The nose, being the most defining central feature of the face, has a very significant impact on how a person looks. Even a slight alteration in nasal shape and structure can often greatly improve one’s appearance.
Dr. Ovchinsky, a double board certified facial plastic and head & neck surgeon, will provide you with the highest level of expertise in both esthetic and functional rhinoplasty. This dual training allows Dr. Ovchinsky to know the nasal anatomy and function literally “inside out” and to be able to encompass esthetic and functional (breathing) improvements in one procedure without compromising either.
It cannot be overemphasized that good communication between a patient and a doctor is essential in planning of rhinoplasty. Nasal anatomy, skin type, history of prior nasal surgery, ethnic background, and age are important factors to be considered in preoperative discussion. During the preoperative evaluation, Dr. Ovchinsky will both listen carefully to your concerns and desires, not only with respect to what you want changed, but also to what you wish to remain the same. Today, computer imaging is an enormous help in the exploration and dialogue between you and your surgeon. By utilizing the imaging system, Dr. Ovchinsky would be able to greatly facilitate the discussion and mutual understanding and show you a realistic view of what can be accomplished by surgery.
Dr. Ovchinsky is equally versatile in either the “closed” or “open” rhinoplasty techniques. In the closed technique, all incisions are concealed inside the nostrils.
In open rhinoplasty, most of the incisions are also made inside the nostrils except for one small incision over the columella – the narrow strip of the nasal skin at the bottom of the tip. The selection of one approach over another is based largely on the nasal anatomy and surgical goals and not on the mere presence or absence of the external incision.
Here is a very happy patient talking about his rhinoplasty experience.
Nasal Tip Surgery
Many patients present for rhinoplasty because they are unhappy with the appearance of the nasal tip: it may be too big or bulbous, sticking out too far away from the face (over-projected), droopy, or excessively pinched and collapsing (especially common in patients who had prior rhinoplasty surgery). While there are many nasal tip techniques involving modification of the nasal tip cartilages, with time certain techniques may result in excessive narrowing or asymmetries of the nasal tip with or without nasal obstruction.
Dr. Ovchinsky’s techniques rely primarily on preservation of the tip cartilage strength, precise suture placement and the use of cartilage grafts to create a naturally appearing and stable nasal tip contour, no matter whether this is your first nose job or a revision.
Dorsal hump reduction is one of the most commonly performed procedures in rhinoplasty, usually resulting in a much more pleasing profile and smaller appearing nose. While removal of the dorsal hump may seem like a fairly straightforward procedure, it is very important, especially in cases with very prominent dorsal humps, to provide the nose with an extra support in order to prevent future weakness and collapse of the dorsal cartilages.
In many instances, especially in cases of prior nasal trauma, nasal bones may be shifted to one side or another, thus causing nasal deviation and asymmetry. This problem can be successfully corrected during rhinoplasty. It is very important to carefully examine these noses internally prior to surgery since most of them have septal deviation as well. The correction of septal deviation should never be neglected. If uncorrected, it may lead to incomplete improvement of nasal deviation and persistence or worsening of nasal obstruction after the surgery.
A masculine nose is characterized by a profile with a strong, straight nasal dorsum and by a well defined, but not overly narrowed nasal tip. In approaching male rhinoplasty, Dr. Ovchinsky’s goal is to improve the overall nasal appearance while preserving the masculinity of the nose, specifically avoiding scooping out of the nasal bridge, over-rotation of the tip (tips that are turned up too much), or excessive narrowing.
Nasal anatomy and tissue characteristics are largely defined by patients’ ethnicity. For example, African American patients who present for rhinoplasty usually feel that their nose is too wide, “too big,” and undefined for their face. This is due to a combination of shallow and wide nasal bones, weak nasal tip cartilages, short septal cartilage, and thick skin. Hispanic noses may vary widely in appearance, however most of them have fairly thick skin, droopy nasal tip and a dorsal hump. Iranian, Middle Eastern, and Mediterranean patients have an overall larger nose, with either a straight bridge or a large hump. In these patients, the nasal tip is also typically large and generally droopier as compared to the average Caucasian nose. Asian noses usually have low-set or flat dorsum and fairly bulbous nasal tip.
