Rhinoplasty

Dr. Guida's Approach To Rhinoplasty
Dr. Guida is renowned for his innovative surgical expertise to achieve natural and elegant appearing cosmetic results for his patients. He believes that detailed communication with his patients and thoroughly understanding their cosmetic goals and desires helps in achieving these goals. Rhinoplasty results should reflect the patient's individuality. This can only be achieved when the surgeon has expert and comprehensive surgical background in the nuances of rhinoplasty surgery and also is able to carefully communicate and understand his patients' wishes.

Dr. Guida also feels that aesthetic surgeons must develop a sixth sense that helps them understand each patient's goals and desires. According to Dr. Guida, "I see myself as both a physician and a craftsman, which means that patients have the benefit not just of my technical expertise, but also of my artistic sense. I spend a great deal of time listening to what my patients want. Computerized digital imaging allows me to demonstrate what I am envisioning so that I can work with my patients to fine tune our approach. This is especially helpful in rhinoplasty surgery."

What further distinguishes Dr. Guida is his unique extensive training in both functional and cosmetic nose surgery. He is double board certified on Facial Plastic and Reconstructive Surgery as well as Otolaryngology - Head and Neck Surgery. Because of this unique training, he is highly skilled in the surgical treatment of all aspects of nasal sinus disease, functional nasal problems, and any cosmetic concerns of the nose, including complex revision rhinoplasty.

Understanding Rhinoplasty
Rhinoplasty, or a "nose job ", cosmetically improves the appearance of the nose. Cosmetic problems of the nose can be either genetic or perhaps as a result of a broken nose. These concerns range from bumps on the nasal bridge, wide bulbous tips, to long crooked noses, and are very individualized.

Often, patients with cosmetic concerns of the nose also have functional problems, such as chronic sinusitis and/or nasal obstruction from a deviated nasal septum or nasal polyps. Dr. Guida strongly feels that these problems most often should be fixed simultaneously. A good-looking nose should also function very well.

How Is It Done?
The operation is done under twilight anesthesia, can be performed in Dr. Guida's AAAHC certified office surgical suite, takes 60 to 90 minutes, has very little pain associated with the recovery, and patients frequently return to work or school within a week. Generally, the entire operation is done through incisions inside the nose and there is no external scarring. There is no packing placed in the nose after the surgery, which allows for a much quicker and less painful recovery. A nasal splint is placed on top of the nose and is removed 5 to 6 days later. Any bruising that mat occur typically lasts 7 to 10 days and is easily covered with makeup. Patients feel comfortable returning to normal social activities at 1 week following the operation.

Can Rhinoplasty Help Me?
Rhinoplasty surgery has made great strides over the last few decades. The cosmetic results are natural looking, yet yield a very significant improvement without an over-done "nose-job" look. A properly performed rhinoplasty can markedly improve a person's appearance, often achieving a significant positive influence on a one's self esteem and confidence level and at the same time improving the over all function of the nose with very little down time.

Best Candidates For Rhinoplasty
Rhinoplasty surgery has made great strides over the few last decades. The cosmetic results are natural looking, yet yield a very significant improvement without an over-done "nose-job" look.

Best Candidates:

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      Patients who are unhappy with the nose that they were born with.
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      Patients who are still unsatisfied with their previous rhinoplasty and want a revision to improve the aesthetic results.
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      Patients who have sustained a nasal injuries that had distorted the shape of their nose.
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      Patients who have noticed changes in the appearance of their nose due to the aging process (as one gets older, the nose becomes more prominent, longer and sags).
    * Patients who have difficulty breathing through their nose or have chronic sinusitis and also have an interest in changing his or her nasal appearance.
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      Patients who are generally medical healthy and are completed with puberty and facial growth; typically girls mature slightly sooner than boys and may have the operation at a slightly younger age

The Procedure:
Dr. Guida's goal in reshaping your nose is to create a natural appearing nose that looks like you were born with it; however, without any imperfections. Skin type, thickness and size of the cartilage and bones, and age of the patient are considerations in the healing process. For these reasons, the surgical result is never the same in any two patients. It is important to understand the basic anatomy of the nose to appreciate how Dr. Guida will reshape your nose. The skin is the outer covering of the nose. It lies over a structure made of both bone and cartilage, (like a blanket draped over ruffled sheets; the thicker the blanket, the less noticeable the ruffled sheets appear). The bones and cartilages are sculpted and the tip is refined. In most instances incisions are made inside the nostrils, meaning no visible scars. Dr. Guida will discuss and review your specific anatomy with you and the surgical plan that best suits your aesthetic needs.

