8-West Cosmetic Surgery

Rhinoplasty is a cosmetic surgery procedure to change the size and/or shape of the nose. Board Certified Facial Plastic Surgeon Dr. Thomas Buonassisi is a highly trained and specialized Vancouver rhinoplasty surgeon. He has the skill and expertise to leverage a variety of techniques which he tailors to each patient.

About the Procedure

Facial Plastic Surgeon Dr. Thomas Buonassisi carefully evaluates each patient’s nasal features, facial features, and objectives before choosing which of the various techniques to most effectively achieve the optimal result. Dr. Buonassisi has a specific philosophy when it comes to rhinoplasty. His objectives are:

• Perform safe and lasting repairs to the nasal framework
• Create a nasal shape that is in keeping with the patient’s gender, ethnic background and other facial features
• Have an informative open dialogue with patients about their specific goals
• Give an honest assessment of what can realistically be achieved with surgery

Benefits of Primary Rhinoplasty

The nose is one of the most noticeable facial features. People who have a well-proportioned nose may not pay much attention to how it influences their overall appearance. But for those who think their nose is too large, too small or out of proportion with their other features, they are often bothered by it’s appearance. More about The Geometry of Beauty can be found in this website’s Knowledge Base.

Surgical Approaches: Open Vs. Closed

With a closed approach rhinoplasty, the underlying nasal framework is exposed through small incisions inside the nose that parallel the nostril rim.  The cartilages and bone of the tip and bridge of the nose are then reshaped to improve the cosmetic appearance of the nose.  Once these modifications are complete the skin settles back onto the reshaped nasal framework and the internal incisions are closed with dissolvable stitches. The closed approach allows Dr. Buonassisi limited access to the nasal tip and is not recommend when a significant tip deformity requires correction.

With an open approach rhinoplasty, the underlying nasal framework is exposed through small incisions inside the nose as well as a small incision in the columella (the small strip of skin that separates the nostrils). This allows for unparalleled exposure to the nasal tip cartilages. The cartilages and bone of the tip and bridge of the nose are then reshaped to improve the cosmetic appearance of the nose.  Once these modifications are complete the skin settles back onto the reshaped nasal framework and the incisions are closed with dissolvable stitches. The open approach allows Dr. Buonassisi improved access to the nasal tip in cases where significant deformity must be corrected.  The resultant external scar is usually imperceptible once it heals. Once Dr. Buonassisi has access to the nasal framework, he chooses from a range of techniques to achieve the desired result. Some of the common corrections requested from patients, include:

Hump Reduction

One of the most common requests is for Dr. Buonassisi to remove a nasal hump. Reducing the nasal hump can dramatically affect the facial profile and is often the most dramatic change to the overall appearance of the patient’s features.

Deviated Septum Correction

Dr. Buonassisi may correct a deviated septum at the time of cosmetic rhinoplasty if it is causing the patient breathing problems.  Patients who require correction of a deviated septum only should visit their family doctor and be referred to an ENT surgeon in their community.

Tip Refinement

Typical requests for the tip include refining a bulbous appearance and increasing or decreasing the projection.  In addition to changes in the size of the tip, patients often request the tip be elevated form a downturned orientation. In most cases, when changes to the tip are requested, changes to the other parts of the nose are required as well. This is because the nose is a three dimensional feature, and changes made to one area can change the way the other areas appear in contrast.

Tip Projection

Tip projection refers to the distance away from the face that the tip projects.  An under projected tip may give the nose a wide appearance.  An over projected tip may make the nose appear overly long.

Tip Rotation

Tip rotation refers to the angle that the tip makes as it comes away form the upper lip.  A tip that is downturned is considered under rotated while a tip that is tilted too far upward may be considered over rotated.

Narrow Nasal Bones

Often the bridge of the nose appears to be too wide. In this care, the nasal bones are narrowed to refine nasal appearance on front view.

Bridge Augmentation

This can be achieved using the patient’s own cartilage, taken from the nasal septum or the ear. Often, hand shaped Gortex implants are used for this purpose.

Alar Base Reduction

This allows for reduction of the width of the nostril base.

The types of rhinoplasty performed by Dr. Buonassisi include:

• Primary Rhinoplasty, when a patient chooses to have cosmetic nose surgery to change the size and shape of their nose
• Secondary rhinoplasty, when a patient chooses to have a revision to their previous nose surgery
• Augmentation Rhinoplasty, when a patient desires a more prominent bridge, or a more prominent tip

Which cosmetic nose surgery is right for you? The most appropriate approach depends on your specific nasal features, your objectives for the surgery and Dr. Buonassisi’s assessment of the risks and benefits of the surgery. During your surgical consult, Dr. Buonassisi will assess your nasal features, clearly explain the pros and cons of each technique, and recommend the most suitable approach for you. Rhinoplasty surgery typically takes from 1.5 – 2 hours, and patients can return home the same day.

