Dr. Ruslan Zhuravsky

Board Certified

Facial Plastic Surgeon

SERVING Marlboro, Manalapan, Freehold, Colts Neck, Howell, Jackson, Old Bridge, and the surrounding NJ Areas

NOW ALSO SERVING: Hoboken and surrounding Northern NJ areas 

Z Facial Plastic Surgery

The Casino 9 Building

1001 Route 9

STE 107

Howell, NJ 07731

RHINOPLASTY

 

 

 

  Rhinoplasty, or as it is commonly referred to as a "Nose Job", is one of the most fascinating, intricate, and complex surgeries in plastic surgery. The nose is not only the central aesthetic feature of the face, but it is also a functional organ that controls our breathing. The cosmetic and functional aspects are inseparable, and must be thoroughly considered in EVERY case. 

    Below, you will find a section on frequently asked questions and misconceptions regarding rhinoplasty, the nasal septum, the sinuses, and more, but first here is a little foundation knowledge that may help you under rhinoplasty. 

NASAL STRUCTURE:

     The external nose as we see it on each other, is made up of bone, cartilage, and the overlying skin. 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. As you move down, the lower 2/3 of the nose starts to feel softer and malleable as this part is made completely from flexible cartilage. More specifically, this section is made from 4 essential pieces of cartilage that support the overlying skin and determine the shape of the nose, as well as play an important part in nasal function. These cartilages are all supported in the center by one of the most important nasal structures; the nasal septum. 

    To help understand this shape and the septum, image that the nose is a tent, with the skin acting as a blanket laying on top of the cartilages, which are the frame work supporting the tent. 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, and supports the cartilages in the middle. Just like a tent, if the septum was removed, the cartilages (and overlying skin) would collapse in at the center.

    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. 

    Although this is a simplified explanation of nasal structure, it does explain the very basic foundation of the nasal shape, and I hope it helps you understand the nose a little better. The complex issues are due to the fact that there is a very wide variety of shapes and sizes of the nasal bones and cartilages. The cartilages themselves even have subsections, and small changes in the shape, orientation, thickness, and strength of each subsection yields a different nasal shape. The septum and the nasal bones also differ in their shape, size, and orientation, leading primarily to effects on the nasal profile (the bridge) and straightness.  

NASAL AESTHETICS:

    As mentioned, the nose is the central part of facial aesthetics. One should not look only at the nose itself in an isolated view, but also how it relates to all other facial features and proportions. Even someone's height should be considered during rhinoplasty. 

    When we discuss overall facial aesthetics, the gold standard is to divide the face into 3 equal sections horizontally, and 5 equal sections vertically. For ideal aesthetics, the features in each of theses sections should line up proportionally to each other. The nose is in the central section both vertically and horizontally, thus it is a critical part and can have a major effect on one's entire facial appearance. This is also one reason why the same nose can look great on one individual, and not another. Thus it is not so much a matter of creating an ideal nose, rather, it is about creating the right nose for each individual. 

    Multiple studies have been done over the decades to determine "ideal" nasal aesthetics. The results are a set of ranges for size proportions and angles that help us identify pleasing nasal characteristics. The key is that these are ranges. 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. 

    When we evaluate nasal aesthetics, we look at these many different features from several different view points, then determine how they relate to each other 3-dimensionally. We then try to determine what aspects, or combination of aspects of the cartilages, bones, and nasal skin make up those particular features, and how we can alter them. There is a lot of medical and artistic consideration that goes into a rhinoplasty, but the good news is that you personally do not have to worry about these decisions, as they are concerns for your rhinoplasty surgeon. However, I find that patients are better able to explain their concerns and desires to the surgeon when they are aware of this process. 

   This leads into the next point and perhaps the one at the very center of the rhinoplasty consultation; communication between the surgeon and the patient is CRITICAL. Most patient seeking a rhinoplasty already know at least some of the nasal features that they would like altered, and the type of nose they desire. The goal is for the surgeon to clearly understand their patients' goals, as every patient has their own desires. Some patients want a perfect "cookie cutter nose", some want only specific aspects changed, and others want only certain aspects altered in minor ways. So again, clear communication between the surgeon and patient is highly important. I find that computer morphing software has been of great value in this area. It allows the surgeon to show patients the possible outcomes visually, and for patients to relay their desires back to the surgeon. 

    Some patients do not know exactly what they want changed, but know that they are not happy with the appearance of their nose. That is ok. Rhinoplasty surgeons can help guide patients based on the previously mentioned ideals to help them realize their concerns and find an outcome that will make them happy. HOWEVER, a good rhinoplasty surgeon will also give patients realistic expectations, and advise them when rhinoplasty may not be the right option. A notable situation of when rhinoplasty is not the right choice is someone who does not know what they want, and not sure what final nasal appearance will make them happy. In these cases, it may not be the nasal appearance that is responsible for the desire for surgery. 

NASAL FUNCTION:

   The cartilages that have been discussed not only determine the shape of the nose, but they also support the nasal airway and so are very important to nasal function. Nasal breathing is the more efficient and easier way to breath. Just think of how much more difficult it is to do anything with your nose clogged. When we breath in through our noses, the sucking force that pulls the air back also pulls inward on the nose. Inhale hard and fast through your nose and you will see it pulled inward. In some cases, the structure is not strong enough to support this force and the amount of collapse prevents air from easily passing through. In other cases, the structure and shape of the nose result in a narrowing that is present even without inhaling. The 2 areas where this can occur as called the external and internal nasal valves. 

