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Rhinoplasty Details Beverly Hills

Deviated Septum
Dr. Moelleken considers a deviated septum a kind of basket term. He says approximately sixty percent of the people in this world have a deviated septum but that does not necessarily mean it is always a problem for the patient. It is only a problem if it matches the symptoms of the breathing obstruction and an indication that the septum is causing the breathing problem. The shape of your nasal cavity could be the cause of chronic sinusitis. The nasal septum is the wall dividing the nasal cavity into halves; it is composed of a central supporting skeleton covered on each side by the mucous membrane. The front portion of this natural partition is a firm but bendable structure made mostly of cartilage that is covered by skin with a substantial supply of blood vessels. The ideal nasal septum is exactly midline, separating the left and right sides of the nose into passageways of equal size. It is estimated that 80 percent of all nasal septums are off-center, a condition that is generally not noticed. A deviated septum occurs when the septum is severely shifted away from the midline. The most common symptom from a badly deviated or crooked septum is difficulty breathing through your nose. The symptoms are usually worse on one side, and sometimes actually occur on the side opposite the bend. In some cases, the crooked septum can interfere with the drainage of the sinuses resulting in repeated sinus infections. Septoplasty is the preferred surgical treatment to correct a deviated septum and this procedure is not generally performed on minors because the cartilaginous septum grows until around the age of 18.

Septal deviations commonly occur due to nasal trauma and a deviated septum may cause one or more of the following conditions:

  • Blockage of one or both nostrils
  • Nasal congestion, sometimes on one side
  • Frequent nosebleeds
  • Frequent sinus infections
  • Facial pain, headaches, and postnasal drip
  • Noisy breathing during sleep

There are other things that can cause breathing problems besides a deviated septum and if you are having surgery, you want to be as well informed as possible. In some cases, a person with a mildly deviated septum has symptoms only when he or she also has a cold or upper respiratory tract infection. In these individuals, the respiratory infection triggers nasal inflammation that temporarily amplifies any mild airflow problems related to the deviated septum. Once the cold resolves and the nasal inflammation subsides, symptoms of a deviated septum often resolve, too. Patients with chronic sinusitis often have nasal congestion and the problem may result from a septal deviation, reactive edema (swelling) from the infected areas, allergic problems, mucosal hypertrophy (increase in size), other anatomic abnormalities, or combinations thereof.

After discussing your symptoms, Dr. Moelleken will inquire if you have ever incurred severe trauma to your nose or if you have had previous nasal surgery. He will examine the general appearance of your nose including the position of your nasal septum. This will entail the use of a bright light and a nasal speculum (an instrument that gently spreads open your nostril) to inspect the inside surface of each nostril. Surgery may be the recommended treatment if the deviated septum is causing troublesome nosebleeds or recurrent sinus infections and remember that not all doctors are trained to correct deviated septums.

Septoplasty
Septoplasty is a surgical procedure performed entirely through your nostrils so no bruising or external signs occur. This surgery may be combined with a rhinoplasty, in which case the external appearance of the nose is altered and swelling/bruising of the face is evident. The time required for the operation averages about one to one and a half hours, depending on the deviation. It can be performed with a local or a general anesthetic and is usually done on an outpatient basis. After your surgery, nasal packing is inserted to prevent excessive postoperative bleeding. During your surgery, badly deviated portions of the septum may be removed entirely, or they may be readjusted and reinserted into your nose. If a deviated nasal septum is the sole cause for your chronic sinusitis, relief from this severe disorder will be achieved as repair of a deviated nasal septum or blocked nasal passages is highly successful at relieving nasal obstruction.

History of Rhinoplasty
The word Rhinoplasty is derived from Greek words ‘Rhinos’ and ‘Plassein’. Because ‘Rhinos’ means nose and ‘Plassein’ means to shape, Rhinoplasty means to reshape the nose. This is a surgical method of improving either the function of nose or giving the nose a better shape and this type of surgery can take place in the form of either reconstructive or cosmetic surgery. It can be performed on a person to either improve the person’s appearance or to treat birth defects, breathing problems and other problems related with the nose. Rhinoplasty surgery can be performed in two ways including the closed and open approach. In the open approach, incisions are made across the columella, which is the skin that separates your nostrils. In the closed approach, incisions are made inside your nostrils. The cartilage and bones of your nose are then reshaped accordingly to give nose a better shape and functionality before the incisions are sutured.

