Rhinoplasty
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Your nose is the central anatomic landmark that helps bring balance to your facial proportions. As a result of natural development, prior injury, or prior surgery, you may feel one or multiple features of your nose stands out – the tip may be too broad or may descend with your smile, you may have a ‘hump’ on the top of your nose, the nose may lack projection or is too upturned with excess nostril show. Our Surrey Rhinoplasty is a specialized surgery that seeks to address these and other aesthetic concerns of the nose.
Your nose is made up of 3 layers - (i) an internal reddish-pink lining (called the ‘mucosa’), (ii) a bone and cartilage scaffold, and (iii) the external skin you see. Rhinoplasty surgery aims to address the shape of the nose by modifying the bone and cartilage scaffold. You may wish to have a nose that looks like someone else’s, like a famous celebrity or friend. While pictures are helpful to better understand your goals, one nose cannot always be converted into another. The final shape of your nose is determined by the amount of movement permitted by your own bone-cartilage scaffold and must respect the breathing through your internal airway. For example, a large nose cannot be converted into a very small nose and vice-versa. To do so may compromise your nasal breathing and function.
Dr. Ratanshi believes that analyzing the entire face is essential to developing a proper surgical plan to address concerns about your nose. The bone cartilage scaffold sits on the bony architecture that supports your face. Together, this bony platform and the nose’s bone-cartilage scaffold both play equal and important roles in defining your facial features. If your facial bones are asymmetric, it will be difficult to achieve a straight nose (or a more aggressive strategy that addresses both is needed).
For example, if you have a smaller chin, an otherwise normal-sized nose may seem larger and more projected. If there is a difference in the projection of your facial bones from right to left, or top to bottom, addressing the nose alone may simply mask the cause of aesthetic imbalance. Dr. Ratanshi will review this with you during your visit.
Dr. Ratanshi regularly performs rhinoplasty surgery and reconstructive nose surgery as part of his practice. Reconstructive concerns range from removal of skin cancers and other lesions on the nose to total nose reconstruction in the setting of trauma, cancer, and other causes.
If functional concerns are identified related to obstructed breathing or sinus issues, Dr. Ratanshi may involve an Ear, Nose, and Throat surgeon in your care before proceeding with a surgical plan. In some cases, surgery to address your breathing concerns by an Ear, Nose, and Throat Surgeon can be combined with your cosmetic rhinoplasty by Dr. Ratanshi. Dr. Ratanshi’s primary goal is to help you achieve your results safely.
You may have had surgery locally or elsewhere in the world and are bothered by your result. If more than 12 to 18 months have elapsed since your previous surgery (it takes at least this much time for a nose to settle), you may wish to seek an opinion on revision rhinoplasty / re-do nose surgery.
It takes up to 12 to 18 months for the results of nose surgery to achieve their final result. Prior nose surgery makes any revision (or “re-do”) surgery on the nose much more challenging. Scar tissue that results from previous surgery requires one to take more time and care to identify and preserve nasal cartilage and other structures. Previous use of common cartilage sources, such as your nasal septum or ear, means alternative and more challenging sources of cartilage may be required.
Dr. Ratanshi frequently performs revision rhinoplasty. He is happy to evaluate your concerns and determine if there is a reasonable surgical solution to address them safely.
You may have a subtle concern about your nose. You may not be sure if surgery is the best strategy to address your concerns or right for you at this time. In cases where the nose is deficient in a specific area, the use of a temporary filler may be considered. Dr. Ratanshi will review your concerns and discuss if a liquid rhinoplasty using dermal fillers is a reasonable option. It is important that any filler placed in the nose be performed by a trained surgeon skilled in nose surgery. Dr. Ratanshi does not place permanent fillers in the nose.
No two noses are the same. Rhinoplasty Surgery is a partnership between you and your Plastic Surgeon. Typically, at least two visits are required to ensure your specific goals are clearly understood and a safe strategy is devised to address them. Dr. Ratanshi will again review your surgical plan the day of your surgery.
