Rhinoplasty Conveniently located to serve New Jersey and Howell

At our practice in New Jersey, Rhinoplasty is one of the most frequently performed procedures. It is one of the more fascinating, intricate, and exciting surgeries in all of plastic surgery. Dr. Z’s expertise ensures that he can offer the best rhinoplasty New Jersey has to offer. As a nose surgery specialist, it’s become his favorite procedure to perform and the results for his patients are very rewarding.

Rhinoplasty can sound very intimidating, but it really should not be so for the patient. The information below is designed to help explain the fundamentals of rhinoplasty in a simple, yet thorough and honest way.

As Dr. Z’s location is in Central Jersey, he performs rhinoplasties on patients from all over the state, including but not limited to Marlboro, Manalapan, Freehold, Colts Neck, Howell, Middletown, and Old Bridge.

WHAT IS RHINOPLASTY

Rhinoplasty is a general term that refers to changing the shape and size of one’s nose. It is often referred to as a “Nose Job”. Although the nasal septum is often involved in a rhinoplasty, it is not the same a septoplasty. This is described in a section below.

Rhinoplasty can be done surgically, or in some cases non-surgically. It can be done through an open approach, or through a closed approach. It is often performed for cosmetic reasons to improve the appearance of the nose itself, as well as to enhance overall facial aesthetics. However, it can also be associated with functional issues, allowing patients to improve their ability to breath. The most important factor is to achieve the desired appearance and function. We explain these differences and more in the sections below.

FUNCTIONAL RHINOPLASTY

In some cases, the external shape of the nose is also responsible for breathing problems, thus a rhinoplasty must be performed for functional reasons. The approach is the same and some of the techniques overlap as we look to fortify and support the nasal structure. In many cases, the functional improvements lead to some improvement in the appearance, and for those that desire, the cosmetic portion can be done at the same time.

WHAT ARE THE 3 BIGGEST FEARS THAT PATIENTS HAVE REGARDING RHINOPLASTY

By far the 3 most common concerns are surgical pain, anesthesia, and botched results.

PAIN

Most patients are very pleasantly surprised to find out that the pain is much less than they had anticipated. Dr.Z’s patients will often describe a low moderate pain. The majority of patients take sparing doses of the provided pain medication during the first 3-4 days, and some take only Tylenol. In the end, when asked in retrospect, ALL patients say that their level of pain is not something that would prevent them from doing the surgery if they could go back in time.

ANESTHESIA

Thanks to modern-day medicine, anesthesia has come a long way since its inception and is generally regarded to be very safe. For those that still would like to avoid anesthesia, Dr. Z is able to offer awake rhinoplasty for most patients, where the patient remains awake but the nose is completely numb during the surgery.

BOTCHED RESULTS

Botched and poor results can mean a few things. It can mean that the nose looks even worse than it did before, that the result is not what the patient anticipated, that the nasal function has been compromised, or all of the above. Choosing a surgeon with particular expertise in rhinoplasty is very important to help prevent this. With properly planned and executed surgery the nose should not only look better, but also improve in function. Dr. Z strives for natural-look results in New Jersey Rhinoplasty patients while placing patient safety and comfort as a top priority.

REVISION RHINOPLASTY

Patients who have undergone a botched rhinoplasty or are unhappy with the results from one or more nose job surgeries might consider Revision Rhinoplasty. Dr. Z specializes in Rhinoplasty and has expertise and experience in the field of Facial Plastic surgery in New New Jersey to help you achieve your beauty goals.

WHAT HAPPENS DURING A RHINOPLASTY APPOINTMENT / EVALUATION?

The initial consultation is often very exciting and much more relaxed than patients anticipate. This is when you get to discuss all your concerns, ask any questions, review computer morphed images and decide if the surgeon is a good fit for you.

Dr. Z is known by his patients as the best rhinoplasty New Jersey surgeon. He enjoys discussing Rhinoplasty with his patients and no one is ever pushed into surgery. In fact, if patients have any hesitations, Dr. Z encourages them to take some time to digest the information, discuss it with their friends and family, then come back for another visit.

Patients come in to our relaxed environment and meet directly with Dr. Z. Some patients have trouble expressing their concerns, and so Dr. Z will help guide the conversation to understand exactly what would make the patient happy. Once the patient feels they have adequately described their concerns, Dr. Z examines the nose visually from several angles, looks inside the nostrils, and palpates (touch) the nose to better understand the actual structure of the nose that is responsible for its appearance. Photographs are taken and uploaded into computer morphing software, which allow patients to see the potential changes to the nose, as well as facial appearance overall. Based on the conversation, exam, and pictures, Dr. Z gives patients a realistic expectation of the changes that are both possible and practical.

