Rhinoplasty Boston | Boston Septoplasty

The nose is the centerpiece of facial balance and harmony and must be properly aligned for normal breathing. The nose is also the most frequently broken facial bone leading to facial imbalance and impaired breathing.

Many of us can remember being struck in the nose during sports or activities and suffering some pain as well as a bloody nose.

Although the nose may not have changed much in appearance at the time, it likely suffered a break or disruption of the nasal bones, nasal cartilages or nasal septum. Over time, the result of even small nasal breaks may change your appearance or ability to breathe comfortably.

Others, inherit or develop undesirable nasal appearance. Children born with a cleft lip or cleft palate, are born with a nasal deformity which may persist despite repairing the lip and palate. The range of concerns can include a bump, wide nose, bulbous tip, droopy tip, long nose, short nose, crooked nose, big nose, hooked nose, or wide nostrils. Regardless of the cause Dr. Taylor and Dr. Sullivan can evaluate your nose for both cosmetic as well as functional (breathing) concerns and determine if a rhinoplasty is the right procedure for you.

WHAT IS RHINOPLASTY and SEPTOPLASTY SURGERY?

Nose Surgery (Rhinoplasty, Septoplasty, Turbinate removal) can improve breathing and improve appearance.

The goals of nose surgery are a natural appearance, facial balance, and harmony, as well as normal breathing. These goals can only be obtained with meticulous surgical care, careful planning, and experience.

In addition to being board-certified plastic surgeons in the Boston area, Dr. Taylor and Dr. Sullivan are both fellowship-trained in Craniofacial Plastic Surgery, which includes the most complex nasal surgery. Dr. Sullivan has a passion for performing precise nose surgery or "nose job", and it is one of the most common operations he performs.

Each patient is carefully evaluated and the approach is customized based on your goals and symptoms. Some operations may be covered by your medical insurance while others may be considered cosmetic. Schedule an appointment with Dr. Taylor and Dr. Sullivan to learn more.

What Are The Types Of Rhinoplasty And Septoplasty

Closed Rhinoplasty - all scars and incision are hidden inside the nose.

Open Rhinoplasty - incisions are made inside the nose as well as across the columella.

Revision Rhinoplasty - also known as secondary rhinoplasty, performed on patients who have had a previous nasal operation.

Non-Surgical Rhinoplasty - improves the contour of the nose and softens the appearance of bumps or deformity.

Septoplasty - to correct impaired nasal breathing by straightening the septum.

Turbinectomy - to improve nasal breathing by removing swollen and overgrown tissue.

PROCEDURE FOR RHINOPLASTY

Improving the shape and function of the nose and septum can be performed through an open technique with a small incision disguised on the undersurface of the nose or a closed technique with incisions limited to inside the nostrils. While each individual’s nose is different and every operation is customized, Dr. Sullivan most commonly performs closed rhinoplasty.

Through incisions hidden inside the nose, the structures can be carefully sculpted and refined for a natural appearance. Cartilage grafts can be harvested from the septum to provide soft natural tissue for improved nasal tip definition or projection or to smooth the depression from the eyebrow to the nose. Cartilage grafts are also often used to smooth the contours of the nasal dorsum, improve dorsal aesthetic lines, and improve breathing with internal nasal valve grafts. Most rhinoplasty operations take 2-3 hours with general anesthesia and patients are able to comfortably leave the hospital on the same day.

PROCEDURE FOR SEPTOPLASTY

Septoplasty treats impaired nasal breathing, nasal obstruction, sleep apnea and can provide relief from using a CPAP machine. The nasal septum separates the left and right nostrils. The front of the septum is made of soft flexible cartilage while the back is made of thin rigid bone.

When cartilage is damaged it can bend, warp or tear and when a bone is damaged it can break and form bone spurs. Septoplasty or nasal septum surgery is usually performed to restore or improve nasal breathing. Cartilage is often harvested from the septum to create natural “breath right strips” for use as internal nasal valve grafts or flaps to improve breathing and nasal shape.

When indicated, the procedure is covered by your health insurance company. Septoplasty and turbinectomy can be performed in approximately 1.5 hours. At the time of turbinectomy and cartilage harvest, many patients will also elect for simultaneous cosmetic nasal reshaping (rhinoplasty), which takes additional time and recovery. Dr. Taylor and Dr. Sullivan can evaluate your septum and internal nasal valves to determine if you are a candidate for surgery.

PROCEDURE FOR Turbinectomy

Turbinectomy helps to correct nasal obstruction. Nasal turbinates hang from the walls inside the nose – there are three on each side. The turbinates are responsible for warming and moistening the air you breathe. They have a normal cyclical rhythm of swelling and shrinking. This cycle alternates from one side of the nose to the other and can be responsible for the annoying intermittent obstruction that is often made worse when you have a cold.

