A newsletter from David J. Levens, MD, FACS
Board-certified Plastic Surgeon
Please contact me for a free consultation with Dr. Levens.
CASE STUDY: Nose Reshaping
High school teacher Elisa DeCarlo, 30, Coral Springs, doesn’t avoid having her picture taken anymore.
“The bump in the middle of my nose wasn’t that noticeable when I looked in the mirror head-on, so it didn’t bother me most of the time. But whenever a photo captured my profile, I’d be reminded how unattractive that bump was. When I was 24, I decided to permanently change my profile.
“At that point, I was established in my career and I had the money for cosmetic surgery,” she says. “I also had the maturity to make a decision that would permanently change my face. I know a lot of people in their teens want to have their noses reshaped, but I would really advise them to wait until their facial features are fully developed and they have the sound judgment to make such an important decision.”
The Procedure: When performing a rhinoplasty procedure, Dr. Levens makes small incisions inside the nose, and sometimes externally (in concealed areas) as well. He then carefully alters and reshapes the structures, which make up the framework of the nose, including cartilage and bone. The skin is then re-draped over the new framework to achieve the desired appearance. Internally, areas of narrowing of the airways (such as from deviation of the septum) that can contribute to breathing difficulties may be modified to maximally open the airways while preserving support and function. After closing the incisions, a dressing consisting of tape, and often temporary internal packing and an external splint are applied to maintain and protect the changes made to the framework of the nose.
The packing is removed 1-2 days after surgery, and the splint is removed within a week. The patient can see the refinements in the nose immediately after the splint is removed. Improvement in definition will continue for several months. Swelling and bruising develop within the first 24 hours after surgery, and will begin to decrease by the third day. Most patients report only minor symptoms following nose-reshaping surgery, including minor discomfort and a sensation of fullness, which lasts only a few days.
The vast majority of patients return to work and normal social activity within 7-14 days or less. Aerobic or strenuous activity should not be resumed for 2-3 weeks.
The Results: “I’m not camera-shy anymore,” Elisa says. “In addition to improving my profile dramatically, the surgery also improved the overall balance of my facial features.”
Dr. Levens comments: Proper planning is the key to a successful rhinoplasty. The process should begin with a frank exchange between surgeon and patient, with the patient explaining what he/she likes and dislikes about the nose and also sharing concerns: Will my parents hate me for changing the “family nose”? Will it be painful? How soon can I return to work? Will it impact my breathing problem?
The surgeon should then discuss the patient’s most realistic surgical options. For example, converting a large strong nose into a small turned-up nose will seldom, if ever, be one of those options because the goal isn’t to create an entirely different nose but to reshape it in ideal proportion to the patient’s face. It can be straightened and altered in terms of width, size and angle between it and the upper lip. “Dorsal humps” (the convexity on the top of the nose) can be reduced, bulbous tips downsized and nostrils tapered and reshaped. Such changes can vastly improve an unattractive nose without producing an artificial look.Please contact me for a free consultation with Dr. Levens.