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Rhinoplasty probably requires more “artistic interpretation” than any other procedure on the face. Simply stated, no two noses are alike since it is the most unique individual feature that one has. With training in ear, nose, and throat (Otorhinolaryngology), Dr. Liu has an unparalleled appreciation of the anatomy both inside and outside the nose. He is most aware that the nose not only serves as a central feature on the face, but it also performs an important function – to breathe well! Not many people would want the perfect looking nose but not be able to breathe well.
Many people seek different changes in their nose. Some examples of why people desire rhinoplasty include the following: making a nose smaller, removing a bump on the nose, straightening the nose, narrowing the base and sides of the nose, improving nasal breathing, refining the tip of the nose, decreasing the droopiness of the tip, and building up the bridge of the nose (common in Asian patients). The evaluation of the nose is the most critical step and the actual surgical techniques follow. Digital imaging has been an invaluable tool specifically in nasal surgery in determining what looks good and what the patient wants.
What does open approach versus closed approach mean
This refers to the surgical approach used to expose the underlying nasal structures for surgery. A closed approach uses incisions that are entirely inside the nose. The open approach requires a very small concealed incision under the nose in between the nostrils. One method is not necessarily "superior" to the other. Every surgeon has his or her particular method – what is important is the result. Dr. Liu performs most of his nasal surgeries through the open approach. He has found that the incision heals so well it is not a factor. Especially in revision surgeries, it often yields better exposure as well. This topic has been an eternal debate throughout the history of rhinoplasty. The bottom line – the surgeon should perform the procedure that he/she is most comfortable with. There may be more than one way to achieve an excellent result.
What is the expected post-operative recovery phase for rhinoplasty?
After rhinoplasty, one typically has minor swelling and bruising around the eyes which lasts approximately 1-2 weeks. Bruising occurs because often to create a narrower straight dorsum (the bridge of the nose) the nasal bones must be reset. Small dressings are placed inside the nose and removed in the office the following day. Some people may have heard horror stories from friends who had nasal packing. In Dr. Liu's experience, this has not proven to be much of an issue. After surgery, a hard splint or cast is placed over the nose. The dressing and splint are removed on day 5 as well as any skin stitches if needed. There may be dissolvable stitches inside the nose that are left alone. Sometimes, the nose will be taped again for another 5 days which helps to reduce swelling and allows the nose to heal in the proper shape.
As a general rule, at one month, roughly 30% of the swelling will be gone. At 3 months, 90% of the swelling will be gone. The last 10% may take even up to one year or longer. For revision surgery, these rough timelines may be doubled.
What is a graft?
A graft refers to placing a material (whether from one's own body or a man-made substance) into a part of the body. Cartilage from one’s own body is the most used material for nasal surgery. There are several sources – the nasal septum, ear cartilage, or even rib cartilage. Typically the nasal septal cartilage is used first unless there has been previous surgery and most of it has already been removed. Various synthetic materials exist that make excellent grafts. These are especially useful in revision surgery where most of the nasal septum has already been removed. The various materials that are available go beyond the scope of this information.
For additional information on this procedure from the American Academy of Facial Plastic & Reconstructive Surgery, go to: http://www.aafprs.org/patient/procedures/rhinoplasty.html