Rhinoplasty is the second most commonly performed facial plastic surgical procedure. Since 1996 the number of rhinoplasty surgeries has increased steadily in the united states, according to data from the American academy of Facial Plastic & Reconstructive Surgery (AAFPRS). It is the most commonly performed procedure in men and patients 25 years of age and younger. Rhinoplasty or nasal reshaping can be performed to enhance ones appearance, correct a traumatic deformity, or to improve breathing difficulties. Whichever the case, one thing is clear, nothing has a greater impact on how a person looks than the size and shape of the nose. Because the nose is the central and defining characteristic of the face, even a subtle alteration can cause dramatic improvement. Since there is no ideal nose, the goal of rhinoplasty is to improve the shape of the nose so that it looks natural on the face. Skin type, ethnic background, age and personal preferences all play a role in the final result. In Manhattan Rhinoplasty surgery traditionally produced turned up noses with unnatural profiles and overdone results. Dr. Zimbler performs the latest in rhinoplasty techniques which result in elegant, natural noses with long term cosmetic results. Dr. Zimbler can remove a bump, narrow a wide tip, straighten a profile, and narrow nostrils. His attention to detail and focus on natural looking noses make him unique in New York City for obtaining the best rhinoplasty outcome possible. Dr. Zimbler’s extensive training in Plastic Surgery and Ear, Nose and Throat Medicine make him a true expert in rhinoplasty surgery. If you are considering a rhinoplasty, you need to know how this surgery is performed and what to expect.
How Do I Know If Rhinoplasty Surgery Is Right For Me?
Are you unhappy with the shape of your nose? Do you think the tip is too large or perhaps it’s just the profile you don’t like? Are you having issues with breathing and was told you have a deviated septum. Perhaps you injured your nose and were unhappy with it ever since. Maybe you had prior surgery and were never satisfies with the results. If you answer yes to any of these questions, you should consider Rhinoplasty surgery.
Why Dr. Zimbler?
Dr. Zimbler is a Facial Plastic and Reconstructive Surgeon with particular expertise in rhinoplasty surgery and revision rhinoplasty surgery. Dr. Zimbler is the Director of Facial Plastic & Reconstructive Surgery at Beth Israel Medical Center in New York City, a tertiary medical center in Manhattan. Dr. Zimbler is also the Director of resident education at Beth Israel which means he teaches residents and medical student training to be future surgeons. He is double board certified in both Facial Plastic Surgery (AMFPRS) and Otolaryngology – Head & Neck Surgery (ABOHNS). That means that before Dr. Zimbler started performing plastic surgery on the face he trained in diseases of the ears, nose and throat. Dr. Zimbler’s limits his practice to facial surgery only, making him a true expert in the face. He does not perform breast surgery, abdominoplasty, or other body plastic surgery procedures. Because his practice is devoted to facial surgery he has vastly more experience with the nose than many surgeons who perform plastic surgery over the entire body. Rhinoplasty is one of the most complex and challenging of all plastic surgery procedures and requires years of expertise and training so that it is done just right. Dr. Zimbler’s unique surgical background makes him an expert in surgery on the nose.
The Rhinoplasty Procedure
Surgery takes place while the patient is completely asleep in an accredited surgical facility with a board certified anesthesiologists. Tiny incisions are made inside the nose which allows cartilage and bone to be reshaped. A closed rhinoplasty is performed when all incisions are made on the inside of the nose, or an endonasal rhinoplasty technique. While many rhinoplasties and revision rhinoplasties can be performed in this manner, some cases require the open technique. An open rhinoplasty, or external rhinoplasty, is defined as having similar incisions to the closed technique except one additional small incision is made at the base of the nose, on the columella. This incision, which is only a few millimeters in length, heals extremely well and is nearly impossible to detect. Reasons for performing a procedure closed or open is determined by Dr. Zimbler since he performs both types of surgery. Other incisions on the outside of the nose in rhinoplasty can be performed when the nostrils are made smaller. Tiny incision, hidden in the side creases of the nostrils are made to narrow a wide nostril or to define an already thick nasal rim. The tips can be refined and either elevated or lowered. The profile is usually straightened and the width is narrowed. Dr. Zimbler prefers natural looking noses which are never over done or look too surgical. The profile is a critical factor in obtaining this result and he never performs scooped out profiles or the older ski-slope rhinoplasty result often obtained in the 70’s and 80’s.
