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Tuesday, September 13, 2011



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Rhinoplasty Nose Job or Nose Reshaping is one of the most common cosmetic plastic surgery done world wide. Central part of face including forehead , nose and peri oral area ( lips and adjacent area) gives our face a unique feature. Nose, Being the most projected part of face is noticed first when one sees our face. Various Rhinoplasty criteria have been defined for aesthetically pleasing nose but all these cant be used on every case. Common Rhinoplasty procedures include Augmentation Rhinoplasty, Hump Reduction Rhinoplasty or Nose job, Nose tip-plasty, Rhinoplasty for Broad, long , deviated or broken nose & Cleft Rhinoplasty, Alar-plasty with Nostril reduction. Each and every race (Indian, Caucasian, Negroes, Asians Orientals) have different characteristic and any Rhinoplasty Nose job surgery should be planned considering the characteristic of that race. We have multiple races with minor to major variation in facial features in our country , means we have almost every type of face and so every type of nose here. Your Rhinoplasty surgeon should be able to design and tailor surgery individually for your best. This page illustrates different types of noses plus their Rhinoplasty before after Pictures.
Breathing problems:- Nose is an organ of breathing first, cosmetic next. It works as humidifier and warmer for the air we breath. Septum, the middle wall of nose which divides it in two passages, is partly bony and partly cartilaginous.
Deviated nasal septum or DNS is a very common occurrence in general population and often considered reason of obstruction in breathing, which is not always true.
Nose is having two valve areas, external and internal, breathing difficulty occurs usually due to narrow valve area rather than deviation of septum, unless the later is very severe. Of course deviated nasal septum gives nose a deviated look from outside and correction restores its look and when associated with procedures to open the collapsed valves, improves both look as well as breathing. Most of our male population face breathing problem which is not due to deviated septum but external valve collapse, very common in India.

Rhinoplasty (Nose job) Before After - 60 years old male with severe drooping of tip with external valve collapse leading to obstruction in breathing - first treated with Septoplasty , turbinate reduction and tip correction outside India without improvement - Simple nose lift with external valve correction provides best correction of breathing as well as look.
Common complaints by patient & Concerned Rhinoplasty or Nose Job / Nose Reshaping Procedures:-
Broad Nose :- Osteotomy & Narrowing of Nose with Tipplasty.
Hump Nose or Bumpy Nose :- ( Hump) Reduction Rhinoplasty or Nose Job
Long Nose with Drooping tip :- Tip-plasty with or without Augmentation Rhinoplasty (Nose Job) or Reduction Rhinoplasty (Nose Job)
Lateral Deviation of Nose or Crooked nose:- Straightening of Nose or Corrective Rhinoplasty (Nose Job)
Low Dorsum or Bridge of Nose :- Augmentation Rhinoplasty or Nose Job with or without tip plasty
Big or Bulky Nose:- Reduction rhinoplasty with tip plasty. ( for examples of all - see pictures below)
Commonly, combination of various Rhinoplasty or nose job procedures is needed to provide a cosmetically or beautiful nose in every Rhinoplasty or nose job.
In general , a narrow nose with optimal projection beyond face, straight dorsum (with slightly elevated tip in females), nose lip angle 105 degrees with tear drop shaped nostril is considered good.
Overall , changes done during surgery are demand based, means what patient feels abnormal.
Deviated Nasal Septum (DNS) (Septoplasty) :- Correction of DNS with or without other rhinoplasty procedures or nose job procedures.

Before after picture of severe S shaped curvature of septum, this septum was curved not only in upside down plane but also in antero posterior plane, straight septum after correction. (Note: - Please Don't see this picture if sight of blood hurts you, we have tried to blur the blood soaked areas. A complete Septoplasty involves not only correction of cartilaginous septum but also of bony part of septum and realignment of all structures to provide a straight nose with patent nasal passages..
congenital and post traumatic deformities :- Rhinoplasty or nose job in such situations are designed according to the deformities or nose and other associated deformities.

