Introduction

New York City, a global metropolis, is renowned for its advanced medical facilities and top - notch healthcare providers. In the field of nasal base shaping, several hospitals stand out with their exceptional expertise, advanced techniques, and experienced medical teams. This article will introduce five hospitals that are notable for three - dimensional nasal base shaping in New York City, covering aspects such as their services, procedures, and unique features.

1. Mount Sinai Hospital

Overview

Mount Sinai's division of facial plastic and reconstructive surgery is a well - recognized name in the realm of rhinoplasty, including nasal base shaping. The nose plays a crucial role in both facial aesthetics and physiological functions, and the surgeons at Mount Sinai are committed to creating natural, long - lasting results for their patients. According to the American Society of Plastic Surgeons, rhinoplasty is one of the most common cosmetic surgeries in the U.S., with over 213,000 people receiving a nose job each year, and Mount Sinai is at the forefront of this procedure.

Surgeon Qualifications

The facial plastic surgeons at Mount Sinai are double - board - certified in facial plastic and reconstructive surgery and otolaryngology (ear, nose, and throat). Their vast knowledge of nasal function and aesthetics ensures that patients not only get an improved - looking nose but also enhanced nasal breathing. This dual expertise is crucial as it allows them to address both the functional and cosmetic aspects of nasal base shaping.

Types of Rhinoplasty for Nasal Base Shaping

There are two main types of rhinoplasty performed at Mount Sinai for nasal base shaping:

• Primary Rhinoplasty: This is the first - time surgery for patients looking to address cosmetic concerns or improve nasal breathing. For patients seeking nasal base shaping as part of primary rhinoplasty, the surgeons carefully analyze the nasal anatomy and the patient's aesthetic goals to determine the most appropriate approach.
• Revision Rhinoplasty: In cases where previous nose surgeries have led to concerns or deformities, Mount Sinai's surgeons are skilled in performing revision rhinoplasty. They can correct issues related to the nasal base, such as excessive width or an unbalanced appearance, using advanced techniques.

Surgical Techniques

• Closed (Endonasal) Rhinoplasty: All incisions are made inside the nose, which has the advantage of no external scarring and a relatively shorter operation time. This technique is suitable for patients with less complex nasal base issues and who desire a more minimally invasive approach.
• Open (External) Rhinoplasty: A small incision is added at the base of the nose to increase the surgical field of vision. This allows for better visualization of the nasal anatomy and enables more complex alterations and grafting to be performed. It is often used for patients with more significant nasal base problems that require a more comprehensive correction.

Multidisciplinary Approach

Mount Sinai patients have access to a large, tertiary hospital with a wide range of specialists. For patients with concerns related to nasal breathing, allergies, sinus disease, or deformity after cancer treatments, the hospital's facial plastic surgeons work closely with experts in the division of rhinology and sinus surgery and the head and neck institute. This multidisciplinary approach ensures that all aspects of the patient's condition are addressed, providing more comprehensive and effective treatment for nasal base shaping.

Combining Procedures

To achieve the best facial balance, patients who undergo rhinoplasty for cosmetic improvements at Mount Sinai may also benefit from cheek or chin implants. Whenever possible, the cosmetic surgeons combine procedures to reduce recovery time and lower operating costs. This integrated approach allows patients to achieve a more harmonious and natural - looking facial appearance.

Adolescent Rhinoplasty

If a nose job, including nasal base shaping, is for cosmetic reasons, younger patients should wait until they stop growing and their nasal bone has reached its adult size. For girls, this usually occurs around age 15 after puberty, while boys may need to wait until 17 or 18 years or older. However, if the surgery is to correct a breathing problem or repair the bone after an injury, it can be performed before the patient is fully grown.

Before and After Surgery Care

Patients interested in nasal base shaping at Mount Sinai start with an extensive consultation to identify their concerns and review their goals. The surgeons then develop an individualized treatment plan. Rhinoplasty surgery is usually performed in an outpatient setting under general anesthesia or a combination of local anesthesia and sedation. Before surgery, patients receive instructions on medications and how to prepare for recovery. After surgery, they are given a short course of antibiotics and mild pain medication, and the majority of swelling subsides within the first two weeks, although it may take up to a year for all swelling to fully fade. Patients are expected to return to work or school within one to two weeks after surgery and are advised to avoid strenuous activities for two weeks.

Cost Considerations

Insurance may cover surgery performed to improve breathing, such as correcting a deviated septum, but it does not cover surgery for cosmetic reasons. Mount Sinai provides patients with expected costs prior to any intervention, allowing them to make informed decisions about their treatment.

2. Cangello Plastic Surgery

Specialization in Nasal Base Reduction

Cangello Plastic Surgery is well - known for its expertise in nasal base reduction, also known as alarplasty. This rhinoplasty technique is intended to narrow the alar base of the nose when it is excessively wide for the face. The alar base is a crucial factor in the overall proportion and appearance of the nose and its harmony with the rest of the face. Many rhinoplasty and revision rhinoplasty patients come to Cangello Plastic Surgery with concerns about a nose that looks too big or too wide at the bottom.

