Rhinoplasty In Michigan

“Closed” Rhinoplasty—a rare art in the modern world  
An experienced plastic surgeon’s viewpoint by
Dwight V. Galloway M.D.

Rhinoplasty, or cosmetic nose surgery, is one or the first plastic surgery
operations, started over one hundred years ago by Dr. Jacque Joseph in Berlin. He
was well known and many came to learn from him but he was very secretive and did
not show what he was doing or explain it. Although the techniques are now well
known “closed Rhinoplasty” is still an art and must be learned over many years after
being taught by an expert. Most present surgeons use the open technique as it is
much easier to understand even though it takes almost twice as long to perform,
often gives an operated look, and leaves much more scar tissue in the nose. I was
taught the closed technique in residency at the UCLA medical center in the 1960s
when that was the standard method. This leaves much of the delicate tip structures
and the character of the nose intact and addresses only the undesired
characteristics. For severely twisted and deformed noses (like with cleft lip patients)
the open technique is well worth the problems and I use it for them. Both the open or
closed technique can be done either under local or general anesthesia and I have
done well over 500 under local anesthesia. However with the present medical
system in either the hospital or surgicenter, the price and risk is the same for general
or local anesthesia so now you will have no pain and less anxiety and I can
concentrate only on the operation without worry that I am hurting you. My intention is
to change what you do not like about your nose so the final result will look natural
and not like a “nose job”.

Rhinoplasty if considered one the most difficult operations to master and there is
a whole society of “experts and learners” that meets at most of our national meetings
where only that one operation is discussed year after year. Many text books have
been written on the subject. The steps of the operation are not hard to teach or learn
but deciding what to do and how much in each nose, takes about 5 years to learn.
The biggest problem is that you need to reexamine enough patients after about
2 years to see how the skin, bone, cartilage and scar have healed and matured
in relation to what you started with and what you did. The other factor to consider
is that it is well documented in the literature that about half of the rhinoplasty
candidates have a fixation on their nose and correcting the physical part of the
nose does not eliminate the way they feel about themselves. If you decide to do

rhinoplasty you have to accept the unhappy patient even when you think you have
done your best. Most plastic surgeons just “do not do noses”. The other half with the
improved self-image and happy smile makes it all worth it, at least to me.

The nose is in the center of the face and there is no way to hide it. The most
common complaints are (1) the hump, (2) the bulbous and wide tip, (3) too big and
(4) the tip “pulls down when I smile”. Some are so self-conscious they cover it with
their hand or do not smile and stay away from social situations. Curing that is what it
is all about.

After the surgery there will be a tape and aluminum splint on the nose for about a
week to hold the bones, cartilage and skin in place until they are stuck together. It
takes about 16 days for the bones to get solid and I have you push them together for
about 3 weeks to be sure they do not spread apart. You will be instructed how to do
that on the day the splint is removed.

I take many before and after photos to help me decide what to do and record the
results at various stages after surgery. I usually use the computer and Photoshop to
help me decide how much to take off and change the angles and do a “choice 1” and
an overdo “choice 2” to emphasize what I am proposing, so that you can have some
input into my decision, and also to follow-up at 2 years after the operation when the
final result is achieved. About 10 percent of noses, like most cosmetic operations,
could stand a revision when fully healed. Sometimes it is the patient and sometimes
me that feels a further touchup is warranted. But you never know if you don’t look
and good photos are a must. Healing and judgment are not always perfect and if a
second operation can make a significant improvement the time and effort to check
and get the photos is worth it. The nose and the chin are related to facial balance but
I do very few chin implants initially since fixing the nose is usually enough.

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