Often cartilage grafts are used in rhinoplasty and can be obtained from either the nasal septum of ear. These grafts are used to define highlight points or strengthen the nose in certain regions to give the desired cosmetic result. In most cases there is enough septal cartilage for grafts. In some cases, often revision rhinoplasty cases, the septal cartilage may have already been removed and ear cartilage is required. Ear cartilage or auricular cartilage can be removed through a tiny incision in the ear and does not change the ear shape. A very large portion of ear cartilage can be removed without anyone noticing. In more dramatic cases cartilage may need to be obtained from both ears when larger cartilage grafts are needed. Lastly, in traumatic nasal deformities of large revision cases cartilage can also be obtained from the rib cage. If rib cartilage is needed Dr. Zimbler will discuss this in length with you prior to your surgery, and again this is only in the most extreme circumstances
If you have difficulty breathing threw your nose this can be corrected at the same time as rhinoplasty surgery and typically insurance will cover this portion of the procedure. The procedure is done under anesthesia in an accredited out-patient surgical facility and takes between two to three hours. Sometimes a chin implant or neck liposuction is performed at the same time as rhinoplasty to balance the nose with the remainder of the face.
Deviated Septum, Breathing Problems & Sinus Surgery
Many patients who requests rhinoplasty surgery in New York often complain of nasal obstruction, breathing difficulty, snoring, or sinus conditions. These conditions are typically treated with medications and antibiotics to no avail. In that case correcting these issues at the time of surgery can be ideal. It requires only one surgical operation and recovery time and often insurance will cover this medical portion of the procedure. Nasal breathing difficulties are most commonly caused by a deviated septum. The nasal septum is the cartilage structure that separates one nostril from the other. This deviation can be congenital, worsen with age, or be the result of a nasal injury or fracture. Septolplasty is the procedure in which portions of twisted septal cartilage and bone are removed to improve the nasal passage and increase air flow.
Often with septal deviations one sees turbinate hypertrophy. The nasal turbinates are the humidifiers of the nose and swell to moisten air. This swelling is cyclical and can often be worse at night, explaining why many patients have difficulty breathing in their sleep and in some cases resulting in snoring. Turbinate surgery is typically performed in conjunction with septolplasty and rhinoplasty surgery to improve nasal breathing. Dramatic turbinate procedures which often remove the inferior turbinate have been abandoned over the past few years because they have caused more nasal problems. Dr. Zimbler performs limited turbinate reduction surgery which often involves leaving the turbinate intact but just shrinking the tissues with lasers or ultrasound therapy.
Sinus infections or sinusitis is different than nasal airway breathing problems. Sinusitis is an infection of the nasal sinuses which can cause nasal swelling, breathing difficulties, and blockage. Sinusitis is often treated with antibiotics however in many cases patients require multiple treatments of antibiotics without resolution of symptoms. In these cases of recurrent sinusitis a CT scan can determine if sinus surgery would be beneficial. Sinus surgery is performed with telescopes inside the nose and tiny nasal instruments. Sinus surgery is often performed in conjunction with rhinoplasty surgery and in many cases with septolplasty surgery as well. If Dr. Zimbler suspects you may have recurrent sinusitis he will examine your nose with an endoscope in the office to make sure you don’t have an active nasal infection or in some case nasal polyps. A CT scan or cat-scan is often required to determine the extent of sinus disease before any surgery is performed.
Dr. Zimbler has been using computer imaging for over a decade for his rhinoplasty patients. Computer imaging is an excellent way for Dr. Zimbler to show the patient how he anticipates the outcome of the surgery should result. Computer imaging is an opportunity for both the patient and surgeon to see exactly what the desired results are, and to what degree. This session will help stimulate dialogue between surgeon and patient so that there are no surprises after surgery. Often patients may require changes that may not be obtainable because of anatomy or skin thickness. This imaging sessions is a way to describe to the patient what constitutes a realistic aesthetic outcome during cosmetic rhinoplasty surgery. Imaging is also very helpful in revision rhinoplasty cases or secondary rhinoplasty where changes may be dramatic or in some very cases subtle.
