Rhinoplasty

Rhinoplasty in Salt Lake City, UT

Rhinoplasty

Before
After

Rhinoplasty overview

One of the most common complaints of patients in a facial plastic surgeon’s office are regarding the nose. When one’s nose is distracting it produces disharmony with the face, and the view is automatically guided away from other pleasing facial features. For example, someone with “beautiful eyes” will always have a nose that is in proportion with the rest of the face. When choosing a rhinoplasty surgeon it is important to find someone who understands both the cosmetic and functional aspect of nasal anatomy. It is also important for the doctor and patient to have a way to properly discuss individual ideals of nasal beauty.

Not only is the nose a cosmetic aspect of one’s appearance, it also serves an important functional role. Indeed, we are designed to breath through our noses. When forced to breath through the mouth it makes one feel restricted, look sick and seem unhealthy. A well-proportioned nose will not only fit the face but will also work the way it is meant to. A sound and thorough understanding of a nose’s functionality on both the inside and outside is vital whenever considering surgical alteration. Dial (801) 525-8727 today to schedule your Rhinoplasty consultation with Dr. John Bitner!

When discussing a procedure that will alter the shape of a persons nose, it is often difficult to convey the effect. Furthermore, the surgeon’s view of the ideal nose on a person’s face may be different from the patient’s view. While aesthetic ideals of nasal proportion have been described, how the nose will harmonize with the rest of the face must be individualized. For example, generally a woman’s nasal bridge should be flat to slightly concave. Most would say that a convex nasal bridge on a woman is masculinizing. However, this rule can not be universally applied. Artistic creation of a nose that is in complete harmony with the rest of the face and fits the patient’s view of beauty is the goal. Preoperative patient and surgeon communication is imperative. Use of computer imaging to fully convey these thoughts are very important. Please refer to the 3D imaging section for further discussion of computer imaging.

Rhinoplasty Surgical Approach

During Dr. Bitner’s residency and fellowship training, he learned rhinoplasty techniques from many of the world’s experts. While there are a great many minor variations, grafts, suturing techniques and cartilage cutting to each surgery, there are two general approaches he uses. About 80% of the rhinoplasties he performs are through incisions made only inside the nose. This avoids any external scarring and speeds the recovery process. This type of approach is called a closed or endonasal rhinoplasty.

Occasionally, the tissues are not able to be elevated off the stucture of the nose or visualization is inadequate and an open approach must be taken. This approach is called either an open, open structure or external rhinoplasty. The main difference between a closed and open rhinoplasty is an incision at the base of the nose. Although the incision is visible during the initial portion of the healing process, the final scar is barely noticeable. Decisions about whether to use an open or closed approach is one specific to each case and is decided by the surgeon.

Recovery After Nose Surgery

Most patients need to account for approximately one week to recover from a rhinoplasty. Although not particularly painful the most common complaint it that it’s just hard to breathe though the nose as you recover. While Dr. Bitner does not place any packing inside the nose during or after surgery, there is usually scabbing, crusting and swelling of the tissues that blocks one’s airway. Bruising around the eyes is common especially when any bony work has been done and the bones were fractured. The bruising has generally started to fade during the first week, but can take two or more weeks to completely resolve.

At the time of nose surgery, paper-thin splints are placed inside the nose along the septum and tape and a cast is placed on the outside. The stitches on the inside are all dissolvable. The patient is asked to return at one week and everything is removed. The nose will still usually appear swollen and bigger than what the patient wants, but will not look strange or obviously bizarre. However, the final cosmetic result may take many weeks or even months to achieve as the swelling resolves and the healing process completes. Once the splints are removed and the cast is taken off, the breathing improves but the person may continue to feel stuffy for several weeks.

Risks And Possible Complications of a Nose Job

As a general rule, a rhinoplasty is a safe operation and can be done in Dr. Bitner’s office based operating suite or in the surgery center on an outpatient or day surgery basis. Most patients do very well after surgery, heal completely and are very pleased with the final cosmetic and functional result. However, in surgery many variables exist and nothing can be guaranteed. Some of the risks that have been described are: worsening of nasal obstruction, abnormal scarring on both the inside and outside of the nose, bleeding, infection, unacceptable cosmetic appearance, perforated nasal septum, exposure of grafts or implants, memory loss and even death. During your initial consultation, Dr. Bitner will review some of these risks and provide reasonable expectations. During your preoperative visit just before surgery Dr. Bitner’s staff will review and ask you to sign a surgical consent form. This form will review the risks of the surgery. Please take the time to fully review the consent form and feel free to ask any questions as they arise.

