Rhinoplasty is a cosmetic surgery procedure for reshaping the nose. Also referred to as a “nose job” or “nasal reshaping surgery”. Rhinoplasty is a very popular procedure that can make profound differences not only in the balance of facial features but also in a person’s self-esteem. Dr. Harounian uses the most advanced surgical techniques to make aesthetic improvements that include decreasing or increasing the size of the nose, changing its overall shape, altering the nose’s tip or bridge, and narrowing or changing the shape of the nostrils. He can remove a bump, change the angle between the nose and the mouth, and correct injuries or other concerns that affect breathing, such as a deviated septum or a sinus condition.
The ability to breathe comfortably can promote a better night’s sleep and is an important part of a healthy lifestyle. Dr. Harounian treats many patients referred by other surgeons with complex breathing issues or when previous surgery has uncovered breathing concerns that patients had not recognized before the procedure. He is well-known for his revision rhinoplasty method, which restores the patients’ ability to breathe and improves the appearance of the nose by rebuilding previously removed cartilage or bone.
The following is a list of some of the conditions for which rhinoplasty may be an appropriate treatment option. Diagrams are provided for reference.
Twisted nose:There are many causes for a crooked nose and diagnosis of the causes is very important. The bones or cartilage of the nose may have grown at different rates, or there may be a history of trauma. Previous surgery may have uncovered a twisted nose or the nose can change shape as it heals. A deviated septum frequently causes changes in the outside shape of the nose. If you nose shape bothers you then a deviated septum repair or nasal bones straightening may help.
The tip is too large or uneven:A bulbous or irregular tip can be corrected by conservative removal of the top edge of the lower lateral cartilage, and by bringing the left and right lower lateral cartilages together.
The nose seems too big:Reduction in the size of the nose can be done by conservative removal of some of the bone and upper and lower cartilages of the nose. The skin and soft tissue of the nose will conform to the new shape quickly.
A hump on the nose:A dorsal hump can be treated by removal of the bone and cartilage that is extending from the bridge of the nose. The nasal bones are then brought together to give a more natural shape to the outside of the nose.
Depressed nasal bridge (“saddle nose” or ski-jump”):If the middle of the nose is flattened, it can be elevated by building it up with nose or ear cartilage or rib grafts.
Wide nostrils:The nostrils can be narrowed by removing small wedges of skin at the nostril base. This is done at the end of surgery and can be done in the office if necessary.
Many surgeries can be performed at the same time as a rhinoplasty. In fact, multiple procedures done together require only one healing period instead of more than one recovery. Cost can also be decreased as the first operative hour is the most expensive, and insurance can help with functional problems of the nose. Common nasal procedures combined with rhinoplasty are listed below.
Deviated Septum Surgery: A septum that is bent may need to be straightened by reshaping or removing the septal cartilage and bone. If the outside of the nose is made smaller, a deviated septum may affect breathing quality. A deviated septum can be straightened during a rhinoplasty procedure. Insurance will generally pay for a septoplasty.
Sinus Surgery: Dr. Harounian can address the causes of recurrent acute sinusitis or chronic sinus infections during a rhinoplasty. Recover is similar with or without sinus surgery. Insurance will generally pay for the functional portion of any surgery.
Revision Rhinoplasty: Even in the best of hands, about ten percent of patients will eventually have something about the nose that they would like changed. The septal cartilage has “memory” and can move after repair or the dorsum may have a residual bump. A revision surgery refers to any subsequent rhinoplasty.
Dr. Harounian individualizes every patient’s care. A minimum of half an hour is needed to fully understand your expectations and to get a complete history and evaluation of the inside and outside of your nose. Knowing what to expect will make the entire experience more pleasant and increase your satisfaction with the surgical results. Dr. Harounian will discuss the cosmetic and functional expectations of your rhinoplasty in detail to make sure all of your questions are answered. We will make sure you understand all the costs associated with a rhinoplasty. Depending on whether you have functional/breathing issues insurance may cover part of your surgery.
Computer Imaging: Reviewing photographs of your nose from several different angles gives you the opportunity to say what you like or dislike about your nose, and what you would like to change. Computer imaging provides an additional step where we can agree on a final goal for the procedure. Computer imaging is not a guarantee of outcome and individual results may vary.
Knowing what to expect will make for a smoother and more enjoyable experience. Dr. Harounian performs the procedure at Lenox Hill Hospital, Midtown Surgery Center or at the Grammercy Surgery Center, both state-of-the-art East Side ambulatory facilities. You will need to arrive – with a chaperone – two hours before your procedure is scheduled to begin. You will speak with the nurse about your medical history and what to expect during the procedure and then change into a surgical gown. Dr. Harounian will discuss your treatment and goals before you receive any medications. You will then receive some medicine to relax you, followed most times by a general anesthetic. Dr. Harounian will come to speak with you again after you have awakened. He will have already spoken to the person taking you home. You will leave the ambulatory center with your chaperone about an hour after surgery. Dr. Harounian places a small plastic splint over the healing nose for protection but rarely finds it necessary to pack the nose. Dr. Harounian’s techniques minimize the recovery period and allow most patients to return to a normal routine the week after surgery.
Dr. Harounian employs both the closed (endonasal) and open (external) surgical techniques to sculpt an attractive and natural-looking nose with minimal incisions and rapid recovery time. When performing a rhinoplasty, Dr. Harounian emphasizes preservation of nasal breathing and structural support. A natural-looking nose is also very important. These concepts are the basis for an excellent long-term outcome.
The week after the procedure it is normal to have a mild headache for a day or two. You will be given some pain medicine, although most patients take only one or two doses and then switch to an over the counter pain medication. If you see scant, reddish fluid draining from the nose, you should place a dressing under the nostrils to avoid sniffling. You will probably feel a lot of congestion, although some people can breathe very well immediately after surgery. You may have bruising and swelling around the nose and eyes. This will start to resolve within a few days. Most swelling will go down after a couple of weeks, but changes in the nose can continue for a year or more. You will return to the office one week after surgery to have the nasal dressing removed, then return as needed to have the nose checked. Avoid strenuous exercise for three weeks. Avoid wearing glasses for six weeks.