Measurement and Aesthetic Considerations

The width of the nasal base can be measured from the outer margin of one nostril to the outer margin of the opposite nostril, and its axis can be classified as vertical, divergent, or convergent. Generally, the ideal nasal base width should fall between the distance between the inner corners of a patient's two eyes. However, in ethnic rhinoplasty, the concept of an "ideal" measurement may vary. For patients of African American, Middle Eastern, or Asian descent, a more natural - looking nasal base with a width that falls slightly outside the lines of the inner canthus may be the desired goal.

Benefits of Nasal Base Reduction

Nasal base reduction surgery at Cangello Plastic Surgery offers several benefits:

• It refines and improves the overall appearance of the nose, giving it a more balanced and aesthetically pleasing look.
• Improves facial symmetry and balance, enhancing the patient's overall facial aesthetics.
• Increases self - confidence as patients are more satisfied with the appearance of their nose.
• Decreases the size of the nostrils and reduces nostril flare, resulting in a more refined nasal appearance.
• Provides long - lasting results, ensuring that the improved nasal appearance is maintained over time.

Anatomy Understanding

Dr. Cangello has in - depth knowledge of the nasal base anatomy, which is essential for determining the optimal surgical technique. The nostrils are separated by the columella, and the nasal sill extends from either side of the bottom of the columella to the alar base insertion. The anterior nasal spine, lower lateral cartilages, caudal septum, maxilla, upper lip, and the soft tissue and skin that envelop the nose all contribute to the overall appearance and width of the nasal base. Dr. Cangello evaluates each patient's unique nasal anatomy to determine the surgical technique that will best achieve an improvement in the appearance of the nose while enhancing functionality and retaining the patient's individual, racial, and ethnic characteristics.

Surgical Techniques

There are three main surgical techniques used at Cangello Plastic Surgery for nasal base reduction:

• Alar Wedge Excision: Also known as the weir incision, this is the preferred technique for minimizing excessively flared ala to reduce a wide nasal base from the frontal appearance. It removes wedge - shaped pieces of tissue from the nasal flare and spares an incision in the nostrils, preserving the natural curvature of the ala and avoiding telltale incisions in the nostril opening.
• Nasal Sill Excision: Typically used in the correction of enlarged nasal sill width along with excessive flare in the ala. Sill reduction is indicated when the nasal base has a horizontal axis and the nostrils are enlarged. In rare cases where the alar base is wide because of a large nasal sill and presents no flaring, the sill alone can be directly narrowed.
• V - Y Advancement: This technique is used to reposition the alar insertion if the lateral insertion of the ala is responsible for excessive nasal base width. However, it is rarely performed as it will leave a scar on the face.

Candidates and Risks

Candidates for nasal base reduction at Cangello Plastic Surgery are individuals who are concerned about the excessive width of the base of their nose. The procedure is a fairly common one with minimal risks when performed by an experienced surgeon like Dr. Cangello. If performed alone (without concomitant rhinoplasty), it can be done under local anesthesia only. Recovery time is roughly one to two weeks, with the base of the nose being slightly swollen and red immediately after surgery, which gradually subsides. Stitches are typically removed one week after surgery, and full recovery takes approximately one month. Although rare, risks can include infection, bleeding, and scarring.

3. NYU Langone Health - Division of Rhinology & Endoscopic Skull Base Surgery

Comprehensive Care for Nasal and Sinus Disorders

The Division of Rhinology & Endoscopic Skull Base Surgery at NYU Langone Health provides comprehensive clinical care for a wide range of sinonasal and skull base diseases, which also has implications for nasal base shaping. The department focuses on training clinicians in the latest treatments, from severe nosebleeds, sinus infections, and nasal obstruction to skull base tumors, cerebrospinal fluid leaks, and advanced sinus cancers.

Education and Training

• Medical Students: Medical students at NYU Grossman School of Medicine can take electives in the department of otolaryngology — head and neck surgery as part of the curriculum for the 21st century, exploring otolaryngology and head and neck surgery, which includes knowledge relevant to nasal base shaping.
• Residents: Residents complete rotations in rhinology and endoscopic skull base surgery, see patients with attending physicians, and assist with rhinologic, sinus, and skull base surgery. They gain experience in performing endoscopic surgical procedures for various nasal and sinus conditions, which can be applied in cases where nasal base shaping is combined with the treatment of other nasal disorders. For example, during their residency, they perform more than 150 endoscopic sinus surgery procedures using advanced techniques and technology, including intraoperative image guidance.

Research and Continuing Medical Education

The division is actively involved in research, with several ongoing projects exploring areas such as antibiotic use in patients with unilateral purulent sinusitis, prophylactic antibiotic use in patients with nasal packing for epistaxis, and the management of the nasolacrimal duct during extended maxillary procedures. Residents actively participate in the research, and the findings can contribute to the improvement of surgical techniques and patient outcomes in nasal base shaping. Additionally, the division hosts a continuing medical education course, the New York Advanced Rhinology and Sinus Surgery Course, to educate practicing otolaryngologists and residents on current treatment guidelines and advances in the medical and surgical management of patients with rhinosinusitis and associated otolaryngologic conditions.

