Nose Reshaping - Rhinoplasty at The Cosmetic Surgery Clinic of Waterloo, Ontario

Nose Reshaping (Rhinoplasty)

Dr. Robert Shenker welcomes Dr. Cory Goldberg to The Cosmetic Surgery Clinic.

Dr. Goldberg is a Plastic Surgeon certified by the Royal College of Physicians and Surgeons of Canada. He earned his MD degree from Queen’s University, Canada and completed his Plastic Surgery residency training at the University of Toronto, including a Master’s of Applied Science in Biomedical Engineering. He subsequently did sub-specialty fellowship training in Craniofacial and Pediatric Plastic Surgery at University of Southern California in Los Angeles, California.

Dr. Goldberg has active membership with the Canadian Society of Plastic Surgeons, and he is licensed by both the College of Physicians and Surgeons of Ontario and the Medical Board of California. Dr. Goldberg is also certified by the College of Physicians and Surgeons of Ontario as an Inspector of Independent Health Facilities.

Dr. Goldberg is well known and respected in the Toronto Plastic Surgery community. He has held clinical appointments at Sunnybrook Health Sciences Centre, Children’s Hospital of Los Angeles, Cedars-Sinai Medical Center, and Trillium Health Centre.

Rhinoplasty is surgery to alter the nose. It has the dual purpose of improving the appearance of the nose, as well as addressing any functional problems with breathing through the nose. Rhinoplasty is one of the most challenging procedures for any surgeon because it is a balance of aesthetic and functional issues. It requires a precise technical hand to make fine alterations and also an accurate artistic eye to judge the shape and balance of the nose with the rest of the face. In Rhinoplasty more than any other procedure precision is paramount since the nose is the most central and prominent feature of your face, and small alterations can have a profound impact. Dr. Goldberg has special interest, training, and experience in Rhinoplasty and performs many primary Rhinoplasty operations.

Common specific concerns that people want to address with Rhinoplasty surgery are:

Hump on the top of the nose
Deviated or crooked nose
Wide or boxy nasal tip
Large or bulbous nasal tip
Wide nose or flaring nostrils.
Inability to breathe on one or both sides of the nose

Some people have more general concerns about their nose such as feeling that their nose is:

Too large for their face
Not balanced with their face
Too ethnic

Open Rhinoplasty

Background: Open Rhinoplasty is the most common approach to nasal surgery. It is performed through incisions on the inside of the nose, as well as a single 4 or 5 mm external incision on the undersurface of the narrow area between the two nostrils. This type of approach allows visualization of the involved structures during surgery to make the alterations according to the plan that you make with Dr. Goldberg. The alternative approach is Closed Rhinoplasty, but this is not appropriate for all patients and requires careful consideration between you and Dr. Goldberg.

The Procedure: The operation is most often done under general anesthetic as same-day surgery at The Cosmetic Surgery Clinic. The operation takes approximately 3 hours, and you are usually allowed to go home within 2 hours after surgery. Long lasting local anesthetic is injected after you are asleep to prevent sensitization of the nerves during the procedure, and this significantly reduces discomfort after surgery. You are also given intravenous medication to reduce swelling and prevent nausea after surgery. After the incisions are made and the relevant structures are visualized, reduction and alteration of the cartilage and bone of the nose are performed according to the plan made between you and Dr. Goldberg. At the end of surgery dissolving sutures are used to stitch the internal incisions, 5 or 6 non-dissolving miniature sutures are placed in the one small external incision. Packing is sometimes placed inside the nose to reduce bleeding. Dr. Goldberg uses a patented type of packing with integrated breathing tubes, which allows you to breathe through your nose even while the packs are in place. Finally, a padded split (cast) is placed on the top of the nose to protect the shaping that was done in surgery.

Recovery: Dr. Goldberg prescribes several medications to ensure your comfort. These usually include Celecoxib and Percocet to control inflammation and pain, Ondansetron to prevent upset stomach, and Lorazepam (Ativan) to help with sleep if you need it. You will be seen in 2-3 days after surgery for a check-up, and to remove the packs from your nose (if any were inserted). Once the packs are removed you will also be prescribed nasal sprays that reduce swelling, improve nasal breathing, and help cleanse the internal incisions. Swelling will involve the nose and the area around the eyes, and usually increases over the first 3 days. It then rapidly subsides over 1 to 2 weeks, at which point you will be able to see the improvement in the shape of your nose. Approximately 15-20% of the swelling remains and it takes 9 to 12 months to subside and for your body to re-absorb this extra fluid.

