Dr. Buonassisi Talks About 4 Iffy Rhinoplasty Requests

<p>In this insightful video, Dr. Thomas Buonassisi, MD, FRCSC — Specialist in Otolaryngology – Head and Neck Surgery, with a practice limited to facial plastic surgeries, shares his expertise on some of the more common and sometimes misguided requests he receives from patients considering rhinoplasty. With over 20 years of experience and having performed over 2,500 rhinoplasties, Dr. Buonassisi is well-versed in addressing both the aesthetic and functional aspects of nasal surgery. He begins by discussing the frequent requests for specific surgical techniques, such as closed rhinoplasty, which many patients believe to be less invasive or to result in less scarring. Dr. Buonassisi clarifies that the choice between open and closed rhinoplasty should be based on the specific changes needed for the patient's nose, rather than preconceived notions about the procedures. He explains that while closed rhinoplasty might be suitable for minor tip adjustments, more complex cases often require an open approach to achieve the best results. This is because the open technique allows for more precise maneuvers, especially when dealing with asymmetries or refining the nasal tip. Dr. Buonassisi also addresses the misconception that open rhinoplasty results in significant scarring, noting that any small incision made during the procedure typically heals well and becomes nearly invisible over time. Another common request he encounters is the desire to avoid osteotomies, or the precise cutting of nasal bones, which some patients fear due to the potential for bruising and swelling. Dr. Buonassisi emphasizes that osteotomies are often necessary when reducing a nasal hump, as they allow the bones to be repositioned correctly, preventing undesirable outcomes like a flat or hollow appearance. He reassures patients that while osteotomies do cause some temporary bruising and swelling, these effects are short-lived, and the long-term aesthetic benefits far outweigh the initial recovery period. Dr. Buonassisi also cautions against making overly dramatic changes to the nose, such as excessively reducing its size or drastically altering the tip's position. He explains that such changes can lead to disproportionate facial features and even functional issues, such as impaired breathing. He stresses the importance of maintaining a balance between aesthetic desires and functional integrity, ensuring that the nose not only looks natural but also functions well. Throughout the video, Dr. Buonassisi underscores the importance of a thorough consultation process, which includes computer imaging to help patients visualize potential outcomes. This step is crucial for setting realistic expectations and ensuring that both the surgeon and patient are aligned on the desired results. What is the difference between open and closed rhinoplasty? Open rhinoplasty involves a small incision on the columella, allowing for greater access to the nasal structures, which is beneficial for complex cases. Closed rhinoplasty involves incisions within the nostrils and is suitable for minor adjustments. Why are osteotomies necessary in rhinoplasty? Osteotomies are necessary when reducing a nasal hump to reposition the nasal bones correctly, preventing a flat or hollow appearance. They ensure a smooth and natural contour of the nose. Will an open rhinoplasty leave visible scars? The small incision made during open rhinoplasty typically heals well and becomes nearly invisible over time, making scarring a non-issue for most patients. Can dramatic changes to the nose affect its function? Yes, making dramatic changes can lead to functional issues, such as impaired breathing, and may also result in disproportionate facial features. How long does bruising last after rhinoplasty? Bruising from rhinoplasty, particularly when osteotomies are performed, typically resolves within eight to ten days. What should patients consider when planning rhinoplasty? Patients should prioritize a thorough consultation with a specialist, including computer imaging, to set realistic expectations and ensure the desired results. Why might a patient request a closed rhinoplasty? Patients often request closed rhinoplasty due to misconceptions about scarring and recovery, believing it to be less invasive. However, the choice of technique should be based on the specific needs of the surgery. How does Dr. Buonassisi approach patient requests for specific techniques? Dr. Buonassisi evaluates each case individually, recommending the technique that will provide the safest and most effective results, while considering patient preferences.</p>

