Dr. Guida’s Approach to Rhinoplasty
Dr. Guida is renowned for his innovative surgical expertise to achieve natural and elegant appearing cosmetic results for his patients. He believes that detailed communication with his patients and thoroughly understanding their cosmetic goals and desires helps in achieving these goals. Rhinoplasty (cosmetic nasal surgery) results should reflect the patient’s individuality. This can only be achieved when the surgeon has expert and comprehensive surgical background in the nuances of rhinoplasty as well as functional nasal surgery and also is able to carefully communicate and understand his patients’ wishes. Dr. Guida also feels that aesthetic surgeons must develop a sixth sense that helps them understand each patient’s goals and desires. According to Dr. Guida, “I see myself as both a physician and a craftsman, which means that patients have the benefit not just of my technical expertise, but also of my artistic sense. I spend a great deal of time listening to what my patients want. Computerized digital imaging allows me to demonstrate what I am envisioning so that I can work with my patients to fine tune our approach. This is especially helpful in rhinoplasty surgery.” What further distinguishes Dr. Guida is his unique extensive training in both functional and cosmetic nose surgery. He is double board certified on Facial Plastic and Reconstructive Surgery as well as Otolaryngology – Head and Neck Surgery. Because of this unique training, he is highly skilled in the surgical treatment of all aspects of nasal sinus disease, functional nasal problems, surgery for nasal obstruction, repairing broken noses, and any cosmetic concerns of the nose, including complex revision rhinoplasty.
Rhinoplasty, or a “nose job”, cosmetically improves the appearance of the nose. Cosmetic problems of the nose can be either genetic or as a result of a broken nose. These concerns range from bumps on the nasal bridge, wide bulbous tips, long crooked noses, or simply noses that project out too far from the face – and each of these concerns are highly individualized. These concerns can range from:
- A “bump” or convexity on the bridge of the nose: This exaggerated convexity is generally an unattractive feature of the nose and is removed by carefully shaving down the cartilage and bone of the bridge of the nose. The nose bones are centered and narrowed achieving a well-balanced, natural shape to the nose.
- Wide, bulbous, and asymmetric tip of nose: Dr. Guida can improve this by reducing the size of the tip cartilages, suturing the cartilages in a particular manner, and sometimes removing extra cartilage, thus softening the overall look of the tip and nose.
- Crooked or Asymmetric Nose: A crooked or twisted nose can be unsightly and cause nasal obstruction. There are a variety of reasons for a crooked nose and it is important to uncover the underlying causes. It may be due to trauma causing a broken nose, a congenital deviated nasal septum, or perhaps even a growth or tumor in the nose. A careful exam and an x-ray will help decide what the cause is and determine the best way to correct the problem.
- Large Nose relative to other facial features: Making a big nose smaller to blend in more appropriately with the rest of the facial features is the most common reason people decide to have a rhinoplasty. The underlying cartilage and bone can be appropriately reshaped so that a harmonious and more attractive balance can be obtained with the facial features. Because of good elasticity of facial skin, the overlying soft tissue redrapes nicely over the newly shaped nose.
- Broad, Wide Nostrils: Sometimes it is necessary to make the nostrils narrower and smaller to give the nose a more defined and balanced look. This often requires removing a small amount of skin at the edges of the nostrils. The incision is well camouflaged and gives a significantly positive improvement to the nasal shape.
- Lack of a Nasal Bridge or “Saddle Nose” Deformity: The bridge of the nose may be very low or nonexistent due to congenital causes, trauma, or prior surgery. When there is lack of support to the bridge of the nose, it can be fixed using the patient’s own cartilage, bone, or possibly synthetic material.
Each particular anatomic concern needs to be understood and discussed with the surgeon and patient to obtain the best cosmetic and functional result. Dr. Guida frequently will write down a check list of each anatomic and functional concern that his patient has regarding the shape of the nose. Then Dr. Guida will address each one in detail so a comprehensive plan for rhinoplasty surgery can be done. This helps ensure the best achievable cosmetic result. Often, patients with cosmetic concerns of the nose also have functional problems, such as chronic sinusitis and/or nasal obstruction from a deviated nasal septum or nasal polyps. Dr. Guida strongly feels that these problems most often should be fixed simultaneously. A good-looking nose should also function very well.
How Is It Done?
