Open rhinoplasty or nose job plastic surgery

The Medical Director of the Loudoun Center for Plastic Surgery, Dr Michael J Brown MD, presents a nose job plastic surgery. This video presents an overview of what to expect from an open rhinoplasty plastic surgery, or nose job.

Open Rhinoplasty Walkthrough

This plastic surgery video demonstrates an open rhinoplasty and what you see here are two different views of the nose with some markings on it, which I will use during her surgery. When we call it an open rhinoplasty, it means we're actually going to make an incision on the underside of the nose and then we're going to elevate the skin off of the tissues that are underlying. And basically those tissues are mostly cartilage and bone. So these incisions for the most part are all hidden in the nostrils and are not visible. The only incision that is visible is that tiny stair-step incision you saw me make right in the middle of her nose.

So I'll create incisions in both nostrils, connect all the incisions, and then I have to carefully elevate the skin and superficial subcutaneous tissue off of the underlying structures. This is actually one of the most delicate parts of the procedure and that's because the cartilage of the nose or the structure of the nose or framework or the nose is literally right there. So it takes a little bit of time to elevate these flaps. The pencil-like device you see with the red tip is actually an electric cautery. And what that does is cauterize the blood vessels and so it minimizes the bleeding. The metal tube you see is actually a suction device and so it helps suction the blood and it also helps suck the smoke away.

So at this point I've elevated the skin off the cartilage. The cartilage is the tissue that's in the forceps right there and you can see those are what make her nostrils and the skin is obviously being pulled up in the air, so you can kind of get the sense where I've lifted the hood of a car and now I'm kind of working on the engine area, if you will.

So after I've elevated the skin off of the bony structures, then I can start to assess what needs to be fixed. And in this particular patient, she had what we call a dorsal hump, or she had a bump on the side of her nose, which she didn't like and effected her profile. And so she wanted her hump taken down. And so basically what I'm doing now is I'm separating the cartilages away from the midline structure, which is called the septum. And by doing that I'll be able to trim the septum down to give her a different profile.

So the device you see right here is actually called a file or a rasp and it has teeth on it and as I pull away from the patient it actually files that piece of cartilage down. And so this actually takes a little bit of time to do and again for the video this will be abbreviated. And I basically continually file it down and I'll check the top of her nose until I feel like she's had enough of a change and after I feel that the contour has improved and I'll even look at it from the side view to make sure it's down enough.

In this particular patient she needed to have a little bit more taken out on a direct vision and I'm actually using a scalpel blade to cut away that cartilage. And this is the area right above the tip of the nose and this will really help her contour. What you see here is after finishing that trimming, I'm going to change the definition of the tip of her nose. One of her concerns was that her nose was a little too boxy at the tip, and so I'll use these permanent sutures placed into the cartilages of her nose to reshape her nose. And this is actually a pretty delicate part of the operation because the cartilage is very thin and placing these sutures directly where you want them is very important because you really don't want to take them out and put them in, take them out and put them in. But if you have to do that, sometimes you have to do that.

So these sutures will actually bend the cartilages in her nose and truly reshape her nose and I will put these sutures into the same cartilage and they'll actually sew the two cartilages together if necessary. I can actually reshape the nose not only with sutures, but I can use the scalpel to weaken the cartilage in some areas. And then I can actually take cartilages from other areas and sew them to the top of those cartilages to really change the nasal tip. Now this particular patient doesn't need to have any additional cartilage put in and only requires a little bit of tip reshaping and using sutures and then a little bit of scoring of the cartilage with the scalpel.

And so this will really change her aesthetic. Really I can dictate how severe of a change there can be. The majority of my patients really don't want that super dramatic, oh, I've had a nose job look. They're really looking for a refinement of their natural attributes. This is a very pretty woman and she just wanted to have her nose made a little bit narrower and have the profile really improved. So at this point we have done all the surgery on the inside of the nose and I'm going to go ahead and close this wound and I will use dissolvable sutures in a deeper layer. And then I will also use dissolvable sutures inside of her nostrils so that none of the sutures will have to come out. She will have a few permanent stitches placed on the outside of the skin of the nose and those will have to be taken out in the office on about postoperative day number four.

And these just really help align this incision. This is real important because this incision is visual if she was laying down. And so I really like to make sure that over time the scar essentially becomes invisible or very, very difficult to see. Because her nose is a little wide in this area, I'm going to go ahead and narrow her nose and I do this using a device that allows me to actually cut through her bone. And so this chisel, if you will, and hammer are used very delicately and under my feeling of her nose, I can actually feel when I cut through the nasal bone and I can reshape the side or width of her nose using this technique. And so I will do these types of maneuvers on both sides of her nose and then narrow her nose up.

So she's had her nose made a little narrower. She's had the profile improved so that she no longer has the bump and she's had the tip of her nose refined.

Postoperatively she will have a nasal splint put on the top of her nose or the dorsum of her nose and she'll have packing in her nose for approximately 24 hours, at which point she'll take the packing out at home and she'll be able to breathe through her nose fine. This view, you can't appreciate a lot because of the swelling, but it does show that she is narrowed and obviously you can see a significant change on the profile view.