Rhinoplasty Recovery Time
Most patients are presentable a little over one week after surgery, however many patients are up and about within the first few days. A splint is applied to the nose and remains in place for one week. Discomfort is minimal and easily controlled with oral medication. Swelling and bruising under the eyes is to be expected and resolves within a week. Ice compresses should be applied the first few days after surgery to minimize bruising and swelling. This, along with medications Dr. Zimbler prescribes, will minimize bruising and speed up the recovery period. Light exercise can be started 2 weeks after surgery however aerobic walking can resume after the first week. Nasal swelling decreases dramatically for the first few weeks after surgery, however it will take many months before the nose takes on its final aesthetic result. As with any plastic surgery procedure, the healing process is gradual but the benefits from surgery will last for years.
What To Expect Following Rhinoplasty Surgery
Certain physical changes are expected following nasal surgery. Some individuals experience all of the following changes while others experience only some. The degree to which each person is affected is variable and unpredictable. Most patients experience some swelling and mild bruising around the eyes. Blood tinged nasal discharge is not unusual for the first few days. Breathing may be difficult for the first 2-3 weeks, while numbness or stiffness of the nose may take longer to resolve. If you have a splint on your nose it will be removed in one week. When the splint comes off, your nose will be swollen and may need to be re-taped for several more days. Remember, nasal swelling resolves slowly over time. Most swelling resolves within the first few weeks, however it may take 6-12 months for the swelling to completely resolve. Avoid exertion, extreme physical activity, or strenuous exercise for one week after surgery. Avoid bending, heavy lifting or staining of any kind. Since you have just undergone surgery, use good common sense by restricting your normal daily activities. Try to obtain more rest than usual. Remember, you just had an operation and you body require time to heal. Please don’t take chances! If questions arise or you are concerned about something you consider significant do not hesitate to communicate with my office immediately. Keep you head elevated for 48 hours after surgery. Make sure you try to sleep on your back, supported by several pillows. Apply cool ice packs to the eyelid region to further diminish swelling. Change the dressing under your nose until the drainage stops. If you have packing in your nose do not disturb it, it will be removed in my office after surgery.
Start your antibiotic prescription the evening of surgery and take twice daily thereafter until the bottle is complete. Prescriptive pain medication may not always be required and Tylenol may be substituted when appropriate. If you have a cast on your nose, do not disturb it. It will be removed in the office in one week. Until then, it must be kept dry. If you have sutures on the undersurface of the nose, clean the suture line three times a day. This is done with hydrogen peroxide on a clean Q-tip to remove any crusting or oozing. After cleansing, apply a thin layer of Polysporin ointment over the suture. Do not blow your nose until instructed. If you need to sneeze, open your mouth and cough instead. Do not rest glasses on your nose.
As a patient you might wonder why do I need revision surgery? Typically revision rhinoplasty is required when patients had surgery years ago and surgical techniques were not as accurate. Sometimes a revision is required if the cosmetic portion of the procedure compromised the functional portion causing a secondary breathing problem. Or perhaps scarring occurred or the healing process did go as well as was hoped causing imperfections and irregularities. The fact is, Rhinoplasty surgery is the most challenging facial plastic surgical procedure performed and unfortunately revisions are required. Because of Dr. Zimbler’s highly specialized training and dual board certification in both Facial Plastic Surgery and Otolaryngology, it makes him one of only a few physicians in the New York metropolitan region expert enough to deal with complex revision rhinoplasty surgery.
Patients seeking revision rhinoplasty surgery have a number of concerns. First is the loss of trust regarding the procedure. Next is how do you know if a second procedure will achieve the goals you hope to obtain with your doctor. Dr. Zimbler and his staff are well trained in dealing with patients who have had poor surgical outcomes. Revision surgery in many cases can be tedious and time consuming and requires great patients on the part of the surgeon, a skill Dr. Zimbler is blessed with. This and a particular attention to detail combined with his perfectionist nature makes Dr. Zimbler and excellent choice when considering your revision surgery. After meeting Dr. Zimbler it will be clear to any of his patients how caring, attention oriented and exacting he is. He will spend as much time as necessary during consultation to answer all of your questions and review his surgical plan with you. Since revision rhinoplasty patients often shop around or have seen many physicians in consultation it is clear that this particular subset of patients require additional time and hand holding during the entire recovery process. Secondary rhinoplasty surgery requires more time to heal than primary surgery and results may not be evident for months after surgery. Also cartilage grafts from the septum, ear or rib may be required in secondary surgery, making this procedure a more complex operation.
In many cases revision surgery is required because too much was removed and the nose looks over operated or too done. Things like pinched nostrils, scooped out profiles, overly narrow frontal view, difficulty breathing, and a pinched up nose are often the results. Dr. Zimbler will review with you in detail his approach and surgical plan on how to deal with each of these particular issues and how much improvement is to be expected after surgery. Although significant improvement should be expected, patients undergoing revision surgery need to realize that outcomes may never be perfect but can improve significantly.