Risks: There are general risks with Rhinoplasty such as bruising, bleeding, infection, and risks associated with general anesthetic. There are functional risks such as reduced nasal airway and dryness in the nose. Cosmetic risks include irregularities that may be visible or felt by touch only. It is possible, though uncommon, to worsen deviation. Approximately 15% of all Rhinoplasty patients will undergo revision surgery at some point. This may be to address minor irregularities such as a small bump of bone that can be felt, or as major as a complete Revision Rhinoplasty.

Alternatives: Some minor nasal deformities can be addressed by Filler Products, though their role is very limited. There are no other non-surgical alternatives. Closed Rhinoplasty is an option for some people.

Benefits: Rhinoplasty is a reliable procedure that can dramatically improve the appearance and balance of your face. With good communication between you and Dr. Goldberg you will be able to direct a personalized plan for surgery that will address your goals and fulfill your needs. Also, it is an operation that can greatly improve your nasal breathing, restoring function and improving your ability to breathe during sleep and while participating in sports.

Closed Rhinoplasty

Closed Rhinoplasty is also known as Internal Rhinoplasty, this type of operation is done through incisions just on the inside of the nose, with no external scars. This technique is able to address many common issues in Rhinoplasty surgery, and is the best choice for some people. The advantages are that it has no external scar, and may result in less swelling since it requires less dissection and exposure during surgery. However, it is not for everyone and not all problems can be addressed with this approach. The decision of what approach to use for your surgery will be made in discussion between you and Dr. Goldberg after your objectives and personal needs are assessed.

Revision Rhinoplasty

Overall, about 15% of Rhinoplasty patients will choose to undergo some revision surgery. This may be to address a minor concern such as a bump on the bone, a moderate concern such as limited nasal breathing, or a major concern with unsatisfactory results. These complications are best avoided, which can be accomplished by good communication between you and your doctor.

Dr. Goldberg sees many patients for Revision Rhinoplasty who have been operated on previously by other surgeons. Many people who are unsatisfied after Rhinoplasty feel betrayed and disappointed that their surgeon failed to address their initial objectives, and afterwards were often unresponsive to their concerns about the outcome. Many surgeons are reluctant to operate on these patients due to the formidable challenge of Revision Rhinoplasty.

Revision Rhinoplasty is a particular challenge because the tissue around the nose is scarred internally. Also, normal anatomy and anatomic relations are disrupted, making planning and operating especially challenging. Often, the original operative report is not available or inadequate to outline what was done in the initial operation.

Performing this surgery requires particular skill and experience. Dr. Goldberg performs many such operations every year. Revision Rhinoplasty may be done through either an Open Rhinoplasty or Closed Rhinoplasty approach, depending on the particular needs of the patient. Dr. Goldberg is pleased to offer this service, and will listen to your concerns without judgment or reservation.

Ethnic Rhinoplasty

The most common people to request Rhinoplasty are those of Asian, African and Middle-Eastern Descent. The objective is usually not to eliminate the ethnic character of the nose, but rather to reduce it only, while maintaining a natural appearance. Of course, this is not always the case, and some individuals ask to completely eliminate the ethnic features and create a nose with a Caucasian appearance. This is a matter of personal taste, and requires good communication between yourself and Dr. Goldberg so that your personal goals can be translated into the appropriate surgical plan.

Asian
A common concern raised by Asian patients is that the bridge (dorsum) of the nose is too flat and undeveloped, with poor projection of the tip. Often, the base of the nose is broad with upturned nostrils. To address these concerns extra tissue must be added to augment the bridge and increase projection of the tip, and reduction of the nostrils must be performed to reduce the width of the base of the nose.

African
A common concern raised by people of African descent that their nose is too flat and too wide along the bridge and at the base. This usually includes wide and flaring nostrils. To address these concerns it is necessary to augment the bridge of the nose with tissue, and reduce the nostrils. This latter part may require incisions in the lower part of the nostrils.

Persian and Middle-Eastern
The most common concerns raised by people of Persian and Middle-Eastern descent are a long nose, with a wide drooping tip and a hump on the bridge. These concerns can be addressed with reduction of the bone and cartilage on the top of the nose, with elevation and refinement of the tip of the nose.

Facial Feminization
Male-to-female trans-gender individuals often struggle with achieving their ideal physical appearance to match their identity. Many of these features cannot be altered or camouflaged by injectable products or with make-up, but are very amenable to alteration with surgery. There are many such procedures, and the decision to select any of them is very individual.

Rhinoplasty for Feminization
The male nose is usually very wide and high along the bridge. Also, the base is often wide, with a wide tip that projects straight forward. The ideal female nose is narrow along the bridge and base, with a refined nasal tip that is elevated slightly, forming an angle just greater than 90 degrees between the lip and nose. These features can be created with Rhinoplasty surgery. The effects of surgery are predictable and longstanding, and it is arguably the operation that can most augment the femininity of ones face.