RHINOPLASTY

(NOSE RESHAPING)

Dr. Panossian offers the latest rhinoplasty techniques with an emphasis on producing natural appearing yet stunning noses. As a photographer, Dr. Panossian has studied the face and the intimate relationship of the nose with the rest of the face. His practice is largely dedicated to both cosmetic and revision rhinoplasty. He is an expert in both closed and open rhinoplasty techniques in order to deliver beautiful noses with improved breathing mechanics. Dr. Panossian stresses the importance of correcting existing nasal airway obstruction while delivering excellent cosmetic improvements. Dr. Panossian’s closed rhinoplasty technique (known as endonasal surgery) is a scarless procedure that avoids the typical incision at the base of the nose that is common in an open rhinoplasty technique. The incisions in a closed technique are confined to the inside of the nostrils and are, therefore, hidden.

Reshaping the nose is one of the most commonly requested plastic surgical procedures but also one of the hardest. The nose is the prominent central feature of the face and requires a wealth of experience on the part of the plastic surgeon in order to deliver beautiful and permanent results. Because of the difficulty level, the surgeon’s training, experience, and volume of patients is extremely important to ensure excellent results. Dr. Panossian has trained in craniofacial surgery in addition to performing rhinoplasty procedures on a weekly basis. He is one of the busiest rhinoplasty surgeons in Los Angeles. His reputation in the world of rhinoplasty draws patients from around the world, with an exclusive clientele that includes Hollywood celebrities and prominent public figures. Dr. Panossian was named the “go-to” plastic surgeon for “nose jobs” by Maxim Magazine.

Dr. Panossian has appeared on The Doctors, Good Morning America, CNN, HLN, CBS, PBS, TLC and the Discovery Channel for his work in plastic surgery and his rhinoplasty technique.

AS SEEN ON:

  • Maxim Magazine Logo - Andre Panossian, MD's In the Media - Rhinoplasty Top Doc in Los Angeles
  • KCET Logo - Andre Panossian, MD's In the Media
  • ABC News Logo - Andre Panossian, MD's In the Media
  • Los Angeles Times Logo - Andre Panossian, MD's In the Media
  • The Doctors Logo - Andre Panossian, MD's In the Media
  • CNN Logo - Andre Panossian, MD's In the Media
  • Good Morning America Logo - Andre Panossian, MD's In the Media

FREQUENTLY ASKED QUESTIONS ABOUT RHINOPLASTY

I want a rhinoplasty. What do I do next?

Schedule a consultation first with Dr. Panossian. Your nose is not the same as others. Dr. Panossian will tailor your rhinoplasty plan to your desires and needs. He will then guide you through the consultation process to decide what technique will work best for you, given your facial features. A thorough exam of your nose is necessary both externally and internally. Dr. Panossian will help you visualize the individual parts of the surgery to deliver changes that are in line with your expectations. He will then meet with you again for a preoperative visit 2-3 weeks prior to surgery to review the rhinoplasty plan and give you preoperative and postoperative instructions.

To schedule you rhinoplasty consultation with Dr. Panossian, call us at 310-275-5086 or complete the contact form to the right ☛.

For patients located outside the greater Los Angeles area or in other countries, an initial rhinoplasty consultation can be done by phone or email. You would need to email us high quality and well-lit photos of your face (front, side, and from below views) to Dr. Panossian at [email protected] Dr. Panossian will then review your photographs and talk to you over the phone or via email. Our practice is located in Beverly Hills and services Southern California and the greater Los Angeles area.

What are the goals of rhinoplasty?

The primary goal of rhinoplasty is to produce a nose that is aesthetically superior to your existing nose and in excellent proportion to your face. In addition, it is important to address any nasal airway obstructions or breathing difficulties you may have. Specifiic goals will be discussed as to how much nasal narrowing, tip refinement, hump reduction, and possible narrowing of the nostrils, etc. is necessary.

Am I a candidate for closed rhinoplasty?

Schematic drawing of open vs. closed rhinoplasty techniques.Whenever possible, Dr. Panossian prefers a closed rhinoplasty approach. It allows the nasal reshaping without a visible external scar. Reducing the hump on top of the nose and refining the tip is performed through incisions placed inside the nostrils. Dr. Panossian is also able to perform nasal airway surgery using this technique. Leaving the nasal skin intact allows for quicker healing and more predictable results.

Open rhinoplasty may be indicated when an extensive rhinoplasty or revision rhinoplasty is required. In this technique, a cut is made across the base of the nose (columella) and the skin of the nose is lifted. The advantage to this technique is that there is superior visualization of the internal structures and more aggressive corrections may be performed. The resulting scar typically heals well and is concealed.

Patient Example #1: This patient underwent closed rhinoplasty to straighten the nose, reduce the dorsal hump, correct the septum, and slightly refine the tip. The result was improvement of nasal shape and symmetry without losing his masculine appearance. Incisions were placed inside the nose (endonasal rhinoplasty), leaving no visible scarring. 