The non-surgical nose job or 15 minute nose job is an in office procedure in which nasal shape can be improved with simple injections rather than extensive surgery. The procedure is performed in the office with minimal discomfort and simple topical numbing cream. Various FDA approved injectable materials, typically Radiesse® or Restylane®, are used to contour the nasal profile and tip. Through precise injections nasal bumps, humps and irregularities are easily camouflaged. Radiesse® is made from calcium hydroxyl appetite crystals, similar to the material found in teeth and bone, so it is an ideal substance to place in the nose along the nasal bridge. The results typically last 8-12 months but the procedure only takes a few minutes with minimal down-time and mild discomfort. Sometimes bruising and swelling can occur, but typically resolves within a few days.
For patients who are considering rhinoplasty surgery this is a great way to see what is possible before actually undergoing surgery. For patients not interested in surgery, this is a great way to avoid going under the scalpel. It is also ideal for patients who have undergone previous rhinoplasty and were unhappy with the results. By simply injecting the defects and contour irregularities improvement can be obtained without undergoing extensive revision surgery.
Frequently Asked Questions
- What Will Happen During My Consultation For Rhinoplasty?
Dr. Zimbler will take an extensive history and then perform a detailed examination of both the inside and outside of your nose. Both the history and exam will give the doctor an idea of what will be required during surgery and to make sure no prior trauma, infections, or surgeries will affect the ultimate outcome of your surgery. Dr. Zimbler will then discuss the procedure in detail along with how the procedure is performed, where he performs surgery and what the recovery period will be like. A Detailed discussion of risks and benefits is also critical to making any type of informed decision before agreeing to undergo surgery. At Dr. Zimbler’s Fifth Avenue office we specialize in rhinoplasty computer imaging. Our specifically designed software will give you the most realistic image of what your nose will look like after surgery.
- Can I Have An Idea What My Nose Will Look Like After Surgery?
At Dr. Zimbler’s Fifth Avenue office we specialize in rhinoplasty computer imaging. Our specifically designed software will give you the most realistic image of what your nose will look like after surgery.
- Can My Deviated Septum Or Sinus Condition Be Corrected At The Same Time As A Rhinoplasty?
The simple answer is yes. Many rhinoplasty surgeries go hand in hand with functional nasal surgery and it is not uncommon for Dr. Zimbler to perform his procedure in conjunction with one of his ear, nose & throat colleagues.
- What Is The Best Age For A Rhinoplasty?
Any age is appropriate as long as the face and nose has fully developed. In females, this is typically around age 16 and in males around 17 or 18. Many patients, however, decide at varying points in life to correct the shape of the nose or to make certain cosmetic refinements.
- Do I Need To Have General Anesthesia?
While many patients are scared of having anesthesia, surgery can only be performed properly when both the patient and surgeon are comfortable. Most patients do not want to be conscious during rhinoplasty surgery and we make sure the appropriate amount of sedation is given to each individual patient. Typically rhinoplasty surgery is performed with a LMA under deep sedation anesthesia.
- Can My Previous Rhinoplasty Be Corrected?
Revision rhinoplasty is an art onto itself and Dr. Zimbler’s combined training in Facial Plastic Surgery and ear, nose & throat medicine make him one of any a handful of surgeons expert in treating complex revision nasal cases.
- Will Insurance Pay For Any Part Of My Surgery?
The cosmetic portion of surgery is never covered by insurance. However if you have a functional breathing problem that will be addressed at the same time as the cosmetic portion, typically insurance will cover that portion of the surgeon’s fee along with the overhead of the operating room and anesthesiologist.
- Do I Need To Have My Nose Broken During Rhinoplasty?
In many cases, Dr. Zimbler will not need to break your nose or the nasal bones during surgery. Often these structures can be shaved or carved so that breaking them is not necessary. In a good percentage of cases however this may be required but it will depend on your nose and what particular outcome or goal you wish to achieve. In many cases not breaking the nose will lead to less bruising and swelling and a speedier recovery.
Rhinoplasty / Nose Surgery Before & After
Rhinoplasty with sub-mental liposuction
Patient unhappy with nasal hump deformity.
How To Get Started With Rhinoplasty/Nose Surgery?
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