Rhinoplasty

RHINOPLASTY (NOSE JOB) IN WASHINGTON DC

WHAT IS A RHINOPLASTY?

Rhinoplasty ("nose job") surgery aims to improve external nasal appearance and to improve nasal breathing. Particularly in Washington DC, limiting down time is often as important as the result itself. Therefore, Dr. Rad prioritizes minimizing invasiveness by performing the least amount of surgery to achieve the desired objectives. As such, Dr. Rad performs the “closed" (endonasal) approach to achieve natural, balanced results with a fraction of the recovery time as compared with the "open" approach.

WHY MIGHT I BENEFIT FROM A RHINOPLASTY?

Rhinoplasty surgery focuses on 2 goals: improving aesthetic form, and improving airflow through the nose. As a consequence, self-confidence and breathing can be significant improved.  

Functional goals:  

  • correct a deviated septum (to improve breathing)
  • open collapsed nostrils (“external valve” problems)
  • open collapsed internal airways (“internal valve” problems)
  • enhance airflow through the nasal passages
  • improve comfort during nasal breathing

Aesthetic goals:

  • refine and define a bulbous or ball shaped tip
  • reduce a large dorsal hump
  • elevate or rotate a drooping tip
  • narrow a widened nose
  • shorten a long nose
  • improve projection (not to increase length) of the nasal tip
  • lift a hanging columella (the column of tissue between nostrils on the underside of the nose)
  • reduce nostril retraction
  • restore symmetry
  • straighten deviation

HOW CAN RHINOPLASTY IMPROVE MY BREATHING?

About 80% of people have a deviated septum which blocks breathing, leads to sinus blockages or infections, and impairs sleep which can lead to fatigue, lack of concentration and poor work performance. Rhinoplasty can significantly improve airflow through nasal passages which can improve sleep and restfulness.  Even in the absence of a deviated septum, Dr. Rad employs techniques (such as the use of “spreader grafts”) designed to open the airways further. Opening the airways does not cause the nose to appear wider.  Improved breathing by 20-30% is common even when the primary goal is to improve shape.

WHAT RHINOPLASTY PROCEDURES ARE THERE?

The 3 approaches to rhinoplasty are:

  1. Non-surgical: using filler, Dr. Rad can make modest aesthetic improvements such as filling in the bridge of the nose or defining tip shape
  • Advantages: in-office procedure is cost-effective and involves no down-time.
  • Disadvantages: improvements disappear after 6-12 months, and only small improvements can be made.
  1. Surgical, “closed” or endonasal approach: using incisions hidden within the nostrils permanent improvements can be made to shape and nasal breathing.
  • Advantages: hidden scars and minimal disruption of tissues lead to minimal discomfort, minimal swelling and congestion, and short recovery (~5-7 days).  
  • Disadvantages: none. This technique is state-of-the-art and is Dr. Rad’s preferred approach (read below for more detail).
  1. Surgical, “open” approach: using a visible incision across the base of the nose, permanent improvements can be made to shape and nasal breathing.
  • Advantages: improved surgeon visibility of underlying structures; however this is not a true advantage to the patient and is unnecessary to achieve the common goals of rhinoplasty.
  • Disadvantages: aggressive dissection and invasiveness leads to greater discomfort, swelling and congestion, and longer recovery times (~4 weeks).

The "closed" approach requires exceptional artistic nuance and skill. Dr. Rad employs the “closed” approach because results are excellent and recovery is minimal. This is in contrast to the "open" approach which involves a visible scar, significant swelling and recovery due to unnecessary invasiveness.  In Washington, minimizing invasiveness is often as important as the result, and Dr. Rad performs the "closed" approach to achieve natural, balanced results with a fraction of the recovery time.  

TELL ME MORE ABOUT OPEN AND CLOSED RHINOPLASTY - WHY IS THERE SO MUCH CONTROVERSY?

The open and closed approaches refer only to how the internal structures are accessed. Both are equally effective in allowing the surgeon to achieve patients' goals. However, there are big differences in scar and recovery.

