James L. Pertsch, MD

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Rhinoplasty

Many individuals have been unhappy with the appearance of their nose for an extensive period of time. Fortunately, rhinoplasty offers a solution to these individuals. Surgery of the nose is one of the most common of all plastic surgery procedures.


The best candidates for a rhinoplasty are those who are looking for an improvement in the way they look, not those searching for perfection. There are many ways rhinoplasty can improve upon one’s nasal appearance. This surgery can reduce or increase the overall size of your nose, change the shape of the tip or bridge, and/or narrow or widen the nostrils. Not only can rhinoplasty enhance the overall facial appearance, it can also help improve one’s breathing.


A consultation at Dr. Pertsch’s San Mateo or Mountain View practice is an important part of the process. This allows him to thoroughly examine the current state of the nose and determine what can be done to enhance its appearance. Because each patient has a unique facial anatomy and desired outcome, every procedure is personalized to meet his/her goals.


The rhinoplasty procedure usually takes an hour or two; more complicated procedures may take longer. Dr. Pertsch will perform an “open” or “closed” rhinoplasty based on the complexity of the procedure. A closed rhinoplasty entails incisions on the internal part of the nasal structure, while an open procedure requires incisions on the bottom part of the columella. Scarring from either technique is often indistinguishable as they fade over time.


Dr. Pertsch begins the surgery by separating the skin from its supporting framework of the bone and cartilage, which is then sculpted to the desired shape. The skin is then redraped over the new framework. After the surgery is complete, a splint is then applied to help the nose maintain its new shape. Nasal packs or soft splints may be placed in the nostrils to stabilize the septum; this is the dividing wall between the air passages.


After surgery, during the first 24 hours, the face will feel puffy, the nose may ache, and the patient may experience a dull headache. The patient should plan on resting with his/her head elevated for the first day. There will be swelling and bruising around the eyes, reaching a peak after two to three days. By the end of one week all packing, dressings, splints and stitches should be removed and the patient is able to return to school or work. It will be a few weeks following surgery before patients can resume more strenuous activities. Healing times vary with each patient.


To learn more regarding your options available with nose surgery, be sure to schedule an initial consultation with Dr. Pertsch at either of his facilities – Mountain View or San Mateo. Your questions and concerns may be addressed at this time.

BEFORE

AFTER

BEFORE

AFTER

Rhinoplasty, Caucasian

DESCRIPTION: 28 yr. old who hated her nose since 8th grade:
“Nose is crooked, tip too prominent, and bump: nose is now focus of my face.”
Her small jaw further emphasizes the relatively big nose.
She has tired of questions about her ethnicity.
An oral surgeon did complete cephalometric studies but recommended no maxillary or mandible surgery.
5’5” 130 lb. Exam confirmed a very narrow oval face, very prominent nose and mid-face with less prominent lower face and small jaw.

Surgery performed: Rhinoplasty with augmentation genioplasty (chin implant) via intra-oral approach
Open rhinoplasty: stair step incision across skin of columella (part of nose between nostrils) to give surgeon best view and access for precise adjustment to these delicate structures.
Chin augmentation was done via incision inside the lower lip (implant used was 3 dot extended anatomic design Spectrum Medical Designs anatomic chin size 3 catalog 250-134S net projection 0.6mm)

After photos only 3 months after surgery
Patient very happy! Can already see changes. Nose starting to soften.

 

 

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