Individual Rhinoplasty procedures and before after pictures (Case Examples) - Scroll down to see individual nose types.
i) Augmentation Rhinoplasty:- Some amount of augmentation you will find in almost every nose job except hump reduction, even in nasal hump reduction, cartilage graft in dorsum is needed to close open roof. Augmentation rhinoplasty or nose job done to elevate the depressed dorsum or tip or both. In augmentation rhinoplasty autogenous and artificial material can be used. We usually use autogenous material unless there is no natural source for it. Here in this page augmentation has been associated with other nose job procedures in almost all cases except hump reduction and in every case only nose framework has been modified for natural & best rhinoplasty results. Silicone nose implant or any other implant has not been used in any rhinoplasty.

Augmentation rhinoplasty before & after picture of dorsum or bridge of nose augmentation to match with tip along with tip plasty : Augmentation with septal cartilage graft : For Surgery see rhinoplasty video
ii) Nose Tip Plasty : (A) Droopy projecting tip) Tip plasty usually involves correction of nearby framework also to create a harmony with rest of nose. Tip of nose gives us a distinct appearance and nose tip deformity is always obvious as its the most projected part of our nose.

Before after picture Tip plasty - Such deformity is usually found in occult type 0 facial cleft. This tip plasty has been done by remodeling of nose framework (Alar & upper lateral cartilage under local anesthesia , no artificial material used.
(B) Low (Bridge) Dorsum & Bulky Tip (Big Bulky or Bulbous Tip of Nose) :- Augmentation Rhinoplasty or Nose Job with Tip Plasty. Tip plasty to reduce bulkiness , in such noses alar cartilages are usually hyperplastic and fat accumulation is found between cartilage framework and skin. Ear (Conchal) cartilage has been used for nose dorsal elevation. Done under local anesthesia.

Before After Rhinoplasty for Bulky or Bulbous Nose tip and depressed dorsum - Dorsum augmentation with conchal (ear) cartilage graft with tip plasty
(C) Flat Broad Tip : Tip-plasty for falt broad tip (these cases usually have hypertrophied alar cartilages)

Rhinoplasty Nose job before after - Hyperplastic alar cartilages- hyperplastic variant of type 0-type 14 facial cranial cleft- a cleft nose variant without a visible cleft - feature of cleft on surface is increased distance between eyes .
(D) Depressed Tip : Nose tip Augmentation for depressed tip

Nose tip plasty before after picture : This depressed tip is an example of binder's Syndrome (Central face hypoplasia- Nose, maxilla ( upper jaw) and chin (Mandible) Hypoplasia ( Underdevelopment ). Tip and dorsal nose augmentation with coastal cartilage (rib cartilage)
iii) Septo-Rhinoplasty with Nostril Adjustment & Tip Plasty : Rhinoplasty or Nose Job with tip plasty. septal cartilage for elevation of bridge of nose, tip plasty and osteotomy - under general anaesthesia

Septo-rhinoplasty before after picture: Wide or broad depressed nose with depressed tip - Septoplasty to harvest septal cartilage graft (best graft material for nose augmentation), osteotomy to make nose narrow tip plasty and nostril reduction.
iv) Deviated nose:- deviated nose ( Abnormally healed nasal bone fracture or Congenital Deviation ) Rhinoplasty or Nose Job for correction of nose deviation.

Post Traumatic Deviation of Nose - Before After Rhinoplasty, Patient wanted to retain other racial Characteristics like tip and Nose length which has been respected.
v) Long & Broad Noses
A) Broad nose or Wide Nose :- Broad or Wide Nose with lack of tip definition Before after rhinoplasty picture

Rhinoplasty Before After for Broad Nose with wide nose tip- This nose was one of extreme broad nose treated with Nose reduction, osteotomy and tip plasty.
B) Extreme Broad Nose

One of extreme broad nose with dorsum irregularity (history of dorsal hump reduction and rhinoplasty somewhere else) , deformed flat tip, supra-tip depression , huge ala and wide nostril - before after rhinoplasty picture or photo
C ) Long Nose Rhinoplasty : Long Nose with deviated & drooping tip - Before after rhinoplasty picture

Rhinoplasty for long nose correction, long nose with drooping tip before after Picture
D ) Low & wide dorsum with broad & low tip:- Rhinoplasty or Nose Job with tip-plasty. An Example of Asian Rhinoplasty.