My name is Doctor. Bonesisi and I'm a board certified facial plastic surgeon with a practice in Vancouver, Canada. I've been specializing in cosmetic rhinoplasty for almost twenty years and I'm here to answer your questions about this very interesting procedure. Happy patients are educated patients, and that's why every question is a good one. So it's very common for patients to come and see me requesting very specific things, a very specific surgery or a very specific change to their nose, that they probably don't need or that isn't actually gonna look good on them. One of the common ones is that people will come and say, I I don't want an external rhinoplasty. First of all, I often find that patients don't really know what that is, that they've just read that, you know, external is, invasive, or it produces, you know, terrible scars or whatever. You know, and that that's just, you know, marketing. It's, you know, the difference between an external and an internal rhinoplasty in terms of the amount of scarring, the amount of swelling, is really minimal. So I think that the approach to the inside of the nose that's taken, for a particular patient really should be determined by what types of changes they need with their rhinoplasty. I don't think it's really all that helpful for a patient to say, I want a closed rhinoplasty versus I want a open rhinoplasty. It's like asking me to use a knife and not a pair of scissors when I'm cutting something. I think it's probably best for me to decide what technique is gonna be the safest and what's gonna be the most effective. So, you know, that's that's I hear that quite often. And once I've sort of explained the difference between the different surgical approaches, you know, people usually go with what I recommend. Like I said, some people are request or specifically want a closed or ionoplasty. They don't they don't usually understand what that is, but, you know, they've somehow they've, read or heard that it's better. You know, I think if somebody has a a tip abnormality, for for example, their tip is tilting downwards and it needs to be lifted up, as long as they have a straight septum, their their lateral cartilages are not particularly curved. If they really have a very simple straightforward, rotation of the tip required, sure, that can be done closed. That's very uncommon. Most people have asymmetric cartilages. They're often a little bit too wide. They need to be narrowed a little bit to make the nose look a bit more refined. These are all things that are very difficult to do with a closed approach, and often you compromise the result by, you know, trying to do it in closed because it's the patient's request. You know, I think it's it's always best for me to to recommend what's gonna give the best final result, and then if someone is willing to make a compromise and say, well, I don't mind maybe not getting as good a result because I really wanna use the closed approach for some reason. Well, you know, that's up to them, and that's something that I would certainly consider, but I think that's pretty uncommon. The mindset of patients when they're asking for a closed approach is that they are told or they've read that the scars are going to be much less if it's closed, that they'll have less swelling if it's closed, and that's not true. I think that the amount of swelling after an external rhinoplasty is no different than a closed rhinoplasty. The small little scar that is required with a skin incision for an open rhinoplasty will become invisible with time. I mean, it's not something that people notice. I find it hard to to see the scars in the postoperative period when I examine patients. It's really a non issue. The the the main reason to consider an external approach is if you have lots of very specific, very particular, very refined, maneuvers that need to be performed on the nasal tip. You know, you can do these much more, predictably with an open approach. So I I, you know, I mean, I don't often see a patient that is gonna get a better result with a closed approach, but if I do, then I will use that. So often patients will will will come in and say, look. I wanna have a rhinoplasty, but I don't want you to break my nose. You know, that I I could also do your surgery with one arm tied behind my back as well if you request that, but that's preventing me from achieving the results that most people really wanna have. If you have a big hump, you need to have osteotomies because you take the hump off, and you're gonna have a hollow, open roof in your nose, and your skin is gonna suck into there. That that would be a disaster. So unless you have a very, very small bump that can just very, very gently be shaved down, in a hundred percent of cases, you need to have osteotomies. Those nose bones need to be brought back together because the nose is hollow. If you take the hump down, there's a space there, and not only will your nose look very flat, but eventually the skin will grow down into the hole, and you'll have a big defect there. The osteotomies are definitely gonna cause bruising and swelling that you wouldn't have if you, if you didn't do them. But if you have a a hump on your nose that needs to be reduced, then, you you know, it has to be done. There's no way to to bring the nose bones back together appropriately without breaking the nose bones. So, again, you know, the term break is not particularly, elegant. Really, what we're doing is we're very precisely making cuts in the nose bones so that the nose bones can be moved to where they need to be to give you a good aesthetic result. And, yes, moving those nose bones does cause bruising, and it probably contributes to swelling, but that bruising and swelling is gone after eight to ten days. And I think if you you know, in the long run at the three three week mark, for example, you're you're not gonna have more bruising or swelling if you if you did the osteotomy, but you're gonna have a much, much nicer nose. And I think the goal is for your nose to be to look good for your whole life, not to come out of the surgery with no bruises. So the other worrisome request that I sometimes see is a patient who wants a very, very dramatic change to the shape of their nose. They may they may have a small hump, but they want or or even a large hump, wanna have vast majority of it taken away and have a very small nose. Or somebody wants their tip tilted dramatically upward to to a point that probably is beyond, you know, sort of aesthetic norms. That always worries me a little bit. I and I think in general, although they might think it's a good idea, it probably isn't. I think when you rearrange the nasal anatomy that much, chances are it's gonna cause some unusual aesthetic result in another part of the body. They may see their lip too much. Eyes may look too far apart if you narrow the nose too much. I think there's some some definite cosmetic risks with making dramatic changes to the nose, not to mention functional risks. If you're taking if you're making a nose extremely narrow or if you're taking a very large hump off, I think there can certainly be some some physiologic problems as a result of that. So if you're thinking about making changes to your nose, the most important thing is to have a quality consult with someone who does a lot of rhinoplasty, and you've got to do computer imaging so that you know what to expect from your result. Also, you need to be able to trust that the surgeon can predict what your nose is going look like with surgery. Thanks for listening, and check back regularly for new questions and my honest answers about rhinoplasty.

[{"href":"/rhinoplasty-knowledge-base/dr-buonassisi-cast-removal-and-nasal-taping-with-ashley-at-1-week-post-rhinoplasty","title":"Dr. Buonassisi: Cast Removal and Nasal Taping with Ashley at 1 Week Post Rhinoplasty"},{"href":"/rhinoplasty-knowledge-base/dr-buonassisi-explains-body-dysmorphic-disorder-and-rhinoplasty","title":"Dr. Buonassisi Explains Body Dysmorphic Disorder and Rhinoplasty"},{"href":"/rhinoplasty-knowledge-base/dr-buonassisi-answers-how-is-rhinoplasty-computer-imaging-different-to-self-photoshopping","title":"Dr. Buonassisi Answers: How is Rhinoplasty Computer Imaging Different to Self Photoshopping"},{"href":"/rhinoplasty-knowledge-base/dr-buonassisi-talks-about-4-iffy-rhinoplasty-requests","title":"Dr. Buonassisi Talks About 4 Iffy Rhinoplasty Requests"},{"href":"/rhinoplasty-knowledge-base/drbuonassisiexplainhealthconcernsforrhinoplastyv1-1080p","title":"dr._buonassisi_explains_health_concerns_for_rhinoplasty_v1 (1080p)"},{"href":"/rhinoplasty-knowledge-base/sample-title-3-x-explained","title":"Sample Title 3: X Explained"}]