Allergies can temporarily irritate and inflame turbinates and nasal tissues, which is treated non-surgically with nasal steroids, antihistamines, and nasal saline irrigation. Sometimes the turbinates can become persistently enlarged and cause nasal airflow obstruction and in severe cases, sleep apnea. This is made worse with nasal septum deviation. If the obstruction is persistent, you may be a candidate for surgery on the lowest and largest turbinates, the inferior turbinates.

Surgical options include inferior turbinate out-fracturing, reduction, or excision, with tremendously improved nasal breathing. This is typically performed in conjunction with septoplasty. Dr. Taylor and Dr. Sullivan can evaluate your turbinates to determine if you are a candidate for surgery.

BENEFITS OF NOSE SURGERY (RHINOPLASTY AND SEPTORHINOPLASTY)

Reduced nasal bump
Improved nasal tip projection
Refined nasal tip
Correct drooping nose
Narrower and improved nostril position
Improved facial harmony
Crooked nose made straighter
More symmetric nose
Smooth dorsal aesthetic nasal lines
Natural appearance
Youthful lift to the nasal tip
Narrower nose
Improved breathing
Better sleep
Less snoring
Alleviation of nasal obstruction

Nose Surgery (Rhinoplasty) At A Glance

IDEAL NOSE SURGERY CANDIDATE

At least 14 or 15 years of age
Adults
Realistic expectations

WHAT NOSE SURGERY DOES

Restores facial harmony
Improves facial projection and balance
Rejuvenates face

DURATION OF NOSE SURGERY RESULT

Years

LENGTH OF NOSE SURGERY PROCEDURE

2-3 hours

TYPES OF ANESTHESIA

General Anesthesia

RECOVERY

Comfortably at home
1 month for most swelling to resolve
1 year for the final result

TIME OFF SCHOOL OR WORK

5-7 days

TIME OFF ACTIVITIES

Activities of daily living – 1 day
Light exercise – 1 week
Full exercise and contact sports – 4-6 weeks

NOSE SURGERY Frequently Asked Questions

Will there be a scar?

With a closed rhinoplasty, the incisions and scars are all placed inside the nose and the scars are not visible. If an open rhinoplasty or narrowing of the nostrils is performed, the scars will be placed in the most inconspicuous locations so that others will not easily see the scars.

Will insurance cover rhinoplasty?

If you have severe nasal obstruction, your insurance policy may provide coverage for functional problems related to impaired breathing such as septoplasty or turbinectomy. At the same time, cosmetic refinements of the nose can be performed though these are not covered by insurance.

How long does it take to recover from rhinoplasty?

The operation is usually outpatient, meaning that you are able to return home on the same day and recover comfortably. Most of the swelling will resolve within the first few weeks and Boston rhinoplasty patients can quickly return to work and most activities. The final outcome of nasal surgery is usually one year for the tissues to soften, the sensation to return, and the swelling to completely resolve.

Am I a good candidate for rhinoplasty?

The ideal candidate is healthy and at least 14 or 15 years of age, with a lack of nasal harmony, realistic expectations, and otherwise normal facial proportions. Very commonly a patient will have a concern about their nose being too large, when in fact the nose is beautiful, but the chin is deficient and the best change could be a chin surgery.

The Müller-Lyer illusion explains how the appearance of a central facial feature such as the nose appears distorted in virtue of other facial aspects such as the chin. As craniofacial plastic surgeons and specialists of the rhinoplasty Boston plastic surgeons Dr. Taylor and Dr. Sullivan will evaluate facial harmony and proportions.

