Rhinoplasty

Rhinoplasty is an art and mastering it a lifelong endeavor. There are many nuances, details, dynamic and temporal aspects and variations. No two operations are ever the same. ⁣ ⁣ This is an art I am passionate about. It is an art I obsess over. There is daily dedicated time for thinking about rhinoplasty in my life. Not a day goes by without me thinking about one aspect of another of rhinoplasty: How can I optimize my results yet preserve more and dissect less?  Where can I graft less and maximize outcome predictability?  ⁣ 

There are so many dogmas in rhinoplasty: External versus internal approaches, osteotomy techniques, structural versus preservation concepts, autoflap or grafts, rib cartilage or ear, diced or not, push down, let down, roof sparing, component reduction, and the list goes on and on. ⁣ ⁣ With humility, and with abundant respect to my rhinoplasty colleagues, a turning point for my rhinoplasty career has been the realization that there is no single “correct” way of doing rhinoplasty and a bespoke approach must be formulated for achieving beautiful and functional results.  My approach draws on the best of these various techniques for a customized treatment that results in the desired look. 

There are fundamental truths and principles one must adhere to, of course, but at some point, following old teachings in a step-by-step fashion makes rhinoplasty limited and rigid. I don’t know about you, but I much prefer to watch art happen in the passion of flawlessly improvised masterful street tango than to watch well-performed but rigid execution of step-by-step instructions in a rehearsed first dance. #youareart

What is rhinoplasty and why is it performed?

 Rhinoplasty refers to procedures, surgical or nonsurgical, performed in order to improve nasal shape and function.  The procedure is performed in order to improve breathing, and or nasal shape.   there are many approaches to rhinoplasty.  In addition, there are many reasons for this procedure including the correction of previously unsuccessful surgery,  nasal trauma,  and more.

Primary rhinoplasty refers to nose reshaping in a patient who has not had nasal surgery before. 

Revision rhinoplasty refers to corrective rhinoplasty on a patient with previous nasal surgery and untoward outcome.

Preservation rhinoplasty refers to a modern approach to rhinoplasty where minimal architectural dissection of the nose is performed while achieving desired aesthetic results. Dr. Saman is one of the very few surgeons trained in Preservation Rhinoplasty in the United States.

Nonsurgical rhinoplasty refers to the use of botulinum toxin (Botox, Jeaveau), PDO threads, and dermal fillers (such as Restylane or Juvederm) to reshape the nose without surgery.

Endonasal rhinoplasty (or closed rhinoplasty) refers to a surgical approach in which incisions are not made externally and the entire operation is performed through incisions placed inside the nose.   

Open rhinoplasty is the most common rhinoplasty approach performed and allows for on paralleled visualization of nasal structures.

Will rhinoplasty make me look different?

The goal of rhinoplasty is not to make you look like a different person but instead, we work to improve nasal function and aesthetics to improve overall facial harmony and balance.  Our consultation goal is to understand your desired goals and cosmetic vision so the appropriate approach and techniques could be selected for optimal outcomes. 

Will rhinoplasty affect my breathing?

Dr. Saman is board certified in both facial plastic surgery as well as ear, nose, and throat surgery and is uniquely qualified to address both the aesthetics of the nose as well as function.  Although there are risks associated with all surgeries, every rhinoplasty is performed with the nasal function in mind and if problems involving the nasal septum, turbinates, or valves are noted, they will be corrected during the procedure. 

I have some difficulties breathing as well. Will my health insurance cover parts of my surgery?

Generally comprehensive cosmetic rhinoplasty is includes improvement of functional components important in breathing including nasal septum, nasal valves and turbinate. Limited rhinoplasties such as tip plasty and alar plasty may not involve functional portions. However, we do not combine cosmetic (for reshaping of the nose) and functional (breathing issues) nasal surgeries. 

Although we are have preferred provider status a few select PPO insurance plans, for all patients seeking cosmetic rhinoplasty, with or without functional issues, the entire surgical fee is payable four weeks prior to date of surgery. For insurance with which we are not in-network, you may be able to submit a claim to your insurance company and have a portion of the functional part of the procedure possibly covered if you have Out-of-Network benefits. For insurances for which we are in-network, all patients must provide us with a waiver that they will not seek reimbursement from their insurance company as this may constitute fraud. 

Do you perform revision and ethnic rhinoplasty?

Yes.   Revision rhinoplasty and ethnic rhinoplasty comprise a large portion of our practice.

What is the consultation like?

Our consultations are generally 30 minutes in length. During that time Dr. Saman will review your history and will listen to your concerns and goals for the desired look. He will then perform a comprehensive analysis of your nasal shape and contours, septum, cartilages, skin thickness, as well as your facial angles and shape. Finally, he will go over possible treatment plans and outcomes. Our patients have often said the encounter is the most complete and involved consultation process they've ever had and walked out having a deeper and realistic understanding of the options available.

Pro tip: Bring in a few photos of noses you like so we can see!

Is rhinoplasty painful?

Dr. Saman's gentle technique makes recovery generally very comfortable.  Minimal discomfort a few days after surgery is well controlled with prescribed medications.  Our patients usually bruise very little. Most patients are up and about the day after surgery. 

What is the downtime after rhinoplasty? 

Your first postop visit is at about one week and although there are limitations, you are almost back to normal after that time. 

Good news: Dr. Saman does not use painful internal packings which makes the whole process much more comfortable and you can breathe through your nose after surgery! 

How long before I can see my results?

After rhinoplasty, the final outcome is dependent on internal scarring and swelling.  About 60% of the swelling is resolved by the first 2 months.  The rest gradually dissipates over the ensuing year.   As the nose starts to heal, scar tissue is formed internally.  We ask that you follow our post-operative instructions very strictly in order to maximize the results.