Low Broad dorsum Broad tip - Before after rhinoplasty tip-pasty picture

Low broad dorsum with wide drooping tip - Rhinoplasty before after picture- Dorsum and tip augmentation with correction of drooping tip and creation of a sleek nose.
Ala & nostril reduction : some people have wide and big ala & nostrils. side wall of nose surrounding nostril is called ala. a wide nostril is usually associated with a low tip and low dorsum. correction of involves reduction of ala & narrowing of nostril with or without tip plasty and augmentation of dorsal bridge of nose ( see picture iii below)

(Dorsal hump reduction, cartilage graft to smoothen dorsum, tip-plasty, narrowing of nose with Internal Osteotomy) Rhinoplasty with alar base nostril reduction before after picture (Photo)
vi ) Dorsum hump or Bumpy (nose) with or without drooping tip:- Hump Reduction Rhinoplasty or Nose Job with tip plasty & Narrowing of nose in male.

Before After Picture Rhinoplasty or Nose Job with Hump Reduction, Correction of supra-tip depression, Tip plasty for elevation of tip of nose as well as narrowing and Correction of wide nasal base.

Before After Pictures Reduction Rhinoplasty Hump Reduction, Tipplasty Broad Nose Correction in Female
VIII ) Post traumatic nose deformity:- (Broken Saddle Nose with nostril and airway stenosis or blockade) Augmentation Rhinoplasty or Nose Job with tip plasty and reestablishment of nasal passages. Case Example-

X )Nasal deformity associated with cleft lip and palate:- Cleft Rhinoplasty or Nose Job with tip plasty & correction of Cleft lip nose deformity along with base of nose ( Maxilla)

Cleft Lip Palate & Cleft Nose Deformity Correction - Cleft Nose Correction involves correction of base of nose i.e. adjacent maxilla (jaw bone) which is less developed in cleft lip cases along with nose correction. Almost every structure of nose id deviated deflected and deformed including bony and cartilaginous septum, alar cartilage , upper lateral cartilage , nostrils and ala with alar base- so correction involves every aspect of nose along with bone grafting or implant augmentation of jaw bone or maxilla. Details you may see in our research paper on cleft lip nose deformity - link is there in publication page. for Details of Cleft lip and palate - Visit Cleft Lip and Palate Page.
For details on open rhinoplasty & cleft nose correction you go through our research paper on cleft nose & open rhinoplasty - please visit Research & Publications page.
X ) Revision Rhinoplasty for Crooked Deformed Nose :- Revision Rhinoplasty or Nose job Revision is for those who are not satisfied with their result of primary surgery. as such best opportunity to provide the best result is in first surgery, but sometimes patient wants some more change, or some changes are deliberately left for second stage ( rare). In such Cases Revision Rhinoplasty Can be done after 3 to 6 months after first surgery, depending upon magnitude of dissection in first surgery and resolution of swelling. In our Cases, We do all possible changes in one go only but we are getting cases for revision rhinoplasty first operated elsewhere, this is one example.

Revision Rhinoplasty Before After : (History of hump reduction and rhinoplasty somewhere else 3 years back ) presented at our clinic for revision rhinoplasty with Long Deviated Nose with Severe DNS (Septum totally out of midline) Bony Hump, Supra-tip Depression Deviated & Drooping tip - Natural Septo-Rhinoplasty (No artificial material used).
xi ) Rhinophyma:- Cosmetic rhinoplasty or nose job.