WHY IS RHINOPLASTY SUCH A GREAT PROCEDURE AND WHY DOES IT HAVE SUCH A BIG IMPACT ON APPEARANCE?

The nose is the centerpiece of the face. Its shapes and contours must not only be attractive independently, but they must also harmonize with the rest of the face. For this reason, changes to nasal shape can have a profound effect one’s overall appearance. This is also the reason that the same nose can appear attractive on one person, yet not another.

FACIAL ANALYSIS

When discussing facial aesthetics and attractiveness, the standard is to divide the face into sections based on certain facial features. These should ideally be equal in size, with 5 vertical sections and 3 horizontal. The nose is responsible for the middle section both vertically and horizontally, thus it’s size has a large influence on facial proportions. When looking at the side profile, we analyze the angles created between the nose and forehead, as well as nose and chin. So again, the nose is central and influences the overall appearance.

NASAL AESTHETICS

Multiple studies have been done over the decades to determine “ideal” nasal aesthetics. The results are a set of ranges for size proportions, contours, light/shadow lines, and angles that help us identify pleasing nasal characteristics. The key is that these are ranges, and the same “cookie cutter” nose will not look good on everyone, nor meet their expectations. As rhinoplasty surgeons, we generally operate within or close to those ranges to achieve a result that will be both aesthetically pleasing and consistent with our patients’ desires.

There is a plethora of features that we, as Rhinoplasty surgeons, look at when we evaluate a nose, and unless

WHY IS RHINOPLASTY SO INTRICATE AND COMPLICATED?

The nose is composed of 2 bones, 4 cartilages, the septum (bone and cartilage), and the skin. Seems simple, but each one of these structures has tremendous variability in shape and strength. They can even be variable between sides on the same patient. This variability is the reason that each rhinoplasty and each patient is unique, and so needs a unique surgical plan.

MORE ON NASAL STRUCTURE

The nasal bones comprise only the upper 1/3 of the nasal structure. These are the bones that people often refer to when they describe having to “break the nose”. You can feel these on yourself as the firm upper part of the nose that begins between the eyes. The lower 2/3 of the nose starts to feel softer and malleable as this part is made completely from flexible cartilage. These 4 cartilages vary in length, width, strength, configuration, and strength. They not only determine the shape of the nose, but also play a big role in function.

To help understand the septum, image that the nose is a tent, with the skin as a blanket and cartilages inside that blanket. The septum in this case is a wall that runs down the middle of this tent, separating it into a right and a left side, supporting the cartilages in the middle.

The skin itself is also very important to nasal structure. The characteristics of ones skin, especially relative to the cartilages, will determine how it drapes over the cartilages. To go back to the tent analogy, imagine using a very thick and heavy material to create a tent. In this case, you would not really be able to see the fine definition of the tent shape, and if the support (cartilages) are not strong enough, the tent may even sag down. Alternatively, if you use a very thin sheet, each and every aspect of the support structure would be seen from the outside.

HOW MUCH IS A RHINOPLASTY IN NEW JERSEY?

As an experienced Rhinoplasty New Jersey specialist, Dr. Z will meet with you in his office to discuss all options and pricing.

COST DEPENDS ON

• The amount and complexity of changes required
• Primary or revision surgery
• Whether or not grafts are required (taking cartilage from the ear or fascia from the scalp)
• Whether it is done awake or under general anesthesia

AWAKE RHINOPLASTY VS. GENERAL ANESTHESIA

While the tradition and by far most common way to perform rhinoplasty is with patients under full general anesthesia, in many cases Dr. Z is also able to perform rhinoplasty with patients awake and WITHOUT ANY SURGICAL PAIN.

MORE ON AWAKE RHINOPLASTY

By applying a specially designed numbing ointment, injecting numbing medication, and giving the patient a medication to curb anxiety and pain, Dr. Z is able to keep his patients happy, relaxed, and free of pain while he performs the rhinoplasty.

WHAT IS THE DIFFERENCE BETWEEN OPEN AND CLOSED RHINOPLASTY?

The open vs. closed approach is a long ongoing debate amongst rhinoplasty surgeons. The open approach requires a small incision underneath the nose, while the closed approach employs techniques that do not require the surgeon to directly see the underlying cartilages.

Dr. Z believes that for most cases the open approach achieves superior results as it allows for better visualization and more precise manipulation of the cartilages. The small incision under the nose heals very well, and has not been an issue for any of Dr. Z’s patients. HOWEVER, there are certain cases that Dr. Z believes can be approached with a closed technique.

WHAT IS NON-SURGICAL RHINOPLASTY (LIQUID RHINOPLASTY)

Non-surgical rhinoplasty (Liquid Rhinoplasty) is performed by injecting filler material underneath the skin, changing the shape of the nose by adding volume into very specific areas.

