Introduction
In New York City, where beauty standards are high and the pursuit of perfection is a common goal, nasal soft tissue adjustment procedures have gained significant popularity. Whether it's to enhance one's appearance or improve breathing, there are numerous options available. This article will provide an in - depth update on the top ten nasal soft tissue adjustment procedures and the leading surgeons in New York City.
1. Pinched Nasal Tip Correction
Understanding the Procedure
Pinched nasal tip correction is a surgical procedure aimed at restoring nasal harmony and function by addressing deformities in the nasal tip region. A pinched nasal tip occurs when the lower lateral cartilages are overly narrowed or weakened, resulting in malposition of the lateral crus of the lower lateral cartilage. This can lead to an obtuse lateral crural resting angle, collapse of the nostrils, and a pinched tip appearance. It can also be a result of an overdone supratip break from previous rhinoplasty surgery. Dr. David Cangello, a leading board - certified plastic surgeon in New York City, specializes in this procedure.
Aesthetic Considerations
To achieve optimal results, it's crucial to understand aesthetic nasal polygons. These include dorsal and lateral aesthetic lines, the scroll line and lateral crus resting angle, and the nasal tip diamond. The dorsal and lateral aesthetic lines play pivotal roles in nasal aesthetics. The dorsal aesthetic lines, originating from the glabella and extending to the nasal tip, create a fusiform pattern for a natural - looking dorsum. Lateral aesthetic lines accentuate nasal triangularity and contribute to overall facial balance. The scroll line and lateral crus resting angle are key determinants of nasal tip aesthetics. The nasal tip diamond, characterized by double light reflections, embodies ideal tip aesthetics.
Procedure Steps
- Preoperative evaluation and markings: Dr. Cangello evaluates the nasal anatomy and discusses the patient’s aesthetic goals. He marks the existing and desired nasal tip on the lateral cheek skin to simulate the expected surgical outcome.
- Incisions: The surgical approach may be open or closed. In open rhinoplasty, a V - shaped incision across the columella provides direct access to the nasal structures, while closed rhinoplasty involves incisions within the nostrils.
- Cartilage reconstruction and grafting: When previous rhinoplasty procedures result in an over - resection of cartilage, Dr. Cangello utilizes advanced cartilage reconstruction techniques. He may opt for septal, ear, or rib cartilage for grafting.
- Management of lateral crura: If the lateral crura is over - resected, lateral crural strut grafts are used to reconstruct and reinforce the lateral crura, followed by precise suturing techniques to orient the crura properly.
- Cartilage dissection and marking: Dissection is performed in the subperichondrial / subperiosteal plane to control midline and scroll ligaments and enable precise cartilage shaping. Cartilages are marked to ensure correct manipulation.
- Dome - defining point identification: Precise identification of the dome - defining point is crucial for proper reshaping of the nasal tip. Symmetric reference markings are made on the lateral crura to ensure alignment and symmetry.
- Cephalic dome sutures: These sutures stabilize the middle and lateral crura, correct resting angles, and define the position of the dome.
- Dome - equalizing suture: A dome - equalizing figure - of - 8 suture is placed to stabilize the domes and ensure symmetry and proper tip rotation.
- Columellar strut graft: A curved columellar strut graft may be placed to support the nasal tip and maintain proper polygonal aesthetics. In some cases, a specialized septal extension graft developed by Dr. Cangello is used.
- C′ breakpoint remodeling: Reshaping of the c′ breakpoint is performed to enhance nasal tip surface aesthetics by redefining the transition line between the infralobular and columellar polygons.
- Redraping: The skin is redraped to ensure correct reduction and settling of soft tissue components, maintaining symmetry and stability.
Recovery
Patients can expect some initial swelling and bruising, which typically resolve over the following weeks. Dr. Cangello will provide detailed post - operative care instructions, and patients are encouraged to rest and avoid strenuous activities during the initial recovery period. Follow - up appointments will be scheduled to monitor progress.
2. Revision Rhinoplasty
Reasons for Revision
A revision rhinoplasty is a procedure that adjusts initial changes from a prior rhinoplasty. There are many reasons why a patient may need a revision, such as asymmetry of the nasal septum, nostrils, or tip; nasal collapse; graft loss; and synechiae. In some cases, the initial rhinoplasty may not have delivered satisfying aesthetic results, or the patient may have breathing problems.
Benefits
The benefits of a revision rhinoplasty include creating a more harmonious, symmetrical balance to facial features, improving nasal air flow for easier breathing, reducing the risk of sinus infection and “mouth breathing,” correcting undesirable scar tissue formation from prior surgery, reconfiguring nasal tissues to a more attractive appearance, and using donor tissue (bone or cartilage) to augment nasal shape where required.