Recovery Time:
Immediately after surgery, Dr. Guida will place a small splint on your nose for protection. In the immediate days after surgery you may experience bruising and swelling to your eye area. The splint will be removed 5-6 days after surgery. At that time, the nose will look appreciably better even though there may be some swelling. You will probably feel comfortable being seen socially. Most people return to school or work 1 week after surgery. Over the next few weeks, more of the subtle swelling of the cheeks, face, and nose will be markedly reduced and the nose will continue to look and feel better and more natural. It takes 6-9 months for more subtle swelling of the tip and sides of nose to come down. Vigorous activity may be resumed 4-6 weeks after your rhinoplasty.

Insurance:
Surgery to improve just the shape of your nose is considered cosmetic surgery and insurance companies will not cover this type of surgery. Medical insurance companies may however cover other, distinctly separate procedures performed during rhinoplasty surgery to improve your nasal breathing or chronic sinusitis. Dr. Guida's experienced staff can help you determine what parts of your procedure may or may not be covered by your medical insurance. If you have any questions, feel free to call us.
Rhinoplasty FAQs

What is a “Rhinoplasty”?
Rhinoplasty, commonly referred to as a "nose job ", is an operation that cosmetically improves the appearance of the nose. Cosmetic problems of the nose can be either genetic or acquired, as for example due to an accident, resulting in a fractured nose. The most common cosmetic problems encountered are noses that are too large or elongated relative to the rest of the facial features, noses with prominent bumps on the bridge, noses with wide nasal bridges and wide tips, or noses that are very crooked due to a fractured nasal bones or a congenital deviated nasal septum. Again, the cosmetic concerns are very individualized and each patient must be analyzed accordingly.

What is the best age to perform a rhinoplasty?
Typically, the rhinoplasty is best performed after the age of 15 or 16 on young boys and girls. Because girls tend to mature sooner than boys, it may be possible to perform the operation at a slightly younger age in girls. Ideally, the patient should be completed with puberty and with facial growth. There really is no limit on how old the patient can be for a rhinoplasty. Typically, as one ages, the supporting tissues of the nose weakens making the nose appears longer and wider. A rhinoplasty in an older person can often give a more youthful and perkier look.

Tell me more about the anesthesia and recovery period.
The operation is done under twilight anesthesia, performed in Dr. Guida's AAAHC certified office operating suite, takes 60 to 90 minutes, has very little pain associated with the recovery, and requires less than 1 week out of work. Generally, the entire operation is done through incisions inside the nose and there is no external scarring, there is no packing placed in the nose after the surgery, which allows for a much quicker and less painful recovery. A nasal splint is placed on top of the nose and typically removed 5 to 6 days following the operation. Blackish blue as a result of the surgery varies from patient to patient and typically last 7 to 10 days. It is easily covered with makeup. Patients feel comfortable returning to work or school at 1 week following the operation.

I had a bad nose job years ago. Is there any hope of improving the appearance?
Dr. Guida performs a large number of revision rhinoplasties involving patients that have had an unsatisfactory result elsewhere. In about 30% of these cases an external incision (open rhinoplasty) will be necessary at the base of the nose. This incision heals extremely well and is often nearly invisible once it heals. This approach gives Dr. Guida a direct view of the underlying structures and much control over the final result. The success rate with revision rhinoplasty is very high.

Can I get an idea of what my new nose will look like before actually having surgery?
Because of the individualized concerns each patient has with rhinoplasty surgery, Dr. Guida prefers using a digital computer imaging machine to analyze the patient's facial and nasal proportions with the patient prior to surgery. We can change the shape of the nose on the computer and it allows for a more interactive discussion between Dr. Guida and the patient in terms of the final outcome of the surgery.

I cannot breathe through my nose. Can that be fixed at the same time as making my nose look better?
Frequently, cosmetic nasal surgery is done simultaneously with functional nasal surgery. The most common functional complaint patients have regarding their nose is that they cannot breathe through it. There are a variety of causes of nasal obstruction, most of which can be corrected surgically. Surgical problems that are easily corrected related to the nose include a deviated nasal septum, a fractured nasal septum, nasal polyps, chronic sinus infections, or enlarged turbinates. Dr. Guida can determine the cause of the nasal obstruction by both a physical examination as well as a CT scan of the nose and paranasal sinuses. This will give Dr. Guida detailed information and allow him to give you a clear assessment of your chances of improvement following surgery.

Will there be packing in my nose during the recovery period?
No, Dr. Guida rarely needs to uses nasal packing after rhinoplasty and functional nasal surgery. Bleeding is kept to a minimum during the procedure and structures are secured with dissolvable sutures, eliminating the need for uncomfortable nasal packing in most cases.

