Dr. Joseph M. Perlman Advanced Plastic Surgery Centre

When I was a resident in plastic surgery training over 25 years ago it seemed that everyone who had a rhinoplasty, or nose job, all seemed to have the same result. The same held true for facelifts.

Things have changed dramatically in cosmetic surgery. In many procedures, the axiom has been “less is more”. By that, I mean that plastic surgeons have developed techniques to individualize the procedure to the patient’s wants and needs.

Most of the rhinoplasty patients that I see in my practice are interested in keeping the appearance of their nose, but only want it to be more refined, to look better. This holds true, especially in the Caucasian population. In my Asian, Hispanic, and African-American patient population, changes are more radical and the procedures more complicated.
During my consultation, I ask the patient what features of their nose they would like to change. I also inquire if they’re having any internal problems such as airway obstruction, whether they’ve had trauma to the nose, previous nasal surgeries, and problems with allergies. All of these factors influence the final outcome.

The most common areas of treatment are removing the hump on the nasal dorsum, narrowing the nose, refining the tip, changing the shape of the nostrils, and lessening the “gummy smile” that some patients have. It’s important to thoroughly analyze the nasal features and set up a game plan individualized for the patient. In my practice, I often use the open rhinoplasty approach to treat their problems. This technique requires making a small incision in the columella (the skin between the nostrils at the bottom of the nose) and elevating the skin and fatty tissue off the underlying cartilage, which provides the framework for the lower two-thirds of the nose. This allows access to the dorsal hump, as well as for refining the tip, by trimming some of the cartilage and using cartilage grafts to give it a better definition. I can relax the gummy smile, refine the nostril shape and correct any septal problems through this incision.

It’s important for patients to know that the final results may take up to a year to be evident and there may be noticeable swelling for the first four weeks.