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Rhinoplasty Washington DC

What You Should Know Before You Have a Rhinoplasty Procedure Done

What is a Rhinoplasty Procedure Meant to do?

Rhinoplasty is a procedure that is performed on people of all ages.  Some seek consultation for a rhinoplasty because they are unhappy with the noses they were born with or with the manner in which aging has changed their nose. Some of the features that one may look to correct are the nasal profile, a bulbous tip, a crooked nose, or a deviated septum. For others, an injury may have distorted the nose and caused permanent deformity. In addition to desiring a cosmetic improvement to the nose, some may also be looking to improve their breathing. Nothing has a greater impact on how a person looks than the size and shape of the nose. Because the nose is the most defining characteristic of the face, a slight alteration can greatly improve one’s appearance. 

Rhinoplasty is one of the most complex and intricate procedures of the face. For this reason, one should go to a surgeon with the experience and knowledge of this procedure. Dr. Somenek is specially trained in plastic surgery of the face with a particular focus on rhinoplasty. He has extensive training and experience with this surgery. His fellowship training was under the tutelage of some of the best rhinoplasty surgeons in the country, Drs. Regan Thomas and Dean Toriumi at the University of Illinois at Chicago.   He brings with him a unique perspective and understands how to not only make the nose look good, but also preserve the structure for a long lasting and satisfactory result for the patient. Patients often seek Dr. Somenek for his expertise for some of the most complex rhinoplasty cases.

Before Surgery 

During the initial consultation, Dr. Somenek uses this time to understand your motivation and expectations for a rhinoplasty. It is an opportunity to develop a mutual level of trust and understanding. A detailed physical examination is performed to determine the areas that will require correction in the nose to provide the best result. Dr. Somenek will go over a thorough list of expectations and risks that are involved in surgery. 

Photos will be taken and with the help of sophisticated imaging software, computer imaging will be performed to create a realistic outcome that is in line with the patient’s needs and desires. Dr. Somenek will explain the various structures in the nose, including bone and cartilage, and how sculpting these can alter the appearance of the nose. Dr. Somenek believes that the use of computer imaging provides the patient with a realistic outcome for the patients individual anatomy and expectations. In addition, Dr. Somenek may suggest other procedures such as chin augmentation that can enhance the overall harmony of the face. It is always beneficial for the patient to compile a list of questions to ask during the consultation as this can clarify any concerns about the procedure and help better delineate if your expectations are in line with Dr. Somenek’s aesthetic goals for your nose.

Dr. Somenek believes in creating a natural, aesthetically pleasing nose for the patient. Rhinoplasty is one of the most difficult operations in facial plastic surgery. The difficulty lies in the anatomy of the nose as this varies from patient to patient. For this reason, Dr. Somenek creates an individualized surgical plan for each patient and utilizes comprehensive techniques to achieve this plan. Dr. Somenek emphasizes preservation of the nasal structures and minimal excision of the supporting tissues. Removing more tissue and cartilage than necessary may lead to a pinched tip and nasal obstruction. For primary rhinoplasty, Dr. Somenek uses cartilage grafts that are harvested from the nasal septum to reinforce critical structures and regions in the nose to create a long lasting result not only aesthetically, but functionally for nasal breathing. In more complex cases, cartilage from the ear or rib may be used. Skin thickness is an important consideration for rhinoplasty. Special attention must be given to thin skinned individuals as they are at a higher risk for visible or palpable abnormalities postoperatively. Medium skinned patients are more ideal candidates for rhinoplasty because as the skin contracts over the underlying cartilaginous structures it is more easily camouflaged.

After the Rhinoplasty Procedure

The surgery is typically performed on an outpatient basis under general anesthesia. Dr. Somenek will see you the following day to clean the area around the nostrils and ensure that you are doing well. Dr. Somenek does not routinely use packing for the nose as he thinks it adds unnecessary discomfort for your recovery. At your one week postop visit, the nasal cast and fine sutures will be removed that are used to close the incision. It is important to realize that your nose will be swollen when the cast is removed. Dr. Somenek will place tape on the nose when necessary to decrease the overall amount of swelling. The majority of swelling will resolve within 2 weeks. Your face will feel puffy, especially the first day after surgery. Dr. Somenek will advise you to avoid blowing your nose for seven days after surgery. In the immediate days following surgery, you may experience bruising and minor swelling in the eye area. Cold compresses often reduce the bruising and discomfort. Your nasal splints and sutures are removed seven days after surgery.

Following up with Dr. Somenek

Follow-up care is vital for this procedure to monitor healing and it is essential that you keep your follow-up appointments with Dr. Somenek. Much of the swelling will decrease about two weeks postoperatively. However, the healing process will continue to occur for many months after surgery. Persistent swelling of the nasal tip can occur in some patients depending on their individual anatomy and thickness of their skin. Throughout the followup period, Dr. Somenek may recommend steroid injections to the nose or nasal taping to aid in resolution of the swelling and produce the best outcome for his patients. Occasionally a minor revision to the nose is required and will be discussed with the patient if needed.

Insurance does not generally cover surgery that is purely for cosmetic reasons. Surgery to correct or improve nasal function or surgery for major deformity or injury may be reimbursable in whole or in part. The office will work with the patient to provide the best care possible. Dr. Somenek looks forward to meeting you and working to provide the best aesthetic result to meet your needs.

