Rhinoplasty (Nasal Reshaping, "Nose job")

Although the nose is situated at the center of the face, an attractive nose should not draw attention to itself. Rather, the viewer's attention should be drawn to the most attractive facial feature: the eyes. An unattractive nose may become the focus of attention and detract from other pleasant features.

Rhinoplasty (frequently referred to as a "nose job") aims to reshape the nose by modifying or softening its appearance to bring it into harmony with the remaining facial features. A natural "unoperated" look is ideally sought. It is arguably the most complex and challenging surgical procedure performed. It requires intimate knowledge of not only the external esthetics but also the internal anatomy. The surgeon is required to execute the necessary refinements while predicting the healing process and how the final outcome will materialize several months later. Every rhinoplasty procedure demands that the entirety of the surgeon's technical skills, knowledge and experience be brought to bear to achieve a pleasing, natural, and long-lasting result.

Dr. Samaha is specialized in otolaryngology (ears, nose and throat) as well as facial plastic surgery. His extensive experience in all types of nasal surgery, functional, esthetic, and reconstructive, makes rhinoplasty a procedure of particular interest to him. Occasionally, patients consulting for esthetic rhinoplasty also suffer from a functional (breathing) problem which can be addressed at the same time.

There are two main surgical approaches to rhinoplasty surgery. In the "open" approach, incisions are made on the skin of the columella (the soft partition between the two nostrils) and inside the nose, and the structure of the nose is modified underneath the skin. The "endonasal" approach means that the necessary changes are performed by placing small incisions inside the nose only, without an external scar. Dr. Samaha usually favours the endonasal approach, reserving the external approach for situations where it is absolutely necessary. He has extensive expertise in both approaches and, together with his patients will select the approach best suited to their anatomy.

Most patients consulting Dr. Samaha for rhinoplasty surgery are referred by friends or family members who have had surgery, or other plastic surgeons who feel that the patient's case is very complex, requiring more advanced techniques.

The Day of the Surgery
Patients are able to go home within one hour following surgery. Upon leaving, patients do not have any "packing" or gauze in the nose, but simply a small piece of cotton dressing the size of a pea on either side at the tip of the nose, to be removed that evening or the next morning by the patient or a family member. The absence of a packing is greatly appreciated by many patients, since packing and its removal can be quite uncomfortable. There is a dressing on the outside of the nose to minimize swelling and support the nose, allowing it to heal in the desired shape. This dressing is removed at the first post-operative visit, one week after surgery.

The appearance of the nose at this point is not the final result. Nevertheless, the patient can expect the nose to look better than before the surgery. The swelling from the surgery will gradually decrease over the ensuing weeks to reveal the fine details and refinements. The nose continues to heal for several months. Depending on the situation, another appointment is scheduled at 1-2 months, as necessary. A final appointment is scheduled at 6 months after surgery. The long-term result is assessed and photos are taken. Other appointments are scheduled as needed.

Accessory Procedures
In addition to rhinoplasty, reshaping the chin (mentoplasty, chin augmentation) for some patients will provide an additional improvement to the overall facial esthetics. This is particularly true of the profile in certain patients where a slight augmentation of the chin will harmonize the alignment and provide a significantly more balanced facial profile.

Frequently Asked Questions

What are the restrictions after surgery?
The main restriction is the avoidance of strenuous activity, which includes vigorous exercise and heavy lifting for one week. Other actions that increase the pressure in the nose are also to be avoided. These include nose-blowing and bending forward. Otherwise, patients may carry out usual activities.

How long is the recovery?
Recovery time is usually about 7-10 days. Patients are usually comfortable returning to work after the removal of the dressing at 7 days, some prior.

What about bruising or "black eyes"?
Most rhinoplasty surgeries are associated with some bruising under the eyes. This does not apply to patients who are having only modifications to the tip of the nose. The degree of bruising depends upon surgical technique and the patient's own tendency to bruise. Dr. Samaha uses advanced, minimally invasive techniques to minimize bruising and swelling after surgery. In most of his patients, bruising is minimal and is usually 90% resolved at the first follow-up visit at one week. Patients who have a natural tendency to bruise easily will experience slightly more bruising under the eyes after rhinoplasty surgery.

Are any implants used?
Although foreign materials are routinely used in surgery for various parts of the body, the implantation of foreign material in the nose is associated with an increased risk of infection, rejection of the material, and scarring, even several years after surgery. For this reason, Dr. Samaha strictly avoids use of any foreign materials in the nose. Occasionally, adding tissue to support certain areas of the nose or modify its appearance is required. In these instances, Dr. Samaha will use some of the patient's own tissue, which is very safe.

Photos?
The Collège des Médecins du Québec prohibits physicians practicing in Quebec from posting testimonials from other patients or photos on a website or other media. For patients who wish to see examples of outcomes of particular surgical procedures, "before and after" pictures can be shown from Dr. Samaha's portfolio at the time of their visit. These are photos of patients who have undergone surgery and have agreed to have their pictures shown to help other patients who are contemplating a similar procedure.

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