Before after picture rhinophyma correction or potato nose : Rhinophyma is exaggerated activity and growth of sebaceous glands of tip of nose which discharges creamy white oily substance. Discharge instead of coming out becomes collected in glands.
Rhinoplasty or Nose job , Septoplasty, Septo-rhinoplasty Frequently Asked Questions:-Rhinoplasty or Nose Job Procedure, Course & Outcome of cosmetic & Plastic Surgery of Nose
1) What are open and closed approaches for Rhinoplasty?
Ans:- in closed approach, incision for modifying nasal framework, are entirely inside the nose, no visible mark outside. In open rhinoplasty , the same inner incisions are connected externally either in mid columella (middle pillar of nose between nostrils when seen from basal view) or at lip columella Junction. Over the time they heal well and practically there is no visible scar in long term.
2) which rhinoplasty or nose job approach is preferable, open or close?
Ans:- preferred approach depends upon amount of work needed in any particular nose. Both can be done in any nose, close is preferred for minor modifications. Open approach provides clear view of entire nasal framework so fine manipulations are always better with this. All the incisions are kept inside nose in both approaches and not visible outside except that a mid collumellar incision or lip columella junction incision joins incisions of both sides in open approach. No noticeable scar in both cases.
3) How long the rhinoplasty or nose job surgery takes?
Ans :- may take one and half to two and half hours , depending upon amount of work needed.
4) General or local anesthesia for rhinoplasty or nose job ?
Ans:- local and nerve block anesthesia is sufficient for most of cases. Short term general anesthesia is used for osteotomy (cutting and inward mobilization) of nasal bones.
For a complete Septo-rhinoplasty general anesthesia is preferable to local as its safer, more controlled and more comfortable for patient, also it allows surgeon to work in a comfortable environment which is most important for fine cosmetic and functional manipulations.
5) what manipulations usually done in rhinoplasty / Septoplasty / Septorhinoplasty or nose job ?
Ans:-A complete rhinoplasty usually involves correction of bony and cartilaginous dorsum ( the part of base of nose visible in front view), tip correction ( narrowing or elevation) , correction of nostrils and lip nose relationship.
Overall all work needed in a nose are done simultaneously, depending upon individual requirement.
In , septorhinoplasty, septum is dealt along with rest of nose, straightening, debulking etc are done , again decided by need of individual nose. Besides this septum provides the best possible source of cartilage for dorsum augmentation or tip work. so septoplasty is often added to rhinoplasty as it corrects septum as well as provides autogenous material for use in rest of procedure.
6) what about breathing difficulty in Rhinoplasty or nose job ?
Ans:- nose has two valve areas , internal and external. In an otherwise normal looking nose , it’s the internal valve collapse which causes breathing difficulty and needs to be widen with spreader graft. In a nose with drooping tip, external as well as internal valves are affected and need correction.
7) Rhinoplasty Recovery After Surgery : How much is recovery time after Rhinoplasty or nose job surgery?
Ans:- surgery takes around two and half hours . recovery from general anaesthesia is almost instant after Rhinoplasty surgery. You may feel little tiredness for a few hours (2-3).
Mobile and may take normal diet after 6-8 hours. Nose will be packed for 48 Hours. Discharge from hospital after 6-8 hours or next morning. Dressing on nose 7 days.
Your nose will look normal to others but you will feel swelling at 2 weeks.
After three weeks , nose looks almost normal , in newer shape, but mild ( undetectable) swelling is still there. It takes around three months before nose looks almost normal with all evidences of surgery resolved except very little amount of edema ( Swelling ) which is unnoticeable.
8 ) Any difference in Female & Male Rhinoplasty :-
Male Rhinoplasty is always believed to be a separate entity , as male noses are usually more deformed also expectations in male is always more than females, their thick skin makes result late to appear. In our practice we see every nose as a different and individual entity be it male or female Rhinoplasty and contrary to the common belief in plastic surgery society our male patients are equally happy. In females skin is usually thin and shape of nose appears well after rhinoplasty.
9) what are materials used for nose augmentation?
Ans:- materials used for augmentation can be autogenous ( from patients own body) or artificial materials.
Autogenous :-
Cartilage:
from nasal septum—most commonly used;
conchal cartilage ( from ear);
or rib cartilage.
Bone:- pelvic bone ( iliac creast);
Calvarial ( outer table of skull )
Artificial materials:-
Medpore ;
Silicone
Goretex .
10) Which material is better autogenous or artificial ?
Ans: use of autogenous material is always better whenever available and applicable. use of artificial material is a compromise rather than a choice. in most of noses remodeling of nose bony and cartilaginous framework itself is sufficient to give desired result, if not cartilage harvested from septum , or ear cartilage or any other option is chosen for.
many people think cosmetic surgery always needs use of artificial material, its a big confusion, cosmetic surgery is surgery which is intended to improve your look when function problem is not there, in fact almost every cosmetic surgery involves improvement of both look and function.
10 ) Any rest required ?
Ans: yes, Rest for six hours after surgery, its better to take leave from work for 2-3 days, avoid exertion and heavy work for a week at least. There will be dressing on your nose for Seven (7) days if osteotomy has been done , for 5 days if not.








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