Are You a Good Candidate for Rhinoplasty?

Dr. Dibelius partners with RealSelf to discuss what makes a good rhinoplasty candidate. 

Read The Interview Below

Gregory Dibelius  0:00 

Hi, I’m Dr. Gregory Dibelius, a board-certified and real self-verified facial plastic surgeon in New York. This is how to tell if you’re an ideal candidate for Rhinoplasty.

Gregory Dibelius  0:14 

We’ll be looking at videos of real people who are looking to have rhinoplasty or revision rhinoplasty, and we’ll see if they can achieve ideal results. Finally, we’ll share what you need to know if you’re interested in having any of these procedures. Let’s get started. So, rhinoplasty is just a term that means reshaping the nose for some purpose. Frequently that’s either aesthetic purposes or functional, which is basically nasal breathing. A typical primary rhinoplasty patient is somebody who has sort of thought about the appearance of their nose for a while, and there’s just a few issues they don’t really enjoy about it, they’d like to make a change to it. A typical functional primary rhinoplasty patient has a breathing issue, either a deviated septum or sometimes, something more complicated like with the nasal valves, the tip of the nose, or that kind of thing. So, revision rhinoplasty refers to any sort of secondary procedure. So, a patient has had a primary rhinoplasty performed in the past for some reason, and something is off with it. Either they’re having a breathing problem, they’re having an aesthetic issue, so it needs to be revised. Revision rhinoplasty can sometimes refer to secondary, tertiary, quaternary, or even more iterations of the surgery. So generally, revision rhinoplasty embodies sort of a much more complex set of surgical techniques and issues that need to be corrected.

Asia  1:37 

Hi, my name is Asia, and I’m 25 years old from New York City. And I’m interested in getting a rhinoplasty. I’m interested in getting a rhinoplasty because I’m currently unhappy with the width of my nostrils. I have rather wide nostrils, and I feel like it draws a lot of attention to this part of my face, specifically, rather than my smile. I feel like a lot of times people are just focused on my nose. I would like to reduce the size of my bridge as well as my nostrils. I do really love my side profile. I love that it’s so slim, and it kind of comes straight down to a point. The only concerns that I have would be whether or not the procedure can be done going through the nose, rather than on the outside. I do worry about scarring a little bit. Because my nostrils would be reduced, I do have some concerns about breathing. I have wider nostrils now, so I imagine I’d taken a lot of oxygen. And so, I just wonder if the quality of my breathing would be affected by this procedure. I’m really looking forward to hearing back from the surgeon to see if I’m a good candidate for this procedure. And I can’t wait to see if I am a go for this.

Gregory Dibelius  2:50 

Asia has concerns about her nostrils and the width of her nose. Asia mentioned if this could be done in a closed approach. So, one of the big sort of divides in rhinoplasty surgery is the open versus closed approach. Open approach essentially means, to me, that there’s an incision on the bottom of the nose, it’s usually just a few millimeters wide across this area known as the columella. And then, closed rhinoplasty, all the incisions are inside the nose, and therefore, they’re not visible to the patient really ever. The Alarplasty or Alar base reduction, this is pretty commonly done to narrow the nostrils. This is performed sort of on the margins where it intersects with the face. In order to do that, you need a scar on the actual outside of the nose. And it will be visible, although we have techniques to make it less visible or hidden. But that’s one of the tried and true ways to get that nostril to be narrower. In terms of scarring on the nose, I essentially think that one of the most helpful techniques is a little bit of SPF on the scar, usually you have to wait a few weeks to apply this safely to the wound. However, one of the factors that makes scars visible is just pigment changes from sun exposure. So, if you can really sort of regulate that with postoperative SPF, that’s probably the most helpful thing. Asia is an interesting case because, in her situation, she’s looking for sort of a reduction of the width on the front view, but she really does like to preserve the side profile. There are techniques that could do it, and I think what’s really helpful in this case is sort of looking at computer imaging, seeing if there is a role for some augmentation to the bridge to help ease the transition. If we bring the tip out to get definition, we might need to augment the bridge to make that a smooth profile. A lot of people will come in talking about narrowing the nose, but one important factor to discuss is the skin thickness. So, there’s a natural limitation to how much the nose can be changed, or, at least, how much can be changed that’s actually visible depending on the skin thickness. That’s a really important conversation because not every nose that’s on a different person can be just simply cut and paste onto every patient. That’s why doing photography, computer imaging, and all these other visual tools are so critical to my consultation process. Asia is also concerned about the function of the nose. The breathing of her nose is adequate right now, she likes the amount of oxygen she’s getting in and she would not want that changed. So, correctly done, Alar reduction should not affect your breathing. However, in some circumstances where somebody does a very, very aggressive change in the nostrils, it’s a really difficult situation because, if the breathing is affected, it’s very, very hard to correct that. However, these days, most people are looking for really natural changes, not a sort of unnatural appearing amount of Alar reduction, and in that case, by and large, there is not usually an effect on the breathing.

Kitty  5:51 

Hi, I’m Kitty. I’m 27 and I live in Queens, New York. I had my primary rhinoplasty about six years ago, and I got a hump reduction and a tip lift. I really like my nose job, but I’m wondering if my nose could ever be perfectly straight. I don’t think it got quite perfectly straight the first time. So, I would need a second opinion on that. And I’m also wondering if the surgeon would need to perform a frenectomy; cutting this muscle right here because, the first time I had the surgery, I couldn’t smile for about three months after. So, I’m wondering if I’m a good candidate for revision rhino.