One of the first known uses of plastic surgery dates back to 3000 B.C. when ancient Egyptians used surgical techniques to repair facial injuries. Reconstructive facial reconstruction is also evident in India’s history as far back as 800 B.C. The surgical process of rhinoplasty has a long history and is the main reason it has evolved as one of the safest surgical methods known today. A physician known by the name of Sushruta, while living in India is said to have developed the first rhinoplasty surgical process around 500 B.C. He and his students used rhinoplasty to reconstruct noses that had been amputated as punishments for crimes committed. Rhinoplasty history reveals that the Renaissance period was a time of both technological and societal progress for facial plastic surgeries. In the mid to late 1800s, rhinoplasty history shows that doctors in Europe and America began to experiment with different cosmetic surgical procedures to enhance the shape, appearance, and functionality of the nose. At this time in rhinoplasty history, medical professionals began to acknowledge the aesthetic values of cosmetic surgery’s ability to cause improvements in their patient’s lives.

Officially, John Orlando Roe performed the first rhinoplasty in the year 1887. Later in 1898, Jacques Joseph used it as a cosmetic surgery procedure to reshape the nose of those people who thought their nose size and shape was a matter of embarrassment. Rhinoplasty history began to show major improvements during one of the darker periods of human history: World War One. During this war, thousands of troops suffered extensive facial injuries including severe deformities caused by bullet and shrapnel wounds. In order to respond to these atrocities, surgeons and medical professionals were obliged to make major technological advances in reconstructive faciomaxillary procedures in a short and intense period of time. With these advances came related improvements in anesthesia and antiseptic techniques and major advances in rhinoplasty history. During this time, many surgeons made rapid technological advancements in the way this surgery was carried out and with the advancements, the process of rhinoplasty was made safer.

A collection of surgeons from all over the western hemisphere collaborated in advancing the technologies of plastic surgery and began to form societies, which later turned into organizations such as the American Society of Plastic Surgeons. Rhinoplasty history enjoyed dramatic advancements during the First and Second World Wars and from the 1950s to today, rhinoplasty history has witnessed technological and cultural advancements. When first developed, the surgery was expensive and could only be afforded by the rich or famous. Since 1950, the process of rhinoplasty has been improved upon and can now be performed on any kind of patient, irrespective of their cultural and financial background. The surgery has become quiet cost effective and the main reason it is so popular is that it is considered to be a safe as well as an effective surgery showing good results for the patient on whom it is performed.

Most patients have begun opting for newer and trendier procedures, forgoing more traditional methods. Dr. Moelleken says that one of the many things a doctor can achieve as a rhinoplasty surgeon is to narrow the nose or reduce the hump. He explains that when you take the hump off the nose, it will usually get wider because the nose is like a pyramid. Once you work your way down the pyramid by removing the hump, the nose starts to get a little bit wider and that is why doctors perform what is called an osteotomy. This traditional rhinoplasty method known as the Joseph Rhinoplasty, an osteotomy involves breaking the bones on the side of the nose, then pushing them towards the center to make the bones narrower. This method was utilized when the nose was very wide but a dilemma occurred when the bones were narrowed because this also narrowed a patient’s breathing capacity. Known as the “cookie cutter” formula, it is now considered unacceptable as nasal surgery is tailored to the patient’s anatomy and desires.

Dr. Moelleken realizes how important it is to look at the breathing ability of the nose, the septum, and to determine what is best for the deep part of the septum as these are important factors to make sure the patient breathes properly. Often, manipulation of the bones can be avoided with new septal graft techniques and this method greatly reduces healing time and bruising. Today, people are much more concerned about preserving normal breathing after rhinoplasty surgery. Dr. Moelleken feels every nose surgery he performs is different and tailored to the patient because every nose is different. He believes in taking a nose that a person has and maximizing how it looks and he will not take a nose from a book and put it on a patient. Instead, he will take the nose a person already has and make it the most beautiful nose for their face.

