RHINOPLASTY

With just 6-8 days of recovery time, a rhinoplasty can be one of the biggest, most life-changing decisions and is one of the most performed plastic surgery procedures in the world.

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RHINOPLASTY | In Detail

Dr.Kassir performs over 1,000 rhinoplasties a year (for over 22 years), making him one of the top rhinoplasty surgeons in the world. The experience of your rhinoplasty surgeon is based not only on their board certification in facial plastic surgery and ENT but also on the total number of procedures they have performed and their length in practice. You can see thousands of before/after rhinoplasty photos on Instagram @drkassir. Patients fly into his New Jersey and New York City offices from around the world to have their face and life changed through his excellent work.

At your virtual whiteboard/video consultation (15 minutes of educational content specific to your face), our surgical coordinator (trained by Dr.Kassir for 8 years) will perform an extensive nasal analysis. Kassir Plastic Surgery is one of the only rhinoplasty surgical centers where you can get video consultations with whiteboard-involved diagrams and sketches that allow us to provide exact estimates and even book surgical dates online. This results in an extensive, thorough consultation that is still exceptionally efficient. During the nasal analysis, we discuss the correction and reconstruction of the subunits that you'd like to change. While knowledge of the nasal anatomy is not required, you can bring photos of desired nose shapes or even edit your own photos so we have a better idea of what you want.

In a rhinoplasty, an entire subunit must be corrected in order to maintain symmetry and aesthetic appeal. The nose must vertically occupy 1/3 of the face and horizontally occupy 1/5 of the face. The nasofrontal angle is the angle between the frontal bone and nation and is expected to ideally be 120 degrees. This angle is slightly smaller for males than for females. An ideal nasofacial angle (slope of the nose) is about 30-40 degrees. The nasolabial angle (angle between tip of nose and upper lip) is 90-95 degrees on the male face and 100-105 degrees on the female face. Dr. Kassir will determine facial projections and proportions for the face by utilizing the Goode method which states that the height of the nasal tip should be 55-60% of the vertical length of the nose tip.

The Goode method states that a ratio of .55-.6:1.0 is the perfect tip to length projection.
The classes of noses used for rhinoplasty analyssi from I-VI include the roman nose, greek nose, african nose, hawk nose, snub nose, and celestial nose.

Beyond this, surgeons must evaluate patient characteristics to make sure the individual is a good candidate for surgery. Looking at a complete medical and psychosocial history is essential to this step. At Kassir Plastic Surgery we go above and beyond to ensure patient safety and satisfaction by making sure you get full medical clearance so recovery is as simple, safe, and easy as possible. Beyond this we also evaluate the motivation for undergoing surgery and whether the results you want are within reach as each subunit of the nose must be grafted if more than 50% is removed. The physical exam lets us know if you can tolerate the stresses of a rhinoplasty. This can be accomplished during the consult and pre-op appointment and is a crucial step in the process of achieving a successful rhinoplasty. Facial evaluation of skin type, surgical scars, the symmetry of aesthetic nasal subunits, and internal examination of the nose lets Dr.Kassir determine the ENT-focused and cosmetic-focused changes we can make on your nose. The Cottle maneuver is done pre-operatively to determine if there is a need for an airflow correction during the surgery (done by installing a spreader graft to improve the open angle of the nasal valve).

An open rhinoplasty requires a small incision on the columella whereas the columella is not cut during a closed rhinoplasty. An open rhinoplasty allows surgeons to easily add grafts and see nasal cartilages for internal ENT fixes. This is more difficult in thick-skinned or ethnic noses and in revision rhinoplasties. Dr.Kassir has performed surgeries on patients from 119 countries and counting. His extensive background in performing procedures on individuals from various backgrounds and races ensures his expertise and that his ethnic rhinoplasty results are exactly what the patient wants while remaining authentic to their ethnicity.

The nasal-tip classification used by plastic surgeons is based on skin thickness which is genetically related to different ethnic groups. This system allows Dr.Kassir to determine whether you may require a closed or open rhinoplasty.

