Rhinoplasty (Nose Surgery)

Dr. 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.

Rhinoplasty is the most common cosmetic procedure performed today. Nasal surgery can be done any time after the physical growth of a nose is completed, which corresponds with puberty. The only exception is a younger patient with severe nasal obstruction or sinus disease. 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, we re-shape the nose on an individual basis to achieve a more desirable, natural, non-surgical shape. This is in contrast to the unfortunately common and obvious surgical appearance of the scooped-out, turned-up nose with a pinched tip. Surgery may also improve nasal breathing when the septum is deviated or the patient suffers from allergies or sinus problems. Regardless of what is needed, removal of a hump, decreasing the length or width, 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.

The operation generally takes one to two hours. 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 who 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 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.

POSTOPERATIVE PERIOD

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.

Rarely are friends and associates of our nose surgery patients able to tell that surgery has been done. This seems hard to believe, but it is true for two reasons. A natural, non-surgical appearance is achieved and others do not clearly remember that a deformity existed.

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