All of these noses require different approaches and techniques to achieve the beautiful result the patients are looking for. Dr. Ovchinsky has years of experience with ethnic rhinoplasty surgery working with a diverse patient population of the greater New York area.
If you are considering Rhinoplasty or Revision Rhinoplasty surgery, you have come to the right place. Dr. Ovchinsky specializes in naturally beautiful rhinoplasty results and is passionate about rhinoplasty surgery, having made it a focus of his facial plastic surgery practice. He is the author and the teacher of the latest rhinoplasty techniques proven for reliability and longevity, and places as much importance on function (good breathing) as on appearance. It is Dr. Ovchinsky’s paramount goal that your satisfaction with your beautiful new nose lasts for a lifetime.
“Rhino(nose)-plasty(shaping)”, also known as nose surgery or a "nose job," is a surgical procedure which can alter the size and/or shape of the nose, as well as relieve some breathing problems. There are many changes to the nose that can be achieved through rhinoplasty, including a reduction or increase in the size of nasal bridge or nasal tip, refinement of the nasal tip, a change in shape or size of the nostrils, or an alteration in the angle between the nose and upper lip.
There are 4 distinct types of rhinoplasty:
Cosmetic rhinoplasty improves the nasal shape and its proportion to the rest of the face.
Reconstructive rhinoplasty rebuilds a severely damaged or congenitally malformed nose.
Revision rhinoplasty corrects a suboptimal result from earlier surgery.
Individuals who are looking to improve the appearance and/or function of the nose may be good candidates for rhinoplasty, though they must also be physically healthy and realistic in their expectations.
Rhinoplasty should not be performed on younger patients until their nose has finished growing. The nose tends to be finished growing around the age of 15 for girls and 16 for boys. There is no maximum age limit for rhinoplasty as long as the patient is reasonably healthy and has no medical contraindications to anesthesia.
During a consultation for rhinoplasty, your nose will be thoroughly examined and your medical history taken. Dr. Ovchinsky will examine both the inside and outside of the nose to make sure that both cosmetic and functional concerns are fully addressed. Your photographs will be taken and Dr. Ovchinsky will use a special computer software to show you what type of a result can be expected. This is the time when you and Dr. Ovchinsky will discuss your goals, your surgical options, and all details of the surgery.
The rhinoplasty surgery can be performed in an outpatient surgery center, or as an outpatient at a hospital.
In most cases, rhinoplasty is done under general anesthesia. General anesthesia is safest, as it allows for protection of the airway during surgery. In cases of a limited rhinoplasty (small tip refinements, small hump reduction, etc) the surgery can be performed under intravenous sedation or even local anesthesia in the office.
During the rhinoplasty surgery most of the access incisions are made inside the nose. Fairly commonly a small external incision is made on the columella (middle bottom portion of the nasal tip). With the incisions made, the surgeon will separate the skin from its underlying nasal framework. The bone and cartilage will then be sculpted to achieve the desired shape. The skin is then re-draped and the incisions are closed.
If you are undergoing so called “closed rhinoplasty”, where all incisions are made inside the nose, you will have no external scars. If you are undergoing so called “open rhinoplasty”, you will have a small 2-3mm scar that is well-concealed as it is located between the nostrils on the underside of the nose.
The presence or absence of the external scar should not govern your decision whether to have an open or a closed rhinoplasty, as the scars in this location almost universally heal very well and are not readily noticeable. Most important factor when deciding on the type of rhinoplasty approach is your surgeon’s opinion as to which approach is more likely to provide you with a better final result.
In most cases, rhinoplasty can be completed within 2 hours, however the duration of the procedure depends on the complexity of surgery. Sometimes the procedure takes longer in revision or more difficult cases.
As surprising as it may sound, recovery from rhinoplasty surgery is not a very painful one. Patients may expect some discomfort as the head and nose may ache during the first few days after surgery. Most of the post-operative discomfort is typically related to nasal congestion for a week or so after surgery, and feels like a head cold. Pain medications are commonly prescribed for after the surgery to be used on as needed bases.