Rhinoplasties can be done to remove nasal diseases, the unwanted aesthetic appearance of the nose, failed primary rhinoplasty, obstructed airways, and congenital anomalies of the nose. A rhinoplasty can be done for cleft lip/palate, cheiloschisis, palatoschisis, an unwanted aesthetic appearance, etc. Types of rhinoplasties are congenital nasal rhinoplasty, cleft lip and palate rhinoplasty, allergic and vasomotor rhinitis rhinoplasty, inflammation rhinoplasty, autoimmune disorder rhinoplasty, animal bite rhinoplasty, rhinoplasty for burns, connective-tissue disease rhinoplasty, nasal fracture rhinoplasty, ethmoid bone rhinoplasty, neoplasm rhinoplasty, septal hematoma rhinoplasty, toxin rhinoplasty (caused by cocaine use rhinoplasty, antihistamine rhinoplasty), rhinoplasty for traumatic deformations, blunt trauma rhinoplasty, rhinoplasty for broken nose, and venereal infection rhinoplasty.

A rhinoplasty is performed under sedation, general anesthesia, or local anesthesia by an anesthesiologist who works with Dr. Kassir. For safety, make sure you know the experience of your anesthesiologist in advance, and recognize the difference in training between a CRNA (nurse anesthesiologist 2-4 years of education training) and anesthesiologist (physician anesthesiologist with 8-12 years of education training). Dr.Kassir always uses a physician anesthesiologist to increase the safety of the surgery under local or general anesthesia for rhinoplasty; this will make you feel more comfortable when in the OR. Local anesthesia for rhinoplasty uses an injection of lidocaine and epinephrine to numb and reduce bleeding. Dr. Kassir separates the nasal skin/tissues from the bone/cartilage and shapes the structures for you. He then sutures and applies an external stent to allow for healing. During healing, proper care must be taken to prevent unwanted scarring. If Dr. Kassir uses a graft for the rhinoplasty procedure, these are harvested from the nasal septum, ribcage, or ears. A bone grab can be taken from the cranium, hips, or ribs, and sometimes a synthetic graft or nasal implant is used for the bridge.

A closed rhinoplasty can be used for reducing need to cut tissues, maintaining nasal-tip support, reducing post-op swelling, reducing visible scars, reducing overall damage to nose, increasing ability to make newly found technical changes during operations, allowing surgeon to feel interior changes to the nose, reducing OR time, and allowing for a quicker recovery. More experienced surgeons such as Dr.Kassir are better able to perform these due to having done thousands before. This is one of the reasons why patients of Dr.Kassir can recover much faster.

Photographs are taken before, during, and after procedures and are sometimes supplemented with videos for patient use and visualization. Dr.Kassir processes before photos with an editing software to show you the potential new look. Photos are taken at 5 different angles. You can see before and afters on our instagram @drkassir.

The types of rhinoplasties include primary rhinoplasty (first-time rhinoplasty for reconstruction, function, or aesthetics) or secondary rhinoplasty. 5-20% of patients have a secondary or revision rhinoplasty; which is why having a rhinoplasty with a trained rhinoplasty expert such as Dr.Kassir can be essential to preventing the need to have a second revision. Dr.Kassir has one of the lowest revision rhinoplasty rates in the world, meaning that he is one of the safest, most skilled physicians to consider when looking into rhinoplasties.

A nonsurgical rhinoplasty is the best option when you are not ready for a surgical rhinoplasty. While it only lasts 1-2 years, this can be a quicker method to resolve or "try out" a new nose before having a fully invasive, permanent rhinoplasty. A surgical rhinoplasty lasts forever and therefore may be more likely to suit you if you've considered it for a long time. We suggest you book a free online consult so you can determine whether a nonsurgical or surgical rhinoplasty is better for you.

We will walk through the nasal anatomy so you can best describe the concerns you have with Dr.Kassir during your consult for rhinoplasty. The main surgical anatomy of the nose includes the nasal soft tissues, certain aesthetically domain segments of the nose, blood vessels such as arteries/veins, nasal lymph, nerves of the nose and face, bones of the nose, and the cartilages of the nose. The nasal soft tissue is composed of the nasal skin, nasal lining, and nasal muscles. The nasal skin is divided into thirds; the upper third is thick and becomes thinner as it comes from the glabella (between eyebrows) to the bridge (where glasses sit) of your nose. This is more flexible. The middle third is incredibly thin (over the middle bony part of your nose). The lower third is very thick with sebaceous glands that can increase the aesthetic size of the tip as you age. The nasal lining helps to prevent infections and is lined with a changing cell type to modify the inner breathing pathway. The muscles on your nose that are important to consider in a rhinoplasty include 4 overall groups connected by a thick sheet called the superficial musculoaponeurotic system. The elevator muscle (procures muscle + elevator labii superiors alaque nasi muslce), depressor muscle (alar nasalis muscle + depressor septi nasi muscle), compressor muscle (nasalis muscle), and dilator muscle ( dilator naris muscle anterior/posterior) control the nose's movements.

