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Nasal Surgery (Rhinoplasty)


The goal of cosmetic nasal surgery, or rhinoplasty, is to reshape your nose so that it complements and even enhances your other facial features and overall facial balance. Perhaps more than any other cosmetic procedure, there is a wide variation in how patients view their nose in relation to the rest of their features and in their personal concept of how they would like their nose to look. Some patients want to maintain their basic ethnic identity or family appearance; some want to change it significantly. Some have a reasonable and realistic concept of facial balance and what is surgically possible and appropriate for their face; some do not. Even more so than most other cosmetic procedures, rhinoplasty appears to be particularly emotionally “charged”. Dr. Gold takes great care to understand your concerns and desires, your perception of your nose and the changes you envision, before recommending those changes that he feels would be best, and will then fully discuss all of your surgical options and the procedure in detail. Once you both agree on those changes, he always strives to produce the most natural and “balanced” aesthetic result possible.

Dr. Gold usually performs rhinoplasty through a “closed” rhinoplasty approach with all incisions placed within the nose, particularly in primary procedures in which the supportive bone and cartilage of the nose are to be reduced and the nose made smaller. Surprisingly, sometimes portions of the nose must be built up or augmented and better supported to produce the definition and contour improvement desired. This is particularly true in patients with thick nasal skin and/or weak cartilage support, especially with a “drooping” or flattened nasal tip.

In such cases, and in the revision of the sometimes seen unsatisfactory results of a rhinoplasty performed elsewhere in which the degree of scarring or of remaining cartilage symmetry and support is uncertain, a small incision is made across the columella, the bridge of skin separating the nostrils, and an “open” rhinoplasty approach is utilized. Directly visualizing the abnormal or surgically altered tissues often allows a more precise and controllable reconstruction and tailoring and insertion of the necessary grafts.

Although patients often focus on the desired alteration of one or two particular aspects of their nose, they may not appreciate that it is often necessary to address and possibly alter all aspects of the nose to keep things in proportion. Rhinoplasty often requires modification of the tip of the nose, the nasal septum, the nasal profile, and the nasal bones in order to produce the desired result. Also, if the width of the nostrils needs to be reduced, small wedges of skin may be removed though incisions placed within the nostril crease and extending into the nose. All of those external nasal incisions should fade well and ultimately be barely visible.

Additionally, if you have difficulty breathing through your nose because of irregularity or deformity of your nasal septum or other intranasal structures, correction of those deformities can be performed at the same time as the alterations to the external appearance of your nose. Most insurance companies will usually provide some degree of coverage for that functionally necessary reconstructive portion of the procedure.