What is a rhinoplasty?

Rhinoplasty is simply an operation performed to change the shape of the nose.  We have learned over the years that it is important to maintain nasal function, and to avoid sacrificing this for the sake of nasal form.  Thus the goal of rhinoplasty in our practice is to create beauty without causing long-term consequences such as breathing obstruction.

Given that form is determined by perception, and perception by the way light and shadow falls on a given structure, rhinoplasty is at it’s essence an artistic and engineering operation--it is a sculpture of the most complicated type.  Only by study of the artistic component of this surgery, and knowledge from years of experience, does a surgeon begin to realize the nuances of creating the form and stability necessary for great long-term result.
 

Why select Dr. Most for my rhinoplasty?

Many years experience are required to reach a point where, by studying the operation and one’s own results, we can be confident about best possible chance for a positive outcome from this operation.  Dr. Most has over thirteen years of experience in this operation (Not including residency and fellowship--some doctors include that in this number.  If we do that, he has been performing plastic surgery of the head and neck for 20 years), and has performed over 1500 rhinoplasty operations.  His double-board certification in Facial Plastic & Reconstructive Surgery as well as Otolaryngology-Head and Neck Surgery makes him uniquely qualified to perform rhinoplasty.
 

May surgeons may claim renown for this operation.  How does one determine if this is true?

The best rhinoplasty surgeons are part of a small circle that publishes regularly and speaks regularly at national and international meetings.  Some may be members of the Rhinoplasty Society.  They are truly fascinated by this challenging operation, and strive to get better by sharing their own knowledge and gathering knowledge from others. Dr. Most has published original articles regularly in the field of rhinoplasty and has been asked to write book chapters for major textbooks in rhinoplasty.  Just a few of the topics of his papers and chapters:

• How to preserve the nasal airway after dorsal hump removal
• How to correctly perform osteotomies for crooked noses and to close an open roof
• Studies of nasal airway patency before and after nasal surgery
• Secondary/revision rhinoplasty-My methods
• In addition, he is asked regularly to speak about rhinoplasty at national and international meetings.  Just a few of those national and international engagements in the past couple of years:
• The British Academic Conference on Otolaryngology (2015)
• The Dallas Rhinoplasty Meeting (2015)
• The AAFPRS Advances in Rhinoplasty Meeting (2015, 2013, 2011, 2009)
• The Rhinoplasty Society (2014)
• The American Society of Aesthetic Plastic Surgery (2014)
• The Milan Masterclass Meeting on Rhinoplasty and Rhinology (2013)
• There have been many more through the years…
   

In addition, he is recognized nationally by his own American Academy of Facial Plastic & Reconstructive Surgery (AAFPRS) for his prowess in the area.  Twice he has been selected for national awards from the AAFPRS (2003 and 2014).  He is regularly selected by his peers as both “Best Doctors” and “Top Doctors” in America, the two premiere physician rating services.  

Perhaps most important, however, is Dr. Most’s desire to obtain the best possible outcome from each and every patient who entrust him with their care.  He promises to always bring his very best to each operation:  Many years of experience, attention to detail, meticulousness, aesthetic ideals and knowledge of the interaction of form and function.  No surgeon can promise perfection, but Dr. Most can promise his best effort each and every time.

What does a rhinoplasty achieve?

The basic idea with rhinoplasty is that we alter the form of the nose.  What is achieved with any given rhinoplasty is impossible to predict with certainty--hence rhinoplasty is called the ‘most difficult operation in plastic surgery’.  

Given that the are so many different facial and nasal shapes, the ‘ideal’ nose will vary.  Furthermore, we have to take into account gender, ethnicity, and individual preference when determining what to make our goal.  

In many cases, we will perform a computer simulation with our patients to help improve communication regarding what is possible, and how it would fit on a given person’s face.  While this is never a guarantee of results, it can be useful in determining if this operation is right for you.

How long does this procedure take?

A primary rhinoplasty usually takes 2 to 3 hours. A secondary or revision rhinoplasty may take longer.

What kind of anesthesia is used during a rhinoplasty?

We recommend a ‘light’ general anesthetic for patient safety.  This is more more well-tolerated, as patients wake up quickly and are more comfortable for the procedure.  If you have specific concerns about this, feel free to speak to our staff or Dr. Most.

What is a ‘closed rhinoplasty’ versus an ‘open rhinoplasty’?

This is commonly used terminology, and I am not a big fan of it.  In fact, we would propose that there is NO SUCH THING as a ‘closed rhinoplasty’, as that implies there are no incisions  Nothing could be further from the truth. There are many incisions used in this technique, and it can be quite destructive. Thus, we and many experienced surgeons use the term endonasal rhinoplasty, meaning all incisions are inside the nose.  Dr. Most performs many revisions on patients whose noses have been destabilized with this method, or who have nasal collapse.  

The so-called ‘open approach’ is better termed external rhinoplasty, as it better describes the method used. It is considered by most U.S. rhinoplasty surgeons the ‘gold standard’ for rhinoplasty, as we have more control over the structural components of the nose when we do it this way.  For this reason, may who evangelized the endonasal technique switched to external over the years.

In some cases, an endonasal rhinoplasty can be appropriate.  Dr. Most can perform the operation either way, and can help determine which way is best for you at your consultation.

What is the typical recovery from a rhinoplasty using Dr. Most’s technique?

The typical patient who undergoes this surgery mild swelling, with or without bruising, that peaks on the third day after surgery.  At the time the external nasal splint (or ‘cast’) is removed one week later, most bruising, if present, is resolved.  Swelling of the nose reduces quite quickly, and patients are typically able to be in public soon after cast removal.  However, the minimal residual swelling that is typical of rhinoplasty takes one year to resolve.  This may result in improved results over time!  This is why experienced rhinoplasty surgeons and knowledgeable patients know final results can take one year.

What can I do to speed recovery after a rhinoplasty?

Rest, elevation, and icing are all important in reducing swelling and bruising after facial surgery of any type.  Please see our Rhinoplasty Postoperative Instruction Sheet for specifics.

What about these ‘injectable nosejobs’ I hear about?

You may hear of doctors who perform quick ‘facelift’ surgery procedures under local anesthesia.  A number of names for these exist, such as ‘S-lifts’, ‘minilifts’or other such terms.  In most cases, these involve minimal to no SMAS elevation, and provide short-term fixes with potential scarring due to the tension placed on the skin.  While these may work for some patients, we strive to provide high-quality, long-lasting results for our patients with our facelift techniques.  Many doctors have taken to naming facelifts that are minor modifications (or not modifications at all!) simply for marketing purposes.  We have specifically chosen not to do so with our techniques--we let our results speak for themselves.

What are the potential risks of rhinoplasty surgery?

While it is impossible to be all-inclusive here, some of the potential risks are nasal obstruction, a hole in the septum, scars in or outside the nose, new asymmetries (we all have these at the start), and dissatisfaction with the outcome.

Regarding this last item, this is perhaps the most common concern encountered as patients seek their rhinoplasty.  Again, while no one can guarantee outcomes, the key to a good result are choosing an experience surgeon, and communicating with him/her well.

I am interested in rhinoplasty!  How do I learn more?

We are happy to see you in consultation. Contact our Care Coordinator, Amy Mladineo, at (650) 736-3223 to schedule your visit. During your consultation, you will meet our care team and spend time with Dr. Most. Dr. Most will help you determine if this procedure is right for you.