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Rhinoplasty (Nose Job)

Rhinoplasty In-depth

‘If you are contemplating a ‘nose job’, Toronto Rhinoplasty surgeon Dr. Lawrence Tong can help you attain your goals’

Introduction

Often referred to as a ‘nose job’, Rhinoplasty is not only popular with Hollywood celebrities, but it has become an established procedure for anyone wishing to improve the appearance of their nose. First described in Indian medical texts dating back to 500 B.C., Rhinoplasty is one of the oldest plastic surgery operations, yet it is also one of the most difficult to master.

Toronto Rhinoplasty surgeon Dr. Lawrence Tong has extensive experience dealing with primary Rhinoplasty (first-time Rhinoplasty), secondary Rhinoplasty (Rhinoplasty for patients who have had prior Rhinoplasty), and treating complications related to Rhinoplasty. He can guide you on the various options for your concerns.

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What does a Rhinoplasty do?

Rhinoplasty is a procedure that can improve the appearance of the nose and the function of the nose as well. The procedure primarily involves reshaping the cartilage and bone to achieve these goals.

 

Who are candidates for Rhinoplasty?

Almost anyone with a legitimate concern about the appearance of his or her nose could benefit from cosmetic Rhinoplasty. Patients may seek a dramatic difference in the overall look of their nose, or they may just want a small degree of change.

Here are some common reasons why you may want Rhinoplasty and how the procedure can help:

  • Your nose looks too large for your face: overall nasal dimensions can be made to look smaller
  • Hump on the nasal bridge: bridge is made straight
  • Fat, round, or undefined nasal tip: tip is made thinner, sleeker, more defined
  • Wide nose: nasal bones are thinned, nostrils made less wide
  • Nose sticks out too much: nose is deprojected for better facial proportions
  • Nasal tip points downwards: tip is elevated and slightly upturned
  • Crooked nose (naturally or from accident): nose is straightened
  • Crooked septum: septum is straightened, breathing may be improved

Other Candidate Criteria:

  • Patients should be old enough so that facial growth is completed (usually mid-late teens)
  • Smokers should quit smoking at least 2 weeks prior to surgery
  • Patients should be generally fit and relatively healthy; Dr. Tong will always assess your general health and suitability before undergoing any type of surgery
  • A patient should have realistic expectations about what can be accomplished with Rhinoplasty

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Issues to be Considered about Rhinoplasty

It is important know all information regarding previous Rhinoplasty, nasal surgery, or nasal injury. The presence of these factors can make a straightforward Rhinoplasty more challenging.

It is helpful to have a sense of what you would like changed or improved. Try to list at least one or two things that you would like to change about your nose. From there, Dr. Tong can discuss his findings, and formulate a personal Rhinoplasty strategy for you. Dr. Tong can provide computer imaging of possible surgical outcome if requested. It is important to note that computer imaging is an estimation of what might be accomplished surgically, and should not be taken as an implied or explicit guarantee of results.

In analyzing your anatomy, Dr. Tong may recommend a chin implant is if he feels your facial profile would benefit from one.

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Open vs. Closed Rhinoplasty

There are two methods of performing Rhinoplasty: open and closed. These terms refer to the way in which the underlying cartilage, bone, and soft tissue are exposed to allow for the procedure to be conducted.

Open Rhinoplasty

In open Rhinoplasty, the framework of the nose in fully exposed.

  • Advantage
  • Disadvantage: there may be more swelling that takes longer to resolve after surgery
  • Open Rhinoplasty is preferred in: cases of revision (redo) Rhinoplasty, significant asymmetry, unusual anatomy, or when there is a need for very precise modifications.

Closed Rhinoplasty

The closed technique is the more traditional method of Rhinoplasty that has been popular for decades. It involves making fewer incisions in the nose, and performing the alterations to the framework without seeing the structures directly.

  • Advantage: less swelling and less incisions
  • Disadvantage: it is less precise, and the range of options to manipulate to the framework is not as great
  • The closed method is preferred with: straightforward primary (first time) Rhinoplasty that does not need significant tip alteration.

When you come in for Rhinoplasty consultation, Dr. Tong will give his recommendation about which technique would be best for your goals.

