Rhinoplasty (Nose Surgery)

Rhinoplasty in Beverly Hills - Richard W. Fleming, M.D.

Richard W. Fleming, M.D. FACS is considered one of the best, most experienced Beverly Hills rhinoplasty surgeons. He uses a unique combination of superb surgical skill, sophisticated techniques and refined artistic judgment to provide all of his patients with outstanding aesthetic results. His reputation for excellent surgical outcomes and impeccable patient care attracts numerous rhinoplasty and rhinoplasty revision patients worldwide. In the paragraphs below, Dr. Fleming explains the rhinoplasty procedure and the results his patients can achieve.

The Role of Rhinoplasty in Facial Aesthetics

We’re defined by our profile: Strong, delicate, or refined, the shape of the nose speaks volume about who we are. Having a proportional nose is also essential to achieve proper facial balance. A nose that is too large or too small can distract from your other features and make your face less photogenic. Rhinoplasty is therefore the most common cosmetic operation. Many people seek nose surgery for personal or professional reasons, knowing this procedure will greatly improve their facial contours. In fact, most surgeons recommend having rhinoplasty (if necessary) before pursuing other facial modifications. Patients often discover that their eyes, nose, and cheekbones look far more striking once their nose is brought into proper balance. This sometimes eliminates the perceived need for other facial procedures.

Dr. Fleming performs rhinoplasty surgery to modify the nose by changing its size and sculpting the nasal structures so that the nose is in harmony with other facial features. When the surgery is done to improve appearance, he reshapes the nose on an individual basis to achieve a more desirable, natural, non-surgical shape. Every rhinoplasty Dr. Fleming performs is carefully personalized to ensure that the patient’s goals are met and that his or her overall facial shape is complemented by the procedure. As a rhinoplasty super specialist, he understands the importance of avoiding the obvious surgical look created by many non-specialists.

before nose surgery profile view
after nose surgery profile view

Why Choose a Rhinoplasty Super Specialist?

Though many plastic surgeons perform rhinoplasty, few truly specialize in it. This is problematic because the nose is one of the most structurally complex parts of the face. It contains multiple bones and plates of cartilage, which must be carefully manipulated during surgery. General training in plastic surgery does not confer the advanced knowledge of nasal anatomy needed to create truly flattering rhinoplasty results. This is why many otherwise skilled plastic surgeons over-correct the nose, reducing it down until it looks “pinched” at the tip or scooped-out along the bridge.

Rhinoplasty super specialists are rare, and they differ from board-certified plastic surgeons. While a board-certified plastic surgeon may only have general rhinoplasty training, a super specialist like Dr. Fleming will have completed in-depth training and residencies focusing specifically on head and neck surgery (otolaryngology). Dr. Fleming is certified by the American Board of Otolaryngology, as well as being certified by the American Board of Facial Plastic and Reconstructive Surgery.

Rhinoplasty super specialists also have significant experience performing rhinoplasty. These surgeons typically perform nose surgery more often than any other type of procedure, and they operate on a wide variety of patients. This breadth of experience allows them to easily adapt their techniques to effectively reshape any nose, regardless of its shape or tissue composition.

Seeing a rhinoplasty super specialist ensures that you get the results you want after a single operation, thereby eliminating the need for revision rhinoplasty. Rhinoplasty super specialists are also uniquely qualified to adjust unflattering primary rhinoplasty results. Dr. Fleming sees a high volume of revision rhinoplasty patients who require a skilled expert to correct the results of a previous surgery.

Who Makes a Good Candidate for Rhinoplasty?

The ideal rhinoplasty candidate is a healthy adult non-smoker who has a clear idea of what he or she wants to achieve through this procedure. (Rhinoplasty candidates are encouraged to bring images depicting their preferred nasal shape to their consultation.) However, nasal surgery can be safely performed any time after the physical growth of a nose is completed, which corresponds with puberty. In rare cases, Dr. Fleming operates on younger patients in order to treat severe nasal obstruction or sinus disease.

Though most people seek rhinoplasty for cosmetic reasons, this procedure also has a number of medical applications. Nose surgery may improve nasal breathing when the septum is deviated or when the patient suffers from allergies or sinus problems. Regardless of what is needed—removal of a hump, decreasing the length or width of the nose, correcting a deviation, or in some cases building up nasal depressions—we tailor the procedure to meet the individual needs of each one of our rhinoplasty patients. If you have both medical and cosmetic objectives, Dr. Fleming will adjust your procedure to improve the form and function of your nose.

About the Rhinoplasty Procedure

Rhinoplasty is often used to reduce a prominent nasal bridge or tip, or to slim the patient’s nostrils. This operation can also be used to augment the nose (doing so is often necessary during revision rhinoplasty). Dr. Fleming uses specialized cartilage grafts to permanently “build up” the nose where needed.