The external scar from open rhinoplasty, while usually not terrible, is still often visible, may require makeup to cover, and can be disconcerting to patients. Additionally, the significant swelling, and thus the recovery time, associated with the open approach is much greater than swelling and recovery after a closed approach.  The difference can be 3 to 4 fold.  Particularly in Washington, recovery time and social downtime can be as important as the result itself.  This is where the closed approach shines: the two greatest advantages of closed rhinoplasty are (1) the limited invasiveness and therefore a quicker recovery for the patient, and (2) the ability to “fine tune” the result. Limiting invasiveness is also advantageous to achieving better results: Dr. Rad can control the external shape better if the nasal skin is disturbed less.

Whereas the focus in the open approach is the underlying bone and cartilage, the emphasis in the closed approach is the external shape. After all, what we see on the outside is what matters! The fact that all the incisions are inside the nose does not mean that the surgery is “blind.” Almost every step is still executed very precisely and under direct vision, but the planning and technique are unique. In fact, avoiding unnecessary dissection of the nasal skin is an advantage because Dr. Rad can better assess shape, symmetry and proportion.

IF I’VE HAD A RHINOPLASTY BEFORE AND I NEED FURTHER IMPROVEMENT, AM I ABLE TO UNDERGO RHINOPLASTY AGAIN?

Primary (1st time) and revision (2nd, 3rd or more) rhinoplasty patients are well suited to achieving excellent results with the closed approach.  Many surgeons who advocate the open approach argue that it is more effective than the close approach when the anatomy is distorted and the tissues are scarred. The reality is the reverse: the more difficult the anatomy, the more the closed approach shines because minimizing invasiveness helps to minimize further distortion from scar tissue. In this scenario, less is more.

HOW DO I CHOOSE A RHINOPLASTY SURGEON IN WASHINGTON DC?

Particularly in rhinoplasty, surgery can’t be reversed and correcting inexpert work is more challenging (but not impossible), so choose right the first time.  When vetting a plastic surgeon, use this check list:  

  • S/he should be certified by the American Board of Plastic Surgery.
  • S/he should have trained at premier institutions.
  • S/he should have at least 5 years of experience performing rhinoplasty regularly.
  • S/he should have extensive before/after photos to show during your consultation. Keep in mind that the number of photos displayed publicly is not indicative of the surgeon’s volume. Dr. Rad’s rhinoplasty page shows representative cases because the vast majority of his patients prefer not to have their photos displayed on the internet. Within a private consultation, Dr. Rad will show many before/after cases.  
  • S/he should spend time discussing the procedure/benefits/expectations, answering your questions and addressing concerns. Surgery is significant undertaking with many details to review, and your consultation should be unhurried.
  • Attention to detail is crucial. Note how the surgeon addresses the details of your surgery and pre-operative and post-operative care. Also pay attention to the cleanliness of the office, friendliness and competence of office staff, presentation of information of the website, and other clues to how attentive to detail the surgeon is.
  • Cost: Consider the quality you’re “buying.” Cheaper is not better.

WHAT SHOULD I EXPECT IN MY CONSULTATION?

Dr. Rad spends time with his patients, and you can expect to receive his undivided attention for an hour or longer.  Your consultation will be unhurried and your questions will be answered fully.  Dr. Rad’s primary concerns are for your safety and to achieve the best results possible. During your consultation Dr. Rad may use morphing software to create a realistic “after” photo of your result to highlight surgical goals. This is applicable for dorsal hump reductions, tip rotation or length changes or radix (bridge of nose) augmentation.  If you have a history of nasal trauma and deviation, Dr. Rad recommends bringing old photographs taken prior to the traumatic event. Photos are helpful to compare your natural facial anatomy and to facilitate discussion of how to restore normal nasal architecture.  Some patients require “medical clearance” from their primary care physicians (PCP) and possibly from specialists.  Additional medical tests and blood work may be needed for patients with a certain medical concerns, although this is not routine for those who are in good health.

HOW DOES DR. RAD PERFORM RHINOPLASTY SURGERY?

General anesthesia is administered by a Board certified anesthesiologist in an operating room. Dr. Rad makes incisions hidden inside the nostrils, then creates a precise tunnel through which a dorsal hump can be reduced and straightened.  Dr. Rad then borrows cartilage from the septum (thus straightening a deviated septum) and uses it as graft material to make refinements in nasal shape.  When extra cartilage is required the ear or rib provide good sources. Dr. Rad places cartilage grafts in key areas to enhance and refine shape and also to enhance airflow.  Dr. Rad narrows the nasal bones and nasal base when necessary. Splints are placed inside and outside the nose for approximately 1 week, after which time patients can return to work and most activities with little restriction.