Rhinoplasty FAQS

The short answer is sometimes, but with many exceptions and exclusions. If the main complaint is nasal obstruction, has failed medical therapy and I deems the external portion of the nose as the cause of the obstruction then a request can be submitted. Photos must be taken and sent for review. If the concern is primarily cosmetic, no matter the cause, it will usually be denied.

If the person has never had nasal surgery before, the surgery will take somewhere between 1.5-2.5 hours. That is surgical time and doesn’t include the time needed to put the patient to sleep, numb the nose and otherwise get ready to start the procedure. Revision rhinoplasty cases can take even longer. Rest be assured, I will take the time necessary to perform the operation correctly and afford someone their best possible outcome.

Cosmetic rhinoplasties performed in the office are done with the assistance of an anesthesiologist. This is a medical doctor who is specifically in charge of putting and keeping the patient asleep and comfortable. The anesthesiologist will also continuously monitor the airway and vital signs to make sure the procedure is done in a safe manner. Usually this means the patient remembers nothing and awakens in the recovery area comfortable and happy.

The first thing to understand in rhinoplasty, is that the healing process is a long one. While the majority of the swelling resolves after the first two weeks, small and subtle changes in nasal swelling continues to take place for weeks and months afterwards. Further, the healing process where scar tissue, fibrosis, scar remodeling and reformation is a process that can take up to a year. In the vast majority of cases, if someone is not happy, just wait and things will usually improve and become more and more in line with a persons preoperative expectations. Unfortunately, even with the most experienced rhinoplasty surgeons, the forces of contracture and scar remodeling that occur over time can change the nose in an unpredictable fashion. For this very reason, I use techniques which mold and contour the underlying cartilages but also provide added strength and reinforcement. This helps resist the force of contracture accompanying healing over time. I don’t perform revisions until at least a year out from surgery. This is rarely necessary. On the other hand, a fair number of my patients come just for revision rhinoplasty. This is personally a very gratifying part of my practice.

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 patient Testimonials

#1 Rated Facial Plastic Surgeon in Utah

*Based on RealSelf.com reviews with physicians having at least 50 reviews of surgical results (specifically excluding Botox or filler results). Please visit realself.com
Simply a world class experience. I don’t know who was better: Dr. Bitner or his amazing staff. The results were better than I had even hoped for. I had a chin procedure done. I wouldn’t even hesitate to go back for anything else. Thank you for the fantastic experience!
I had a facelift, eyebrow lift, and my lips done 2 years ago... I still love the way I look. Dr. Bitner and staff are the best!!!
Dr. Bitner and his staff were incredible to work with. I could not recommend him enough! He cares about you as a patient, listens to your concerns, and has the skills and expertise to make you feel completely confident in what he can do for you.
I went to Dr. Bitner for an eyelid surgery. I am so happy with the results!! I feel like years have been taken off my face. There was no scarring under my eyes. You can not even tell that there was an eye tuck under my eyes. The surgery was easy no pain at all. I would recommend him to everyone I know. The office staff was very nice also and professional.
I cannot say enough good things about my experience with Dr. Bitner and his kind staff. They went above and beyond to help me. Truly exceptional service and care.
I love my results from the surgery with Dr Bitter. The change is amazing. I wish I had found him sooner. I’m 61 years old, feel 40. The main reason I chose Dr Bitter is he specializes only in faces. I think that’s what makes him more of a specialist. For me that is important. I love how excited he gets when he sees the amazing results.
Dr. Bitner is not only a first rate surgeon but an approachable, caring doctor that makes you feel comfortable and confidant in choosing the right procedure. His staff is knowledgeable, professional and friendly. All together, choosing this Doctor was a great decision!
The best experience I could have hoped for amazing Doctor I’m so happy with my face lift it’s changed my life and gave me back my self esteem I look and feel amazing! Thank you Dr Bitner! And the most amazing sweet staff!
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