgery is crucial as nasal bone fractures tend to heal quickly. As a rule, nasal Injury Repair Surgery is performed through a “closed” technique where skin incisions are not necessary. In those with very severe nasal skeletal collapse “open Rhinoplasty” will provide better access to the nasal skeleton.
Today, plastic surgeons can also restore “over-operated” areas by harvesting septal or ear cartilage and grafting it into a tiny pocket made inside the nose to correct certain deformities such as that of the bridge such as a “Saddle Nose Deformity”, or that of the tip via Tip Rhinoplasty.

Depending upon the patient’s needs, Tip Rhinoplasty can reduce or increase the size of the nasal tip, narrow the width of the nostrils, or change the angle between the nose and the upper lip. Tip Rhinoplasty can also help correct birth defects.

“Open” vs. “Closed” Rhinoplasty. Which one is better?

A decision that you and your plastic surgeon will have to discuss is whether the “open” or “closed” technique of Rhinoplasty is best for you — closed being the more traditional kind.

Closed Rhinoplasty

In Closed Rhinoplasty an “endo-nasal” incision is made in the nostrils. This incision is not visible and it provides a plastic surgeon great access to most of the structures of the nose for refinement. Closed Rhinoplasty is a more challenging and demanding technique for most plastic surgeons. Those that use this technique are usually more experienced and are skilled to manipulate the internal nasal structures through only an intra-nasal approach, without having to “open the nose.”

One of the major advantages of the Closed Rhinoplasty is that there are no external nasal scars, thus sometimes being called “Scar-Less Rhinoplasty.” Another advantage is that which this approach there is less swelling and faster recovery of the nose.

In my experience, most Rhinoplasties can be performed with this technique with the exception of some patients who need to have extensive work done on the framework of the nose and the tip.

Open Rhinoplasty

In “open” or “external” Rhinoplasty, a small incision is made in the columella, the central column that separates the nostrils. This is also known as a “trans-columellar” incision. The skin of the columella is very thin and the plastic surgeon makes a very short incision, which should be practically invisible following healing. It is through this incision that the nasal skin is lifted off the tip of the nose. It’s this one extra incision at the nose’s base that separates it from “closed” Rhinoplasty. Other incisions are hidden up inside the nose.

The advantage of this approach is that it gives the greatest visibility and access to the structures of the nasal tip. Therefore, in cases where there is need for extensive reshaping of the nasal tip, this might be a preferred approach.
The disadvantage of Open Rhinoplasty is the scar over the columella and the longer time that it takes for the swelling of the nasal tip to subside.

Is The Nose Packed After a Rhinoplasty?

A typical cosmetic Rhinoplasty does not require nasal packing and patients are able to breath through their nose immediately. Despite this, there is going to be some drainage of blood and mucus from the nose that can obstruct the nose if not cleaned routinely.

With a Functional Rhinoplasty that involves a Septoplasty and Turbinectomy, the nose is packed with a soft moist sponge which is similar to a tampon. This packing is basically the bandage for the surgery that is performed for the internal nasal structure. It prevents formation of scars and adhesions between different nasal structures, and lessens the chance of bleeding. I usually instruct my patients to remove this packing in one and a half days after surgery and to start cleaning and irrigating their nasal passageway then.

Dr. Younai is a Board Certified Plastic & Reconstructive Surgeon with experience in all aspects of Facial Cosmetic Surgery including that of the Nose, Sinuses, Eyes, Ears, Chin, Cheek, etc. He is skilled and experienced in all techniques of Rhinoplasty and Sinus Surgery, and strives to create the nose that is natural looking and harmonious with the rest of your face. During your consultation he will discuss all details including: if you are a good candidate, surgical options and techniques, potential risks and complications of surgery, pre- and post-operative instructions, recovery course, as well as what to expect after surgery. At that time Dr. Younai will also show you before-and-after pictures of other patients with Rhinoplasty and Facial Cosmetic Surgery, who might be similar to you.




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