How does Dr. Guida fix a deviated nasal septum?
Fixing a deviated nasal septum involves one small incision inside the nose. Fixing this problem by itself does not cause any external bruising and there is no need for a nasal splint following the operation. Dr. Guida also does not pack the nose after the operation, as he uses a dissolvable suture to hold the structures in place afterwards. Typically, the patient can breathe well initially in the recovery room, but within several hours after the operation, the nasal lining swells and it will take approximately 1 week for the swelling to go away.

How does Dr. Guida fix a deviated nasal septum?
Fixing a deviated nasal septum involves one small incision inside the nose. Fixing this problem by itself does not cause any external bruising and there is no need for a nasal splint following the operation. Dr. Guida also does not pack the nose after the operation, as he uses a dissolvable suture to hold the structures in place afterwards. Typically, the patient can breathe well initially in the recovery room, but within several hours after the operation, the nasal lining swells and it will take approximately 1 week for the swelling to diminish.

Can nasal polyps and chronic sinusitis be fixed surgically?
Nasal polyps are frequently associated with chronic sinusitis and allergic symptoms. Ideally, these are removed endoscopically under twilight anesthesia. It is best to get to the source of the problem and this usually involves removing not only the polyps but the diseased tissue in the ethmoid and maxillary sinuses where the polyps originated. This will allow for much longer lasting results and increase the possibility that the polyps will not recur.

My doctor told me I had swollen turbinates. Can this be fixed?
Turbinates typically enlarge over the years due to chronic sinusitis and or allergic symptoms. Some people are born with congenitally abnormally large inferior or middle turbinates. These are usually diagnosed on a CT scan prior to surgery. Dr. Guida prefers trimming these endoscopically under direct vision. Turbinates are essential for nasal humidification and filtration. Therefore, the turbinates should not be removed in their entirety, but conservatively reduced in size. Again, this generally does not require postoperative nasal packing. There is postoperative nasal congestion which last for approximately 1 to 2 weeks.

What is chronic sinusitis?
Chronic sinusitis is a functional problem of the nose which affects a large part of the population. Often times it also related to allergic rhinitis. Typically, people with chronic sinusitis have recurrent sinus infections and head colds several times a year over a few years. Antibiotic treatment will typically improve the situation initially. However, shortly after stopping the antibiotic therapy the infection will recur. Symptoms include headaches, facial pain, nasal congestion, nasal drainage, postnasal drip, and occasional visual changes. Prior to the use of antibiotics, sinusitis was life-threatening potentially causing meningitis and even death.

The best way to diagnose chronic sinusitis is by history, the physical exam, and a CT scan of the paranasal sinuses. Dr. Guida prefers reviewing the CT scan carefully with the patient so that both of a clear understanding of the underlying cause of the problem.

Has sinus surgery changed in recent years and is it effective?
Endoscopic sinus surgery has revolutionalized the surgical treatment of sinus disease. Using a small rigid endoscope connected to a large television monitor, this surgery can be done under direct vision ensuring very specific and positive results. A CT scan is used during the procedure as a road map, allowing for accuracy during the operation.

Tell me more about the anesthesia and recovery of endoscopic sinus surgery.
This operation can be done under twilight anesthesia and there generally is no nasal packing postoperatively. When not done in conjunction with the rhinoplasty, there is no need for an external splint rarely any bruising. Patients typically require 5 to 7 days off of work after this procedure. Dr. Guida follows up the patient closely afterwards almost weekly until the nasal congestion resolves. The nasal congestion after this operation can last anywhere from 2 to 6 weeks.

I have a skin cancer on my nose. If it is removed can the nose be made to look normal again?
Dr. Guida has extensive experience with nasal reconstruction following removal of skin cancers or as a result of trauma. This can involve anything from smaller reconstructions of the nasal tip to rebuilding an entire nose due to excisions of large skin cancers. Dr. Guida has written medical articles, lectured extensively about nasal reconstruction, and is an expert in the field.

Typically, a Mohs' surgeon will remove the skin cancer and then refer the patient to Dr. Guida for subsequent reconstruction. Depending on the size and location of the defect, a skin graft or a local flap can be utilized to reconstruct the nose. Again, concern is both with achieving a natural appearing nose as well as obtaining a nose that functions well.

I have rosacea of the nasal skin. The nose is very bulbous and it looks like a “W.C. Fields type of nose.” Is there any hope of making my nose look better?
Many people suffer from rosacea of the nasal tip, which results in a bulbous, red, wide nasal tip that is out of proportion to the rest of the upper nasal structures. Typically people think of W.C. Fields' nose and wonder if there is any specific treatment. Dr. Guida has had excellent results using the CO2 laser resurfacing technique. This results in a very natural appearance and will reduce the size of the nose considerably. This involves using twilight anesthesia, approximately 1 week recovery, and will result in a marked improvement.