Nose

Rhinoplasty (also known as a nose job) is a very rewarding and popular procedure. A rhinoplasty can change the shape of the nose, bringing it into harmony with the rest of the face to dramatically improve the overall facial appearance. In order to provide the most precise and aesthetically pleasing results, Dr. Irvine does the majority of her rhinoplasties using an open technique. A small, well-hidden incision is made at the bottom of the nose on the columella, between the nostrils. Dr. Irvine uses a structural rhinoplasty approach. This means that she utilizes patients’ own cartilage to reshape the nose while supporting it to ensure long-lasting cosmetic and functional improvements.

Dr. Irvine has performed hundreds of rhinoplasties over the past six years. She received highly specialized training in rhinoplasty and revision rhinoplasty, having worked with rhinoplasty specialist Dr. Paul Nassif on some of the most difficult cases in the world while filming for his television show Botched. This unique experience combined with her attention to detail and perfectionism make her an excellent rhinoplasty surgeon.

During the consultation, Dr. Irvine takes the time to listen to patients’ goals. She performs a thorough nasal examination to understand each patient’s unique nasal anatomy. Using computer software, she creates a picture of what the nose will look like after surgery and makes sure that she and each patient are on the same page.

Recovery after rhinoplasty usually takes about 1-2 weeks. After this time, most patients return to work. The scar under the nose may remain red for approximately six weeks. Swelling lasts for two years but most of the swelling is improved within the first three months after surgery.

Check out before and after images of rhinoplasty surgeries performed by Dr. Irvine here.

Profile views before and 3 months after primary rhinoplasty surgery

A revision rhinoplasty is performed to correct imperfections, irregularities, or difficulty breathing after prior nasal surgery or surgeries. The goals of revision rhinoplasty are to make the nose look natural and aesthetically pleasing and to improve breathing. Because the nose is a three-dimensional structure composed of bone and cartilage covered by skin, healing can be unpredictable as the skin contracts around the underlying framework. Dr. Irvine’s structural rhinoplasty approach corrects these problems, improving breathing while making patients look better at the same time.

Dr. Irvine received highly specialized training in revision rhinoplasty, having spent one year with rhinoplasty specialist Dr. Paul Nassif, operating on hundreds of the most difficult cases in the world while filming for his television show Botched. This unique experience combined with her surgical skill, attention to detail and perfectionism make her an excellent revision rhinoplasty surgeon.

Recovery after revision rhinoplasty usually takes about 1-2 weeks. After this time, most patients return to work. The scar under the nose may remain red for approximately six weeks. Swelling lasts for two years but most of the swelling is improved within the first three months after surgery.

Check out before and after images of rhinoplasty surgeries performed by Dr. Irvine here.

Many patients have difficulty breathing through their noses but do not want to dramatically change the appearance of the nose. Often, patients have been told that they have a deviated septum, which is when the internal cartilage and bone that separate the two nostrils (septum) is obstructing one or both nostrils. Sometimes simply correcting a deviated septum improves breathing sufficiently. However, in many cases nasal obstruction is more complex and is due to narrowing of the internal and/or external nasal valves. In these cases, a functional septorhinoplasty is often the best option. During this surgery, Dr. Irvine uses a patient’s own cartilage to create grafts that open the airway. Sometimes these grafts will alter the appearance of the nose slightly, usually for the better, and the goal is always to ensure that the balance and harmony of the nose with the rest of the face is maintained.

Dr. Irvine’s extensive training in the structural septorhinoplasty approach makes her uniquely positioned to balance the cosmetic and functional demands of this surgery to create excellent results.

Recovery after functional rhinoplasty usually takes about 1-2 weeks. After this time, most patients return to work. The scar under the nose may remain red for approximately six weeks. Swelling lasts for two years but most of the swelling is improved within the first three months after surgery.

Check out before and after images of rhinoplasty surgeries performed by Dr. Irvine here.

Before and 6 weeks after a functional septorhinoplasty performed solely to improve nasal airway breathing.
Tip swelling will continue to resolve and scar will continue to improve over the next 10 months.

Ultrasonic Rhinoplasty

The use of powered ultrasonic instruments is one of the newer and most exciting advances in rhinoplasty surgery. In this technique, the nasal bones are precisely contoured by using powered instruments that vibrate at specific frequencies to remove unwanted bone. The overlying skin, soft tissue, and blood vessels on the nose are not disrupted by this technique. This leads to little or often no bruising at all. When necessary, the nasal bones can be precisely cut using the ultrasonic technique. This technique is also used for septoplasty surgery, allowing careful and atraumatic removal of bony deviations in the septum that block the airway.

Nasal Fracture Treatment:
Another important advantage of using powered ultrasonic instruments is the ability to perform rhinoplasty surgery on patients who have had recent nasal fractures. Traditionally, after a nasal fracture, aside from resetting the bones right away, a full rhinoplasty was not performed for 6-12 months. With the use of ultrasonic rasps and blades, the delicate nasal bones can be treated, reset, and a full rhinoplasty performed shortly after a nasal fracture has occurred. This has the advantage of allowing patients to return to work and school sooner without having to live with an injured/broken nose for months.

                                     

Before and 4 weeks after ultrasonic rhinoplasty surgery

Nasal Fractures

As both an otolaryngologist and facial plastic surgeon, Dr. Irvine has extensive experience treating all types of nasal and facial fractures.

In general, trauma that involves the bony part of the nose (the upper third) can be fixed in the immediate post-injury period. If a nasal fracture has displaced the nasal bones laterally (visibly moved the nose to one side causing a crooked appearance), it is best fixed with a closed nasal reduction. This can be performed within the first 5 hours of the injury or between 5 and 14 days after the injury. A closed nasal reduction involves simply moving the bones back to the midline and resetting them without making any internal or external incisions.

Traditionally, injuries that affect the cartilage of the nose (the lower two thirds of the nose) have only been addressed at a later date, usually 6-12 months after the injury. This practice was adopted in order to give enough time for all the nasal swelling to resolve, to be able to see contour irregularities in the nose that may not be obvious at the time of the injury. However, newer studies and Dr. Irvine’s own experience have demonstrated that in certain situations, it may be okay and even preferable to perform a complete rhinoplasty, addressing the nasal bones and the cartilage, at the time of the injury. Using powered ultrasonic instrumentation facilitates this. Dr. Irvine can delicately address nasal fractures without disrupting the framework of the nose, even when fractures are still mobile.

Regardless of the intervention chosen, treating displaced nasal injuries promptly is beneficial. Numerous studies have shown that even when the outcome of an immediate closed nasal reduction is not perfect, and even when a second surgery is still required, having an initial closed nasal reduction improves outcomes of secondary surgery.

Thus, Dr. Irvine and most urgent care and emergency room physicians encourage evaluation by an otolaryngologist or facial plastic surgeon within one week of nasal injury.