Dr. John E. Sherman
Dr. John E. Sherman MD, FACS is one of New York’s most experienced plastic surgeons. In his 40 years of practice, he has performed countless corrective craniofacial surgeries, including rhinoplasty. He will counsel every patient thoroughly before the procedure, starting with an initial consultation to assess the nasal structure and function. He will ask about the patient's first rhinoplasty, its recovery, and any nasal obstructions.
Procedure and Recovery
The revision rhinoplasty is generally an outpatient procedure, but it is often more complex and lengthier than the first rhinoplasty. Most cases are performed under general anesthesia. After the procedure, patients can expect considerable swelling and bruising at first, which may distort other facial features. The distortion will gradually settle over the months ahead, and it may take 1 - 2 weeks of recovery before returning to most activities. Final results can take 12 months or more to see.
3. Standard Rhinoplasty
Types of Rhinoplasty
Rhinoplasty can be divided into functional rhinoplasty (correcting breathing problems) and cosmetic rhinoplasty (correcting aesthetic problems). Functional problems include nasoseptal deviation, turbinate hypertrophy, and middle - vault collapse, which are usually insurance reimbursable. Aesthetic problems can be a hump or bump of the nose, a bulbous tip, a plunging tip, a too - wide or too - flat bridge, and asymmetrical nostrils.
Dr. Barry Weintraub
Dr. Barry Weintraub is a board - certified and Ivy League - educated plastic surgeon. He has more than two decades of experience and performs rhinoplasty surgery at his New York City office. He prefers his rhinoplasty patients to be in a comfortable state of twilight sleep and insists on the most sterile conditions in his operating room. He performs both primary and complex secondary and tertiary rhinoplasties.
Procedure and Patient Selection
The best candidates for rhinoplasty are well - balanced, in good general health, and have realistic expectations. The procedure can be performed using a closed or open approach. A closed approach is often used for primary rhinoplasties, while an open approach is more suitable for complex secondary and tertiary rhinoplasties. After surgery, there will be a short period of minimal swelling and sometimes bruising. Patients must follow all instructions provided by Dr. Weintraub to achieve the best results.
4. Nasal Tip Surgery
Procedure and Benefits
Nasal tip surgery, also known as tip rhinoplasty, is a procedure to change the shape of the tip of the nose. It can make the nose wider or narrower, change the angle between the nose and upper lip, or change the size or shape of the nostrils. This surgery can be performed for cosmetic reasons or to improve breathing. The benefits include improving appearance, boosting self - confidence, and potentially faster recovery compared to other types of nose surgery as no bone is removed.
Dr. Kassir
Dr. Kassir is a triple - board - certified facial plastic surgeon with extensive experience in nasal tip rhinoplasty. He will work with patients to create a personalized treatment plan. The surgery is performed under general anesthesia and usually takes around one to two hours. Small incisions are made in either the inside of the nostrils or across the columella, and the cartilage and soft tissue are sculpted and repositioned.
Recovery
Recovery from tip rhinoplasty is typically fairly quick and easy, with less swelling and bruising than a full rhinoplasty. Most people can return to their normal activities within a few days. The nose may be taped or splinted to help with swelling.
5. Septoplasty
Function and Indications
Septoplasty is a common procedure often performed in conjunction with other nasal surgeries. The septum is the midline structure in the middle of the nose, and a deviated septum can cause nasal obstruction, breathing difficulties, snoring, and chronic sinus problems. Septoplasty aims to reposition the deviated cartilage and bone in the septum to the midline, opening the nasal airway and relieving the obstruction.
Procedure Details
The surgery is usually done under general anesthesia. A small incision is made on the inside of the nose to allow the surgeon to remove the bone and cartilage without damaging the fragile lining of the nose. The incision is closed with special material that dissolves over time. Sometimes, a plastic ‘stent’ is placed inside the nose to help the septum heal in a straight position, which is usually removed at the first post - operative visit.
Recovery
After septoplasty, patients may experience some discomfort, swelling, and bruising. They are advised to rest and avoid strenuous activities. The recovery period can vary, but most patients can resume normal activities within a week or two.
6. Turbinate Reduction
Role of Turbinates and Problem
Turbinates are paired structures on each side of the nose that help warm and humidify the air we breathe. When they become enlarged or swollen, they can block the passage of air through the nose, leading to nasal obstruction. Turbinate reduction is a common procedure to address this issue.
