Nose Surgery (Rhinoplasty)
What does the procedure entail?
Rhinoplasty is extremely common, and Dr. Rubach has performed over 1,000 of these surgeries. Patients turn to rhinoplasty to improve the aesthetic look of their nose, though nose surgery is also used for medical reasons as well. During your consultation, Dr. Rubach will determine if an open or closed approach will be appropriate, and he will be able to tell how extensive the surgery will need to be.
How do I make a decision on the right Rhinoplasty surgeon?
Rhinoplasty is a complex and difficult procedure and requires excellent training as well as a significant amount of experience. It takes years of experience and a significant number of surgeries for a surgeon to understand the complexity of Rhinoplasty surgery and understand how to manage all of the variables that occur with different types of noses. This complexity stems from the tremendous variation of the nasal structure between different patients. Along with this is the complex the of changing the nasal structure but maintaining normal breathing. Dr. Rubach has years of experience performing Rhinoplasty and is available for a consultation!
What will my recovery be like?
Typical recovery involves a splint on the outside of the nose and an intranasal splint for one week. If the procedure involves an external approach then an incision is made at the base of the nose. Intranasal rhinoplasty does not involve an external incision. The first week requires sleeping with the head elevated to decrease swelling. At one week after surgery, the splints and sutures are removed. Typically, swelling or bruising take 10 to 14 days to subside. I often tell my patients to expect 2 weeks recovery before the signs of surgery will subside.
How soon after surgery can I expect to see the results?
Very often, the results are noticeable immediately after the splints are removed one week after surgery. Typically acute swelling and bruising take up to three weeks to resolve. An additional 6 to 12 months is needed for the final refinement to occur.
What should you avoid after a rhinoplasty?
The initial recovery phase of rhinoplasty is one week. During this time, an external splint must be worn, and typically an intranasal splint is in place. Patients may lightly blow their nose and clean any dry blood in the nostrils that would impede breathing. It is highly advisable to sleep with the head slightly elevated at a 30 degree angle to reduce swelling. I ask patients to avoid strenuous exercise for three weeks following the procedure. Also, while the splint is in place, avoid showering the face. Patients may however body shower or wash their hair inn the sink if they keep the nasal dressing dry.
Are nose jobs painful?
There are many aspects to post-operative pain following rhinoplasty. It is not typical for my patients to experience significant pain following their procedure. This is due to several technical aspects to my procedural approach to Rhinoplasty. First, I do not use packing and instead use thin internal splints. Packing is very painful and uncomfortable. Second, I use a local anesthetic called Marcaine, to numb the surgical site that lasts for 8 to 10 hours following the procedure. This provides anesthesia to the surgical area during the immediate recovery phase where pain would be most acute. There is discomfort from swelling, however this can be reduced by sleeping with the head elevated at 30 degrees for the first week.
Can rhinoplasty improve my breathing?
Rhinoplasty is surgery of the nose to improve form and function. It is essential that each patient being evaluated for rhinoplasty be evaluated for function, meaning the ability to breath, as well as for form, which is the overall shape of the nose. Both are very interrelated. Change in shape can have very significant impact on breathing and can significantly reduce nasal airflow. Factors that affect breathing are deviation of the septum, turbinate size, and support of the lower nasal tip cartilages that affect the shape and opening of the nasal airway at the base of the nose. The septum is the bony and cartilaginous structure that divides the left and right side of the nasal passage. Deviation from trauma to one side or the other can create obstruction of nasal airflow. The turbinates are internal structures arising from the lateral nasal wall of the nasal passage that humidify air. These can swell due to allergies or other causes and can cause obstruction. Lastly, the lateral wall of the nasal tip requires support from the underlying cartilage. In some cases there is not enough support and the lateral nasal area collapses with inspiration causing nasal obstruction. All of these issues must be evaluated on the initial consultation for rhinoplasty as they can be addressed at the time of surgery to improve nasal airflow. Septoplasty, turbinate reduction or reconstruction of the lateral nasal wall at the time of rhinoplasty can significantly improve breathing.
How does a rhinoplasty change your face?
The nose is the central structure of the face and thus affects the balance of the surrounding facial features. Additionally, chin projection, or lack there of, creates balance and harmony across the face. It is very common to discuss nasal and chin structure in tandem to achieve the proper balance to the facial structure. Computer imaging is essential during the initial consultation to view the proposed changes from rhinoplasty It is not only an important communication tool for the surgeon and patient to view during the consultation process, but it also provides a guide for the surgeon intraoperatively to achieve the desired outcome.
Will rhinoplasty affect the way I sound when I speak?
Improvement of nasal airflow can be achieved with rhinoplasty if there are underlying structural problems that are present that inhibit nasal airflow. If these issues are identified before surgery and then addressed at the time of surgery, then airflow can be increased post operatively and breathing can improve. Changes in nasal airflow can slightly change the sound when speaking by changing the degree of nasal airflow which affects resonance. The change however should be minimal.
What age should you get a rhinoplasty?
It is important to avoid structural changes to the nose until after puberty and facial development has taken place. This typically has taken place before the age of 16 however there are significant variations in the age for onset of puberty and completion of facial growth and this needs to be taken into account when deciding when to proceed with rhinoplasty.
Chin Augmentation
What does the procedure entail?
Patients choose chin implants for a variety of reasons, such as to improve facial proportion. Our surgeon will consult with you to determine the perfect fit for your needs, so you can feel confident in the results. The implants at CCLS are made of a synthetic material that is similar to your bodyโs natural facial tissue. The actual procedure will involve our surgeon making an incision in the chin, where he will then gently stretch the tissue to fit the implant in the chin.
How long does chin augmentation last?
Chin augmentation can be done nonsurgically with hyaluronic acid filler however this is a temporary augmentation. This will last 12 to 24 months depending on the type of filler used. Surgical chin augmentation is done by placing a silicon implant on the chin bone. This is done either through an intra oral incision or an incision beneath the chin. The implant feels natural and is permanent.
Does a chin implant change your smile?
A chin implant will not change a persons smile provided that it is done correctly. Meaning, the correct implant is used and that no injury to the facial nerves occurs. In the hands of a well trained experienced surgeon this would be extremely unlikely.
What filler is best for your chin?
We recommend a highly cohesive hyaluronic acid product to augment the chin. We use voluma as it has a high G prime, meaning it is not easily deformed and is stable. This is very important when using filler to augment bony structure as we do not want the filler to change is shape or position when pressure is applied to the area.
How can I improve my chin and jawline?
There are two options to improve the contour of the chin and jawline. The first is to use filler. Filler can augment and highlight jawline contour without surgery and works well however it has several drawbacks. First is that filler slowly dissipates and usually has a duration of around 12months. Second is that the result is slowly changing and not stable over time. This creates variability in the shape and contour. The second option is for placement of an implant. This is favorable as it is permanent however it does require surgery along with the recovery.
Who is the best candidate for a chin augmentation?
Chin augmentation is ideal for patients with lack of chin projection or angular contour. Aesthetically pleasing faces are defined and angular. Implants help create this definition and angularity.
What will my recovery be like?
Recovery time is seven days, depending on the exact procedure. Many patients find they can get back to their normal activities within the week, but your chin will be a tad sore and swollen. You may have a small bandage or dressing to make sure the implant stays in the right position in case there is swelling. A chin augmentation is a relatively pain-free procedure, but some patients do take oral pain medication for a couple of days after.