SHOULD OTHER PROCEDURES BE CONSIDERED WITH RHINOPLASTY?

If you have concerns for improving other areas of the face then Dr. Rad will advise you. While rhinoplasty can improve the appearance of the nose itself, facial balance and proportion are crucial to consider. Dr. Rad will evaluate your facial architecture to determine if you would benefit from enhancement or refinement of other areas of your facial skeleton.

The most popular adjunct to rhinoplasty is chin augmentation (genioplasty) for a receded or diminutive chin.  When the chin is too small the nose often looks disproportionately large and patients and surgeons alike may conclude erroneously that reducing the nose further is the solution.  Quite the contrary: chin augmentation endeavors to improve projection, shape and size of the chin so that the nose does not appear disproportionately large. Facial width is also important to consider: some patients benefit from enhancement of the cheekbones either through facial fat grafting or malar (cheek) implant augmentation, whereas others may benefit from slimming of “chipmunk” cheeks via buccal fat pad removal.  Patients in later years may combine face lift or neck lift surgery with rhinoplasty.  The bottom line is that combining surgeries is generally safe and requires careful assessment of your facial architecture and your goals.  The range of breast and body procedures are also well tolerated when combined with rhinoplasty.  Overall combining procedures is generally safe, cost-effective and involve one recovery period, making it a popular approach.

HOW ARE COMPLICATIONS AVOIDED?

Surgery entails very low risk.  Nonetheless, Dr. Rad takes every precaution to minimize risk through careful pre-surgery preparation and exceptional post-surgery care.  Rather than performing surgery in a small office surgicenter which cannot handle potential, albeit rare, complications of anesthesia, Dr. Rad performs surgery at the best hospitals in DC and northern Virginia wherein Dr. Rad works only with Board certified anesthesiologists and experienced staff.  This assures the lowest risk of complications.  

HOW LONG CAN I EXPECT MY RHINOPLASTY RESULT TO LAST?

In the right hands surgical results last a lifetime.

IS RHINOPLASTY SAFE?

Your safety is Dr. Rad's top priority and Dr. Rad works directly with a board certified anesthesiologist and performs all surgeries in an accredited surgery center or hospital operating facility.  Recovery is outpatient and lasts approximately 5-7 days after which you can return to most activities as before.  Other surgeries can be performed at the same time as rhinoplasty, increasing cost-effectiveness and offering comprehensive results with low overall recovery time.

WHAT SHOULD I EXPECT FOR RECOVERY?

Pain after surgery is rare, and down time lasts a week or less.  Although temporary nasal congestion is common, bruising and swelling are minimal and typically resolve within a few weeks.  Improvements in nasal shape and breathing are immediate and permanent.  Most patients are able to return to work and to social activities 1 week after surgery. When rhinoplasty is done skillfully, you can expect improved aesthetic shape, improved breathing, rapid recovery, invisible scars, minimal swelling, and return to normal activities in approximately 1 week.

HOW DO I SCHEDULE A CONSULTATION WITH DR. RAD?

Contact us at contact@sherberandrad.com or 202.517.7299. We look forward to providing your care.

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    Patient Focus

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    Before rhinoplasty + buccal fat removal
    After rhinoplasty + buccal fat removal
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    BEFORE RHINOPLASTY + CHIN AUGMENTATION
    AFTER RHINOPLASTY + CHIN AUGMENTATION
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    Before rhinoplasty
    After rhinoplasty
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    Before Rhinoplasty + Face Lift
    after Rhinoplasty + Face Lift
    The most refined techniques produce the most refined results. In rhinoplasty Dr. Rad uses the "closed" technique which involves minimal swelling and pain, scars hidden inside the nose, and less than a week of recovery.

    Photos are of patients who have given explicit written agreement to have them displayed. For patient privacy reasons, the majority of Dr. Rad's patients prefer their before/after photos to remain off-line. However, Dr. Rad will be happy to show you, in the setting of a confidential consultation, a series of before/after photos, not displayed here, to address your specific concerns.

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