Most concerns are addressed through an ‘open’ rhinoplasty approach, where the nose anatomy is visualized through a small incision in the bridge of skin between your nostrils (i.e. the ‘columella’) that extends into the hidden area inside your nostrils. Cartilage or other grafts may be required for additional definition. If cartilage is required (as is often the case), an additional incision may be required on the inside of your nose to access your septum (the structure that divides your right and left nasal passageway). The time required for your rhinoplasty depends on the degree of complexity involved. Typically, most rhinoplasty surgeries are scheduled for 2-3 hours.
Rhinoplasty surgery is day surgery that is performed in a private surgical facility or hospital under general anesthesia. A board-certified anesthesiologist will provide your anesthesia and will discuss your anesthesia plan with you the day of surgery. Once you are asleep, additional local freezing is routinely placed in all incisions and inside your nose to maximize comfort after surgery. Your identified concerns will be addressed through planned incisions, and these incisions are closed using self-dissolving stitches on the inside of your nose.
There are 5-6 very fine stitches on the outside of your nose in the bridge between your nostrils that will be removed at 1 week. You will have surgical tapes on the outside of your nose and a firm splint will be applied to assist with swelling management and protect your nose. Tapes are maintained for 2-3 weeks. If your nasal bones need to be moved (referred to as ‘osteotomies’), you will have Vaseline-covered gauze gently placed inside your nose that will be removed the next day by Dr. Ratanshi or his nurse.
If septal cartilage is required, silicone supports will be placed inside your nose. These will also be removed at 1 week with any of the fine stitches mentioned prior. Aftercare instructions and follow-up appointments will be provided by Dr. Ratanshi and his nurse on the day of surgery. You will have bruising extending into your cheeks and around your eyelids. This will settle over the course of 2-3 weeks. There may be blood-tinged drainage from the nostrils, which typically settles over the course of 1 week. A drip pad will be placed below your nose that you can easily change daily to assist with this as needed.
Swelling from Rhinoplasty Surgery lasts upwards of 12 to 18 months. Peak swelling typically occurs within the first week. The majority of this swelling will resolve over the first 6-12 weeks. It is common to have swelling on the inside of your nose, which takes 2-6 weeks to settle. This can temporarily make your nasal breathing worse. The remainder will settle slowly over the remaining 12 to 18 months. You can expect your final result at 12 to 18 months.
Rhinoplasty is approached through a very tiny external incision in your columella, which will heal as a fine-line scar in the vast majority of cases. The internal scars are not visible. Rarely, some patients may develop a small ‘notch’ at the columellar incision, or retraction of the nostril due to scar tethering. This can be a reason for revision surgery.
Frequently Combined Rhinoplasty Surgery
Rhinoplasty Surgery with or without cartilage harvested from the septum (a ‘septo’-rhinoplasty) requires a general anesthetic. It is important to note that Revision Rhinoplasty Surgery carries a higher risk of needing further surgery than patients who have not had prior nose surgery. Additional Risks you should be aware of include but are not limited to:
If cartilage is required from the nasal septum, additional risks include
Follow-up appointments are scheduled the next day after surgery, 1 week, 2 weeks, 6 weeks and for long-term follow-up.
Internal gauze or packing is removed the next day after surgery. Your external stitches will be removed at 1 week together with your external support splint and any internal silicone splints (if present). Tapes are maintained for 2-3 weeks to aid in swelling management. Patients should avoid heavy eyeglasses for 6-8 weeks. Heavy lifting (> 10 lbs) should be avoided for 4-6 weeks. You can get the area wet in the shower at one week (with no direct pressure from the shower). You can resume sports at 8 weeks.
Starting at $11,500 + GST
Rhinoplasty Surgery to address cosmetic concerns is NOT a benefit of the British Columbia Medical Services Plan.
Functional breathing concerns are best addressed by an Ear, Nose, and Throat Surgeon equipped and experienced to visualize your posterior airway with nasendoscopy and manage your sinuses medically or surgically where applicable. In cases where a prior rhinoplasty was performed, concerns that are cosmetic in nature are also not a benefit of MSP.
