Northern Virginia – Fairfax and Manassas
By: George Bitar, M.D. and Larry Lickstein, M.D.
Board Certified Plastic Surgeons
“I don’t want a Michael Jackson nose,” we hear that frequently from our rhinoplasty patients. Not to worry, our goal has always been to keep the nose looking natural and keeping the patient’s character, while making it look better. There are few perfect noses in this world. Since the “hey day” of the Greeks many criteria have been proposed to guide us towards the ideal dimensions of the aesthetically-pleasing nose, given that it is the centerpiece of the face. As our society becomes more ethnically diverse, so do the noses that a plastic surgeon has to address.
You may seek a rhinoplasty for a variety of reasons. Sometimes the reason is self-consciousness about your noses appearance, and the belief that it makes you less attractive. Other times, it is for functional reasons – for example, difficulties breathing due to a deviated septum – but perhaps you will opt for “a little touch up of the tip” while you are under anesthesia.
Whatever your reasons may be, a rhinoplasty on a patient who is realistic about his or her reasons and expectations will yield tremendous satisfaction, as long as they remember that a rhinoplasty offers improvement, not perfection.
Preparing for Surgery
An initial consultation is set-up where we discuss the rhinoplasty procedure and whether you are a good candidate for the surgery. A thorough discussion about why you want a rhinoplasty, and what you hope to accomplish, is very important.
In the consultation you will be asked what bothers you about your nose, dividing it into top middle and lower thirds. It is important to provide as much information as possible about what you would like your nose to ideally look like. We will address, together, what bothers you about the bridge, the tip, the nostrils, and the width of your nose, as well as if you have breathing problems, and their causes. We will devise a plan together and make sure that your concerns will be addressed. Unfortunately, a perfect result can never be promised, or guaranteed, in plastic surgery.
Your medical history is reviewed, and you will be asked to see your medical doctor for a physical check-up and a few labs, to make sure you can undergo the surgery safely. You are asked to stop smoking, if you are a smoker, two weeks before and two weeks after surgery, for the surgery to be performed safely, and for you to have optimal results. You are given the opportunity to talk to patients who have had the same surgery that you are considering. We will see you shortly after the surgery (in a day or two usually). You are seen regularly after your surgery. You are always welcome to come back for follow-up, even years after your surgery, free of charge.
The Nose Surgery Procedure
We perform both open and closed rhinoplasties. A closed rhinoplasty is performed where the incisions are hidden inside the nose. An open procedure is performed where an incision is made across the columella, the narrow area of skin that separates the nostrils.
With closed rhinoplasties, there is the avoidance of the scar at the base of the nose (columella), and perhaps quicker healing. In our opinion, this technique has limitations, such as good exposure, creating excellent symmetry with both nostrils, and the ability to shape the nose according to a patient’s desires.
The open rhinoplasty approach offers great exposure and ease of visualization of the entire nose, when the skin is lifted up. Since every nose is different, so is every procedure. However, there are common problems that are fixed in a nasal surgery:
- The bridge of the nose can be either augmented or shaved.
- The width of the nose can be narrowed.
- The nasal tip can be altered in shape and size.
- The angle between the upper lip and the tip of the nose can be increased or decreased.
- The nostrils can be reduced.
- The septum can be straightened.
- Breathing can be improved by doing several maneuvers.
How We Minimize Complications of Nose Surgery:
At the Bitar Cosmetic Surgery Institute, we take pride in making sure we provide for our patients the best surgical experience possible , anticipating problems or set-backs, and addressing them before they happen. This is a process that includes the pre-operative preparation, the actual surgery, and the after care.
General complications can occur with any surgery. Cosmetic surgery is usually a safe surgery performed on healthy patients and, as all surgeries go, is with low risk. What we do to even lower the risk of complications is to operate at a first class hospital with board certified anesthesiologists and nurses. To avoid post-operative complications, we advocate early mobilization –patients seen in our office one or two days after surgery- and active participation in their own post-operative care. When we create a partnership, the results invariably improve.
Bleeding after a rhinoplasty is rare. Before surgery, our patients are tested to make sure they don’t have any common bleeding disorders by their own physicians, and by lab tests. Before the surgery commences, the nose is injected epinephrine to decrease the bleeding during and after surgery. Among our practice, the rate of significant bleeding has been less than 1%. The treatment of a hematoma or a blood clot in the nose is to apply pressure and usually the bleeding will stop.
The most important step in avoiding infections, in our opinion, is to perform the surgery at a first-rate surgical facility with board certified anesthesiologists and nurses. Patients are given the appropriate intravenous antibiotics coverage throughout the surgery. During the surgery, the skin surface of the patient is cleaned properly. After the procedure, our patients are prescribed a one-week course of antibiotics to minimize infection. As a result of these extra precautions, and the fact that the face has great blood supply, we have not seen any significant number of infections in our rhinoplasty patients.
In an open rhinoplasty, the skin is elevated from the underlying cartilages and bones of the nose. The skin may be thin, especially if the operation on the nose is a revision or secondary rhinoplasty. Also, a splint is placed on the nose. Patients are cautioned not to sleep on the pillow face-down, or engage in any activities in which the nose can get hit, because that may cause a wound of the fragile skin covering the nose. In the rare occurrence that a wound may occur on the nose, usually it heals very nicely on its own. Very rarely, we will do a scar revision to improve the appearance of that scar.
By having a rhinoplasty, some of the nerves that provide sensation to the nose may be cut and so the sensation of the nose, in particularly the tip, may be altered for several months. This is very common, and usually not a source of patient complaints because it does not interfere with the function of the nose.
Smoking is an absolute contraindication in rhinoplasty. The carbon monoxide and nicotine in cigarette smoke causes severe reduction in blood supply to the skin and breast tissue during healing. This results in delayed wound healing, wound separation, death of the skin, and a higher risk of infection. Cotinine testing is performed in patients with a smoking history to ensure that they are safe when having this procedure.
Our office will provide you with a detailed post-operative instruction sheet that will be individualized to your needs. We usually see patients the day after surgery in one of our offices to make sure that everything is O.K., and that you are healing as planned. Multiple visits in the year after the procedure will ensure the best outcome possible.
For more information about this procedure call our office and speak to our friendly staff member at 703-206-0506.
Information on this web site is for information only. Do not use the information to diagnose or treat your plastic surgery or cosmetic surgery problems. Please contact your plastic surgeon with all questions and concerns.