Types of Rhinoplasty
Rhinoplasty is both a reconstructive and cosmetic procedure that utilizes various surgical techniques to improve the function and overall appearance of your nose. Whether you wish for rhinoplasty surgery to correct a structural abnormality to help you breathe easier or you wish to change what you consider your unattractive nose, Dr. Moelleken looks forward to consulting you on the benefits as well as the risks of nose surgery. Nasal surgery has undergone considerable innovation in the last few years and Dr. Moelleken pays far more attention to breathing by recognizing the anatomy of the nasal valves. While nose surgery can be performed for a variety of reasons, it is not uncommon for cosmetic and functional procedures to be combined in a single operative session.

Primary Rhinoplasty
Primary rhinoplasty refers to procedures on noses that have not had any prior surgeries or trauma. This procedure typically aims to resize, reshape, or reposition the tip, profile, or nostrils. Common problems corrected by a primary rhinoplasty include removing small humps, reshaping a bulbous tip, changing the angle between your nose and mouth, and changing the shape of your nostrils. A primary rhinoplasty is a common procedure.

Revision Rhinoplasty
Revision or secondary rhinoplasty corrects deformities caused by a previous operation on your nose. It is a more difficult procedure to perform than primary rhinoplasty because there is less cartilage to work with and there may be scarring or tissue contracture (tightening). However, with his expertise and exceptional skill, Dr. Moelleken has performed this procedure many times improving both the appearance and the function of your nose.

Functional Rhinoplasty
Functional rhinoplasty is performed for health purposes to relieve a nasal obstruction. This obstruction is often caused by a deviated septum and may result in breathing problems. Through a simple corrective procedure, these problems can be relieved and a more balanced appearance can also be achieved.

Reconstructive Rhinoplasty
Reconstructive rhinoplasty is performed to repair deformities caused by injury, birth defects, or aging. It can also be used to remove external skin tumors or internal nasal tumors. These procedures require extra precision and should only be performed by an experienced surgeon such as Dr. Moelleken. Aesthetic reshaping is an additional benefit of reconstructive rhinoplasty.

Tip Rhinoplasty
The nasal tip, as the point furthest from the plane of the face, is considered a major factor in the appearance of the nose. Tip rhinoplasty can modify the tip and give your nose more definition by adding or removing cartilage. For different tip problems, it is often possible to achieve beautiful, inconspicuous results with this newer technique, allowing precise sculpting of the delicate tip cartilages.

Ethnic Rhinoplasty
Plastic surgery is no longer tailored to only meet Caucasian standards. African American, Asian American and Hispanic patients can now undergo procedures to change the appearance of their nose while maintaining their ethnic identity. Dr. Moelleken recognizes that there are differences that occur between heritage and races so call for a consultation and let Dr. Moelleken work with you to help you reach the look you desire.

Rhinoplasty Surgery Procedures
There are a variety of procedures to improve nasal function and ultimately improve air passage into your nasal airway. These include septoplasty surgery to correct a deviated septum, turbinectomy surgery to remove part of the nasal structure that has become a breathing obstruction, and alar valve cartilage grafts which correct an internal or external nasal valve collapse. During the procedure, incisions are typically made inside your nostrils, although a small, external incision under your nose (also known as the columella) may also be needed to aid in visualization during the procedure. The skin is then lifted off the nasal skeleton and cartilage allowing Dr. Moelleken to sculpt the nasal shape and size, often using cartilage grafted from other areas of the body, such as the septum (or the vertical piece of cartilage separating the nostrils). After the structural changes are in place, your skin is then re-draped on the new nasal framework. A light splint and tape are worn approximately one week during rhinoplasty surgery recovery and then removed in our office along with any external sutures. The rhinoplasty operation may take place under a general or local anesthetic, depending on the amount of surgery involved and takes approximately one to two hours.

