Expert Rhinoplasty from Toronto Facial Plastic Surgeon Dr. Mounsey
Rhinoplasty General Information
Over the years he has built a reputation for rhinoplasty surgery founded on the principles of natural results and specially designing the surgery to complement your facial features. Whether British, European, African, Asian, Middle Eastern, South Asian, the techniques used and surgical plan are devised to optimize your result. Revesse has become the rhinoplasty destination. If you feel that your nose would look better if it were smaller or larger, or if it had a more streamlined tip or bridge or differently sized or shaped nostrils, then you probably have already considered what you might look like after rhinoplasty. Using the Canfield Medical Imaging system, Dr. Robert A. Mounsey can help you envision your results and learn more about the nose surgery procedure at Revesse near Toronto, North York, Mississauga and Brampton. Although Dr. Mounsey customizes this procedure to the unique needs of each patient, it is always performed using one of two basic techniques: open or closed. In an open rhinoplasty, Dr. Mounsey makes an incision across the columella, the strip of skin that separates the two nostrils. Dr. Mounsey can then easily access and manipulate nose tissue and bone for an optimal aesthetic result. In a closed rhinoplasty, Dr. Mounsey makes the incisions inside the nostrils. For people of color who would like to correct aesthetic issues with their noses without compromising their ethnic identity, Dr. Mounsey offers specific solutions based on their ethnic origins.
There are many aesthetic changes which can be made to the nose during rhinoplasty. A hump or bump on the nasal bridge may be lessened or removed by filing it down or by performing an osteotomy. Many patients want to address a bulbous or droopy nasal tip or overly wide nostrils and there are a variety of techniques which may be used to refine the tip including cephalic resection, alar base resection or suture techniques. Other times grafting techniques may be used to widen the nose, lengthen the nose, refine the tip, alter the nasal projection, or change the nasolabial angle.
Rhinoplasty is commonly performed with general anesthesia or local anesthesia and sedation. The surgical time is two or more hours. Following surgery, a splint is placed on the nose and this and other dressings are typically removed after six to seven days. If nasal packing is used after surgery, it is commonly removed on the next morning. Some discomfort, bruising and swelling may result. Discomfort can be alleviated with pain medication. Bruising is common around the eye area and may be present for up to ten days. Swelling will take a month or more to resolve. Patients are often able to return to work after one week.
While rhinoplasty is typically performed to improve the appearance of the nose, functional problems may be addressed as well. In many cases patients are seeking both cosmetic and functional improvement.
Functional rhinoplasty improves the airway function by addressing nasal obstructions. Common functional rhinoplasty techniques include septoplasty, turbinate reduction and nasal polyp removal. Septoplasty is performed to straighten a deviated septum and open the blocked air passage to improve breathing. Enlarged turbinates may lead to nasal obstruction and turbinate reduction reduces enlarged turbinates. Nasal polyp removal involves the removal of nasal polyps which are benign small growths that can obstruct the nasal passage. Functional rhinoplasty can also address nasal valve collapse.
Insurance typically does not cover rhinoplasty when it is performed strictly for cosmetic reasons. However, some coverage may be available when correcting or improving the nasal function or addressing a major deformity or injury.
The nasal septum is the wall of bone and cartilage that divides the two nostrils of the nose. Ideally, the septum should be straight and located in a central position inside of the nose with equally sized airways on either side. However, the septum can become crooked or displaced to one side, which is known as a deviated nasal septum. Whether congenital or caused by injury, a deviated septum can lead to airway obstruction and breathing difficulty, as well as other possible symptoms like nosebleeds, snoring and sleep apnea. If these symptoms become severe enough to detract from one’s quality of life, surgical intervention may become necessary.
Septoplasty is the surgical procedure to correct or straighten a deviated septum. It is typically performed as an outpatient procedure with either local anesthesia or general anesthesia. In some cases, an endoscope may be used. During surgery, the septum may be trimmed and repositioned, and cartilage or bone may be replaced. Incisions are typically confined to the inside of the nose and are closed with absorbable sutures. The surgery usually takes 60 to 90 minutes to complete.
Once the surgery is complete, soft silicone splints may be inserted into each nostril and nasal packing may be placed inside the nose. These will help to support the septum and minimize bleeding. Packing is often removed the next day while the splints may remain in place for about one week. Some swelling, bruising and discomfort may result. Many patients are able to return to work within one to two weeks.
