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RHINOPLASTY

RHINOPLASTY

If the natural shape of your nose is making you unhappy, impeding your quality of life, or if your nose is misshapen because of an accident or injury, discussing your situation with Dr. Brent of Moelleken Plastic Surgery is the first step, as he will give you a good idea about what can and cannot be done to help you. He pays close attention to aesthetic concerns to avoid a “one size fits all” approach to nose reshaping and he also specializes in reconstruction of the nose after trauma or the removal of cancer. Dr. Moelleken is an Attending Surgeon in the Division of Plastic and Reconstructive Surgery at UCLA, where he often performs surgeries and teaches residents. He specializes in patients diagnosed with skin cancers in the facial area who require complex, artful reconstructions. His greatest joy is returning them to a normal life and appearance after they have survived such devastating trauma.

Rhinoplasty Consulation

Dr. Moelleken believes that art and perspective comprise 30% of the surgical equation, while the other 70% come from unhurried, compassionate surgical judgment, knowledge, and technique. His patients range from every walk of life including schoolteachers, architects, celebrities, company presidents, and foreign dignitaries to name a few. He individualizes his surgical approach with each patient and when you meet with Dr. Moelleken, you will receive a surgical plan that is highly customized to your individual needs. Dr. Moelleken performs all surgical consultations himself and he believes that all new procedures should pass the test of respected peer reviewed publications to be considered legitimate. He encourages patients to seek several consultations and research potential physicians thoroughly before deciding on the right plastic surgeon.

Dr. Moelleken feels it takes a strong surgeon to say “no” if plastic surgery is not the right answer. He quotes, “We have a saying in plastic surgery that you make your money on the patients that you operate on but you make your reputation on the patients you do not operate on and I think that is very true.” He believes a reputable surgeon with a good practice should be honest with his patients by telling them if the surgery they are considering is in their best interest or not. He says that it is his philosophy to take someone’s nose and say, “What’s the best nose that we can make for this person?” He will not take someone else’s nose and put it on a patient if the structure is not built for them. The exact appearance of your nose cannot be determined before the surgery is completed. A patient cannot expect to be able to select a particular nose since changes are limited by such factors as skin and bone thickness, nostril size, and general facial configuration. In general, Dr. Moelleken’s surgical and aesthetic judgment must be trusted and together you will work to decide the most beneficial procedure based on your personal nasal anatomy.

It is a well-known fact that Rhinoplasty is one of the most complex cosmetic surgery operations performed today and some of the top board certified plastic surgeons choose to refer their patients to specialists instead of performing the procedure themselves. What may seem a simple hump removal or tip refinement is often a series of very precise surgical maneuvers that can easily be over or under-corrected by a novice plastic surgeon. Rhinoplasty is an operation of millimeters or fractions and it is a three dimensional cosmetic surgery that can affect the most important function of the nose – breathing. It is an operation that takes the utmost skill, artistry, and a complete comprehension of the nasal anatomy and Dr. Moelleken excels in all categories.

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Deviated Septum

Dr. Brent 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.

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.

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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.

Steps involved in rhinoplasty surgery

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

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

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

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

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

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

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.

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.

Concerns about Nose Job Recovery

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.

Week 1 Recovery

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.

Week 2 Recovery

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 of Rhinoplasty Surgery

  • 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
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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.

Nose Job Can Correct Other Issues

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

NOSE JOB FACTS

Rhinoplasty or nose surgery is the medical term used for the reconstructing and correction of a nose. Sometimes referred to as “nose reshaping” or a “nose job,” this procedure improves the appearance and proportion of your nose, enhancing facial harmony and self confidence. A rhinoplasty can address many different aesthetic complaints including a high dorsum (or bridge), a wide dorsum, a low dorsum, a narrow dorsum, bulbous tip, a tip that is too low, a tip that is too high, and a nose that is too large. Rhinoplasty is considered one of the most difficult procedures in aesthetic surgeries as it must balance a combination of form and function to provide a nose that not only looks good but one that is easy to breathe through as well. A Rhinoplasty is also one of the most popular cosmetic procedures in America, with approximately 200,000 people undergoing the surgery each year

When many men, women, and young adults are asked what they do not like about themselves, the answer is their nose. They say they are unhappy with a bump, the length, the shape, or the breathing problems they experience. There are so many unknowns about rhinoplasty that if you are considering the procedure, it is crucial to understand all of the many facts involved. Your nose is the center of your face and choosing an experienced doctor is the first priority because experience counts. Dr. Brent Moelleken, M.D., F.A.C.S. is a Plastic and Reconstructive surgeon practicing in Beverly Hills and Santa Barbara, California. Double board certified, he received his training at Harvard University, Yale University, UCSF and UCLA. Dr. Moelleken is one of three specialty-trained surgeons in the world to complete the year-long Aesthetic Surgery Fellowship at UCLA.

Dr. Moelleken says every doctor has his own style so the first thing you should do when considering any cosmetic procedure is to check credentials and make sure the doctor is board certified. He says to also make sure the doctor has a hospital that he can do the surgery at instead of just working solely out of his own office because that can be an indication that the doctor is not very well trained. During your consultation, you want to determine what the plans are for your nose and to do this you should define ahead of time what it is about your nose that bothers you. If it is about breathing, Dr. Moelleken will ask you if your breathing is worse when you exercise and if it improves when you are taking decongestants.

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Dr. Moelleken is concerned about every aspect of your nose: not just the appearance. He says it is very important that a nose is able to smell and changing the physical and external appearance is extremely multi-faceted. Dr. Moelleken warns that many people who are board certified cosmetic surgeons might not actually be plastic surgeons. He explains that when you are having your nose operated on, you should choose a doctor that is trained in plastic surgery of the ear, nose, and throat because the internal structure of your nose is just as important as the outside appearance; in fact, it may be the same. When you have problems corrected such as a deviated septum, which makes breathing easier on the inside, it can actually make your nose look better on the outside too.

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PLASTIC SURGERY IN BEVERLY HILLS & SANTA BARBARA

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BEVERLY HILLS
120 S Spalding Dr #110 Beverly Hills, CA 90212 | (310) 273-1001
SANTA BARBARA
601 E Arrellaga St #103 Santa Barbara, CA 93103 | (805) 898-9299
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