    The septum is also very important to nasal function. Septal deviation means that the septum (the wall down the middle of the nose) is not ideally straight. Most people have some degree of deviation, but it is not a problem unless the amount of deviation obstructs breathing. 

THE SURGERY:

    Rhinoplasty is performed by facial plastic surgeons, and general plastic surgeons with extensive experience in rhinoplasty. It is a surgery that has dramatically evolved over the decades and certain aspects continue to be a topic of debate at specialty meetings.  

    Rhinoplasty is typically and traditionally performed under general anesthesia, meaning the patient is asleep the entire time. HOWEVER, it is possible to perform at least a limited rhinoplasty with the patient mildly sedated in a specialized office setting. This is similar to the way some facelifts and blepharoplasties (eyelid surgery) are performed, although it is much less common for rhinoplasty. 

AFTER THE SURGERY

    After the surgery is complete, a splint is placed ON the nose for 1 week to protect is and to limit swelling. I personally DO NOT place packing or splints INSIDE the nose in most cases. This significantly reduces the amount of discomfort and improves the patients ability to breath nasal 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 many patients having none to mild bruising, while some can persist for 5 - 10 days. During the first week, it is normal to get small amounts of bleeding from the nose. 

    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. 

    

 

FREQUENTLY ASKED QUESTIONS (FAQs)

  • WHAT IS THE DIFFERENCE BETWEEN RHINOPLASTY AND SEPTOPLASTY?

    • A rhinoplasty (nose job) refers to changing the external shape of the nose. This involves altering the nasal cartilages and bones, and is done mostly for cosmetic reasons. A septoplasty primarily refers to addressing the nasal septum INSIDE the nose, without touching the nasal benies and cartilages, and is performed primarily for functional reasons to improve breathing. This does not result in external changes, "breaking nasal bones bones", bruising, or swelling 

    • HOWEVER, sometimes a Rhinoplasty must be performed for functional reasons. This is done when the external nasal shape results in obstruction of breathing (as described above in NASAL FUNCTION). 

    • When performing a rhinoplasty, it is often neccesary to also perform a septoplasty as the shape of the septum plays an important role in nasal shape. These are parts of the septum that often affect shape but not necessarily function. The septum is also a great source for cartilage that we often use to achieve a desired result with rhinoplasty.   

  • WHAT CAN I EXPECT FROM A RHINOPLASTY CONSULTATION?​

    • Your surgeon should evaluate your nose aesthetically and functionally, inside and out. They will then discuss your goals for surgery, asking questions to understand which aspects you would like changed, what degree of change you hope to accomplish, and the type of nose that would make you happy. The surgeon will take pictures from at least 6 different angles. I personally use these photos with computer morphing software to further communicate the desired changes and assure that I clearly understand my patients' goals, and that they have realistic expectations. 

  • HOW MUCH TIME DO I NEED FOR RECOVERY AFTER RHINOPLASTY?​

    • The short answer is 7 - 14 days. ​

    • The long answer is it depends on the extent of surgery, your personal recovery, and what you intend on doing. I discuss each patients personal postop plans with them prior to surgery.  

    • During the first week patients experience a general fatigue, headache, nasal congestion, and have a runny nose with occasional blood tinge. That combined with a splint on the nose, some swelling under the eyes, and possibly some bruising makes going back to any line of work unfavorable. However, you are not limited to strict bed rest so it is ok to work from home and take it easy in general. On caveat is it may be difficult to stare at a computer screen for prolonged consecutive periods of time. Also, most patients find it more difficult to focus the first few days as the anesthesia wears off, or if they require pain medication beyond tylenol. Do NOT drive if taking pain medication. 

    • After the splint comes off (1 week) you can resume activities that do not involve heavy lifting or physical exertion. Avoid returning to work for another week if your job is of a physical nature.  

    • For most individuals, plan on taking 7 - 10 days off work/ school.

    • You may start exercise in the form of brisk walking or mild-moderate stationary bike after 10/14 days, but avoid any lifting or higher intensity exercises until approximately 3-4 weeks. 

    • Avoid activities / sports that are high risk for nasal injury for at least 6 weeks. (Examples: cheerleading, soccer, basketball, baseball, wrestling, football, diving etc )

  • WHEN WILL MY NOSE LOOK GOOD? WHEN WILL I HAVE MY FINAL RESULT?​

    • For those with a significant degree of change, the nose will have an improved appearance when the splint comes off, and many are immediately happy a this point. HOWEVER, there is still a significant amount of swelling and the nose may even swell a slight bit more after the splint is removed. This will be dramatically less at week 2 and week 3.

    • Most people are very satisfied with their results and ready to show off their new nose at approximately 3 - 4 weeks, but the dramatic improvements continue on a weekly basis for the first 6-8 weeks. 

    • The nose continues to change and refine, with noticeable changes every few months for an entire year after surgery. This can be even up to 2 years for those with thicker skin. 

  • WHAT IS A LIQUID RHINOPLASTY?

    • This refers to using injectable filler material to alter the shape of the nose.​ 

    • There is a limit as to what can be accomplish with this method as it can only ADD volume under the nasal skin. Thus a nasal hump cannot be taken down, but it can be disguised by placing filler around it and elevating the surrounding structures. The nasal tip can be refined, but will also be projected more. 

    • Only specific nasal characteristics are amenable to this method and must be evaluated by carefully. 

    • It is a temporary fix, as filler material degrades.

If you have any additional questions, please feel free to contact Dr. Z. 

For more personalized answers and a complimentary rhinoplasty consultation:

 

CALL: 732 - 851 - 1232

or, EMAIL: DrZ@DrZface.com