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Rhinoplasty Procedure

Rhinoplasty is the most challenging cosmetic surgery procedure. Many plastic surgeons choose not to perform rhinoplasty surgery in their practice. This is because millimeters can make a significant difference in the appearance of the nose. Dr. Hart has taken a special-interest in rhinoplasty and revision rhinoplasty. He trained in otolaryngology and head neck surgery and subsequently became fully board-certified in plastic and reconstructive surgery. He has performed rhinoplasty surgery in private practice for over 20 years.

Rhinoplasty is unique in that function that is breathing of the nose is as important as the external appearance. Is important to take into consideration not only the appearance of the nose but how any changes may affect breathing as well.

The nose occupies a central position in the face. Symmetry balance proportion and relationship to the remainder of the face are critically important in the overall result. Dr. Hart's experience and artistry are evident in the pre-and postoperative photographs we have on this web site and available in the office. Dr. Hart uses computer imaging to provide a template as to what can be done and cannot be achieved in the rhinoplasty procedure. A copy of this is provided to the patient for informational purposes only.

Dr. Hart will personally listen to your requests and evaluate the possibilities with regard to your nasal surgery. He will be available to answer any questions that you have regarding your surgery. He will also be available following your consultation for any questions and you will receive his pager number to call after surgery should any questions arise.

Revision rhinoplasty
Revision rhinoplasty is particularly challenging. Each case is different and requires careful analysis of the deformity and careful planning in order to achieve the optimum result. Many of these cases have significant scarring and loss of cartilage and bone framework that is essential to the function and appearance of the nose.. A detailed knowledge of nasal anatomy is required to identify and reposition graft or reshape what is left to achieve a precise attractive and functioning result. Revision rhinoplasty requires a surgeon with experience in both traumatic and reconstructive cases who can use superior technique artistic and aesthetic judgment to achieve the result the patient is expecting.

Revision rhinoplasty requires the surgeon to have a complete arsenal of different options to achieve the best result. This may include cartilage grafting from the septum, the ear or the ribs. It may require the use of fascia grafts or bone grafts. It definitely requires artistic judgment and experience in placing very fine sutures and a knowledge of wound healing that will allow for a stable long-term result.

Challenging noses
Patients with different ethnic backgrounds require an individualized approach. It is important in these cases to listen to the patient with regard to how much change and what type of change they want from their rhinoplasty. Some patients prefer to maintain certain ethnic characteristics that others may not choose to maintain.

There are significant differences in skin thickness and texture as well as bone and cartilage structure that proved challenging in these individual cases. Dr. Hart has extensive experience in rhinoplasty in the black patient, the Asian, middle eastern and Mexican-American patients. These types of cases as well as complex revision cases are the reason why we use computer imaging to identify the patient's expectations.

Open versus closed rhinoplasty
Open rhinoplasty, refers to an external skin incision beneath the nasal tip halfway to the lip. This incision may take on a number of different shapes, but is used to gain access to the cartilage and bone structure by direct vision. The remainder of the incisions are inside the nose. This approach allows the skin to be pulled back toward the brows and the cartilage and bone work can then be done under direct vision. The drawback to this procedure is the small external scar across the columella. This approach is used in difficult secondary or revision rhinoplasty cases where exposure is critical. It may also be suggested in cases involving difficult tip work. The incision, normally feels extremely well.

Closed rhinoplasty refers to an approach that uses no external incisions. This approach is used in a large number of cases where more extensive exposure is not necessary. The incisions are all closed with dissolving sutures and splinting is still required.

Postoperative course.
Following completion of the surgical procedure in most instances packing is not used. If it is required from some specific reason it usually stays in two to three days. All incisions are closed intranasally with dissolving sutures any external sutures will be removed in the office at five to seven days. The splint is also removed at that time. The splint usually consists of paper tape, adhesive tape and plaster. This stays attached to the nose without the need for additional taping. It is removed easily in the office without the need for local anesthesia.
Swelling and bruising began to subside in two to three days it may take two to 2112 weeks for discoloration to completely disappear. The majority of the puffiness is gone and approximately 6 to eight weeks but final detail may take six to 12 months.
Most patients can return to work in seven to 10 days.
Patients can resume regular activities including exercise at three weeks.


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Hart Cosmetic & Reconstructive Surgery Institute
969 North Mason Road, Suite 170, St. Louis, MO 63141
Phone: (314) 991-1700 • Fax: (314) 628-9504