Contact Our Office Today!

If you have further questions regarding Rhinoplasty, please call or contact our office today to schedule your initial consultation.

FAQ’s

  • What is open structure rhinoplasty?
    Open structure rhinoplasty has advantages of direct visibility, control, precision and access to the structures of the nose. Open rhinoplasty typically involves a small incision at the base of the nose between the two nostrils at the columella (the area of your nose between your nostrils). The columellar incision hides very nicely in the shadow of the undersurface of the nose and heals very well, making it imperceptible to others.
  • What is closed rhinoplasty?
    The closed rhinoplasty technique, also referred to as endonasal rhinoplasty, uses incisions on the internal lining of the nose to avoid any incision or scars outside the nose. The endonasal technique or closed approach is limited by the amount of nasal tip work that is needed. It is less precise when it comes to shaping the tip, yet it is ideal in patients who primarily want the hump or bridge taken down.
  • What is the benefit of an open versus closed rhinoplasty?
    Open rhinoplasty provides better visualization of the nasal cartilages and bones, allowing for the absolute best control in shaping and strengthening the nasal structures. For these reasons, open structure rhinoplasty is generally preferred over closed rhinoplasty and gives more precise post-operative results. Dr. Somenek believes that closed rhinoplasty is only appropriate for small dorsal hump removals and minor tip changes.
  • What are cephalic trims?
    Cepahlic trims are a technique used to narrow the width of the nasal tip by trimming parts of the lower lateral cartilages. This contributes to a more refined and natural tip appearance. Dr. Somenek preserves the vital portions of the lower lateral cartilages during the cephalic trims as to avoid any nasal obstruction postoperatively from lack of support.
  • What is a columellar strut?
    A columellar strut is a piece of cartilage that is frequently taken from the nasal septum and placed within the nasal tip to provide a long lasting support to this area. This has the benefit of stabilizing and preventing the nasal tip from drooping postoperatively. The columellar strut does not widen the nose or the nasal tip as it is a graft that is placed between the medial crura(the structures that are part of the columella).
  • How is the nasal tip rotated in rhinoplasty?
    There are many maneuvers that can be used to achieve rotation of the nasal tip during rhinoplasty. Examples of these include a cephalic trim, a caudal septal trim, or trimming the lower edge of the septum, which creates significant rotation to the nasal tip.

    The tongue-in-groove technique is often used in combination with other rhinoplasty procedures. This technique is used to correct excessive columellar show and when extensive rotation of the nasal tip is required. It also allows for increased nasal tip projection if the tip is set back too far. The tongue in groove involves suture fixation of the columella’s medial crura to the caudal septum, which provides long-term, stable support. Dr. Somenek will determine the appropriate rhinoplasty rotation technique to achieve your desired results.

  • What techniques are used for increased nasal projection?
    Nasal projection is defined as how far the nose sticks out, or projects from the face. Depending on nasal skin type and how much projection is needed, there are a variety of grafting techniques that can be used. Shield grafts and cap grafts are used to refine and help project the nasal tip. Open rhinoplasty is the most ideal technique for graft placement within the nasal tip, as it allows for more precise placement and fixation and prevents potential shifting of the grafts. A shield graft is a versatile tool that can improve tip projection and define the nasal lobule. Thicker-skinned patients are typically better suited for this type of grafting. Shield grafts are usually not appropriate for thin skinned patients as they are at a higher likelihood of showing through the nasal skin envelope over time. For this reason, Dr. Somenek often rearranges the cartilages in the nasal tip to create more projection.
  • When is a rib graft necessary in rhinoplasty?
    A rib graft is typically needed for revision rhinoplasty cases where much of their septal and/or ear cartilage has already been used. Rib cartilage is rarely used in cases of primary rhinoplasty. If Dr. Somenek determines that much of the structure needs to be rebuilt within the nose, then he may recommend a rib graft to ensure there is enough cartilage to achieve the desired aesthetic AND functional outcome for your nose.
  • When is a chin implant considered with a rhinoplasty?
    Maintaining appropriate facial proportions is essential to achieving an ideal cosmetic result. If a patient has a weak chin, then it can create the illusion that the nose sticks out too far from the face. The ideal chin projection is defined in relation to the projection of the lower lip. In men, the chin should ideally project to the same extent as the lower lip. In women, ideal chin projection may be a couple of millimeters behind the lower lip. Using a chin implant to restore chin projection can balance the perceived projection of the nose from the face, which is an important aspect when planning rhinoplasty.
  • Is nose packing used after a rhinoplasty with Dr. Somenek?
    Dr. Somenek does not routinely use nasal packing in his rhinoplasty patients. He does not think it contributes to an expedited recovery and in fact believes that it adds a considerable amount of discomfort for his patients.
  • Can a teenager undergo rhinoplasty?
    Dr. Somenek does perform rhinoplasty on teenagers. However, it is offered with careful consideration, especially to their specific age. Teen rhinoplasty should be performed after the patient has completed their growth spurt, which is typically between 15 and 17 years of age. If you have a teen whose misshapen or asymmetrical nose is a source of embarrassment or peer ridicule, Dr. Somenek will consult with the parents and patient to discuss the procedure and help set goals for rhinoplasty.

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