Swelling and bruising are common, and patients may experience some nasal discomfort. Some bloody discharge can also occur for the first few days, but rarely is there a severe bleeding. Stitches and nasal splint (white firm plastic) are usually removed within one week. Though some subtle swelling of the nose can take as much as a year to fully fade out, the majority of swelling will clear up in about two weeks. Dr. Ovchinsky almost never uses nasal packing after the surgery, which dramatically reduces postoperative discomfort.
Dr. Ovchinsky usually prescribes a prophylactic antibiotic to be taken for 1 week after the surgery. Pain medications are prescribed to be used on as needed bases. Dr. Ovchinsky also recommends to use Saline nasal spray starting the following day after the surgery to gently irrigate the nose.
Most rhinoplasty patients find that they can return to work/ school in about one week. Even sooner return to work/ school is possible for those who don’t mind appearing publically wearing nasal splint and don’t do any physical work. Patients should avoid strenuous activities for two to three weeks and should avoid contact sports with a potential trauma to the nose for at least 6-8 weeks.
If external incision is made, it is closed with very fine sutures which are usually removed in about one week after the rhinoplasty procedure. Internal incisions are closed with absorbable sutures and don’t require any suture removal.
Dr. Ovchinsky usually sees his rhinoplasty follow up patients at 1 week after the surgery, at which point nasal splint and sutures are removed. The subsequent follow ups are at 1 month, 3 months, 6 months and 12 months after the surgery. All patients are encouraged to follow up at any time in the interim if they have specific problems or concerns.
Although not common, some of the potential complications that can occur with rhinoplasty are as follows: bleeding, infection, adverse anesthesia reactions, septal perforation or hematoma, persistent or worsened cosmetic problem or nasal obstruction, poor scarring, and the need for additional surgery. Dr. Ovchinsky will oversee your care until complete healing has occurred and satisfactory, realistic results have been obtained.
Although our patients are generally out and about within 10 days of the procedure (sometimes within a day), the tissue concealed beneath the skin of the nose takes about a year to heal completely from surgery. Of course this healing process happens indiscernibly and does not affect patients’ life style.
Because rhinoplasty is a complicated procedure and neither you nor your surgeon can fully control your healing process, there is a chance you may need to have some post-surgery touch- up/ revision procedure. About 10 percent of rhinoplasty operations require touch-up procedures, ranging from small touch ups in the office to a full revision surgery in the hospital.
The cost of the surgery is determined by the complexity of the operation, whether the surgery is primary or revision, and whether there is an insurance based component of the procedure. All patients get a detailed surgical quote at the end of their consultation visit which is tailored to their specific circumstances.
Though some amount of coverage may be available for rhinoplasty procedures performed for functional (breathing improvement) purposes, most rhinoplasty procedures are considered cosmetic and are not covered by insurance. The determination whether there is a place for insurance coverage is usually done at the initial consultation and is primarily based on patients’ symptoms, history and physical examination findings.
Financing is available for many plastic surgery procedures. Our office manager/ patient coordinator will go over available payment options at the end of your consultation visit.
Dr. Ovchinsky’s research work on rhinoplasty techniques was presented at the Annual Meeting of the American Academy of Facial Plastic and Reconstructive Surgery in Dallas, TX, October 2015
Dr. Ovchinsky’s Recent Book Chapter on Revision Rhinoplasty
Comparison of Permanent Versus Absorbable Suture in the Tonguein- Groove Technique in Endonasal Rhinoplasty
Comparison of Permanent Versus Absorbable Suture in the Tonguein- Groove Technique in Endonasal Rhinoplasty Vol. 33(2) 91–95
Wonderful experience every time I come to Plastic Surgery of Short Hills. Dr. Ovchinsky is the best. He performed a few procedures for me and he has done an amazing job! I am thrilled with my results! Whenever I come to his office, I never feel rushed and he always takes his time explaining all the procedures. The staff in his office is extremely nice and accommodating. The office manager Helen is very considerate and patient and answers all the possible questions that I have. Thank you Plastic Surgery of Short Hills!!!!