The operation is done under twilight or light general anesthesia, is performed in a certified ambulatory surgical facility, takes approximately 90 minutes, has very little pain associated with the recovery, and patients frequently return to work or school within a week. Generally, the entire operation is done through incisions inside the nose and there is no external scarring. Dr. Guida performs approximately 70% of his rhinoplasties through incisions in the nose (closed approach) and 30% using a small, well camouflaged external incision on the bottom of the nose (open approach). The “open approach” is done for noses with more complicated anatomy, marked asymmetry, or complex revisions. Please look at Dr. Guida’s article on Surgical Approaches to the Nasal Skeleton for a detailed explanation of how Dr. Guida decides which approach is best for performing a particular rhinoplasty. Most of the time, there is no packing placed in the nose after the surgery, which allows for a much quicker and more comfortable recovery. A nasal splint is placed on top of the nose and is removed 5 to 6 days later. Any bruising that mat occur typically lasts 7 to 10 days and is easily covered with makeup. Patients feel comfortable returning to normal social activities at 1 week following the operation.
Can Rhinoplasty Help Me?
Rhinoplasty surgery has made great strides over the last few decades. The cosmetic results are natural looking, yet yield a very significant improvement without an over-done “nose-job” look. A properly performed rhinoplasty can markedly improve a person’s appearance, often achieving a significant positive influence on a one’s self esteem and confidence level and at the same time improving the overall function of the nose with very little down time. Many of my patients have the described the positive results of their rhinoplasty as “life –changing” in a very positive way. Before their rhinoplasty, many of my patients were embarrassed to have their pictures taken or felt uncomfortable meeting new people. After a well-performed rhinplasty, they are no longer camera shy or nervous in new social situations because of the shape of their nose.
Best Candidates For Rhinoplasty
Rhinoplasty surgery has made great strides over the few last decades. The cosmetic results are natural looking, yet yield a very significant improvement without an over-done “nose-job” look. Best Candidates:
- Patients who are unhappy with the nose that they were born with
- Patients with a badly deviated nasal septum, which causes not only nasal obstruction, but a twisting and asymmetry of the nose
- Patients who are still unsatisfied with their previous rhinoplasty and want a revision to improve the aesthetic results
- Patients who have sustained a nasal injuries that had distorted the shape of their nose
- Patients who have noticed changes in the appearance of their nose due to the aging process (as one gets older, the nose becomes more prominent, longer and sags)
- Patients who have difficulty breathing through their nose or have chronic sinusitis and also have an interest in changing his or her nasal appearance
- Patients who are generally medical healthy and are completed with puberty and facial growth; typically girls mature slightly sooner than boys and may have the operation at a slightly younger age
Dr. Guida’s goal in reshaping your nose is to create a natural appearing, nicely shaped nose that looks like you were born with it; however, without any imperfections. The shape of the nose after a rhinoplasty should be attractive to the eye, yet not draw attention to itself, and blend in harmoniously to the rest of the facial features. Skin type, thickness and size of the cartilage and bones, and age of the patient are considerations in the healing process. For these reasons, the surgical result is never the same in any two patients. It is important to understand the basic anatomy of the nose to appreciate how Dr. Guida will reshape your nose. The skin is the outer covering of the nose. It lies over a structure made of both bone and cartilage, (like a blanket draped over ruffled sheets; the thicker the blanket, the less noticeable the ruffled sheets appear). The bones and cartilages are sculpted and the tip is refined. In most instances incisions are made inside the nostrils, meaning no visible scars. Dr. Guida will discuss and review your specific anatomy with you and the surgical plan that best suits your aesthetic needs.
Immediately after surgery, Dr. Guida will place a small splint on your nose for protection. In the immediate days after surgery you may experience bruising and swelling to your eye area. The splint will be removed 5-6 days after surgery. At that time, the nose will look appreciably better even though there may be some swelling. You will probably feel comfortable being seen socially. Most people return to school or work 1 week after surgery. Over the next few weeks, more of the subtle swelling of the cheeks, face, and nose will be markedly reduced and the nose will continue to look and feel better and more natural. It takes 6-9 months for more subtle swelling of the tip and sides of nose to come down. Vigorous activity may be resumed 4-6 weeks after your rhinoplasty.
Surgery to improve just the shape of your nose is considered cosmetic surgery and insurance companies will not cover this type of surgery. Medical insurance companies may however cover other, distinctly separate procedures performed during rhinoplasty surgery to improve your nasal breathing, previously fractured nasal bones, and chronic sinusitis. Dr. Guida’s experienced staff can help you determine what parts of your procedure may or may not be covered by your medical insurance. If you have any questions, feel free to call us.
If you would like to know more about Rhinoplasty, please call us at 212.871.0900 or Click Here to request an appointment.