NOSE SURGERY (RHINOPLASTY) AFTERCARE INSTRUCTIONS

In the week before your operation:
- Consider eating pineapple, it may help reduce bruising
- Consider supplementing with Arnica montana, it may help reduce bruising
- Complete household chores and prepare meals for the first few days of postoperative recovery
- Follow preoperative instructions with eating, drinking, and medications
Postoperatively, get out of bed and walk (with assistance) every few hours after your operation to decrease the chance of postoperative problems such as blood clots.
Practice 15-20 deep breaths every hour to keep your lungs open.
After surgery, it is important for you to have someone available to stay with you for the first 24-48 hours, as you may feel drowsy. You may require help the first few times you get out of bed.
Please take your medications as directed by Dr. Taylor or Dr. Sullivan to manage discomfort or symptoms.
- Acetaminophen (Tylenol) 1000 mg every 8 hours, space doses 4 hours after Ibuprofen so one or the other is taken every 4 hours
- Ibuprofen (Motrin) 800 mg or Colecoxib (Celebrex) 200 mg every 8 hours, space doses 4 hours after Acetaminophen so one or the other is taken every 4 hours
- Gabapentin 300 mg every 8 hours for 7 days
- Vitamin C 500 mg daily for 50 days
- Oxycodone 5 mg – 1-2 tablets every 6 hours as needed for pain, though many patients may not need it
- Colace 100 mg twice daily to prevent constipation, it is important to have a bowel movement each day
- Zofran 8 mg every 8 hours if needed for nausea
- Scopolamine patch will be placed on the neck on the day of surgery and can stay for 3 days
- Bacitracin ointment twice daily to the incisions
- Preparation H Ointment with Phenylephrine every 6 hours after the nasal splint is removed to reduce nasal swelling
Eat a light diet for 2-3 days and avoid spicy food. Some suggestions to ease abdominal discomfort or indigestion after surgery:
- Drink water or warm liquids
- Prune juice to prevent constipation
You may have a plastic cast or splint on your nose. Do not put pressure on the nasal splint. The splint will usually be removed 5 to 7 days after surgery by Dr. Taylor or Dr. Sullivan. After the splint is removed, please do not put pressure on the nasal bones or allow glasses to rest on the nasal bones for 4 weeks.
You may have silicone stents in your nostrils. Do not try to remove these. They are sutured to your nasal septum.
You may shower or sponge bath the day after the operation. You may wash your hair and face, though please avoid getting the nasal splint wet.
Elevate your head and shoulders and when in bed keep your head elevated about 30 degrees (two pillows under your head and back) to help with the swelling.
Do not smoke or expose yourself to smokers or nicotine as skin and wounds can be compromised.
You may apply ice packs to the face and areas around the eyes for the first 48 hours to reduce swelling and bruising. Bags of frozen peas and corn make for excellent ice packs. You might also consider Icewraps Gel Packs or Swiss Safe gel packs, which can be ordered from Amazon or online. Apply the ice packs for 20 min of each hour while awake. Do not put pressure on the nasal splint.
Nasal bleeding is expected for 3 to 4 days. You may change the drip pad under your nose as often as you need. Avoid blowing your nose, rubbing your skin, or picking dried blood as it irritates the tissues and can worsen bleeding.
Avoid blowing your nose for 2 weeks. Instead, irrigate your nostrils with saline (saltwater) 4 to 5 times each day.
If you need to sneeze, simply open your mouth when you sneeze to decrease nasal pressure.

ACTIVITY

For the first week following surgery, raising your blood pressure and heart rate can cause bleeding. Avoid straining or vigorous activity. We recommend walking 15 minutes 2 to 3 times per day.
Please do not drive with swollen eyelids or while taking pain medications such as oxycodone.
Do not lift anything heavier than 10 lbs, run, lift weights, or perform strenuous exercise for 7-10 days.
Massage to the skin of the nose can help increase circulation and soften firm areas. Please wait at least 3 to 4 weeks after surgery to start massage to avoid increased swelling.
Avoid contact sports for 6 weeks following surgery.

GENERAL OUTCOMES

Moderate swelling and bumpiness of your nose is to be expected and will increase for 48 to 72 hours. Much of the swelling usually resolves within the first few weeks after the operation though some mild swelling can take one full year to resolve. You may get black eyes. Please be patient. The swelling and feeling of tightness will gradually subside over the following months.
Tightness of the skin and a fuller appearing nose is also normal and will smooth out as the swelling resolves and the tissues soften.
Tingling, itching, and numbness of the nose and cheek skin and upper front teeth are all normal. Tingling and itching are signs of healing and will resolve. Sensation to the skin of the nose and upper teeth usually returns gradually and slowly over weeks to months. Please be patient and avoid resting against hot surfaces, which can injure or burn the skin.
Scars and tissues take one full year to mature. You may notice that they become red, raised and firm for several weeks to months before becoming soft, flat and pale. Avoid Vitamin E as it can irritate the scar. Mederma has no proven benefit and is not worth the expense. All incisions will be sensitive to sunlight during the healing phase. Direct sun contact or tanning booths are to be avoided. Silicone cream or skin moisturizer with sunscreen and gentle massage may be helpful.
Please call our office (617-492-0620) if you have:

Continuous bleeding
Significantly more swelling on one side when compared to the other
Worsening pain
Fever, spreading redness or irritation of the skin
Shortness of breath

It is important to be seen by Dr. Taylor or Dr. Sullivan after your operation. They will see you in follow-up appointments at 1 week, 3-6 months, and 1 year or as often as needed post-op. Call to schedule your appointments at Taylor & Sullivan Plastic Surgery office at (617) 492-0620 between the hours of 8:30 – 5:00 or visit our webpage at www.massplasticsurgeons.com. We are always available for postoperative concerns or emergencies and can be reached through our paging service 24 hours per day at (617) 492-0620.

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Nose Surgery
(Rhinoplasty)in Boston