RhinoplastyRhinoplasty (Surgery of the Nose)

Explore rhinoplasty, nasal surgery, and sculpture of the nose by Dr. Michael Bermant, MD plastic & cosmetic surgery.

Michael Bermant, MD
Board Certified by the American Board of Plastic Surgery

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Anatomy and Function
The nose is the most prominent projection of the face. When looking at someone, eyes are readily attracted to it. Evil characters, witches and creatures are commonly portrayed with disfigured or deformed noses. Its true function is to provide a portal for air to enter and exit the body. Dry external air is moisturized so as not to dry out the airway and lungs.

The nose is made of the outer covering (skin), a support system (cartilage and bone), and lining (mucosa). Cartilage is the softer floppy structure that permits movement and control of the opening of the nostrils. Nasal bones support the bridge of the nose between the eyes. The septum is the wall between the two nostrils that is a sandwich of cartilage and bone surrounded by mucosa. It functions like a tent pole holding up the lower nose. Deeper in the nose opposite the septum, turbinates project into the air flow to humidify the air. The turbinates enlarge and shrink depending on the needs for moisture. Under the turbinates are the holes into the sinuses.

The nasal airway can be obstructed by:

  • thickened mucosal lining of nose (such as in a
  • cold or allergies)
  • a deviated septum
  • a thickened septum
  • distorted external nasal structures
  • thickened or enlarged turbinates

Sinus obstruction can also occur from local swelling of the turbinates. Deviation of the septum and nasal deformities can increase the chance of this obstruction such that a smaller swelling closes off the openings that otherwise would be open.

Cosmetic concerns
Some individuals are not happy with the shape of their nose. You may be concerned that it is too short, too long, too wide, too narrow, too high, or too flat. Different nasal parts may seem out of proportion to each other or the rest of your face. You may not like the nostril shape or position. The tip can be too big, too wide, pinched, or bulbous. The external column between the nostrils (columella) may hang down too far or not far enough. These concerns are cosmetic or appearance related. As such they are not covered by most insurance policies.

Alternative Care (Airway)
Dr. Bermant always explores possible allergic and environmental problems about all patients seeking nasal surgery. If you are allergic to what is breathed through the nose, irritants will swell your passageways closing off your nose. Avoiding irritants, decongestants, and adding humidification can help with allergic problems. Allergies can be seasonal. Partial mechanical obstruction means it takes less swelling before your nose closes off. People with enough chronic irritation even develop overgrowths of the mucosal lining of the nose called polyps. Such overgrowths can also obstruct the nose. Medical treatment can help some allergic problems. Check out what is on the web about allergic rhinitis and the medical treatment of nasal obstruction.

Cosmetic Issues
Your option for cosmetic concerns is not to have any surgery. Cosmetic surgery is elective, surgery that you do not absolutely need. Your deformity may be great enough that it may be a good idea to have the surgery but not if you have significant other medical problems. Cosmetic concerns, deformities and appearance are REAL problems. They are often trivialized unnecessarily, making individuals unhappy. Why live with something you do not like if you can have it changed? Many of Dr. Bermant's patients who elect for a cosmetic change in appearance tell him they wonder why they waited so long and did not have the surgery sooner.

Benefits from Surgery
If medical treatment fails and mechanical obstruction exits, surgical options may have value. Straightening a bent septum, thinning a thickened obstruction of the septum, and moving deformed external structures all can improve certain airways. Enlarged turbinates can sometimes be improved with judicious partial removal. Excessive intervention on the turbinates can be uncomfortable since humidification can be compromised.

There are many possible surgical choices for changing the shape and characteristics of a nose. The evaluation and analysis takes considerable time for your consultation. Flesh is not like a computer image. On a computer you can have a nose appear to change to almost anything you may want. Such virtual changes rarely can be duplicated with surgery. You will need to understand what surgery may be able to do for you. Realistic expectations are the key to a happy outcome.

Rhinoplasty case1 preop Rhinoplasty case1 postoperative

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See a morph of this surgical result

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Rhinoplasty case2 lateral before surgery Rhinoplasty case2 lateral after surgery

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Rhinoplasty case2 front before surgery Rhinoplasty case2 front after surgery

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Before Surgery

After Surgery

This patient was not happy with the size and appearance of her nose.

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Rhinoplasty Nasal Surgery Important Information

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Open Rhinoplasty - Photographic details during surgery of the Black nose (warning graphic pictures).

Open Rhinoplasty - Pictures of dorsal and tip sculpture during surgery (warning graphic photographs)

Patient Pictures before and after surgery

Rhinoplasty Experiences Discussions, Forum, and Chat

Nasal Obstruction Septoplasty and Other Nose Discussion Groups, Forum, and Chat

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This page last updated on: April 21, 2012

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