Rhinoplasty generally takes one to two hours to complete. Most incisions are made inside the nose. However, we regularly make a small incision between the nostrils in difficult noses where there has been previous surgery, in noses with abnormalities of the tip, or noses with severe deviations. Dr. Fleming was one of the pioneers of this open approach over 30 years ago. This technique gives the surgeon the opportunity to see what the problem is, to suture parts directly to minimize later shift, to produce better symmetry and, therefore, to achieve results far better than when we used the older closed technique in these noses. Though the open technique is somewhat more time consuming, the results consistently justify the effort. The external incision is inconspicuous. In noses with wide nostrils, small incisions are sometimes made at the base of the nostrils in order to achieve narrowing of this portion of the nose.

female patient before rhinoplasty profile view
After rhinoplasty female patient side view

Postoperative Recovery from Rhinoplasty

The minimal discomfort some rhinoplasty patients experience after surgery is easily controlled with mild analgesics. A cast is placed on the nose for approximately six days. In the immediate postoperative period, the patient receives medication for swelling and is instructed to place ice on the eyes to keep swelling to a minimum. In most cases there will be some swelling and bruising around the eyes, lasting six to ten days. When the cast is removed, nasal swelling is present, but this generally goes down quickly and is not obvious to others. However, depending upon the amount of work necessary and the thickness of the skin, the final shape of the nose is not achieved for several months, up to a year. There will be some stuffiness and nasal obstruction for a short time after surgery, accompanied by a temporary decrease in sensation of the nasal skin. Strenuous activities should be avoided for approximately two weeks.

Arrange a Rhinoplasty Consultation in Beverly Hills, California

The nose is often considered the central feature of the face, so it merits the care of an expert in the field of rhinoplasty. If you would like to balance and redefine your face via nose surgery, contact Dr. Richard Fleming at (310) 278-8823 to arrange your personal consultation today.

Generally, a physically mature girl of 15 or 16 years and a young man of 16 to 18 years is old enough to have rhinoplasty surgery. However, Dr. Fleming has successfully performed rhinoplasty procedures on younger individuals, as long as nasal growth is complete.

During the initial consultation, the patient will meet with our staff, including our nurse, Maria to discuss their goals and expectations. Dr. Fleming encourages people to bring examples of their ideal nose and any operative reports and previous pictures if they have had rhinoplasty surgery. Dr. Fleming will then examine the patient and discuss treatment options. Finally, our patient care coordinator, MaryAnna will explain logistical and financial matters.

Dr. Fleming typically advises patients to avoid strenuous physical activities for two weeks and avoid any possible trauma to the nose for approximately six weeks. Restrictions will vary depending on the patient’s profession and lifestyle. If one is frequently in front of the camera or a public figure, Dr. Fleming will advise them that they may be compromised for a couple of weeks.

Most incisions are made inside of the nose, and therefore the small scars are not visible. If an open procedure is performed, where a small incision is made between the nostrils, the resulting scar is not seen by virtue of its location.

Dr. Fleming does not pack the nose but places one piece of telfa (the white material that one sees in the center of a band-aid) which is removed the morning after the operation.

Rhinoplasty surgery is performed in our state of the art outpatient surgery center. Hospitalization is not necessary.

In addition to local anesthesia, Dr. Fleming typically performs rhinoplasty with the patient under sedation or a very light general anesthetic, which is delivered by our MD anesthesiologist.

While some patients from out of state or the country take the time to come to Beverly Hills for their consultation, many times we will use Skype or FaceTime to evaluate a patient’s needs after they have sent previous medical records and appropriate pictures. If treatment is planned after these discussions, the patient will come to our office for an examination and final review one to two days before the scheduled procedure or surgery.

We never want the patient alone after receiving sedation or general anesthesia. A friend, family member, nurse, or recovery facility can all be used to assist the patient the night of the operation.

When indicated, we frequently do other procedures at the same time as the rhinoplasty if it will complement the results of the nasal surgery and improve facial proportions. For example, a chin implant is frequently placed at the same time as rhinoplasty surgery, so both improve the profile view of the patient. An important advantage of doing multiple procedures at the same time is the patient has one operation, one anesthetic, and one recovery.

Every nose is different. After all these years, Dr. Fleming has never done two noses the same. One size does not fit all. Therefore, the cost of the rhinoplasty procedure varies depending on complexity and can be determined at your consultation with Dr. Fleming.

Dr. Fleming will recommend an evaluation for patients who have a history of medical problems. Our patients are given a written list of medications, foods, and activities to avoid before and after surgery, so they achieve the best possible uncomplicated result.

A non-surgical rhinoplasty can be performed with filler injections, however, these results are not permanent. This technique is most appropriately used to correct contour irregularities or asymmetries, but are avoided in large noses that should be reduced because the injections will increase the size of the nose.

Rarely will insurance companies pay for cosmetic surgery of the nose, unless there is recent documented trauma. However, many will cover surgery to improve nasal functions such as a septoplasty. Our staff helps our patents determine their insurance benefits.

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