Rhinoplasty

Nose Job

Rhinoplasty is plastic surgery that improves the appearance and function of the nose. Cosmetic reasons for desiring a rhinoplasty commonly include a nose that has a hump, is too large, is too small, is not straight, or has a drooping tip. From a functional standpoint, rhinoplasty can improve breathing by correcting collapse or narrowing of the inside of the nose.

Rhinoplasty

Nose Job

Rhinoplasty is plastic surgery that improves the appearance and function of the nose. Cosmetic reasons for desiring a rhinoplasty commonly include a nose that has a hump, is too large, is too small, is not straight, or has a drooping tip. From a functional standpoint, rhinoplasty can improve breathing by correcting collapse or narrowing of the inside of the nose.

Candidates for Rhinoplasty

Candidates for rhinoplasty are those who desire to change the appearance of their nose and/or improve breathing through their nose.

Candidates for Septoplasty

In patients with nasal obstruction, a septoplasty may be indicated if there is deviation of the septum. The septum is the structure that separates the left nostril and right nostril. Straightening a crooked septum not only improves breathing through the nose, but can also potentially help with snoring and sleep apnea. Another cause for nasal obstruction is large turbinates (e.g. inferior turbinate hypertrophy). The turbinates are structures inside the nose that warm and moisturize air. If these structures are abnormally large and are causing obstruction, a turbinate reduction can be helpful.

The Importance of a Rhinoplasty Expert

Rhinoplasty is one of the most challenging procedures in plastic surgery. The difference of even a single millimeter can significantly affect the appearance and functionality of the nose. Furthermore, some changes after a rhinoplasty may not become evident for months or years later. Scar tissue formation, contracture, and collapse can progressively worsen with time. Dr. Foulad performs revision rhinoplasty following a primary rhinoplasty that did not turn out well, either because of poor cosmetic outcome and/or difficulty with breathing. It is imperative that your rhinoplasty is performed by a well trained surgeon who recognizes the complexities of the nose. The techniques performed should be customized for each patient, while considering the effects on both appearance and breathing.

How Rhinoplasty is Performed

Dr. Foulad commonly performs rhinoplasty using twilight sedation.

Dr. Foulad most commonly uses an external (open) approach. This enables excellent visualization and access to all the structures of the nose. The small incision created at the bottom of the nose for the external approach is typically not noticeable when sutured meticulously.

During the rhinoplasty procedure, the structures of the nose (such as the cartilages) are maintained as strong as possible. Various cartilage grafts are commonly used to help support the nose and the nasal tip. However, these grafts are used in a way to minimize adding bulk to the nose.

How to Prepare for Rhinoplasty

In preparation for rhinoplasty, it is important that you are healthy and optimized for the procedure. Certain medications and supplements might have to be stopped a specific time period prior to the procedure to reduce certain risks. It is important that you do not not smoke or use nicotine products 1-2 months prior to your procedure and for a period of time after your procedure. You will be provided more comprehensive pre-operative instructions specific to your individual case.

We are conveniently located to serve Beverly Hills, West Hollywood, & Los Angeles. However, we are available to help with coordinating your stay if you are an Out-of-Town Patient.

What to Expect After Rhinoplasty

After the rhinoplasty, you may have a soft silicone tube in your nose. This is used instead of more traditional packing so that you are able to breath through the tubes. These intranasal tubes are usually removed 3-7 days after your procedure.

You may have a cast on the outside of your nose for approximately 1 week. The sutures are usually removed at this time as well.

It is recommended to sleep elevated for at least 1 week after the procedure to help reduce swelling as much as possible.

If osteotomies were performed, then there is a high likelihood that you will develop bruising around your eyes.
Bruising and swelling usually peaks around 3 to 4 days after the procedure.

Most patients are presentable in a social setting after approximately 1 to 2 weeks after the procedure. However, it can take several months for the majority of swelling to resolve. It can take a full year for the final results, however the nose may continue to slightly change even beyond that time.

 

Gallery

RHINOPLASTY (NOSE JOB)

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Rhinoplasty faq

Will I be able to breath through my nose after rhinoplasty?

Instead of the traditional packing, I use soft silicone tubes so that you can breath through your nose. The tubes are typically removed 3 to 7 days after the procedure.

Case samples

Case 1: Rhinoplasty

Primary Rhinoplasty  Septoplasty

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The case presented in this section involves a gentleman who presented with concern of nasal obstruction and an over-rotated (upturned) nose. The over-rotation of his nose was associated with excess nostril exposure and tenting of his upper lip.