While septoplasty is generally a safe procedure, as with any surgery there are potential risks and these may include adverse anesthesia reactions, bleeding, infection, persistent nasal obstruction, a change in the shape of the nose, septal perforation, scarring, decreased sense of smell and septal hematoma.
Correction of Alar Retraction, Hanging Columella, and Ala-Columellar Disproportion
Alar retraction is a condition in which the portion of the nose near the tip known as the ala contracts upward, resulting in excess nostril show. This may be congenital or it may result from aggressive lateral crural resection during rhinoplasty or the resection of vestibular mucosa during cephalic resection. Alar retraction can be corrected with a variety of techniques including cartilage repositioning, composite grafting, alar batten grafts, or alar rim grafts.
The columella is the portion of tissue at the base of the nose that separates the nostrils. When too much of the columella is visible, this is known as a hanging columella or alar-columellar disproportion. While a hanging columella will also result in excess nostril show, it is important to differentiate this from alar retraction. Other signs of a hanging columella may include a droopy tip, a short upper lip, a long lateral cruse, and a strong lateral cruse without obvious notching. A hanging columella may be congenital or it may result from prior rhinoplasty surgery. Correction may involve excision of excess cartilaginous caudal septum or redundant membranous septum. Rotation may also be addressed at the same time. If grafts from previous surgery are causing the hanging columella, revision rhinoplasty can be perofmred to excise or alter the graft. Another option for addressing a hanging columella is the tongue-in-groove technique.
Tip rhinoplasty procedures are performed to change the shape of the nasal tip. Patients may complain that the nasal tip is too wide, too narrow, bulbous or boxy. Tip rhinoplasty can add definition to and refine the nasal tip for an improved appearance. The surgery may also adjust the angle or height of the nasal tip.
Depending on the individual concerns, tip rhinoplasty may be a fairly simple, quick procedure designed to achieve a little “tweak” in the nasal tip appearance or it can be very complex. A variety of techniques may be used including sculpting techniques, suture techniques and the use of grafts. When grafts are used, they are often made from the patient’s own cartilage which can be harvested from the septum, ear or even the ribs.
Not all rhinoplasty procedures involve major changes. For those seeking subtle changes or “tweaks” in their nasal appearance, finesse rhinoplasty can help. Finesse rhinoplasty basically involves very minimal, specific changes which are made to fine tune the appearance of the nose while maintaining the other features of the nose. This can be particularly attractive for models, actors and actresses and others who do not want a very noticeable or obvious change. Finesse rhinoplasty is typically performed with local anesthesia using a closed rhinoplasty approach. While the changes may be subtle with finesse rhinoplasty, this procedure does require a very skilled and meticulous surgeon.
There is a strong relationship between the nose and the chin. A large nose may appear even larger when set against a weak or receding chin. For this reason, chin surgery to address either a receding or prominent chin is often combined with rhinoplasty in order to balance these two features to achieve better facial harmony. When rhinoplasty and chin surgery are performed at the same time, this is often referred to as profileplasty. Profileplasty can dramatically improve the profile and overall facial appearance.
Craniofacial disorders and cleft lip and palate can lead to nasal deformities that can be corrected by a talented surgeon. Dr. Mounsey has more than 15 years of experience performing cosmetic and reconstructive facial plastic surgery. Teens and adults with small or underdeveloped noses, cleft noses, or asymmetrical noses can have these issues corrected with nose surgery at Revesse.
Rhinoplasty is always performed using one of two basic techniques: an external (open) approach or an internal (closed) approach. With the external approach, a small incision is made on the columella, or the column of skin between the nostrils on the underside of the nose. With the internal approach, all incisions are confined to the inside of the nose.
Middle Easterners tend to have very prominent noses, which is likely due to evolutionary adaptations to weather. Persians living in their native Iran undergo rhinoplasty surgery at a higher rate than citizens of any other country. Dubbed the “Nose Job Capital of the World," Iran’s women reveal only a small portion of their faces and bodies to the public, as is customary in their culture. This may play a role in why this commonly seen feature is sought to be perfected. Western ideals that influence many other regions of the world are also likely to set a standard in facial structure for Persians as well.
If you would like to learn more about nose surgery in a consultation with our rhinoplasty expert, Dr. Mounsey, please contact our practice in the Toronto, North York, and Brampton area today.
Call (416.438.2499) or Email Dr Mounsey
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