Face

Rhinoplasty

This procedure is helpful for patients who have a nose that is cosmetically unattractive or not in harmony with other facial features.

A thorough examination and consultation are performed, and the patient’s desires are carefully considered. In-office computer imaging is extremely valuable in assessing the cosmetic imperfection and in communicating with the patient the proposed changes.

During the examination, the patient is questioned about possible previous surgery or trauma, nasal airway obstruction, and seasonal allergies. The exterior nose as well as the nasal airways are examined.

Some patients undergoing cosmetic nasal surgery (rhinoplasty) also benefit from functional nasal surgery, which helps with nasal breathing. Patients who experience nasal airway obstruction may have a nasal septal deviation, acquired genetically, or as a result of trauma. Surgery on the septum may be helpful in creating or restoring normal nasal breathing, and may be essential for straightening of a crooked nose.

Patients may experience difficulty with nasal breathing because of enlarged structures within the nasal airways called turbinates. These structures serve to warm and humidify the air we breathe, but may become excessively enlarged, resulting in airway obstruction. Dr. Casso performs a tissue-conserving procedure called submucosal resection of the turbinates, which helps establish more normal nasal breathing without resulting in drying of mucous membranes caused by more aggressive and destructive turbinate surgery.

Nose reshaping surgery (rhinoplasty) is performed on an outpatient basis under general anesthesia at Houston Methodist St. John Hospital. While this procedure is sometimes performed under local anesthesia in outpatient facilities, Dr. Casso recommends general anesthesia at Houston Methodist St. John Hospital, which provides the patient with a comfortable surgical experience, and close, expert nursing attention, treatment of postoperative nausea, if present, and immediate medical attention in the event of any unforeseen emergency. The option for surgery in a full-service, state-of-the-art facility such as Houston Methodist St. John provides patients with a measure of safety and security which is unmatched.

In this procedure, Dr. Casso makes an external incision across the columella (the strut between the nostrils). The skin and subcutaneous tissues are carefully separated from the underling bone and cartilage. These tissues are then carefully assessed. A bony or cartilaginous hump is lowered surgically. A small amount of excess cartilage on the nasal tip may be removed. Sutures are placed in the cartilage of the nasal tip to reshape it. Straightening of the cartilaginous nasal septum, if necessary, is performed. Enlarged nasal turbinates may be surgically reduced to allow for opening of nasal breathing passages. Sometimes, the nasal bones are fractured in a controlled fashion to narrow the nasal bridge. A closed or endonasal rhinoplasty employs incisions inside the nose only and permits some degree of nasal reshaping without a columellar incision. Large nostrils can be reduced with tiny incisions at the outer base of the nostrils.

With the initial discomfort controlled with oral medication, Dr. Casso discharges the patient with an external cast or splint in place if bony modifications have been performed. If septal surgery was also performed, the nose may have internal nasal splints. The patient is seen frequently in the early postoperative period. External sutures, if present, are removed in 3-5 days. The external cast or splint, if present, is usually removed in one week, and most of the swelling and bruising subsides markedly over two weeks.

Most patients return to light work within 5-7 days. Vigorous exercise is discouraged for one month.

While most patients may participate in social activities within one to two months, the final results are not evident until six to 12 months have passed, which is the period necessary for nasal tip edema resolution and complete tissue softening.

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