I performed a rhinoplasty with septoplasty to treat his nasal obstruction and to improve the appearance of his nose. From a cosmetic standpoint, a major goal was to decrease the rotation and projection of the tip of his nose. In order to precisely set the tip at the appropriate position, a caudal septal extension graft was used. This graft was created using cartilage from his septum that had been harvested during the septoplasty. The caudal septal extension graft is placed to support and position the tip, and help prevent the tip from moving over time. The height of the bridge of the nose (dorsum) was also reduced to match the new height of the tip. This was performed very meticulously to maintain his original straight dorsal profile. Attention was also placed on improving the contour at the junction of the lip and nose. In order to accomplish this, the skin at the bottom of the nose (columella) was recruited downwards, creating a more refined lip-nose junction. This also reduced the pull on the upper lip, which improved closure of his lips. The combination of all these techniques and attention to minor details resulted in substantial overall refinement and a natural appearance.

Case 2: Rhinoplasty

Primary Rhinoplasty  Septoplasty

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The case presented in this section involves a female who desired to reduce the size and hump of her nose. She also had a deviated septum, which was causing nasal congestion.

I performed a rhinoplasty and septoplasty to enhance the appearance of her nose and improve her breathing. Rasping of the nasal bones was performed to reduce the hump and straighten the bridge of the nose. A caudal septal extension graft was performed to precisely support the nasal tip in the desired position. This cartilage graft was obtained from the septum during the septoplasty. A lateral crural turn-in flap, interdomal suture, and alar-spanning suture were performed to refine the nasal tip. These structural tip narrowing techniques maintain much greater support, unlike traditional reduction techniques that rely the removal of cartilage. By maintaining a strong structural framework, the risk of nasal collapse and deformity is significantly reduced.

Case 3: Rhinoplasty

Revision Rhinoplasty  Rib Cartilage Grafts

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This case involves a female who initially underwent two rhinoplasty surgeries with another surgeon. During her most recent operation, the surgeon used cartilage grafts from her ear. However, she continued to have a severe deformity of her nose and developed worsening breathing problems.

I performed revision rhinoplasty using rib cartilage to reconstruct her nose. As with all my patients, meticulous planning was performed before the procedure. Traditional morphs were created to demonstrate the anticipated appearance of the nose after the procedure, and morph ‘blueprints’ were designed to illustrate the exact changes needed. The main challenge of this case involved significant lengthening of her nose and providing appropriate structural support.

Rib cartilage was used to create various grafts in order to support and lengthen the nose. The foundation of the nose was reconstructed with a flying buttress graft. A diced cartilage fascia (DCF) graft was then placed along the dorsum of the nose to improve the dorsal profile. Rim grafts were placed to help support the nostril rim.

CASE 4: Rhinoplasty

Revision Rhinoplasty  Septoplasty

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This case involves a female who underwent rhinoplasty and septoplasty by another surgeon one year prior to her consultation with me. She stated that the goal during the first surgery was to remove a hump and to improve her breathing. However, after the rhinoplasty, her breathing worsened.

On exam, the front part of the septum was deviated to the left. She also had collapse of the side of her nose. The combination of these problems resulted in a very narrow airway (refer to Base View Photographs). From a cosmetic perspective, she had poor contour of her nose and retraction of the alar rim (refer to Profile View Photographs). Alar rim retraction is a condition in which the nostril rim is elevated (pulled upward), which leads to exaggerated nostril exposure. Alar rim retraction is a common complication of rhinoplasty and can occur because of excessive cartilage resection and/or improper cartilage positioning.

I performed a revision rhinoplasty and septoplasty in order to fully straighten the deviated septum, treat the collapse and retraction, and to improve the contour of her nose.

The front part of the septum is a relatively difficult region of the septum to straighten and requires specialized skill to properly manage. I had to separate the septum from its attachment at the front of the nose, straighten the cartilage using various maneuvers, and then re-secure the septum in a more appropriate position. The alar retraction was corrected using articulated rim grafts created from her own cartilage. Unlike conventional rim grafts, articulated rim grafts require significantly more skill to use, but are much more effective in pulling the rim down and preventing future retraction.

Case 5: Rhinoplasty

Primary Rhinoplasty  Straightening Deviation Septoplasty

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This case involves a female who was trampled by a horse and injured her nose approximately a decade before presenting to me for rhinoplasty surgery. Her main concern was a nasal obstruction that was so severe that it forced her to breathe through her mouth. In addition to wanting to improve her breathing, she desired to straighten her nose while maintaining her natural appearance.

I performed a functional rhinoplasty with septoplasty using an external (open) approach. The external approach provides optimal visualization and access to the structures of the nose. This enables the ability to perform advanced techniques that are not otherwise possible using a closed (endonasal) approach. The small incision created at the bottom of the nose for the external approach is typically imperceptible when sutured meticulously.

An important step in the case was to straighten the septum. This involved releasing a significant amount of scar tissue that had formed due to the trauma. The fractured and deviated cartilage at the center of the septum was removed, and the remainder of the cartilage was repositioned in a more straight position. A sufficient amount of cartilage was maintained at the septum to ensure adequate support of the nose. The portion of the cartilage that was removed from the septum was then used as a caudal septal extension graft in order to provide support for the tip of the nose. The remaining structural elements of the nose were then able to be aligned based on the straight and strong foundation.