Although we are adding volume, this technique can make a large nose appear smaller, more narrow, more defined, and even more rotated (turned up). A numbing ointment to eliminate any pain and the results are instant. Liquid rhinoplasty results can last from 9 months to 2 years initially, but with subsequent touch ups they can last for several years.

HOW LONG DOES A RHINOPLASTY TAKE?

Depending on the extent of the rhinoplasty and changes being made it can range from 1 – 4 hours.

CHOOSING THE RIGHT RHINOPLASTY SURGEON FOR YOU

When deciding on a rhinoplasty surgeon it is first important to make sure they are board certified, but that is not enough.

• Has a strong interest in Rhinoplasty, with Rhinoplasty as one of their top procedures
• Understands your aesthetic goals, and shares your aesthetic views
• Understands and respects the functional aspects of the nose
• Choose the surgeon, that is who will be doing the surgery, not their memberships / positions on various boards / affiliations / paid for awards / paid for appearance on various shows etc …
• For BEFORE and AFTER pictures:
  • Make sure the pictures are not all from the side view. The nasal hump reduction can look like an impressive change, but result in unwanted changes on other angles if the surgeon does not take those into account.
  • Make sure all the after pictures do not have the same cookie cutter nose. It may look good on some people, but in many cases, if someone is doing things the exact same way each time, they cannot account for your individual differences, nor accommodate your specific goals.

WHAT IS THE DIFFERENCE BETWEEN RHINOPLASTY AND SEPTOPLASTY? WHAT IS A DEVIATED SEPTUM?

Rhinoplasty refers to changing the external appearance of the nose, while a septoplasty mostly refers to functional changes INSIDE the nose.

As described in the section above on nasal structure, the septum is a wall extending down the middle of the nose, separating the right and left nasal passages. Imagine looking down a hallway with a wall going down the middle. If that wall (the septum) is not straight, and weaves left and right, there will be tight spots on either side of the hallway. That is the meaning of a deviated septum, and is corrected by altering the shape of it INSIDE the nose. HOWEVER, there are parts of the septum that support the external nasal structure, and when these are deviated, they lead to a crooked nose. Such deviations are usually cosmetic in nature, but can have an influence of function as well.

HOW LONG IS THE RECOVERY AFTER A RHINOPLASTY?

The first week after surgery is usually the bulk of the recovery.

This is when patients have a splint on the nose and try to avoid an exertional activity. Those who are not taking any opiod pain medication can work from home as early as 24 to 48 hours after surgery (due to general anesthesia). After the splint is removed on day 7, most patient can return to work as long as they are not at risk of hitting the nose or required to lift and carry heavier items. Patients are to avoid heavy lifting or exercise until 2-3 weeks after surgery, but can start light activities such as jogging. Athletes are asked to either avoid sports for 5-6 weeks, or take extra precautions such limiting to practice only or wearing a face guard.

WHEN WILL MY NOSE LOOK GOOD AFTER RHINOPLASTY?

Most patients appreciate an improvement 1 week after surgery when we take off their splint.

The nose will then continue to change drastically each week for the first 4-6 weeks. Majority of patients are very happy after 3-6 weeks and many even think that they have achieved their final result. However, the nose will continue to change and improve over the next 1 – 2 years, with subtle improvements on a monthly basis.

WHAT TO EXPECT AFTER RHINOPLASTY?

An outside splint is placed on the outside, but for a majority of cases Dr. Z does NOT use

After the surgery is complete, a splint is placed ON the nose for 1 week to protect it and to limit swelling. I personally DO NOT place packing or splints INSIDE the nose in a vast majority of cases. This significantly reduces the amount of discomfort and improves the patient’s ability to breath right after surgery. The amount of pain after the surgery varies by patient, but is typically not as bad as most anticipate. Some patients do well with just tylenol, others need a few days of an added opiod. Either way, it is very tolerable and controllable. There is often some swelling under the eyes that mostly resolves in 4 – 8 days. The infamous under eye bruising is also variable, with most of Dr. Z’s patient having either no bruising, or minimal bruising that resolves in 1 week. During the first week, it is also normal to get small amounts of bleeding from the nose. Patients wear a small piece of gauze under the nose (mustache dressing) to catch any dripping.

When the splint is taken off on approximately the 7th day, there will still be some swelling of the nose, but the general shape can be appreciated. Patients can typically go in public at this point without others knowing they had surgery. The swelling will drastically subside during the first few weeks with a notable difference on a weekly basis for the first 4 – 6 weeks. Although most patients are satisfied either from the moment the splint comes off, or couple weeks after surgery, the healing process continues for an entire year (sometimes more) with minor improvements in refinement and definition



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