Aesthetically, the nose has nine nasal subunits or six overlapping nasal segments which Dr.Kassir uses on a daily basis to track and change nasal shape.
The aesthetic subunits include:
-tip subunit
-columellar subunit
-Right/Left alar base subunit
-R/L alar wall subunit
-dorsal subunit
-R/L dorsal wall subunit
Subunits are merged into certain nasal segments including
- dorsal nasal segment
- lateral nasal wall segment
- hemi lobule segment
- soft tissue triangle segment
- alar segment
- columellar segment
An experienced rhinoplasty expert such as Dr. Kassir knows these segments and subunits to a tee; being able to visually place a grid on this axis on your nose simply through their eyes (no ruler needed). Because the nasal units are so small, if more than 50% of a single subunit is damaged/defective/removed, Dr. Kassir must actually place a tissue graft (taken from another part of the body usually) for the whole segment.

A common side effect after splint removal is the black eye effect. The arteries branching to the nose include the internal carotid artery, part of the anterior/posterior ethmoid artery (from ophthalmic artery); and the external carotid artery, sphenopalatine artery, greater palatine artery, superior labial artery, & angular artery. The nasal veins, unlike most veins, have no valves and lead directly to the sinus. Because of this, infections can be easily spread to the brain if originated in the nose. This is another reason why having an experienced rhinoplasty surgeon such as Dr Kassir is essential. Another interesting fact is that due to the high blood supply to the nose; smoking post-op has less of an impact on the healing but is still not recommended by any plastic surgeon and we at Dr. Kassir's highly suggest using a nicotine patch and avoiding smoking for your safety. Lymph systems in the nose help drain potential bacteria, but during this process your lymph nodes can be slightly enlarged around the jaw and neck. Sensation in the nose comes from the trigeminal nerve. The nerves include the lacrimal (eye socket), frontal (forehead), supraorbital (upper eyelid), supratrochlear (inner eyelid), nasociliary (skin of nose/inside nose), anterior/posterior ethmoid (inside nose), infratrochlear nerve, maxillary nerve (upper jaw), infraorbital nerve (under eye to nostrils), zygomatic nerve (cheekbone), superior posterior dental (teeth/gums), superior anterior dental (sneeze reflex!), and sphenopalatine nerve (inside nose).

Two nasal bones attach in the upper nose to the lacrimal bones, maxilla, and the ethmoid bone. The vomer bone helps make the opening into the back of the throat. The floor of the nose is made up of the premaxilla and Palatine (hard roof of the mouth) bone. The nasal septum is made up of cartilage, vomer bone, premaxilla, and the palatine bones. The outer nose wall has 3 turbinates (superior, middle, and inferior concha) that have small holes near them leading to sinus space. At the inside upper part of the nose, a cribriform plate allows the olfactory nerve to pass and let you smell. The cartilage septum comes from the top bony part of the nose to the floor. You can feel it by grabbing your tip and seeing that it is more flexible than the bone at the top. The septum is rather delicate when compared to bone.
The external nose subunits (dorsum, sidewall, lobule, soft triangle, alar, columella) differ by race and ethnicity, which is why looking at rhinoplasty experts who operate on certain ethnic groups is important. As mentioned previously, Dr. Kassir has extensive experience in performing surgery on patients from all walks of life. African (flat, wide), Asiatic (low, wide), Caucasian (narrow), Hispanic (narrow-sided) are different nose types although many more exist. Internally, the septum divides the nose and the nasal valves must have an angle greater than 15 degrees to allow for proper breathing. Dr.Kassir is able to fix breathing issues internally as well as enhance the overall cosmetic external appearance of the nose.

