Rhinoplasty

Modern techniques in rhinoplasty use cartilage grafts to reshape, support and strengthen the nose. Earlier forms of rhinoplasty relied on removing cartilage to make the nose skinny. If too much cartilage is removed from the nose the results can be disasterous. Pinched, asymmetric nasal tips are frequently the result of over resected nasal tip cartilage. Nostril collapse and the inability to breathe through the nose are common when the nose is weakened at the time of surgery.

Dr. Kolstad practices the newest form of nose surgery called “open structural grafting rhinoplasty”. Dr. Kolstad borrows cartilage from the septum and sculpts it into tiny grafts applied to the nostrils, the nasal tip, the bridge and other areas of the nose. Cartilage grafting rhinoplasty strengthens the nose and minimizes the risk of nasal collapse or breathing difficulties after surgery.

The radix is the highest part of the nose. The radix blends into the frontal bone and should be the least projected part of the nasal bridge. Asian and African noses tend to have very low profile radices, frequently needing augmentation. Easter European and Middle Eastern noses can have very prominent radices, frequently needing reduction.

People with a prominent radix typically have a large dorsal hump as well. Removing the hump on the bridge of the nose is difficult in the setting of a projected radix.

The radix requires specialized instruments to reduce. The frontal sinus can be located deep to the radix limiting the amount of radix reduction. The skin covering the radix is thick and does not always contract to the reduced radix projection.

Most patients report minimal pain after rhinoplasty, describing the sensation more as congestion or pressure than sharp pain, because the techniques used during surgery minimize trauma to surrounding tissues, leading to less bruising and swelling. Prescription medications are available for the first few days, though many patients transition to over-the-counter options quickly.

You will typically have several follow-up appointments after your surgery to monitor healing and ensure your results are progressing well. Our team sees patients the day after surgery, then again at 1 week, 2 weeks, and periodically over the following months. These visits are essential for guiding recovery and making minor refinements if necessary.

One of the most common questions we are asked about rhinoplasty is How long does it take to see the final results? The short answer is that it’s complicated. Every patient experiences a unique healing timeline. Dr. Kolstad typically advises patients that it takes a full year for the nose to reach its final shape.

The good news is that most patients do not have to wait a full year for the nose to look good. They just have to wait a year for the nose to look its best. For example, the skin along the bridge of the nose is very thin. Profile views showing a hump reduction will look significantly better only 2 to 3 weeks after surgery.

The actual time to reach the final result primarily depends on the skin thickness. Thicker skin takes longer to shrink. Most people describe the tip of the nose as looking “puffy” for the first several months after surgery. Throughout the year, the ‘puffiness’ refines into a narrower and contoured nose. People with an average thickness of the nasal tip soft tissue will experience mature, final results in about 12 months. Patients with thinner nasal tip skin will heal sooner, and those with thick soft tissue can take a year and a half to achieve final results.

As a facial plastic surgeon, Dr. Kolstad also performs eyelid surgery, brow lifts, chin augmentation, facelifts, and neck lifts. While he wouldn’t recommend having a facelift in coordination with nose surgery, other procedures, such as eyelid surgery, can be combined.

Doing so limits some of the costs associated with anesthesia, facilities, and the like. But patients also need to remember that it will increase what is involved in their recovery. During your consultation with Dr. Kolstad, you can discuss the pros and cons of combining your rhinoplasty with a possible second procedure.

Nose job surgery includes the usual risks of bleeding, infection, poor wound healing, scarring, and possible reaction to anesthesia. Specific to rhinoplasty, these are the risks:

• Difficulty breathing through your nose
• Possibility of an uneven-looking nose
• Septal perforation
• Septal deviation

One of the most important aspects of cosmetic surgery is choosing the right surgeon. In California, particularly Southern California, there are hundreds of providers seemingly offering the same service. The good news for patients is that most surgeons performing rhinoplasty are well-trained and can achieve good results. Also, being located in a region with many providers allows patients to choose a surgeon who is the best fit for them, rather than having to choose the only surgeon in town.

1. Check out the results: Dr. Kolstad always says that the most important thing a patient can research is the pictures. How do you find the best rhinoplasty surgeon? Study the before and after rhinoplasty images. A great rhinoplasty surgeon should have great results. More than any other plastic surgery, rhinoplasty relies on artistic creation. Every surgeon will have a different philosophy on what makes a nose beautiful. Make sure your surgeon creates a nose that aligns with your goals for the procedure.

2. Check for board certifications: Dr. Kolstad believes the two medical boards that best regulate their members’ credentials are the American Board of Facial Plastic Surgery and the American Board of Plastic Surgery. Your surgeon should be board-certified/eligible by one of these boards. Check the website of your state medical board to see if a surgeon has any actions/censures against them. Bad apples will typically have multiple complaints.

3. Check for hospital privileges: Your surgeon should be able to perform the rhinoplasty at a local hospital. Hospitals go through lengthy review processes before granting surgical privileges. Even if the nose job surgery is scheduled to be done in an outpatient center, every surgeon should be credentialed at a nearby hospital.