In summary, the steps involved in rhinoplasty surgery include:
Step 1 – Anesthesia
During the rhinoplasty operation you may be given a mild sedative or Valium to calm your nerves. Depending on the extent of your nose job procedure, you will either receive intravenous sedation or general anesthesia. Dr. Moelleken will recommend the best choice for you, taking all of your individual factors into account.

Step 2 — The incisions and re-shaping of your nose

  • Closed Procedure: Small incisions are made inside your nose to reach the bone and cartilage. Some is removed or re-arranged to achieve the shape you have agreed with Dr. Moelleken. The skin over your nose is left untouched and shrinks down to the new shape.
  • Open Procedure: An incision is made across the columella or the narrow strip of tissue that separates your nostrils. The soft tissues that cover your nose are gently raised, allowing Dr. Moelleken the access to reshape the structure of your nose

Usually, tiny incisions are made in your nostrils but sometimes small incisions are also made on the skin that divides your nostrils. After the soft tissues have been separated from the structures beneath, the cartilage and bone are reshaped to achieve the pre-determined effect. In rare cases, if your nasal bone and/or cartilage structure has been damaged or compromised, a synthetic implant can be used to reconstruct the nose and nasal passage architecture. Synthetic materials can lead to long-term complications however and cartilage from a patient’s own ear, rib, or septum may be deemed as a more appropriate material for reconstructive rhinoplasty.

To keep your features in proportion, it may be necessary to make your nostrils smaller. This is accomplished by making cuts in the skin of your nostrils, which will leave fine scars on each side of your nostrils. If you are having augmentation rhinoplasty, you may need a graft of extra bone or cartilage to build up your nose. Most commonly, pieces of cartilage from the septum, the partition in the middle of the nose, are used for this purpose. If you have a deviated septum, Dr. Moelleken will straighten it and the projections inside your nose will be reduced to improve breathing. A deviated septum is a condition in which the septum or the wall inside your nose that divides it into two sides is not located in the middle of the nose where it should be.

Although the closed nose job technique sounds better due to no visible scarring, this technique is limited to those who can have this surgery and qualify as good candidates. This nose job technique works better for patients that are looking for minor changes such as removing the small bumps on the bridges of their nose. The open nose job technique is better for those that need more extensive work performed. Of course there is more scarring, one on the columella, which is more noticeable, but taking care of the scar properly will lighten it and eventually it is hardly noticeable.

Step 3 — Closing the Incision
Once the underlying structure of the nose is sculpted to the desired shape, your nasal skin and tissue is re-draped and the cuts are closed with dissolvable stitches. You may also have small plastic splints inserted inside your nose to prevent scar tissue from forming and support your nose as it begins to heal.

Step 4 —The Results
Initial swelling will subside within a few weeks, and you may notice gradual changes in the appearance of your nose as it refines to a more permanent outcome.

New Nose Job Techniques
There are newer nose job techniques that are becoming very popular and each of these nose job techniques helps specific areas of the nose.

Rasping is used when a patient wants to remove the bony hump on their nasal bridge. Doctors will use this technique to smooth the hump down and reduce the amount of bruising and swelling.

Spreader Grafts are another nose job technique. This particular technique helps with short nasal bones, long upper lateral cartilage, thin skin, and narrow noses. This nose job technique can help patients who have wider noses or very long noses. The way the spreader graft technique works is that the doctor will cut rectangular strips of cartilage, which will be placed in between the septum, and the upper lateral cartilage.

Cephalic Resection is a nose job technique that removes a tip of the cartilage to help narrow the nasal tip. This is used more to make the nose look longer.

Strut is a rectangular piece of cartilage that is placed between the medial crura of the nasal tip. This nose job technique is used to make the nose tip look rounder.

Plumping Grafts are placed beneath the skin if the upper lip is acute or retraced. With this technique, patients own cartilage is placed through the incisions inside the nose at the base, which helps with the angle of the nose and helps improve the aging of the nose.

Osteotomies Technique is a technique used in the nose job procedure. This technique is used to reduce the nasal hump, fix a twisted nose, and help with an overly wide nose. This particular nose job technique breaks and cuts the nasal bone. This is a more serious technique for patients who cannot get their noses corrected otherwise.

