There are many things that I ask to assess whether a patient is a good candidate for a rhinoplasty. One of the things that I want to make sure of is whether rhinoplasty is the right procedure for the patient.  I always ask what the patient is desiring from the rhinoplasty procedure as well to find out if what they are asking is possible with rhinoplasty.  I want to find out if their expectations are realistic and that the procedure will be able to achieve these realistic goals.  The one thing to remember is that perfection is not possible but we try to attain it as much as humanly possible.  I ask patient what they expect the surgery will do for them, if it will change their whole life, etc.  I also want them to see if I can be the right surgeon for them as well.  I get a sense during my conversation if this person will fit well in our practice in terms of coming back for follow ups and if their personality gels well with our staff.  My staff usually has a good sense of whether they will fit in and handle the post operative period and recovery well. The best situations are when the patients know what they want. The most difficult patients are those that are not able convey what they don’t like about their nose or the ones that demand a certain look. I usually ask them about the 2-3 things that they would like accomplished. I also put these in order. Understanding what the patients want is more than half the battle and is really the most important thing to find out. I try to find out also why they want surgery at this time. Some of the patients that I get worried about are the overly narcissistic person, the perfectionist, the person concentrating on a minor element but wants major improvements, and someone I don’t think will be happy no matter what the outcome. Rhinoplasty won’t change your life, but it can improve it. If you think it will change your life then you might consider something else in your ire. This is a video on Rhinoplasty.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

This was a question that I answered for someone that was worried about the common perception that when you get a rhinonplasty you have to “Break” the nose. This is how I answered rhinoplasty (Aesthetic Facial Plastic Surgeyr and Dr Young is in Bellevue Washington) does not need “breaking” of the nose but a controlled shaping of the nose to be effective.  It is all in the way that you say things I would say.  Breaking the nose sounds very uncontrolled and unrefined.  Rhinoplasty couldn’t be further from this.  This procedure is the most intricate and detailed that a plastic surgeon can do.  The nasal bones often have to be shaped to take on the new form.  And breaking is not accurately used to depict what is going on during the procedure in my opinion.  The shaping of the nasal bones does require separating the nasal bones from the surrounding facial bones.  This is done with fine osteotomes that are sometimes as small as one millimeter.  This separation is done in an extremely controlled fashion and not like what is done when you break your nose in an accident that commonly can occur in many situations. This is a video on Rhinoplasty, scroll down to view.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

This is a question that I answered for a patient that had a hump, and a wider nose but felt that it has gotten worse as she aged. She wondered if a rhinoplasty could correct those elements in her nose.  This is how I answered her questions:

Your Nose can grow as you age and rhinoplasty (Aesthetic Facial Plastic Surgeyr and Dr Young is in Bellevue Washington) can correct this and other anatomical characterisitics.  When you age, your skin can enlarge over time which can create the appearance of a larger nose.  Also as you lose volume in your face, the nose can take on a larger role.  Also as ligaments in your nose loosen your nose has a tendency to lengthen further creating the illusion that your nose is getting longer.  Many of these elements can be corrected with a rhinoplasty.  The hump that you have will appear larger because your tip will descend as you age.  This descent also brings your nose closer to your face which makes it look wider. This is a video on Rhinoplasty., scroll down to view.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

You should tailor your questions about rhinoplasty (Dr Young is in Bellevue Washington) based on your desires for the type of changes you are interested in.  If you were to ask questions about all aspects of rhinoplasty, you could be in for a long day / night so to speak.  Your questions should be really centered around your interests.  This will take also some research on how this procedure is performed, recovery, preparation etc.  You should go into the consult informed of the procedure as much as possible to facilitate the discussion about your particular concerns based on your anatomy.  Some common questions for your doctor though should be if he is board certified in this procedure, is he fellowship trained, how many rhinoplasties they have done, you should look at the before and afters of his procedure, you may consider asking for references from former patients as well.  You really should look over all of his credentials.  Where they studied can have a huge impact on their skills.

One thing to consider is that sometimes the number of rhinoplasties that a surgeon has done is not necessarily an indicator of how well the rhinoplasties are done. I used to know a surgeon who would always tell his patients that he has done over 3-4 thousand rhinoplasties.  Well that is great, but how many of those are done well.  Some surgeons stick with the same techniques and never get better.  You want to know that your surgeon is continually improving on his technique and constantly learning about new techniques and ways to improve older techniques.  This is more important, sometimes, than how many they have done.

You should find out if the surgeon does his rhinoplasties using open or closed techniques.  Closed techniques are based on older set of skills.  Although the recovery might be faster. These techniques, in my opinion, are much less accurate.  The main difference between closed and open techniques is that with the open technique there is an incision at the base of the nose in between the nostrils. Rhinoplasty link, the before and afters are further down, so you’ll have to scroll down to see it. As you can tell, you can barely see this incision. I totally prefer the open technique.

Another question you should ask your surgeon is how he performs his rhinoplasties and his techniques.  Does your surgeon do destructive maneuvers that lead to uncontrollable outcomes.  These destructive techniques are based on traditional and older techniques that many surgeons still use because they have not learned the newer less destructive techniques.  Nowadays, surgeons that are versed in more advanced up to date techniques tend to use sutures to affect the tip structures and shape them to the desired shape and size.    A surgeon that gives you a brief and easy to understand approach on how he would design and plan your rhinoplasty is probably better than someone that doesn’t.  I have some other blogs that describe how procedures are briefly done during a rhinoplasty. To also help, here is a video on Rhinoplasty.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery is located in Bellevue near Seattle, Washington

The type of anesthesia used during rhinoplasty depends on what is being done. If is a small change, you may use just local anesthesia.  Meaning, you will inject a local anesthetic, that is, you numbing fluid will be injected into the exact local area that you are working on.  Sometimes, regional anesthesia can help. That means that you inject a nerve where the region the nerve controls or innervates is numbed from the local numbing anesthesia to numb the region.  When the procedure that you are doing is more extensive, it could require local, regional anesthesia and then systemic anesthesia which is done throug either gases that are inhaled and anesthesia that are made from fluids that are injected into your veins to create a whole body anesthesia. I have done rhinoplasty under just local; with local and iv sedation; and local and general anesthesia.  I do most of my rhinoplasties under iv (intravenous) sedation, with local and regional anesthesia.  With Iv sedation, I get my patients very relaxed so that they don’t remember a thing after the procedure.  The less extensive the procedure, the less anesthesia.  The more extensive the more anesthesia you will need.  Also it depends on your tolerance as well.  If you are really afraid of needles, and the whole thing you will need more anesthesia compared to other people. Here is a video on rhinoplasty done under intravenous (iv, through your veins) sedation.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Rhinoplasty is the best way straighten a crooked nose. This procedure entails making an incision at the bottom of the nose and then exposing all of the elements of the nose that is creating the outward appearance.  Then manipulating each of these structures will then change the shape of the nose. For the crooked nose, you must change the structures by releasing the forces that are holding the nose in a crooked fashion and essentially weaken these structures then strengthening them in a straight position.  The question of what is it like is variable among patients, their personalities, their tolerance for pain, their genetics that affect their healing / tendency to bleed / tendency to swell, etc.  Generally the first week is the most challenging, then its the first month.  You get most of your healing in the first month.  Generally what I tell people is that you will get 60% of your healing the first 6 weeks, 80% at the first 6 months, and at 2 years the healing will be 89% of what you used to be.  So most of the improvement is within the first month. Here is a video showing a rhinoplasty and an explanation of the tip part of the rhinoplasty.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington