Archive for the 'nose surgery' Category
One of the most frequently confusing issues for patients is the cost of rhinoplasty. Rhinoplasty, external nose reshaping, which is frequently a cosmetic procedure (although not always) is often confused with Functional Nasal Airway Surgery whose onjective is to improve breathing and is often covered by medical insurance.
Th confusion comes in as many patients believe that if they have a breathing problem with their nose that they then can get their reshaping rhinoplasty done under insurance reimbursement. This belief is both inaccurate and fraudulent. Medical insurance may pay for functional nasal airway surgery such as septoplasty, turbinate reduction and repair of nasal vestibular stenosis with cartilage grafts. All of these procedures aim to provide a functional improvement by making one breathe through their nose better. None of these procedures will make any significant difference in the outward appearance of your nose As soon as any procedure is done to change the appearance of your nose, such as hump reduction or tip lifting or narrowing, this enters the realm of a cosmetic rhinoplasty which has no impact on breathing improvement. The only time that any external changes to the nose is covered by medical insurance is if the abnormal appearance of the nose is due to a birth defect (such as cleft lip or palate or other craniofacial deformity) or an accident. (if it is due to an accident, this event must be documented with medical records that substantiate the injury…just saying it happened won’t cut it)
One of the frequent motivations for nasal breathing surgery is to have the nose reshaped at the same time. This is perfectly understandable, achieve two goals at the same time and is commonly done. The rub comes in from a money standpoint. Some patients believe, however, that ‘once you are there doing one thing, you can just the other thing…how does insurance know what you are doing?’ Trust me, they do. The hospital/surgery center knows and I know. It is fraudulent to have your medical insurance carrier ‘pay’ for the cosmetic portion of your nose surgery. In today’s world, the hospital or surgery center knows what is going on in any nose procedure and will ask for payment up front. Any responsible plastic surgeon will as well.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
Rhinoplasty, nose-shaping surgery, is one of the most common plastic surgery procedures of the face. It can have a dramatic effect on one’s facial appearance due to the prominent position of the nose on the face. While rhinoplasty surgery has been performed for over 100 years, modern rhinoplasty techniques create noses that are more natural and can hold their shape over time.
Historically, rhinoplasty surgery was associated with after surgery appearances which were ‘overdone’. This type of reductive rhinoplasty produced noses that were short with up-turned tips(pugnose appearance) and with low bridges. Even if the nose did not appear this way immediately after surgery, this appearance developed months or years later. This nasal appearance was the result of removing too much of the natural structures of the nose. Taking the bridge of the nose down too low (bone and cartilage) or shortening the tip of the nose excessively (all cartilage), while immediately looking good, weakens the support of the nasal framework. Over time, as scar forms and tissues heal and contract, the nose gradually ‘falls’ and assumes an unnatural appearance. It may look too small, too upturned, or too narow and pinched at the tip.
The importance of maintaining as much of the support of the nose is better appreciated today. The nose is like a house, the framework must be maintained to keep the roofline intact. Contemporary rhinoplasty is more of a rearrangement of the framework structures with only small removals of cartilage or bone. In this way, the nasal dorsum (line along the bridge to the tip) remains smooth but at a good height, the end of the nose is lifted but not too high, and and the nasal tip is narrowed but is not made into a single point.
Besides less cartilage and bone removal, the natural rhinoplasty makes use of adding support through cartilage grafts as necessary. Supporting the nasal tip through columellar strut grafts, small hand-carved grafts for better tip definition, spreader cartilage grafts to the middle vault to improve breathing, and adding height at the very top of the nose where it joins the forehead (radix) with small crushed cartilage grafts are some of the ways to help build and strengthen the framework of the nose. These cartilage grafts are usually acquired from the septum of the nose (which may be simultaneously straightened) or from the back of the ear.
