A Caucasian rhinoplasty is usually very different from an Asian rhinoplasty. Caucasian complaints often center on the bridge of the nose being too high and the profile of the bridge being too convex due to bony and cartilage humps. When it comes to the tip, common complaints are that the tip is too long, too big, and too droopy.
Therefore, in the Caucasian nose, we usually need to reduce the bridge by removing the hump, shorten and rotate upwards the overly long tip, and reshape the tip with cartilage grafts to create a more compact tip with good definition and a pleasing shape.
When the nasal bones are crooked or too wide, these problems are corrected by cutting the nasal bones and repositioning them.
If the nasal septum (the wall of cartilage in the midline of the nose that divides it into right and left sides) is deviated or curved and is causing nasal airway obstruction, this is corrected by a septoplasty, which straightens the crooked septum and relieves the airway obstruction. As this procedure is medically indicated, it can be covered by insurance.
Due to part of his training and experience being in the U.S., Dr Huang is as experienced in performing Caucasian rhinoplasties as he is in Asian rhinoplasties.
An open rhinoplasty approach is usually adopted. Incisions are made along the inside of the rim of each nostril and connected in the midline structure known as the columella. The entire cartilage framework of the nose is exposed. The septum is accessed and cartilage is harvested for later use in the tip. The septum is straightened as required. The hump is reduced by removing excess bone and cartilage in that area. This is accomplished using advanced techniques that prevent the bridge from becoming wider after hump reduction. Excess cartilage in the tip area is then removed as required, and cartilage grafts are designed and shaped for placement in the tip to create the desired new shape. If the nasal bones need to be cut and repositioned, this is done as the last step. The wounds are then carefully and meticulously closed with fine sutures.
The procedure is usually completed under intravenous sedation or general anesthesia. It is usually a day surgery procedure. The length of the procedure depends on how much work is done, and it can range from three to six hours.
Tapes are applied over the nose to minimize swelling. If the nasal bones were repositioned, a light thermoplastic splint is also applied over the nose to stabilize the nasal bones in their new positions.
Postoperative pain is usually mild and well controlled with oral pain medications. Swelling is usually mild to moderate. Bruising is normally absent or minimal, unless the nasal bones were repositioned, in which case bruising may occur in the under eye area. This may also be accompanied by slight bleeding through the nostrils for the first few days. The nose will also feel blocked for the first few days due to internal swelling. The tapes and stitches (and splint if used) are removed after one week. Downtime is usually ten to fourteen days. By then, about half of the swelling will have subsided and the nose looks fairly presentable. Exercise can be resumed after one month.
Caucasian rhinoplasty is generally a safe operation with minimal blood loss and a low risk of infection. There are no risks associated with the use of implants, since implants are not used in this type of rhinoplasty.