Benefits of the Surgery

• Correction of the nasal features that are bothersome or out of proportion
• A more attractive nose that is in balance with your other facial features

Are You a Good Candidate

Rhinoplasty surgery in Vancouver is most commonly performed on people aged 18 years  and older who are bothered by the size and shape of their nose. Young people less than 18 years old can have rhinoplasty surgery if they have consent from a parent or guardian. A safe age for women is 15 or older, and a safe age for boys is 17 or older. Dr. Buonassisi encourages young people who wish to have cosmetic nose surgery to attend their consultation with a parent or guardian.

Physical Features

You may be a candidate for rhinoplasty surgery if you have any of the following physical features:

• A high nasal bridge (also called a hump)
• A low nasal bridge
• A drooping tip
• A wide tip
• A bulbous tip
• A long nose
• A short nose
• Wide nostrils
• Over or under projected tip
• A large nose
• A small nose
• A crooked nose
• Any combination of the above features

General Health

You may be a candidate for rhinoplasty if you are in general, in good health:

• You have normal blood pressure
• You are not taking blood thinners, or your family physician can safely recommend that you stop taking them for two weeks

Ideal Candidates for Cosmetic Surgery

Not everyone is a candidate for cosmetic surgery. Ideal candidates for cosmetic surgery demonstrate the following characteristics:

1. Internally motivated to have cosmetic surgery
2. Have realistic expectations
3. Comprehend the potential risks and complication
4. Motivated to follow pre and post operative instructions
5. Can comfortably afford the cost of cosmetic surgery

Recovery

Most patients describe the recovery period from rhinoplasty surgery to be quite easy. There is typically no discomfort, aside from a stuffed up feeling for the first week or so. It is important not to blow your nose in the first week following surgery. Swelling and bruising is at its worst on day three following surgery, and usually subsides two weeks following surgery. The following information will give you a sense for what kinds of activities are safe during the recovery period.

Time Off Work

• Most people who work in the public eye take one week off work
• One week after surgery, some people have perceptible swelling and bruising, which can last for another week or so – signs of bruising can be covered with makeup
• People who work from home are typically feeling good and are able to be back at their desks one or two days after surgery

Back to Normal Activities

• You can resume normal activities, such as light household work and taking a gentle stroll, the day after surgery
• You can resume light fitness activities, such as jogging or yoga, one week after surgery
• You can resume vigorous fitness activities, such heavy weight training or high impact cardio, two weeks after surgery
• You should avoid bending over and lifting heavy objects for two weeks after surgery
• You should avoid suffering any facial trauma or impact for at least one year following surgery

Restaurant Ready

• Once your cast and sutures are removed seven days following surgery, you will typically feel “restaurant ready”, meaning that you would feel comfortable meeting up with friends – however, you will still have some evidence of swelling and light bruising, which can be camouflaged with makeup
• At the seven day mark, some people have light bruising below the eyes, while other experience no bruising whatsoever

Complete Recovery

• Most people are feeling quite comfortable being out in public without much evidence of swelling or bruising two weeks after surgery
• The final results of rhinoplasty can take up to six months – although most of the swelling is typically gone within three months of surgery, some very mild swelling can persist for six months

Risks & Complications

All surgeries have associated risks. Dr. Buonassisi will review the risks and benefits of the surgery in detail during your surgical consult. In general, complications of rhinoplasty surgery, while not expected, include:

• Risk of infection
• Risk of bleeding
• Risk of poor wound healing
• Risk of patient dissatisfaction with cosmetic result

Combination Nasal Procedures

Rhinoplasty is often combined with other facial reshaping or facial rejuvenation surgeries. Many patients opt to have their eyelids and other facial features, such as jowls and neck, treated at the same time in order to save having to take time off work and recover from more than one surgery. Rhinoplasty is often performed with a chin implant, for patients who are dissatisfied with an under projected chin. For these patients, the combination of rhinoplasty and chin augmentation can create an attractive balance of facial features.

Alternative Rhinoplasty Procedures

Recently there has been much media exposure of a procedure referred to as “Non-surgical nose job”. This procedure is portrayed as an alternative to rhinoplasty. In reality, this term is misleading. Fillers can only safely be used to correct minor nasal deformities and in the majority of cases, are not a safe alternative to surgery.

What Rhinoplasty Procedure is Right for You?

While the information on this site is extensive, it is not designed to replace the skill and expertise of a board certified facial plastic surgeon. Use the information to help you explore the possibilities and educate yourself about the typical recovery period of cosmetic surgery. While this site provides general information about cosmetic surgery as it related to the average person, it cannot be used as a tool for people to decide which surgery is best for them. Only a thorough consultation with a board certified facial plastic surgeon can provide the specific information they require to make an informed decision about surgery.

Ready to Discuss Your Needs with a Board Certified Facial Plastic Surgeon? Schedule a Consult

If you are ready to book a consult with Dr. Buonassisi, please Request a Consult. If you would like to learn more about what to expect during a surgical consult, please go here.

Not Sure You Are a Candidate? Use our Virtual Consult Form

Not everybody is a candidate for cosmetic surgery. As a service to clients, we have launched a Virtual Consultation tool. Upload your photos, provide some information about what you would like to change, and a cosmetic surgeon will provide a complementary evaluation. Find out more about the Virtual Consultation here.