Gregory Dibelius  6:34 

Kitty appears to be a fairly typical revision rhinoplasty patient. She had a hump reduction and a tip lift with her primary rhinoplasty surgeon, but she feels that her nose did not get as straight as she would have wanted it. I would tell Kitty that straightening the nose is definitely possible. Problems with straightness after primary surgery are relatively common. To some extent, it has to do with this idea of cartilage memory. So sometimes, the cartilage started out curved, and a surgeon attempts to correct it, however, the cartilage has this memory, it just wants to go back to where it was. And that’s a sort of a force we’re always fighting. I still believe that straightness can usually be improved with the right techniques, but sometimes, making it perfectly straight is not really the goal. In fact, there’s a lot of natural facial asymmetry which is attractive, in fact, and we want to work within the confines of the face. So perfect straightness may actually not be the goal for the better. Rhinoplasties, in general, have a sort of, I’d say, medium revision rate. I think the rate is going down. It’s part of the evolution of rhinoplasty, we’re looking for more natural changes. Surgeons are being educated in more natural techniques, and because of that, the rates are going down. However, revision rhinoplasty is a known type of procedure. And there are still a lot of older techniques or less-than-ideal outcomes out there that need to be revised. When a patient comes in that’s unhappy with a prior rhinoplasty, usually, the first question is, “How long ago did you have this surgery performed?” I get a lot of phone calls from people who are six weeks out from primary rhinoplasty, for example. I’ve seen so many times with swelling in the various healing forces, it does take a long time to get the final result. And in many cases, it actually heals to a very nice final product. Kitty refers to issues with smiling after the first rhinoplasty, and, to some extent, that’s normal. There is a junction between the upper lip muscles, and some of the techniques that we do particularly right in the middle in the columella of the nose, sometimes patients have issues with the nose moving a lot, with smiling, etc, or sometimes they develop a little crease after rhinoplasty in that upper lip area. Those are things we can address, but what I always tell patients is we really don’t want to change the muscles of your face too much, in the end, it helps you smile, they’re important. So, there may be a small role for little changes there, but I think a really really careful thorough physical examination would be critical to determining what that would be.

Ronni  9:19 

Hi, my name is Ronni and I’m 60 years old. And I live in Boiling Springs Lake, North Carolina. I have always wanted to have a nose job in rhinoplasty really since I was definitely 16. I always noticed that I had a larger nose than most, and now, at 60, I’ve really noticed that, to me, it’s much bigger, and I’ve noticed that my nose has dropped. So, what I really would want for a nose job in rhinoplasty is just to be a little thinner. The tip to be a little thinner, but it also to be more natural. My questions would be what could you do for me, and how natural would it be? And what is the downtime in the pain? This area is very, very tender, and am I a good candidate?

Gregory Dibelius  10:09 

So, there are a lot of changes related to aging that occur in the nose as in the rest of the face. The ones Ronni describes are typical, especially the nasal drooping. I’ve seen cases in which this has had an effect on nasal breathing as well. So, I think Ronni is a great candidate for nasal hump reduction, for some gentle tip narrowing, and supportive natural tip elevation. The one issue we’d have to look out in person is the skin thickness. So, the skin thickness is important. Thin skin can be actually the most challenging thing, and sometimes, with aging, the skin does thin out. The issue with it is that it allows tiny little bumps, tiny little imperfections, including even just a stitch, which is a one-millimeter structure, sometimes they can stick out. It doesn’t mean we can’t do the surgery, but it just means we have to discuss the very specific issues with thin skin beforehand. Ronni is concerned about the pain factor. So, I typically think of rhinoplasty as a low to medium-pain-level surgery. There are some different things that contribute. So, for example, if we break the bones in the nose, that can give you a different pain profile afterwards than if you just do the soft tissue. And obviously, there are sort of very wide variations and pain thresholds between patients. But, on average, it’s low to medium I would say. So usually, after a rhinoplasty surgery, there’s some form of splints, casts, bandages, etc. These are a little variable and I use them to support the nose after surgery or specific areas of the nose. But, in general, I’d remove everything around the one-week mark unless there’s something more specific I’m looking to do with the bandages. One of the things I recommend for sort of the aftercare — patients are always worried about the swelling, and there are things you can do to manage it even though it will go down over time. So, for example, one of them is to reduce the salt intake in food and drink, that will help reduce swelling. Keep it down, especially if you have some sort of event or something, just make sure you keep the salt down. Other things are physical activity, the temperature, the heat will always sort of increase swelling. So, we advise patients to be mindful of these things to help get to their preferred result faster. I think one of the most important things, when you’re considering a rhinoplasty or revision rhinoplasty, is having a good consultation. Coming in, meeting the surgeon in person, going over all the questions that you have, doing a state of the art photography with computer imaging, lots of follow-up questions, that kind of thing. Choosing the surgeon is the most important part of the rhinoplasty journey, so that’s why I make my consultations very, very detailed. I give them plenty of time, usually an hour or so, just to get all that done and have the patients feel very comfortable and educated when they leave my office. Are you interested in rhinoplasty or revision rhinoplasty? Find out all you need to know about these procedures and if you are a candidate for rhinoplasty on realself.com.

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