Testimonials

Terry Moler
Terry Moler
2022-03-07
Dr.Foulad and his staff are amazing. The results speak for themselves. Dr. Foulad is meticulous. The experience was beyond great. I had a neck lift, a mid face lift and an upper eye lift. Dr. Foulad was very attentive. Chelsea, the practice manager, took care of every detail. I felt at ease and very taken care of. I had prepared myself for a painful surgery and recovery period but it was not like that at all. There was no pain and very little discomfort. It felt more like a well needed vacation. I had all my surgery on a Friday and I saw Dr. Foulad and Chelsea through the weekend. By the following Saturday I was at an important social function and with a little make up, no one could tell I was a week out from surgery. Some people would call this vanity. I disagree. I don’t feel 63. Why should I have to look 63.(or older!) It’s the best thing I ever did for myself. I can't thank Dr. Foulad enough. If you are considering doing this, I beg you to pull the rip cord, take the plunge, whatever you want to call it, but do it! It’s worth it. You’re worth it!
carol cusson
carol cusson
2021-12-11
There aren't enough stars for this review to tell you how pleased I am with Dr Foulad, Chelsea and the staff. It was so worth the miles traveled to have my facelift, neck and brow lift. Their attentiveness from the consult all the way through to the aftercare has been amazing. He continues to check in with me 2 months later. His attention to detail and his warm and caring personality made this such an enjoyable experience. I could not believe there was minimal pain and you cannot even see where the stitches were. I feel AND look like a new woman. Judge for yourself with my pictures! Highly recommend Dr Foulad and his staff
Kristy Franklin
Kristy Franklin
2021-10-06
Dr. Foulad performed my facelift and neck lift a few months ago and my results are phenomenal! He is kind, talented, and did beautiful work on my face and neck. He is very honest and takes a lot into consideration when giving his recommendations. He takes so much time to answer your questions and explain everything to you. Everything about my experience was top notch. I have seen other doctors in my past and none of them followed up with me or spent the amount of time with me the way Dr. Foulad has. His staff was also incredibly pleasant and accommodating with me. I can’t recommend Dr. Foulad enough. He genuinely cares deeply about his patients and does excellent work!
Miriam Vernia
Miriam Vernia
2021-09-13
Dr. Foulad loves what he does and it shows. He is professional, knowledgeable, skilled, and dedicated to his patients. His "bed manners" are without equal. He follows up on his patients for weeks after surgery, providing timely advice and encouragement. He is honest and upfront about what benefits surgery can provide and he refers to other surgeons procedures that he does not feel comfortable performing.
Victoria Lampley
Victoria Lampley
2021-03-26
Dr Foulad is absolutely amazing! He is super patient, takes the time to thoroughly explain all your issues, thoughts, and goals and maps out all of your options without pushing anything whatsoever (if anything he does the opposite and explains everything in depth). He was completely attentive and super eloquent and smart when describing all of the ways he can help heal and preserve my skin and shared a wealth of knowledge. The practice manager Chelsea is patient, kind and super sweet and helpful. I'll definitely be telling my family and friends to become patients of Dr Foulad's practice. He is a perfectionist in the best way possible.
Kyrra White
Kyrra White
2021-03-14
I went to Dr Foulad for Jowl liposuction. Dr Foulad is a very informed facial artist and a master of his craft. I appreciate how delicate he was with my face during the procedure. He paid close attention to every detail of my face, and his effort shows in my results! I highly recommend Dr Foulad for any facial procedure. It’s important to have someone who is invested in your vision as you are, and that is Dr Foulad.
Aiko Fujimoto
Aiko Fujimoto
2021-03-01
Dr Foulad and his team are the definition of white glove service. They will take the time to explain everything in thorough detail and take all extra precautions to ensure your procedure is done as effectively and safely as possible. I'm incredibly happy with my results and will only be trusting my facial needs with Dr Foulad for all procedures going forward!
Sydney Skinner
Sydney Skinner
2020-12-16
Wow, I am so impressed! From the minute I walked into his office I was warmly greeted by his staff and ushered off for my consult with Dr. Foulad. He was extremely through (I ask a lot of questions) and he was very patient and did not rush me. I followed up the next week for my procedure which I’m thrilled with the outcome and feel so much confident! I’m looking forward to a long relationship with his office and it’s nice because he offers the entire package of treatments, products and procedures to cover all the bases! So no more running around to different offices!
Katia Rodriguez
Katia Rodriguez
2020-11-10
My experience at Dr. Foulad’s office has been nothing but great! From my very first consult, he made me feel comfortable and explained everything with detail. Him and his staff are so kind and were there to help guide me along the process. The results of my surgery were everything and more! I am so happy with the results and would recommend him to all my friends and family.
calvarezds
calvarezds
2020-09-17
I am so happy with my results after going to Dr. Foulad. He is a complete perfectionist and explains everything to you before go through with any injections or procedures. He makes everything look natural and seamless. I am definitely recommending him to all of my friends and family.