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Robert S. Hamas, M.D.
8345 Walnut Hill Lane
Suite 120
Dallas, TX 75231
(214) 363-1073
(214) 890-7844 (fax)

Nose surgery, or rhinoplasty, is one of the most popular cosmetic surgery procedures among men and women of all ages. The goal of rhinoplasty is an attractive, natural appearing nose that is in harmony with your other facial features. It should look like it belongs on your face - not overdone, artificial or like you had a "nose job."

Various "ideal" proportions between the different parts of the nose and between the nose and the face have been described and are present in some attractive noses. However, many other equally attractive noses have proportions that vary somewhat from these "ideals." This is what makes each face unique and is why "beauty is in the eyes of the beholder."

Rhinoplasty improves the appearance of your nose by changing its size, shape and contour. The changes may be significant or subtle and may involve all aspects of your nose or only a part of it, such as the tip or bridge.

How does skin type affect the result?

The shape and contour of the nose is determined by the shape and contour of its underlying framework - the cartilage and bone. The skin is merely a covering. When skin is thin, the shape and contour details of the cartilage show through and give more definition to the nose. When skin is thick, due to sebaceous glands or fatty tissue, these cartilage details tend to be obscured and require additional measures to give more definition to the nose. This is why it is important to consider your skin type when planning nose surgery, so you will have realistic expectations of your result.

To enhance the appearance of the nose, the shape and contour of the underlying cartilage and bone must be modified. This is all done by working beneath the skin. The incisions are hidden inside the nose and often across the narrow strip of skin between the nostrils (the columella).

The shape and contour of nasal cartilages may be improved by placing special sutures, by removing excess cartilage or by adding cartilage as a graft when there is a deficiency. Cartilage grafts may be used to support the tip or to improve the contour of the tip. These grafts are usually taken from the septum, which is inside the nose between the airways.

What about the chin?

A weak or retrusive chin alters the balance of the face and can make the nose appear even larger. Occasionally, insertion of a chin implant at the time of nose surgery dramatically improves the overall harmony of the face, especially in profile.

Chin enlargement is done with an inert implant, usually inserted through a small incision hidden underneath the chin. Sometimes this area is even further enhanced by liposuction of the neck during the same procedure.

What about the eyelids?

Puffy, heavy looking eyelids make a large nose look even more prominent. Combining an eyelid lift with a rhinoplasty can significantly enhance the overall appearance of the face.

What about breathing difficulties?

If your nasal airways are obstructed, you will have difficulty breathing. Obstruction due to internal swelling from allergies is treated with antihistamines and nasal sprays. Obstruction resulting from deviation of the septum (the cartilage between the two nasal airways) is treated by removing or straightening the deviated portion at the time of rhinoplasty. If both the outside of the nose and the septum are deviated, perhaps as a result of previous trauma, realignment of all structures is necessary to improve the airways as well as the appearance.

Airway obstruction can also be caused by a narrow middle portion of the nose along the bridge. This may be a result of trauma, previous nose surgery or the way the nose developed. When this situation is present, cartilage grafts are placed inside to hold open the airways.

Your health insurance plan may cover the cost of surgery to correct airway obstruction. However, any surgery done to improve the appearance of the nose is specifically excluded from all health insurance plans.

What can be done after previous rhinoplasty or trauma?

Today’s surgical techniques are designed to preserve the important supporting framework of cartilage and bone. Older rhinoplasty procedures often removed this support leaving a scooped bridge, a pinched tip and/or breathing difficulties. Similarly, supporting structures in the nose may be damaged by trauma resulting in collapse of the bridge, distortion of the tip and/or airway obstruction.

before  /  after Click image to enlarge	rhinoplasty to correct previous surgery
before  /  after Click image to enlarge	rhinoplasty to correct previous trauma

Dramatic improvement may be obtained in cases like these with cartilage grafts from the septum to support the tip, restore the bridge and hold open the airways. The result is an attractive and natural appearing nose with good airways.

Are you asleep for the procedure?

Nose surgery is usually performed under a light general anesthetic. You will be completely comfortable and totally unaware of the procedure. Because the anesthetic agents are short acting, you will wake up quickly at the end of the procedure when you are taken to the recovery room.

What happens after surgery?

A small splint on the bridge of the nose remains in place for one week. When a crooked nose has been straightened, thin internal splints are used as well. Packing is never used. Discomfort usually does not last beyond two or three days.

Keeping the head elevated the first four to five days helps reduce swelling, most of which is gone by about two weeks. The rest of the swelling gradually resolves over several months. Bruising usually fades away within 10 to 14 days.

Most patients feel well, but choose to stay out of public for about seven to 10 days because of their appearance. You can resume light activities such as office work by three days. Recovery continues rapidly so that you may resume unrestricted athletics by two weeks.

What are the risks?

Some of the risks include infection, bleeding, asymmetry and contour irregularities. Detailed information is provided during the consultation.