Dr. Ratanshi has partnered with Beautifi and iFinance Canada to provide financing options for patients looking to pursue Rhinoplasty Surgery.
The ideal candidate has thin to moderate skin thickness and an obvious deformity or asymmetry in his, her, or their nasal shape. It is important that concerns are reasonable and can be appreciated by your surgeon. Remember, if your surgeon can see and appreciate your concern, a surgical plan can be developed to address that concern. If you'd like to find out if you'd make a good candidate for rhinoplasty Surrey plastic surgeon, Dr. Imran Ratanshi, can address that during an initial consultation. Contact us today!
You are still a Rhinoplasty Surgery Candidate. But it is more difficult to achieve a dramatic change, if that’s what you are looking for.
Your nose is made up of 3 layers - (i) the internal pink lining (called the ‘mucosa’), (ii) a bone and cartilage scaffold, and (iii) external skin. The shape of your nose is determined by the scaffold below the skin. Rhinoplasty surgery primarily addresses your nasal shape by re-modeling this bone-cartilage scaffold – it cannot change the external skin thickness or the inner lining.
Similar to the difference between a thick blanket and a thin bedsheet, thick skin will hide any changes to the scaffolding below. As a result, it is difficult to create dramatic changes in nose shape in patients with thick external nose skin, especially in the tip where the skin is the thickest. Changes will be visible, but they become diminished by the overlying skin.
Therefore, patients with thinner skin will see more dramatic changes. However, in patients with very thin skin, risks of contour irregularities are higher as there is less cover to camouflage them.text edit
Not, for most patients. Dr. Ratanshi regularly performs rhinoplasty in patients with skin of colour. In some patients, there is an unpredictable risk of lightening or darkening of the skin following rhinoplasty surgery, referred to as post-inflammatory hyper- (darkening) or hypo- (lightening) pigmentation. Fortunately, this is a relatively rare phenomenon.
Scars may be more prone to darkening in the sun. This can be exaggerated in patients with skin of colour. Remember to use a good SPF sun screen (SPF 40 or more) on your scar for up to a year after your surgery. You can this with Dr. Ratanshi in your follow-up visits after your surgery.
Unlike other areas of the body, the nose stays swollen for much longer. While the majority of swelling resolves within the early months from your surgery date, there is a residual but still significant amount of swelling that takes up to a year or more. You want your nose to settle into a stable state before making any new changes, otherwise, the results from a secondary surgery become less predictable than the first. Some surgeons even wait up to 18 months before proceeding with a revision!
The exception to this is managing emergency concerns, such as infection, where surgery may be indicated earlier.
Acne can affect the skin envelope and risk of colonization of the middle layer of your nose with P. acnes, a bacteria associated with acne. It is best to have your acne or rosacea treated by a skin specialist, such as a Dermatologist or your Primary Care Physician, before proceeding with Rhinoplasty Surgery.
No, unfortunately. You are not a candidate for rhinoplasty surgery at this time.
The active use of nicotine products is a strict contraindication to undergo Rhinoplasty Surgery. Nicotine is a potent vasoconstrictor (i.e. it shrinks blood vessels) and can substantially reduce blood flow to a healing wound. In extreme cases, it can result in catastrophic full-thickness loss of columellar or tip skin.
Dr. Ratanshi requests that patients who consume any nicotine products, including cigarettes, vaping, chewing tobacco, etc. cease completely for at least 6 weeks before they can be considered a candidate for surgery.
No, unfortunately. You are not a candidate for rhinoplasty surgery at this time.
In a manner more severe than nicotine, cocaine is one of the most potent vasoconstrictors encountered, and it can lead to complete loss of the (i) inner lining of the nose and sinuses and (ii) cartilage framework, causing total nasal collapse.
Dr. Ratanshi prioritizes patient safety and satisfaction above all. He is a Fellowship-trained subspecialist in Craniofacial Surgery and Facial Aesthetics. Dr. Ratanshi aims to utilize the latest evidence-based techniques and technology to deliver exceptional results. Dr. Ratanshi is committed to making your journey to enhanced beauty as comfortable and rewarding as possible.
