Overview

If you are considering surgery to change the size or shape of your nose, the current options are much greater and more satisfying than ever before. Surgery of the nose has advanced in recent years, giving the surgeon and patient more options than ever before. The surgeon now has the ability to "customize" your procedure based upon your specific needs and anatomy. This current ability to "customize" nasal surgery has evolved over the past fifteen years. In the past, nasal surgery was taught and practiced using a "cookie cutter" approach. Surgeons of the time performed the same operation on practically all their patients regardless of their preoperative appearance. Today, the emphasis is placed on looking at your nose individually. Dr Coman will discuss with you which features of your nose need change as well as those features best left untouched. Now, each nasal surgery is "customized" based upon your unique anatomy. With the emphasis on diagnosis, Dr Coman will create a plan to obtain the most satisfying result.

Indications

Nasal surgery can be performed to change consequence of genetics, birth defect or injury. It can be done to enhance your appearance and/or to improve your nasal breathing. Potential changes include:

• Decreasing the overall size of the nose

• Removing the bump on the bridge

• Narrowing a wide bridge

• Refining and narrowing the tip

• Adding "projection" to the tip

• Narrowing the nostrils shortening the nose

• Improving the transition between the nose and the upper lip

• Straightening the nose if it is crooked

• Straightening a deviated septum (the dividing wall between the air passages) to improve nasal breathing

• Restoring the height of the bridge following injury or previous surgery

In younger patients, the surgery can be performed after the skeleton of the face is fully developed. This usually occurs in young men by the age of sixteen. Skeletal growth is usually complete in young women by the age of fifteen. In adulthood, the surgery can be performed at any age.

If you have had a previous operation on your nose and are unhappy with the outcome, you may be a candidate for secondary nasal surgery. If too little bone and cartilage have been removed at the original surgery, additional reduction of your nasal skeleton may be indicated. If, however, too much tissue has been removed or the remaining tissues are distorted, the procedure may involve grafting bone or cartilage from other areas of your body.

Prior to Surgery

At your initial consultation, Dr Coman will ask you to express your concerns about your appearance and to describe your symptoms. Your goal for the eventual appearance of your nose will be discussed. Your medical history will be reviewed and a physical examination will be conducted to determine if nasal surgery is best for you. If you are a good candidate for surgery, Dr Coman will explain what can be done to assist you.

He will discuss the steps of the proposed surgery and the variables that may affect the procedure. Physical characteristics such as the size and shape of your nasal bones and cartilage as well as the thickness of your skin may affect the technical considerations.

Dr Coman may request that you visit your GP for a check-up and for any necessary lab work and x-rays. Some private health insurance agencies will pay partially for nasal surgery if it is medically necessary.

The Procedure

Nasal surgery is generally preformed as an inpatient in a recognized hospital including at least one overnight stay.

After anaesthesia is given, small incisions are made inside the nose. Miniature instruments are used to separate the skin form the underlying supporting framework of bone and cartilage. The bone and cartilage are then sculpted to the desired shape. The nature and extent of the sculpting are dependent on your nasal anatomy and the desired contour. Finally, the skin is redraped over the new framework and dissolvable sutures are used to close the incisions.

Another technique commonly used is the "open approach" which involves making a small skin incision across the columella (the vertical strip of tissue separating the nostrils). This provides more exposure in complex cases and is often used in secondary rhinoplasties. This incision heals very well and is usually inconspicuous some weeks after surgery.

When the surgery is completed, a splint is applied to maintain the new shape of your nose and to limit the amount of postoperative swelling. If the surgery involves straightening your septum, soft nasal splints may be placed in your nostrils to stabilize the septum. You will then be awakened and taken to the recovery room. The operation takes one to two hours.

Results

If your nasal airway is obstructed, you are more dependent on mouth breathing which is much less efficient. This condition leads to early fatigue when exercising and symptoms of dry mouth. Nasal obstruction may also lead to snoring and chronic sinus infections. Septoplasty and nasal airway surgery are performed to alleviate these problems.

Additionally, changes in the size and shape of the nose can lead to a dramatic improvement in your facial appearance. It is of great importance that your new nose be in proportion to your other facial features. It should be "balanced" and natural in appearance. It is of great importance to Dr Coman that your result not appear to be "artificial" or "surgical".