Rhinoplasty is one of the most common plastic surgical procedures performed in the United States today. Surgery on the nose is often done for cosmetic and/or functional reasons. Common requests include removing a bump off the bridge, narrowing the bridge, narrowing or refining the tip, straightening the nose, and lifting a droopy tip. Many patients also have difficulty breathing through their nose; improvement in nasal function is critical and is never compromised for aesthetic goals.
Rhinoplasty is performed in two general ways–closed or open. All incisions are made inside the nose during a closed rhinoplasty while the open approach adds a small incision across the columella (the small bridge of skin between the nostrils). Each approach has its own advantages and disadvantages with the method chosen determined by each patient’s specific needs.
Computer imaging is performed for all patients undergoing rhinoplasty. Dr. Losquadro believes in natural results that do not appear operated on, and the imaging helps set personal, realistic surgical goals.
Rhinoplasty is an outpatient procedure performed under general anesthesia. Dr. Losquadro does not place gauze packing within the nose after surgery and, as a result, many patients require only over-the-counter pain medication. If the height or width of the bridge was changed, patients can expect a small amount of bruising under each eye. A small cast is placed on the bridge of the nose and removed in the office after one week.
Revision or secondary rhinoplasty corrects deformities caused by a previous operation on the nose. Dr. Losquadro has extensive experience correcting numerous types of post-surgical deformities including bridges that have been made too low, noses that are still crooked, pinched tips, droopy tips, asymmetries of the tip, and difficulty breathing.
Revision rhinoplasty is a more difficult procedure to perform than primary rhinoplasty for multiple reasons including scarring from the previous surgery and the frequent lack of septal cartilage to work with. When septal cartilage is unavailable, Dr. Losquadro will use ear or rib cartilage to rebuild, reshape, and strengthen the nose.
Rhinoplasty performed on non-Caucasian patients is frequently described as ethnic rhinoplasty. Dr. Losquadro has experience with with Hispanic, African American, Asian, Persian, Middle Eastern, and Indian patients. There is no single ideal nose for all ethnic groups, and each patient’s surgery is tailored to their aesthetic goals and their desire (or lack thereof) to maintain aspects of their ethnic identity.
Septoplasty is a surgical procedure to correct deformities of the septum. The nasal septum separates the right and left nasal cavityand is composed of both cartilage and bone. It supports the nose and regulates air flow; a deviated septum often impairs breathing, increases mucus production, and may cause sinus infections. A septoplasty is often performed in conjunction with a rhinoplasty to ensure proper nasal function.
Septal Perforation Repair
A septal perforation is a hole within the nasal septum, the wall of cartilage and bone that separates the two nasal cavities. The septum helps to support the nose and regulate air flow. Small perforations may not impair nasal function and can often be treated by rinsing with saline solutions. Larger holes may bleed, crust, whistle, and impair nasal airflow; these frequently require surgical repair to restore the normal function of the nasal airway and to relieve symptoms.
Treatment of a septal perforation depends on the size and location of the hole. Dr. Losquadro repairs perforations using the remaining nasal lining via an open rhinoplasty approach. Rhinoplasty can be performed at the same time if desired.
A saddle nose is one in which a weakening or loss of septal cartilage creates a saddle-shaped depression within the midsection of the nose when viewed on profile. Saddle noses result from any condition the weakens or perforates the nasal septum including prior septoplasty, recreational drug use, medical conditions such as granulomatosis with polyangiitis (Wegener’s granulomatosis), and trauma.
Mild saddle noses are only noticeable when looking at the patient’s profile. The tip may start to droop in more severe cases. In the most difficult cases, the tip of the nose turns upwards, the nose shortens, and nasal breathing is pinched off.
Since saddle noses are caused by a lack of septal cartilage, Dr. Losquadro frequently uses rib cartilage grafting to repair these deformities.
Cocaine affects the blood vessels within the nose and repeated use can damage the septum such that a hole develops. If the hole becomes large, it compromises the structural integrity of the septum and the nose begins to collapse. This results in the bridge of the nose taking on a concave shape, i.e. a saddle nose. Nasal function is also impaired as breathing becomes more difficult and mucus production increases. Since the amount of septal cartilage remaining is often inadequate to repair these deformities, rib cartilage grafting is frequently employed by Dr. Losquadro.
Cleft Lip Nasal Deformity
A cleft lip is one of the most common birth defects of the face and is accompanied by a characteristic nasal deformity. The nostril on the cleft side is often wider and flatter then the non-cleft side, the tip is asymmetric, and the septum is deviated resulting in difficulty breathing. Cleft lip repair is often accompanied by minor procedures to reshape the nose, but all patients will require a definitive rhinoplasty when they reach 15 or 16 years of age. Surgical correction often requires cartilage grafting to reshape the nasal framework and create a more symmetric, functioning nose.
Vasculitis Nasal Deformity
Vasculitis is inflammation of the blood vessels. In certain forms of vasculitis, such as granulomatosis with polyangiitis (Wegener’s granulomatosis), the nasal cavity is frequently affected. The cartilage of the nose may become chronically inflamed, which can result in damage the septum and lead to saddle nose deformities. The underlying disorder must be treated medically before attempting surgical correction. Patients in remission from their disorder can undergo rhinoplasty using standard techniques. Additional cartilage grafting from the ear or rib is frequently required.
Nasal reconstruction may be required after the removal of malignant skin lesions on the nose. The method of reconstruction depends upon the size and location of the defect. Deeper defects may compromise the nasal airway if not properly supported, and septal or ear cartilage grafting may be required.