To find out which nose job technique will work best for your face and achieve the best results, make an appointment with Dr. Moelleken and he will examine your individual case. He will then inform you in detail about the best nose job technique for you, what results to expect, the cost, what to anticipate during the recovery process, and much more. Dr. Moelleken knows how to alter your nose in such a way that it both maximizes the aesthetic appeal of your nose and the appearance of your face in general. Rhinoplasty can do more than merely improve your nose; it can lend a whole new level of symmetry and balance to your face.

Rhinoplasty Surgery Recovery
Rhinoplasty recovery times are very much an individual process and it is very important for you to follow all the instructions given to you by Dr. Moelleken before and after your rhinoplasty procedure to minimize the risks.

Some tips for a speedy recovery from your nose surgery include:

  • Keep your head up as much as possible to reduce the risk of too much bleeding.
  • Do not take a hot bath or drink alcohol at least two weeks after surgery.
  • Do not use any nasal sprays or decongestants, no matter how stuffy you feel.
  • Sleep in a propped up position to help relieve congestion.
  • You will need to breathe through your mouth for the first few days, which can lead to dry lips. Use a lip balm on your lips to soothe any chapping.
  • Do not blow your nose for at least one week after your surgery. If you need to sneeze, cough it out instead of holding it in.
  • Check your temperature on a regular basis as a high temperature may indicate an infection.
  • The vast majority of nose surgeries are outpatient procedures, which means you will go home on the same day as your surgery. After you have sufficiently recovered, you will be released to someone you previously arranged with to drive you home. Once you are home, you should plan on relaxing as much as possible because that will help you recover more quickly. Again, you should arrange for someone to help care for you at least the first 24 hours after your nasal surgery. You may become nauseous following your surgery and this is common and usually not problematic. During many nose jobs, the patient may swallow a small amount of blood and this can make you feel ill.

The first time you look in the mirror after your surgery, you may be surprised but do not worry. Bruising and swelling around your nose are common and these will fade with time. If you are concerned about bruising, Dr. Moelleken may recommend anti-bruise creams. You should keep your nose out of the sun for the first few weeks, as your nose will be particularly sensitive. If you do venture into the sun, always wear sunscreen as this will help to keep the sunlight from changing the pigmentation of your scars.

Within the first week or so, the cast, splints, or packing will typically be removed from the nose. When these are removed, make sure that you are very careful with your nose. You cannot always estimate the aesthetic outcome of rhinoplasty because after the surgery, nasal bones may dislodge and cartilage and soft tissue shape may change over time. It is extremely important that you do not suffer any type of trauma on your nose after surgery, since any applied pressure may affect the final outcome of rhinoplasty. Be cautious because your nose is very weak and it needs the chance to fully heal.

After approximately one week, you should be able to return to work and resume your ordinary activities. However, you should avoid any heavy lifting and you should wait approximately six weeks before you return to regular exercise. Your levels of bruising and swelling will gradually subside over the course of the next weeks and your appearance will continue to improve. At approximately six months, your results are at their best and they will be, for all intents and purposes, permanent. With increased age, your nose will continue to change, just as the rest of your body however, you should be able to enjoy the results of your nose surgery for many years to come. Nose surgery gives patients permanent results and performed correctly, patients are extremely happy with their new nose.
Rhinoplasty Risks

If you choose a highly-skilled, well-trained, experienced cosmetic surgeon for your rhinoplasty such as Dr. Moelleken, complications are infrequent and what complications do arise are usually minor. Following his advice will help to minimize any risks making your rhinoplasty procedure generally safe. In order to make an informed decision however, you need to be aware of the possible side effects and the risks associated with this procedure.

