Nose

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

One of the latest new/old trends to circle back in rhinoplasty surgery is the preservation rhinoplasty.  Preservation rhinoplasty simply means that all or a part of the bridge of the nose (the dorsum) is not taken down or separated.  Instead it is “preserved” during surgery and work is done underneath or deep to a preserved roof of the nose.  Usually this means that the lines that determine the nasal shape from the front (called the brow-tip aesthetic lines or dorsal aesthetic lines) are not interrupted.  Leaving these lines intact can lead to a lower risk of nasal contour discrepancies many years down the line.

Although it is billed as “less invasive,” the group of techniques called “preservation rhinoplasty” still often require fracturing the sides and the superior part of the nasal bones. The advantage is that by leaving the front of the bridge of the nose as it was prior to surgery, we have one less variable to worry about as the nose heals. In addition, these techniques can still improve the nasal airway and often do so without widening the middle part of the nose (the middle vault) too much or at all.

Am I a candidate for preservation rhinoplasty?

You might be a candidate for a preservation rhinoplasty if:

• This is your first rhinoplasty surgery
• Your nose is straight, or mildly or moderately deviated to one side
• You have not had significant trauma to your nose
• You have a small or medium sized dorsal hump on your nose that you would like to have taken down

If you would like to learn more about this and other techniques that Dr. Irvine uses for her nasal surgeries, please call us at 424-225-1280 or request an appointment here.

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.