Before and after photo of young man's profile for rhinoplasty.

View More Rhinoplasty Photos

How do I know what result to expect?

Dr. Panossian will use computer imaging to demonstrate results that you may anticipate with your particular nose. This is not always a reliable way to predict the final appearance but may give you an approximate idea. Ultimately, the surgical outcome depends on the surgeon’s skill and experience, the patient’s anatomy (skin, cartilage, bone thickness, etc.), and the patient’s healing ability postoperatively. There is no way to take these factors into account when using preoperative computer imaging. It is more important to see samples of the surgeon’s actual results to have an idea of what is possible.

Where will my surgery take place?

Dr. Panossian performs surgery only at accredited surgical centers to assure patient safety. These facilities are clean, modern and use the most current state-of-the-art equipment make sure your surgery goes smoothly and safely. Anesthesia is administered only by licensed anesthesiologists who are certified by the American Board of Anesthesiology.

How long does rhinoplasty surgery take?

Rhinoplasty can last anywhere between 1 and 3 hours, if it is a primary (or, first time) rhinoplasty. Revision rhinoplasty usually takes longer.

What happens after surgery?

Rhinoplasty is an outpatient procedure, meaning you will go home the same day. You will have a combination of dressings in place that will stay in place until your visit with Dr. Panossian. You will initially be seen the day after surgery to make sure there are no major problems. Dressings and the splint on your nose will then be removed in approximately 5-7 days after surgery.

Will nasal packing be used?

Dr. Panossian rarely uses nasal packing. If it is deemed necessary during your surgery, he will then remove it in 1-2 days.

When will I see the final result after rhinoplasty?

The nasal appearance will look better immediately after surgery but often will look a bit swollen for up to 2 weeks. After that, there may still be swelling in the nasal tip that will persist for up to 12 months. There is a slow and steady improvement during that time. In some cases, swelling may persist up to 24 months after surgery. Patients with thick nasal skin tend to have more noticeable swelling.

Patient Example #2: This patient underwent closed rhinoplasty to straighten the nose, reduce the dorsal hump, and refine the tip. Nasal airway obstruction was also addressed. Swelling in the tip may take 1-2 years to resolve. Check out the rhinoplasty Before and After photo gallery to see additional views of this patient.

Side view before and after photo of young woman for rhinoplasty.

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Will I have bruising after rhinoplasty?

Bruising in rhinoplasty is usually related to narrowing of the nasal bones in the upper part of the nose. Bruises may develop underneath both eyes, but will typically resolve in 10-14 days. Not everyone will require narrowing of their nasal bones; therefore, bruising is not always a part of rhinoplasty.

What is the pain like after rhinoplasty?

Most of our patients report mild pain or only discomfort following rhinoplasty. Some report the temporary discomfort of nasal congestion. Although a prescription for pain medications will be provided, it is not always necessary to need them.

Can I wear eyeglasses or sunglasses following rhinoplasty?

Eyeglasses or sunglasses are to be avoided for approximately 4 weeks after surgery, IF nasal bone reshaping was performed. But if your rhinoplasty only included shaping of the tip, then patients can usually resume wearing glasses 7 days after rhinoplasty.

Will my health insurance cover rhinoplasty?

Cosmetic rhinoplasty is not covered by health insurance. Patients who have breathing problems through the nose may be eligible for insurance coverage for the medical or breathing improvement part of surgery. Coverage depends on the type of insurance.

What is done to open nasal passages?

The nasal airways are always addressed for patients who have some level of nasal airway obstruction and even in routine rhinoplasty, so that virtually every patient actually ends up breathing better. To do this, Dr. Panossian addresses 3 key areas:

Schematic view from front showing correction of deviated septum during rhinoplasty1. Correction of deviated septum: septal deviation is present to some degree in most individuals and is re-aligned surgically. Whether this causes symptoms really depends on the severity of the deviation. In some patients, the entire nose can be shifted or crooked.

2. Strengthening the internal nasal valve:  every nose has an area near the cartilage and bone portions that is responsible for maintaining the support of the nose during breathing. This area can be weak in many people either naturally or because of an aggressive previous rhinoplasty or trauma. To re-establish the integrity of the internal nasal valve, there are two basic maneuvers that may be necessary. Small strips of your own cartilage called spreader grafts may be required. These are small strips of cartilage taken from the septum itself and  carefully placed on each side of the septum beneath the mucous lining. This will then strengthen the area of the internal nasal valve and prevent collapse. The second major way is to place small strips of cartilage that internally splint the valve open by strengthening the delicate cartilage pieces on the sides of the nose. These are called alar batten grafts.

Schematic illustration of nasal airway and inferior turbinates during rhinoplasty3. Reducing inferior turbinates:  inside the nose, there are long structures that extend from the inner wall of the nose that are made up of a small amount of bone and mucous lining. These are important for warming and moisturizing the air we breathe. In some people, especially those with seasonal allergies, these structures will swell and create congestion. The inferior turbinates are reduced in size during rhinoplasty to improve nasal air flow.

