Dr. Ernst N. Kaplan
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NOSE SURGERY (RHINOPLASTY)

Rhinoplasty reshapes the nose. Surgery is for cosmetic reshaping and is also to alleviate nasal breathing problems. If the nasal shape and breathing problem is caused by documented trauma, the surgery may be partly covered by insurance. The operation can be performed on all age groups, including teens who have reached full growth. Nasal surgery can by either reduction rhinoplasty to decrease the size of the nose or augmentation rhinoplasty to increase the size or projection of the nose.

The bridge of the nose and the tip of the nose are treated separately. It is common to augment the nasal bridge and reduce the tip and in other patients to reduce the bridge and augment the tip. Adding cartilage, bone or silicone can make a wide area look thinner and more defined.

The best results in facial cosmetic surgery are natural, proportioned and consistent with the ethnic character. A natural balanced proportion is important for an individual feature such as the nose and equally it equal important to balance that feature with the face as a whole.

Reduction Rhinoplasty

Reduction rhinoplasty is a surgical procedure to make the nose smaller by removing, or reshaping bone and cartilage. It is possible to reduce the size of the nasal hump and/or of the nasal tip. All noses are different and a special plan must be developed to meet the individual desires. The bone of the nose may require either rasping or cutting to reduce its size and make it narrower. Surgery may include narrowing the nasal bridge and tip by removing or reshaping the cartilage. The nasal tip can: be narrowed to reduce the roundness, have increased or decreased projection, or the angle of the nasal tip can be tilted upward or downward. The length of the nose is most commonly changed by shortening. In most cases this involves removal or repositioning the tip cartilages. However, the appearance of a smaller nasal tip and fine detail may be achieved by adding cartilage to the tip of the nose, or restructuring the existing cartilage rather than removing cartilage.

Augmentation Rhinoplasty

Augmentation rhinoplasty is often requested by Asians, Hispanics or blacks to create a straighter raised nasal bridge. This is achieved by adding a silicone or other synthetic implant to the bridge. In some cases cartilage is used to add to the bridge.

The nasal tip may be flat and rounded. This is improved by repositioning and/or adding cartilage to the nasal tip. Projection is improved by using a “strut” cartilage graft in the columella to push the tip forward. Although the use of a silicone implant in the tip of the nose is an easy way to achieve narrowing and projection, the incidence of significant complication is very high when silicone implants in the tip. For that reason, I use of the patients own cartilage as a safer, more natural method. In cases where the nostrils flare, a segment of skin may be removed.

Before Surgery

We will discuss how to balance your nose in relation to other facial features. Digital photographs and computer imaging allow us to evaluate the appropriate techniques to achieve the desired shape. It is not unusual to combine rhinoplasty with chin augmentation to improve the profile.

Method of Surgery (open vs. closed technique)

Surgery can be performed with local anesthesia under IV sedation or with general anesthesia. The surgery can either be performed with and “open technique” or a “closed technique”

Incision placement

With the open technique, a small hidden incision is place across the middle of the columella.


Before & After


Open technique Closed technique Ability to visualize cartilage and bone Both sides of the cartilage and bones can be completely seen simultaneously Only one side of the nasal cartilage can be seen at a time. So it is more difficult to compare the two sides and achieve symmetry Ability to maintain new position of cartilage Cartilage position is maintained with sutures Cartilage position is maintained indirectly with tape and splints on the skin surface and not directly Ability to access the septum The septum is accessed through the top of the nose where the curvature can be seen. Also the cartilage low in the nose that causes breathing problems is easily visualized The septum is accessed in the nostrils where it is easy to work with the areas of airway blockage, but it is difficult to alter the nasal septum near the bridge.

In summary, I most commonly use the open technique because it provides better visualization and more consistent results.

What to expect after surgery

  • Pain is minimal and is controlled with medications.
  • Bruising occurs around the eyes, but begins to fade within a few days. Discoloration usually disappears in two weeks.
  • The recovery takes one to two weeks. Most people resume their normal activities within a week or two.
  • Following surgery, a lightweight splint is applied to maintain the new shape of the nose. The splint is removed within a week. Nasal splints may be inserted at the time of surgery to protect the septum. These are removed within a week.
  • There is always some stuffiness of the nose, especially when work has been done on the nasal septum. The nose has some slight swelling for many months.
  • The final shape cannot be determined for nearly one year.

Before & After



Before & After