4. Check out the doctor’s reviews: Read what other people are saying about your surgeon. Both positive and negative reviews can be insightful. Two of the most common websites for reviews about plastic surgeons are: 1) Realself.com 2) Yelp & Google Reviews

And finally, go with your intuition. If something doesn’t feel right, it probably isn’t. Be suspicious of a provider that offers the same procedure at half the cost of everyone else in town. Make sure your surgeon is someone you can trust and who will be with you through the end.

Finding the best rhinoplasty surgeon requires a bit of research, but all the necessary information is only a few clicks away.

It takes a full 12 months for 100% of the swelling to be completely gone. The nasal skin must shrink wrap to the new framework and definition. This takes time. Throughout the postoperative period, Dr. Kolstad will use medicines to contour the nasal skin and enhance your result.

It is common for some bruising under your eyes after San Diego rhinoplasty surgery. With frequent use of ice packs, bruising is typically minimal and does not bother most people. Dr. Kolstad recommends that his patients obtain a cover-up makeup kit before surgery to help camouflage any postoperative bruising.

A frequent concern for our patients is appearing “plastic” after a rhinoplasty. There are limitless examples of unnatural, operated results. When surgeons remove too much structure, the nasal tip can look overly narrow.

It is very important to choose a San Diego plastic surgeon who specializes in operating on the face. Dr. Kolstad is an expert in nasal cosmetic surgery and is known as the face specialist, because, put simply, that is all he does.

The rhinoplasty cast will stay on for one week. After removal of the splint, your nose will be a little swollen and “puffy”. However, even when swollen, your nose will look better than it did before surgery.

Elective rhinoplasty for cosmetic/aesthetic reasons is not covered by insurance in the vast majority of cases. If, however, at least part of the goal of this surgery with Dr. Kolstad is to improve nasal function or to correct any traumatic nasal deformity, then the procedure may be partially or fully covered. Our team at Kolstad Facial Plastic Surgery will work with your insurance company to achieve the best reimbursement.

There really isn’t an upper age limit for rhinoplasty. As long as the patient is healthy, there’s no reason, just because they are older, that they have to continue living with a nose they hate. Nose surgery can also improve function, which can help keep tissues prone to sagging from interfering with breathing, especially while sleeping.

Your surgeon best determines the decision to perform an open or closed rhinoplasty. Both techniques have advantages and limitations. Depending on your features and goals, you may be a better candidate for either technique. Dr. Kolstad does not perform one surgery for every nose; different options for your nose will be discussed during your consultation.

Advantages of open rhinoplasty:

• The cartilage is viewed in its natural orientation during cuts, resulting in more precise incisions.
• Cartilage grafts can be used to reshape and strengthen the nose.
• Only suitable approach for large revision rhinoplasties.
• Can correct anatomical breathing obstructions as well as improve the nasal appearance.

Disadvantages of open rhinoplasty:

• The surgery typically takes longer than closed rhinoplasty, leading to more swelling and scar tissue after surgery.
• The “w” shaped incision creates a small scar on the skin.

Advantages of closed rhinoplasty:

• Less swelling after surgery.
• Less internal scarring of the nasal soft tissue.
• No external incisions or scarring.
• The surgery can be performed in 90 minutes, which should reduce its cost.

Disadvantages of closed rhinoplasty:

• Cannot visualize the cartilage or bone in its natural anatomical position. This leads to less precise cuts and refinements.
• Cannot suture bridge cartilage, increasing the risk of collapse after surgery.
• Difficult to apply cartilage grafts used to reshape the nose.
• Difficult to impossible to perform challenging reconstructive rhinoplasty through a closed approach.

The most challenging variable to control in every rhinoplasty surgery in San Diego is the skin. The best rhinoplasty results require an ideal skin thickness. Soft tissue that is too thin is difficult to fix, and skin that is too thick is equally as challenging to change.

Nose job surgery is designed to reshape cartilage and bone. Every rhinoplasty surgeon redrapes the skin over the new cartilaginous framework and waits for the soft tissue to shrink wrap to the new form. Skin that is too thin will shrink too much and heal like Saran Wrap. Dr. Kolstad believes one of the most striking changes to Michael Jackson’s nose was the skin becoming too thin. Thin skin accentuates irregularities and imperfections. Thin nasal skin needs to be thickened using open rhinoplasty grafting. Dr. Kolstad frequently ‘thickens’ thin skin with mastoid fascia (flexible soft tissue from the side of the head). The opposite side of the same coin is skin that is too thick.

Thick skin does not shrink. Thick skin frequently leads to an amorphous, round nasal tip blob. Thick skin will camouflage and hide all of the changes that were made to the nasal tip cartilage. For most people, there are no liposuction or surgical techniques that can decrease the thickness of the nasal skin. The most important way to control thick nasal skin is to identify it before surgery. Patients with thick soft tissue require specialized grafting techniques to achieve optimal results. Dr. Kolstad typically uses shield grafts to narrow and refine the thick nasal tip skin.