WHICH RHINOPLASTY PROCEDURES ARE SUITABLE FOR ME?
The 3 approaches to rhinoplasty are: Non-surgical: using filler, Dr. Rad can make modest aesthetic improvements such as filling in the bridge of the nose or defining tip shape. Advantages: in-office procedure is cost-effective and involves no down-time. Disadvantages: improvements disappear after 6-12 months, and only small improvements can be made. Surgical, “closed” or endonasal approach: using incisions hidden within the nostrils permanent improvements can be made to shape and nasal breathing. Advantages: hidden scars and minimal disruption of tissues lead to minimal discomfort, minimal swelling and congestion, and short recovery (~5-7 days). Disadvantages: none. This technique is state-of-the-art and is Dr. Rad’s preferred approach (read below for more detail). Surgical, “open” approach: using a visible incision across the base of the nose, permanent improvements can be made to shape and nasal breathing. Advantages: improved surgeon visibility of underlying structures – however this is not a true advantage to the patient and is unnecessary to achieve the common goals of rhinoplasty. Disadvantages: aggressive dissection and invasiveness leads to greater discomfort, swelling and congestion, and longer recovery times (~4 weeks).
WHAT IS A NON-SURGICAL RHINOPLASTY?
Non-surgical rhinoplasty is an in-office procedure whereby Dr. Rad injects dermal filler in precise areas of the nose to improve nasal shape and proportion. It is ideal for patients who have volume deficiency in specific areas. The ideal candidate for non-surgical rhinoplasty are those who have a dorsal hump or downward curving shape of the nose and for whom the radix (upper bridge at eye level) is concave. Dr. Rad carefully studies and measures nasal proportions, and he also pays attention to patients’ ethnicities, in order to optimize nasal shape. With topical numbing medicine pain is minimal, no recovery time is necessary, and results are immediate. The results last 6-12 months depending on the filler used and the amount of volume placed. Dr. Rad uses hylauronic acid-based fillers such as Juvèderm, Voluma, Vollure or Radiesse depending on patient characteristics and desired goals.
WHAT ARE THE DIFFERENCES BETWEEN OPEN AND CLOSED RHINOPLASTY?
The open and closed approaches refer only to how the internal structures are accessed. Both are equally effective in allowing the surgeon to achieve patients’ goals. However, there are big differences in scar and recovery. The “closed” approach requires exceptional nuance and skill. Dr. Rad employs the “closed” approach because results are excellent and recovery is minimal. This is in contrast to the “open” approach which involves a visible scar, significant swelling and recovery due to unnecessary invasiveness. In Washington DC, minimizing down time is often as important as the result, and Dr. Rad performs the “closed” approach to achieve natural, balanced results with a fraction of the recovery time. The external scar from open rhinoplasty, while usually not terrible, is still often visible, may require makeup to cover, and may be disconcerting to patients. Additionally, the significant swelling, and thus the recovery time, associated with the open approach is much greater than swelling and recovery after a closed approach. The difference can be 3 to 4 fold. Particularly in Washington, recovery time and social downtime can be as important as the result itself. This is where the closed approach shines: the two greatest advantages of closed rhinoplasty are (1) the limited invasiveness and therefore a quicker recovery for the patient, and (2) the ability to “fine tune” the result. Limiting invasiveness is also advantageous to achieving better results: Dr. Rad can control the external shape better if the nasal skin is disturbed less. Whereas the focus in the open approach is the underlying bone and cartilage, the emphasis in the closed approach is the external shape. After all, what we see on the outside is what matters! The fact that all the incisions are inside the nose does not mean that the surgery is “blind.” Almost every step is still executed very precisely and under direct vision, but the planning and technique are unique. In fact, avoiding unnecessary dissection of the nasal skin is an advantage because Dr. Rad can better assess shape, symmetry and proportion, while avoiding excessive swelling, bruising, pain, numbness, visible scar and extended recovery time as are typical of the open approach.