Clinical Services Related to Nasal Base Shaping

Otolaryngologists in the division provide comprehensive care for people with nasal and sinus disorders, including chronic sinusitis, allergic rhinitis, and deviated nasal septums. These conditions can sometimes be related to the nasal base and may need to be addressed in conjunction with nasal base shaping. The division also collaborates with physicians in the department of neurosurgery and at the Perlmutter Cancer Center to diagnose, treat, and manage skull base tumors, cerebrospinal fluid leaks, and head and neck cancer, including sinus and nasal cancers. Although these are more complex conditions, the experience and expertise gained in treating them can be applied in a more holistic approach to nasal base shaping, especially in cases where there are underlying structural or pathological issues.

4. NYU Langone Health - Anterior Skull Base Surgery Center

Recognition and Expertise

NYU Langone's Anterior Skull Base Surgery Center is highly recognized, with U.S. News & World Report's “Best Hospitals” ranking NYU Langone as the No. 1 hospital in the nation for neurology and neurosurgery. The program is led by Dr. Chandra Sen and Dr. Richard Lebowitz, who have a combined 40 years of experience specifically in using anterior skull base surgery to remove tumors and treat non - tumorous conditions in the delicate area at the base of the brain. While their primary focus is on tumor removal, the knowledge and surgical skills related to this area can also have implications for nasal base shaping, especially in cases where there are complex anatomical or pathological interactions.

Treatment of Tumors and Related Conditions

The center treats patients with malignant and benign tumors that occur in the area at the base of the brain, including meningiomas, pituitary tumors, craniopharyngioma, juvenile angiofibromas, chordomas, and esthesioneuroblastomas. They also treat non - tumorous conditions such as cerebrospinal fluid fistulas and mucoceles. The surgical approach can vary depending on the patient's condition. Many patients qualify for a less invasive approach: endonasal endoscopy. Instead of opening the skull, a tiny camera attached to a long, thin, lighted tube is inserted into the nasal and sinus cavity, and the neurosurgeon inserts small tools through the nasal cavity to remove the tumor using the images on a television screen as a guide. This minimally invasive approach has advantages such as no visible scarring and a shorter recovery time, which can be relevant in cases where nasal base shaping is combined with tumor - related surgery or when considering the overall aesthetic and functional outcomes of the nose.

Comprehensive Patient Care

During the first visit, the medical team at the center reviews the patient's symptoms, imaging studies such as CT and MRI scans, and other test results to assess the best treatment approach. Depending on the specific problem, the patient may be referred for consultation with other members of the healthcare team, including otolaryngologists, endocrinologists, neuro - ophthalmologists, and neuro - oncologists. After treatment, the patient is cared for by a specialized neurosurgery nursing team, and if follow - up cancer treatment is required, they are connected with NYU Langone's Laura and Isaac Perlmutter Cancer Center. For post - surgery issues with walking or balance, the experts at NYU Langone's renowned Rusk Rehabilitation can provide assistance. This comprehensive approach to patient care can also benefit patients undergoing nasal base shaping, especially when there are potential underlying medical conditions or complex interactions between the nasal base and other parts of the head and neck.

5. Mount Sinai - Division of Rhinology, Sinus Surgery and Allergy

Cutting - Edge Treatment of Nasal and Sinus Diseases

Mount Sinai's Division of Rhinology, Sinus Surgery and Allergy is at the forefront of treating the full range of nasal and sinus diseases, which is closely related to nasal base shaping. The fellowship - trained surgeons are experts in endoscopic sinus and skull base surgery, inflammatory sinus surgery, and all nasal obstruction surgeries. The multidisciplinary team also includes experts dedicated to the medical treatment of allergies.

Treatment Conditions

The nasal and sinus conditions treated by the division include acute and chronic sinusitis, nasal polyps, nasal obstructions, and nosebleeds (epistaxis), among others. When considering nasal base shaping, these conditions may need to be addressed first or in conjunction with the shaping procedure. For example, a patient with chronic sinusitis may have inflammation that can affect the nasal base and its appearance, and treating the sinusitis is crucial for achieving optimal results in nasal base shaping.

Novel Treatment Approaches

• Dissolvable Steroid Implants: One of the novel treatments offered is the use of dissolvable steroid implants (Propel) in patients suffering from polyp disease and severe chronic sinusitis. This treatment is currently available in the inpatient setting as an adjunct to sinus surgery. Unlike traditional treatments, such as steroid irrigations, it allows for the direct delivery of steroid therapy to the sinus cavity while decreasing the degree of systemic steroid absorption. This can be beneficial in cases where inflammation in the sinuses may impact the nasal base.
• Minimally Invasive Sinus Surgery: For cases that require surgery, the division uses minimally invasive techniques to effectively treat sinus disease while minimizing recovery time. For example, in patients with severe frontal sinusitis who have failed multiple