Side effects as a result of your nasal surgery may include:

  • Soreness, swelling, and bruising, particularly around your eyes.
  • Stiffness and numbness, particularly at the nose tip.
  • Inability to breathe through your nose, which should ease as the swelling subsides.
  • Scarring – When rhinoplasty is performed from inside your nose, the scars won’t be visible, but you may be able to feel them for a while after surgery. The open nose surgery procedure may give you a small scar on the underside of the nose. Though you should have little or no scarring on your nose, you will have permanent scars if you have bone taken from your rib or hip.
  • Red spots on your skin’s surface, which is caused by, burst, small blood vessels.
  • Chest or nose infection, treatable with antibiotics.
  • Nose bleed either shortly after your operation or after one week.
  • Temporary loss or reduction in sensitivity to smell.
  • Changes in the shape of your nose as scar tissue matures.
  • Damage to the septum.

You should contact Dr. Moelleken immediately if you develop any of the following symptoms:

  • Persistent bleeding that does not stop within 10 to 15 minutes
  • Difficulty or inability to drink or swallow normally
  • High temperature
  • Increased pain

Rhinoplasty Surgery Problems
Dr. Moelleken warns that things can go wrong with nasal surgery if you do not select a qualified surgeon to perform your procedure. He says the injectable nose job is something that is very fashionable at the moment and warns it may not last long. He explains that when you put a filler into the nose, which is basically what the injectable nose job is, the fillers can become lumpy or develop infections over time. That can cause problems in the skin over the top of the fillers. Occasionally doctors will use a small amount of filler in certain places but he does not feel it is a good idea to use fillers to change the shape of your nose on a permanent basis.

Other problems may include:

  • If too much of the underlying structure of the nose (cartilage or bone) is removed, this can cause the overlying nasal skin to have little shape that can result in a deformity called “Polly-beak” deformity.
  • If the septum is not correctly supported, the bridge of the nose can then sink resulting in a “saddle nose” deformity.
  • If the cartilages of the tip of the nose are over resected during rhinoplasty, this can cause a “pinched” look.
  • If the tip of the nose is lifted too much, the nostrils can become too visible and create a pig-like look.
  • If an incision in an open rhinoplasty is made across the columella, there can be variable degree of numbness to the nose that may take up to several months to resolve.
  • After rhinoplasty surgery, adhesions can form in the nose. Adhesions are scar tissues that form to bridge across the nasal cavity from the septum to the turbinates. These are rare but cause obstruction in the nose and need to be cut away for proper breathing. At the time of surgery, a hole can also be made in the septum, which is called a “septal perforation”. This hole can cause breathing difficulties, chronic nose bleeding, and crusting.

In some rare cases, results may not develop as you had hoped and in this case, a secondary (revision) rhinoplasty procedure may be needed to refine the results achieved with the original rhinoplasty surgery. Rhinoplasty is meant to boost your confidence, and with the proper care, it will not interfere with your quality of life and should show superior results in a short amount of time. To ensure that you will have a satisfactory outcome, again Dr. Moelleken emphasizes that a rhinoplasty is not to be taken lightly so research is necessary. Rhinoplasty surgeries require you to make an educated decision and the more you learn about the rhinoplasty procedure, the more chances of success you will have.

Rhinoplasty Candidates
Your face is your face for life so before you decide to undergo rhinoplasty, you should be certain that it is really what you want. Your nose is the most prominent feature on your face and changing its shape can drastically alter your appearance. You should have realistic goals for your rhinoplasty surgery outcome and discussing your expectations with Dr. Moelleken is very important to ensure that your desired results are fully compatible with what is surgically possible.

Rhinoplasty received notoriety when the entertainment industry made having a “nose job” acceptable. While rhinoplasty can give your nose a new size or shape, it is also used to correct a number of physical issues, including:

  • Difficulty breathing
  • Birth defect
  • Injury

If you are wondering if rhinoplasty is right for you, Dr. Moelleken would be happy to talk to you about your options and provide you with a computer simulation.

A rhinoplasty procedure can:

  • Change the sloping angle of your nose
  • Correct defects at the point from the tip to your upper lip
  • Narrow or widen the width of your nose
  • Increase or reduce the size or length of your nose
  • Correct bumps and other issues at the bridge of the nose
  • Change the shape or size of your nostrils
  • Enlarge or reduce nasal passages
  • Change your nose profile
  • Correct large, bulbous, drooping or a too upturned nose
  • Correct an asymmetrical or deviated nose

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