Natural rhinoplasty techniques are a combination of preserving critical nasal tissues, skillfully rearranging the different zones of the nose, and the three-dimensional eye to visualize how to get to the final nasal result. It is usually best done through an ‘open approach’ with a resultant indetectable scar across the columella. (strip of skin between the nostrils) Natural noses fit each patient’s face more proportionately and never have that ‘operated’ appearance. While tedious to perform, I find the long-term results rewarding and the need for secondary revisional surgery reduced.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
I came across an interesting blog from Rodeo Drive Plastic Surgery in Beverly Hills California on Google’s blogspot on rhinoplasty. They had entitled their version of a rhinoplasty as ‘Breathe Easy’. This obviously relates to the concern of some patients (although most patients are not aware of this possibility) that breathing through their nose after a cosmetic rhinoplasty may be worse after such a procedure. It is possible that even if you had not problems breathing through your nose prior to a rhinoplasty, you may have some difficulty breathing through it after.
Such potential breathing difficulty after a rhinoplasty is possible because the inside of your nose may be actually smaller after surgery is some cases. When the nose is reduced in size through either a hump reduction or shortening and/or narrowing a wide and long tip, the internal nasal valve angle (one of the most important structures inside the nose that determines who easy or hard it is for you to breathe) may be narrowed or pinched on with these nose changes. A reduction in the opening of this valve angle can have a dramatic effect on your nose breathing.
Fortunately, most of the time, nose breathing is not affected after rhinoplasty. Certain types of patients are very prone to developing this problem, such as a long and narrow nose or when a very broad nose is narrowed. When these types of patients are identified, some changes can be done during the procedure to try and prevent breathing problems after surgery. Cartilages grafts can be done to open up the internal nasal valve angle as a preventative manuever. This is exactly the type of surgical manuever that is done when the purpose of the operation os to treat a breathing problem in which one of the culprits is collapse of the internal nasal valve angle.
While all potential breathing problems can not be 100% prevented or every patient at risk for breathing problems identified prior to surgery, patients can ‘breathe easier’ knowing that such risks have been reduced wh today’s modern rhinoplasty techniques.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.eppleyrhinoplasty.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
Rhinoplasty (nose surgery) is one of the top ten requested cosmetic procedures for both men and women in plastic surgery. The prominence of the nose and its significance to the appearance of the face makes the need for any rhinoplasty surgery to be very precise. Good results in rhinoplasty are dependent upon an understanding of the complex framework of bone and cartilage that make up the nose. Rhinoplasty surgery changes the shape of this framework which is revealed through the overlying skin.
Think of your nose as a house. The shingles are the overlying skin, the framework and timbers are the cartilage and bone, and the drywall the nasal lining. The support that lies underneath the highest roof angle is the septum. (cartilage) What makes anyone’s nose look the way it does, like a house, is a reflection of how the framework is structured and the roof (skin) that drapes over this framework. As plastic surgeons we think of the nose as 4 areas, the upper 1/3 which is bone, the middle 1/3 known as the middle vault which is all cartilage which is straight, and the lower 1/3 or the tip of the nose which is a combination of scroll-shaped cartilages that come together over the septum and is what gives everyone their unique tip shape. (which is the most different between any two people) The fourth area is the skin, which dependent upon its thickness, can show the underlying framework well if it is thin but can hide much of it if it is thick.
When we alter the nose we are changing the way the framework (bone and cartilage) is joined together and is shaped. This could be taking down the height of the roof in one area (that bump on your upper nose), reshaping the tip of the nose (by changing the shape of the scrolled cartilages, breaking the bone along the bridge to narrow the nose (collapsing the walls), or in some cases adding to the roof line with implants or cartilage to raise the height of the roof line.
Due to the complexity of how all of these framework structures come together, most rhinoplasties today are done ‘open’. While this used to be a controversial area (what was known as the most contested 6 millimeters of skin on the body), it is now accepted to produce the best results in most nose surgeries. All that this means is the skin is lifted off of the tip of the nose so all the framework structures can be seen. To no surprise, you can shape better what you can see better. This only leaves a nearly imperceptible scar at the middle of the skin between your nostrils. (known as the columella) This is a very small price to pay for a better rhinoplasty result!
Dr Barry Eppley
http://www.eppleyplasticsurgery.com/
http://www.eppleyrhinoplasty.com
http://www.ologyspa.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis