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Typical rhinoplasty goals include reduction of nasal hump, narrowing of the nose, elevation of the nasal tip, and/or reduction of fullness from the nasal tip. If you have problems breathing from the nose, this may also be addressed at the time of rhinoplasty.
To be a reasonable candidate for rhinoplasty, you must have significant cosmetic problems (such as a hump or an excessively wide nose) that can be improved with surgery. If you have a subtle problem, surgery may not be worthwhile. Similarly, you must have realistic expectations regarding the potential surgical results. Most patients achieve improvement with rhinoplasty, but no one achieves perfection.
A closed rhinoplasty involves incisions inside the nostrils without an external incision. An open rhinoplasty involves the same nostril incisions with a small incision across the columella (the skin between the nostrils). Many plastic surgeons, including Dr. Friedman, believe that an open rhinoplasty provides greater flexibility and more surgical options, as the nasal framework is directly visualized during the procedure. The columellar scar is very small and is generally quite subtle (see photos).
Over 50% of patients undergoing rhinoplasty benefit from planned nasal fractures. These are performed to narrow the width of the upper nose, help straighten a deviated nose, or to reduce the chance of a flat nasal bridge after removal of a large nasal hump. If the nasal bones are fractured, a splint is worn for one week after surgery. Some bruising of the lower eyelids usually occurs.
Dr. Friedman does not use nasal packing for rhinoplasties. If you are undergoing septal surgery, internal nasal splints may be placed for 3 to 4 days. If you are strictly improving your nasal shape, no internal splints or packs are used.