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Incisions for Rhinoplasty

Any surgical procedure will leave some type of scar. Dr Lawrence Tong specializes in obtaining the least visible scars, and putting them in the least visible places. The incisions for open Rhinoplasty are all inside the nose except for a 2-3 mm incision across the columella (the central tissue that separates the right and left nostrils). It hides well because of its location, and this single scar tends to be almost invisible once healing is complete.

The closed technique of Rhinoplasty only utilizes internal incisions

Dr. Tong will explain the different techniques if you are a candidate for one or both methods.

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Details of the Rhinoplasty Procedure

Dr. Tong performs your procedure general anesthesia, or IV sedation (twilight) anesthesia. During the time you are under general anesthetic, you will be asleep and completely unaware of your surroundings. If you are under twilight anesthesia, you may be aware that you are undergoing surgery from time to time during the procedure, but should feel no pain. Your surgery is conducted in the private surgery centre within the medical complex where Dr. Tong’s office is also located, in Yorkville.

Dr. Tong starts your Rhinoplasty by making small nasal incisions, and exposing the underlying nasal cartilage and bone. Maneuvers are then performed as needed, in order to remove the hump, refine and elevate the tip, decrease (or increase) the projection, and reduce the width of the nose. The surgical maneuvers vary, depending on the individual case.

The hump is removed by shaving cartilage and bone. The appearance of the nasal tip is altered to improve definition by removing, stitching, or adding cartilage in the tip area. The septum is straightened, as needed (again through removal, bending, scoring, or reinforcing the cartilage). The nasal bones are often repositioned slightly to achieve a thinner, more elegant look.

After the last stitches are placed, you will be placed in a special protective Rhinoplasty dressing (nasal splint), and then gently awakened from anesthesia.

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Recovery after Rhinoplasty in Toronto

Our nurses will monitor you in the post-anesthesia recovery area, following your Rhinoplasty. You will be allowed to go home once the effects of anesthesia have worn off, accompanied by your friend or family member.

Once at home, you need to relax and protect your nose from being injured. You may perform non-strenuous activities such as watching television, and reading. You should expect your nose to feel very stuffy, as most patients will breathe only through the mouth during the first week. Pain is typically mild to moderate. Pain medication will be prescribed, and may be used during this time. You may have bruising around the eyes in the first 1-2 weeks. The majority of patients return work (non-strenuous) at 7-10 days.

Dr. Tong will see you at one week to have stitches and the special protective dressing removed. You will likely be allowed to start light exercise (e.g. waking) at 1-2 weeks after surgery. Avoid strenuous activity until 4-6 weeks after surgery, especially sports where you could be hit in the face (e.g. hockey, basketball). After the initial post-surgical visit, you will follow-up visits with Dr. Tong at 6 weeks, 6 months, and one year after surgery. Post-operative photos will also be taken at these visits.

It is important to stress that the nose may look fairly swollen initially. This is entirely normal and it takes between 6-8 weeks for a majority of the swelling to resolve. Even beyond this, full resolution of the swelling can take 12 months or more. As the swelling subsides, you will notice that the nose gradually becomes thinner and smaller, with the tip taking the longest to fully settle. Patients like the look of their nose right after surgery, but the appearance will still slowly continue to improve as time goes on, until it reaches its final form.

As with any surgery, there are risks involved with Rhinoplasty. Although the procedure has a low risk profile, Dr. Tong will make sure to go the pertinent potential problems associated with Rhinoplasty at the time of your consultation.

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Become Educated about Rhinoplasty in Toronto

Our goal is to make you an educated patient. We know that an educated patient will make intelligent choices about their surgery, and their surgeon, too. The initial consultation usually takes over 45 minutes to complete. You will never be rushed or pressured to make a decision. There is a good deal if information to digest during your initial consultation, and Dr. Tong will make sure that you understand every import detail.

To learn more about how Dr. Tong can help you with improving the appearance of your nose, set up a Toronto Rhinoplasty consultation with Dr. Tong by giving us a call at (416) 972-0999. Alternatively, let us give you a call; just fill out our contact form and we will call you on the same or the next business day. No physician’s referral is needed.

See Dr. Tong’s work in our Rhinoplasty before and after photos.

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We practise The Art of Beauty.