Dr.Kassir is among the top rhinoplasty experts in the world, having done over 8,000 rhinoplasties. A rhinoplasty consult can be booked online or in one of our offices as soon as tomorrow.

RHINOPLASTY FAQs

Is it okay to smoke after 15 days of rhinoplasty surgery?

2 things happen: 1 ), when dealing with a healing nose after rhinoplasty. Newly-healing blood vessels grow, and two, The nose begins to swell. Even smoking 1 cigarette may result in the delay in these blood vessels in the growing and also considerably promote the swelling. And do not think that Nicorette or vaping will help, either, as the culprit is nicotine. Although studies have concluded a decrease in wound healing if cessation of smoking happens 2 weeks prior to surgery, and two weeks following...the nose is a different beast. The rise in swelling after the splint is removed at the beginning of week is exponential, and slowly declines by months 3-6. Delayed swelling may ruin an effect -- plain and simple. Everybody understands the overall risks of smoking, and it is known to cause some of the worst diseases: pancreatic cancer, COPD (chronic obstructive pulmonary disease), cardiovascular disease, strokes, diabetes, diabetes, asthma, reproductive effects, premature babies, blindness (cataracts and macular degeneration), in addition to several other cancers. Is it okay to smoke following 15 days of rhinoplasty surgery? Consider this an opportunity to free yourself from the"captivity" of smoke. Your own system, your significant other, your kids, and your friends will thank you for this. Additional Risks of Smoking in Rhinoplasty Everyone Knows the Dangers of Smoking New Lease On Life The question is, how do you need to risk this?

How does life change after a rhinoplasty?

Rhinoplasty can be nearly painless. Medicine will aid your recovery procedure. Many RealSelf members report experiencing little if any pain after surgery, however, your restoration is going to be quite a personal experience and may considerably differ from somebody else. It's likely to make it through the procedure with very minimal pain. You should not wear sunglasses or eyeglasses to get a month following operation. The bridge of the nose will probably require a while to heal after surgery. Wearing sunglasses or eyeglasses immediately after operation can use tension to the bridge and then also trigger indentations. A prosperous rhinoplasty operation will help to enhance the appearance of your nose. It may alter the contour, it may alter the profile, so it may allow it to move from jagged to straight. That does not mean using a prosperous rhinoplasty you are likely to wind up getting a totally perfect nose out of a magazine. Breathing may be more challenging than it had been before rhinoplasty. Rhinoplasty is not only a cosmetic process. Nasal airway function is also an significant part the process, possibly in correction or preservation. But, occasionally support for your nasal airway could be jeopardized throughout the process. If this comes to pass, you might have a congested sense and trouble breathing through your nose. Normally, bandaging is a essential portion of rhinoplasty retrieval. To stop bones from going after operation and control swelling, then you will probably must put on a splint on your nose for at least a week. Based upon your particular outcomes, some extra bandaging may be required to get at least a couple of days.

How risky is a nose job?

For the most part it's a safe procedure, however you can boost your likelihood of a happy outcome by following a few fundamentals. To begin with you ought to be a canditate that is good, with expectations. Physically you ought to be in great shape, no smoking, no other wound healing issues, no recreational drug usage expecially stimulants. When you have an extroadinarily large nose, then in cannot be created small and adorable, If you have and exceedingly wide nose there is a limit to how thin it could be produced. Choose a surgeon with excellent expertise in the processes, ask to see actual images of individuals and ask to consult with other patients of the doctor. Generally speaking just see a Plastic Surgeon or even Ent specialist. Nowadays it appears that everybody wants to perform Plastic Surgery despite the field they were educated in. I would suggest avoiding Dentists, gyncologists or anyone else from a dicipline besides Plastic Surgery or ENT. If you problem is with your stomach or issues such as a perforated septum, I would suggest only viewing an ENT specialist. Ensure that your doctor is alway accessible and does proper each and every post surgical care, this would help remove the majority of post-operative complications such as wound healing, kept nasal packing or premature assymetries. Among the best pieces of advice I can give would be to bring your physician some images of models who's upset you find appealing. This will set you and your physician on exactly the same page and allows him/her to offer you reasonable expectations. If you're a good candidate, then do your homework and follow the directions provided to youpersonally, you need to have a great result.

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