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Primary Nasal Surgery (Primary Rhinoplasty)

What Is It?

Rhinoplasty involves reshaping of the nose. It may be done with a septoplasty (corrective procedure to straighten the nasal septum, the partition between the two nasal cavities) to optimize breathing. The desired result is an attractive nose in balance with the rest of the face, with preservation or improvement of breathing. While it is a common operation, most plastic surgeons state that it is technically the most difficult aesthetic procedure to perform. It requires a high level of perfection, where a 1 mm discrepancy can mean the difference between a very good and an acceptable result.

Common problems addressed by rhinoplasty include correcting the size of the bridge, by reducing or increasing it; correcting the size of the tip, by possibly making it smaller or bigger; correcting the droopiness of the tip; straightening a crooked nose; and correcting asymmetries within the nose. Some nasal surgery is performed to correct congenital nasal defects such as those associated with cleft lip deformities. When there is impaired breathing, part of the surgery inside of the nose may be covered under OHIP.

Rhinoplasty should not be considered in teenagers until they have developed both physical and emotional maturity. Typically this would be age 15 in girls, and age 16 to 17 in boys.

Dr. Neu is an internationally recognized expert in the field of rhinoplasty, and has lectured extensively on the topic throughout Canada, the United States, Mexico and Europe. He has written more papers on rhinoplasty than any other Canadian surgeon in the leading and authoritative Journal of Plastic & Reconstructive Surgery. He is the first Canadian to have become a member of the highly acclaimed American Rhinoplasty Society. Dr. Neu has been on the forefront of various innovative rhinoplasty techniques, particularly what is known as the open approach.

Patient Examples

Click on any photo for larger version and more views of that patient.

Before Surgery Consultation

In the initial rhinoplasty consultation, Dr. Neu will take a detailed history of the patient’s past health, and will review all problems the patient has with their nose. He will document concerns, make note of previous injuries or surgery to the nose and will discuss any breathing problems.

A careful and detailed examination of the external and internal aspects of the nose will then be carried out. The proportions of the nose will be balanced with the rest of the face, keeping in mind goals for surgery. Dr. Neu will make sketches of the patient’s nose in their medical chart. He will then review what is realistically achievable. The thickness of the skin, and the structure of the cartilage and bone will have an influence on the final result. There is a recognized association between the nose and the chin, and if the chin is small, Dr. Neu may suggest the option of a chin implant.

Dr. Neu is considered a perfectionist, but he will explain that no one has a perfect nose. Rest assured that everything that can surgically be done will be done to match or exceed patient expectations.

The Surgery

Dr. Neu usually does rhinoplasty as a day surgery procedure using general anesthesia. While in the past, he typically did this procedure with a closed approach from inside of the nose, it has become apparent to most experienced rhinoplasty surgeons that the open rhinoplasty technique can achieve a more predictable and usually a more superior result. This requires a small incision across the segment of skin between the nostrils, and allows for elevation of the skin so that there is direct visualization of the cartilage and bony structures of the nose. This enhances precision and allows for a higher degree of predictability through a variety of technical procedures not available with the more blind or closed approach.

The closed approach is still used when Dr. Neu feels that an equally good result can be achieved with that technique.

There are many technical aspects to a primary rhinoplasty. Excess bone is carefully filed down. Deformed or excess cartilages are trimmed and then bent into alignment with fine sutures. Emphasis is on stability to avoid long-term problems with the appearance of the nose or the ability to breathe. No effort is spared in making the nose as natural looking as possible. The average primary rhinoplasty carried out by Dr. Neu takes three hours. In contrast, the average rhinoplasty performed in Toronto takes one-and-a-half to two hours.

The surgery may incorporate cartilage or bone grafts from other parts of the body such as the ears, ribs or skull. This possibility will be discussed in advance of surgery. Dr. Neu does not use synthetic materials (such as silicone or gortex) to build up the nose. Even though it is technically much simpler to use these materials, they have an increased risk of infection and extrusion. Therefore, only tissue from the body is used to augment the nose.

Dr. Neu almost always avoids the use of nasal packing at the end of surgery. Packing is only required in rare cases of excessive bleeding, and bleeding is minimized with careful technique. Avoidance of nasal packing dramatically reduces discomfort post-rhinoplasty.

Resumption of Activity

Most patients return to sedentary work in a week, and are able to resume vigorous activities within two weeks. They should not participate in contact sports for six weeks to avoid injuries to the nose.