 

Can rhinoplasty be combined with other procedures?

Yes. Rhinoplasty can be combined with other plastic surgery procedures such as breast augmentation, tummy tuck, eyelid surgery, liposuction, scar revision, brow lift, or labiaplasty (vaginal rejuvenation).

What can I expect if I have thick nasal skin?

Thick nasal skin is a challenging problem in rhinoplasty. It limits the amount of refinement one can expect from reshaping the tip of the nose. Dr. Panossian uses personally developed techniques to improve the definition one can expect from rhinoplasty, especially in individuals with thick skin.

What is ethnic rhinoplasty or Middle Eastern rhinoplasty and does Dr. Panossian do this?

Ethnic rhinoplasty is a more recent term used to described nose reshaping performed in non-Caucasian or non-European individuals with characteristic features that are common to their ethnicity. In other words, ethnic features are preserved. A large part of Dr. Panossian’s practice is ethnic rhinoplasty patients, especially of Middle Eastern descent. He also treates other ethnicities, including African American, Asian, Armenian, Indian, and more.

Does Dr. Panossian perform revision rhinoplasty?

Yes. Revision rhinoplasty has unfortunately become a common procedure in the world of plastic surgery. Often, patients are subjected to aggressive or inaccurate rhinoplasty procedures which, in many cases, leave them with deformities and breathing problems. Many times, Dr. Panossian will use an open rhinoplasty technique to reshape the nose in these cases and may even require cartilage grafts. Patients come from various parts of the world to have Dr. Panossian perform these difficult cases.

Patient Example #3: This patient was unhappy with two previous rhinoplasty efforts. She underwent an extensive revision rhinoplasty using an open technique to reshape the tip of her nose and remove her bulbosity. In addition, the tip was lengthened slightly to give better proportion to the entire nose. Sometimes, due to depletion of cartilage inside the nose, a rib cartilage graft must be used as in this case. View more revision rhinoplasty photos in the Before and After gallery.

Before and after photo of young woman for cleft lip rhinoplasty.

View More Rhinoplasty Photos

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Postoperative Instructions

The following is a set of instructions given to Dr. Panossian’s patients after rhinoplasty. They may be modified as needed for each patient by Dr. Panossian, if necessary.

Day 1 after surgery:  Keep your head elevated. Apply cold compresses during the first 24 hours. Don’t place ice directly on the skin. Start taking antibiotics prescribed by Dr. Panossian the same day of surgery. You may take the prescribed pain and nausea medications as needed according to the instructions on the label. Your nose and face will be swollen for the first 3 days but will steadily improve over the course of a week. Make sure to contact Dr. Panossian’s office to schedule your follow-up in 5-7 days. You may need to come in to the office on Day 1 to remove nasal packing, if it was placed.

Day 3 : Begin cleaning the bottom part of the nose gently using cotton balls or facial tissue soaked in warm water. Apply Vaseline or Aquaphor on the nostril rims once a day. Do not put Q-tips inside the nose.

Day 5-7:  Your splints and sutures will be removed in the office by Dr. Panossian.

– Irrigate the nose with a salt water spray (also known as Ocean Spray, available over-the-counter at any pharmacy). Apply Vaseline or Aquaphor inside the nose at night for two weeks using Q-tips or a thinly rolled tissue. Use a mirror to monitor how you do this to avoid excessive pressure. Sutures, mucous, and dried blood will come out, which will help you breathe better.

– Tape your nose only at night.  Although taping will not affect the final result, it will help minimize  swelling that develops overnight during the early postoperative period.

– Avoid alcohol and  blood thinners (aspirin, motrin, advil, excedrin, naproxen, ibuprofen, vitamin E, fish oil, omega 3 fatty acids, herbal  supplements ) for 2 weeks after surgery.

– Showers, make up, facial creams can be restarted.

Nose blowing: Avoid forcefully blowing the nose for at least 2 weeks after surgery. Then, do so gently.

Driving:  You may begin driving again when you are no longer taking pain medications and feeling comfortable with your vision.

Exercises:  No contact sports or heavy exercising for at least 4 weeks from the time of your surgery. Also, avoid bending over for 2 weeks after surgery.

Swimming:  Swimming can be resumed 6 weeks after surgery.

Sun exposure: Always make sure to use sunblock SPF 50 or higher to protect your nose. Do so either in the sun or under a shade. Avoid prolonged sun exposure, and use a hat whenever possible.

Foul smell in the nose: MThis may occur in some patients after rhinoplasty, but does resolve over time.

Stiff upper lip and smile:  As scars and the nose soften, this will improve. This usually takes several months to improve.

Flying on airplanes:  There are no strict guidelines on flying, but it is generally recommended avoid it for at least 7 days after surgery.