The Surgery
Rhinoplasty surgery is the name for a group of operations. Each component is chosen and modified for your specific nose. Many different three-dimensional problems can be addressed by such sculpting. Some inherit their nasal shape, while others get theirs from trauma and injury. Many patients also need breathing obstruction issues addressed. Not all patients are aware of their nasal obstruction. During Dr. Bermant's consultation with you he will try to learn what your concerns are and help you learn what surgery realistically has to offer.

Preparing for your surgery
Dr. Bermant will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, taking or avoiding certain vitamins and medications, and washing your face. Carefully following these instructions will help your surgery go more smoothly.

While you're making preparations, be sure to arrange for someone to drive you home or your hotel room after your surgery and to help you out for a few days if needed.

Where your surgery will be performed
Rhinoplasty may be performed in our office state of the art operating room, an outpatient surgery center, or in one of the hospitals Dr. Bermant works. It's usually done on an outpatient basis, for cost containment and convenience. Complex procedures may require a short inpatient stay.

Anesthesia for Rhinoplasty
Rhinoplasty can be performed under local or general anesthesia, depending on the extent of the procedure and on what you and Dr. Bermant prefer.

With local anesthesia, you'll usually be lightly sedated, and your nose and the surrounding area will be numbed; you'll be awake during the surgery, but relaxed and insensitive to pain. With general anesthesia, you'll sleep through the operation. General anesthesia is usually better for more extensive rhinoplasty or septal surgery. Local anesthesia is usually better for small adjustments or hump removal. (See anesthesia.) 

The Surgery
Rhinoplasty usually takes an hour or two, though complicated procedures may take longer. During surgery the skin of the nose is separated from its supporting framework of bone and cartilage, which is then sculpted to the desired shape. The nature of the sculpting will depend on your problem and Dr. Bermant's preferred technique. Finally, the skin is redraped over the new framework.

If your nostrils are too wide, Dr. Bermant can remove small wedges of skin form their base, bringing them closer together. View graphic photographs about nasal width reduction.

Open vs. Closed Rhinoplasty
Most nasal surgery is done from inside the nose. Several cuts are made in the nostrils depending on what needs to be done. In open rhinoplasty, the cuts start just inside the nostril and extend over the columella (the post between the nostrils). Dr. Bermant usually makes a stair step incision over the columella. This external scar visible from below is usually not significant. When the two nostril incisions are connected, the nasal skin can be elevated exposing the anatomy of the nose. Particularly effective for nasal tip and complex septal problems, the deformity can be addressed with the structures in their natural anatomic position. The cartilage and bone are sculpted under the skin.

Closed rhinoplasty depends on incisions inside the nose only. There is no incision made across the skin of the columella. When the tip needs to be modified, it must be delivered through the nostrils and worked on in the delivered deformed position. View graphic pictures of the exposure of open rhinoplasty.

Dr. Bermant removes the hump using a chisel or a rasp, then brings the nasal bones together to form a narrower bridge. Cartilage is trimmed to reshape the tip of the nose. Rasping the nasal dorsum (with graphic movie) Moving the nasal bones (with graphic movie) More graphic pictures during surgery of bone sculpture.

Rhinoplasty Nasal Surgery Important Information

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Rhinophyma Acne Rosacea sculpting nasal deformity.

 
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Nasal hump and drooping tip deformity

• Rubens nasal hump and drooping nasal tip (1612)
• Bouchardon's Pope Clement XII Statue (after 1730)
• Houdon's Adrian - Cyprien Statue (19th Century)
• Italian plate (1520-25)
• Thomas Gainsborough painting Mrs. M. Fitzherbert (1780)

Deformity after nasal fracture

• Rodin man with a broken nose
• Rodin Man with a Broken Nose with computer "surgery"
• Young Duke with Deformed Nose (1785)

Nasal tip loss

• Egyptian Statue New Kingdom (1539-1295 BC)
• Sphinx Nasal Loss
  • Ramses nose from mummy reconstruction
  • Kafre nose from statue reconstruction
• Roman Statue Caligula (38-40 AD)
• Ancient Statue

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This page last updated on: August 3, 2008

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