Procedure Methods
There are multiple techniques for turbinate reduction. One method that can be done in the office employs a technology called ‘coblation,’ where a thin metal needle is passed into the turbinate and energy is delivered to shrink the tissue. A more common and traditional method is performed in the operating room, where a small incision is placed in the front of the turbinate, and a special instrument is used to precisely remove the soft tissue inside the turbinate under the guidance of an endoscope. The bone portion of the turbinate may also be gently fractured.
Recovery
Both methods are generally well - tolerated, with minimal pain after surgery. Most patients do not require pain medication and can begin normal activity immediately after surgery.
7. Repair of the Internal Nasal Valve
Problem and Importance
The internal nasal valve is the narrowest portion of the nasal passage, and its weakness or collapse can cause nasal obstruction. This can be due to weakness in the cartilage and soft tissue of the nose, normal development, or prior nasal procedures.
Procedure Approaches
The goal of treatment is to open the internal nasal valve by strengthening the supporting structures of the nose. The two main methods are open and closed rhinoplasty. In open rhinoplasty, incisions are made inside the nose and on the columella, allowing the surgeon to manipulate and strengthen the cartilage precisely. In closed rhinoplasty, incisions are placed inside the nose only, and cartilage borrowed from the septum or ear is positioned to strengthen the weak areas.
Recovery
Recovery from this procedure often takes longer than septoplasty or turbinate reduction, with more swelling and pain. Cartilage may be used to strengthen the nose, and patients need to follow the doctor's instructions carefully during the recovery period.
8. Alar Base Reduction
Indication and Goals
Alar base reduction surgery is often requested by patients with a wide nasal base and flaring nostrils. The goal is to reduce the flare of the nostril and/or the nasal width to achieve a more aesthetically pleasing nose.
Procedure Options
There are several different types of alar base reduction procedures that excise various portions of the alar rim. These procedures can be done at the same time as the rhinoplasty or under local anesthesia at a later time, depending on the patient's anatomy and goals.
Recovery
Recovery from alar base reduction usually involves some swelling and bruising around the nose. Sutures are usually removed within one week after surgery, and patients should avoid strenuous activities during the initial recovery period.
9. Dorsal Hump Reduction
Aesthetic and Technical Aspects
A dorsal hump on the nose can be a source of aesthetic dissatisfaction. To create a smoother nasal profile, surgeons often shave down sections of the nasal bones. An osteotomy may also be performed to adjust the angling of the two nasal bones at the very top of the nose to restore a natural nasal shape. Different types of bone cuts, such as low - to - high, low - to - low, medial oblique, or double - level cuts, can be used.
Procedure Considerations
The procedure is usually part of a rhinoplasty and is carefully planned to achieve the desired result while maintaining the overall balance of the face. The surgeon needs to consider the patient's facial features and nasal anatomy to ensure a natural - looking outcome.
Recovery
Recovery is similar to that of a standard rhinoplasty, with swelling and bruising in the initial days. Patients should follow the post - operative instructions provided by the surgeon to promote proper healing.
10. Tip Refinement
Techniques and Goals
Tip refinement focuses on improving the shape and projection of the nasal tip. The lower lateral nasal cartilage is modified during surgery to achieve the desired tip contours. Cartilage grafts may also be used to improve tip projection, and suturing techniques are employed to create the desired shape. In patients with thicker skin, thinning the subcutaneous tissue a bit may improve the tip definition.
Surgeon's Expertise
Experienced surgeons like Dr. Steven Wallach are able to perform tip refinement procedures with precision. They carefully analyze the patient's nasal anatomy and use appropriate techniques to achieve a natural - looking and refined nasal tip.
Recovery
Recovery from tip refinement is generally quicker compared to more extensive rhinoplasty procedures. There may be some swelling and bruising around the nose, which will gradually subside over time.
Comparative Analysis of Procedures
| Procedure | Main Indications | Procedure Complexity | Recovery Time | Potential Complications |
|---|---|---|---|---|
| Pinched Nasal Tip Correction | Pinched nasal tip due to cartilage malposition | High | Weeks to months | Infection, bleeding, asymmetry, scarring |
| Revision Rhinoplasty | Unsatisfactory results from prior rhinoplasty | Very high | Months | Same as primary rhinoplasty, plus issues related to scar tissue |
| Standard Rhinoplasty | Aesthetic and functional nasal problems | Moderate to high | Weeks to months | Infection, bleeding, adverse reactions to anesthesia, asymmetry, scarring |
| Nasal Tip Surgery | Desire to change nasal tip shape | Moderate | Days to weeks | Infection, bleeding, nasal blockage, numbness |
