The nose is the important central feature of the face and it affects the overall
balance and aesthetic appeal of the face from any angle – full face, profile or
¾ views. Surgery to improve the nose must consider all other facial features so
there is a balance and harmony between them. A small delicate nose on a male is not appropriate –
a larger nose with straight lines and good proportion is preferable. And a
female nose should fit the delicacy of the face as well.
At your consultation, Dr Jacobs will first carefully listen to your desires and goals. He will then examine you and make suggestions for improvement based on his assessment of your nose, your facial features and your desires. He will help you understand the surgery with the aid of diagrams, charts, photos and drawings. Dr Jacobs will bring extensive surgical experience and artistic sensitivity into the discussion so that together a final surgical plan will be adopted. He must understand what you are seeking to achieve and you must also understand what
is feasible to do – ie have realistic expectations. At the end of your consultation, you will have a much clearer idea of what can be achieved so that you can make this very important decision. What is the goal? After surgery, people will say "Hey, you look great!" but they won’t know you had nasal surgery!
A BIT OF HISTORY
Years ago, in the infancy of cosmetic nasal surgery, some practitioners performed only one (and very radical) type of nasal operation. An extensive amount of tissue was always removed and the results were considered "cute" – a tiny, very uptilted nose with a tip that appeared stamped out of an assembly line (i.e. the famous "Goldman tip" and "Diamond tip"). Every teenager wanted one – and they all had look-alike noses!
Today, there is an emphasis on a natural and individual appearance for the nose. From the surgical perspective, it means that only small amounts of tissue are removed or changed – there is an emphasis on preservation of tissue. Great talent and experience is required to determine which tissue to work on and which to leave alone. And precise surgical skill and subtlety is necessary to remove or change those few millimeters of tissue or cartilage which will delicately but effectively change the shape of the nose.
The procedure is usually performed in a 60 – 90 minute operation on an outpatient basis in Dr Jacobs’ fully accredited (by JCAHO) office surgical suite in Manhattan. "Twilight sleep" anesthesia is administered by our Board Certified Anesthesiologist. This is not general anesthesia. You will have no pain and no awareness during the operation and you will be sleeping gently.
Most often, a "closed" technique is utilized, in which incisions are made inside the nostrils and all work performed through the nostrils only. The incisions are closed with dissolving sutures at the end of the operation. On occasion when necessary, an "open" technique is utilized. This requires a small external horizontal incision across the columella (the “little column” of tissue between the nostrils) as well as internal incisions.
During the procedure, Dr Jacobs will alter any or all of the internal support structures – the bones and cartilages – so that they line up perfectly. They are all inter-connected, like a series of closely spaced dominos, so that work on one will affect all the others.
At the end of the operation, some packing will be placed in the nostrils and a thermoplastic splint placed on the nose. The packing will usually be removed painlessly within several days.
WHAT CAN I EXPECT AFTER SURGERY?
There may be a headache on the day of surgery but no pain after surgery! There may be some oozing from the nostrils which will stop in 24 hours. Iced compresses and head elevation is recommended for the first three days after surgery. There may be some swelling and/or bruising near the eyes which will disappear within a week or less. The splint will be removed 5-7 days after surgery. The nose will look nice when the splint is removed but the residual swelling will take about a month to settle down on the bridge of the nose. The very minor residual swelling of the tip may take anywhere from 6 – 18 months to totally disappear and reveal the fine sculpting and shaping that has been done.
You may resume sedentary activities within 4-7 days after surgery and resume strenuous, aerobic activities 3-4 weeks after surgery. Long term, the use of sunblock on the nose is advised for at least six months.
Dr Jacobs will evaluate your entire facial structure with a view towards improving not only your nose but its relationship to other portions of the face. The goal is to blend your nose aesthetically and provide balance and harmony to your facial features. Towards that end, Dr Jacobs may recommend chin enhancement with an implant, liposuction of the neck or cheekbone enhancement with implants. The contour and strength of the chin, angularity of the jawline and nasal profile all combine to effect facial beauty. These will be suggestions only – subject to your acceptance or rejection.
FUNCTIONAL NASAL SURGERY
There are structures within the nose, namely the septum and turbinates, which affect the airflow through the nose. Dr Jacobs will examine the internal structure of your nose at the time of consultation and provide information about possible improvement. Oftentimes, there is blockage of one or both of the nasal passages which results in decreased airflow. Surgery to correct these problems can be performed either alone or in combination with cosmetic nasal surgery. There is no effect on the external appearance of the nose if surgery is performed for functional reasons only.
While there is no insurance coverage for cosmetic nasal surgery, there may be available insurance coverage for functional nasal surgery. Dr Jacobs will discuss this with you and cooperate in obtaining pre-certification for the functional surgery. Please bear in mind that insurance companies oftentimes require extensive x-rays and other tests as well as a six month trial of medications before they may approve coverage for this surgery. In essence, they will do everything they can to delay and/or prevent you from having this operation.
Many patients wish to have cosmetic nasal surgery and yet retain their ethnicity – a real surgical tightrope. Black, Asian and Hispanic noses all have distinctive features which patients may desire to retain. Dr Jacobs will discuss this with you openly and will make every effort to retain the ethnic features that you desire.
CAN I CHOOSE JUST A PART OF MY NOSE FOR IMPROVEMENT?
Yes you can! Frequently a patient will request treatment of a bulbous tip only. Or one may wish to shave down a small bump or reduce some nostril flare. And sometimes one desires to narrow the bony upper part of the nose but leave the tip alone. Dr Jacobs will discuss the pros and cons of your request and together a plan for surgery can be made.
REVISION NASAL SURGERY
Plastic surgery is one of the few surgical specialties where one can get a second chance if the first operation was not totally successful. This is called secondary or revision surgery. That being said, revision surgery is always more difficult and less predictable due to the scar tissue resulting from the original surgery. In essence, you do not have a "virgin" nose. Therefore, improvement and not perfection, is the goal for these operations.
In nasal surgery, revision is even more difficult because it may require replacement of cartilage that was over-zealously removed during the first procedure. This replacement cartilage may come from other parts of the nose, the ears or the ribs. All of this mandates that you carefully choose your surgeon, for the first operation is always the best opportunity to get the best result. Everything after that is playing "catch up."
It is important to inject some philosophy here – which is every bit as important as the hands which perform the operation. There are some operations in plastic surgery where you want to see substantial differences (like making a breast larger or smaller). There are other procedures, such as cosmetic nasal surgery, where subtlety is absolutely essential. The ideal male nose is strong: straight, symmetric, somewhat narrow and not uptilted – definitely not small, delicate and feminine. The ideal female nose is delicate, very slightly uptilted and appropriate for the face. One wants to look normal -- not overdone. In nasal surgery, the difference between success and failure is measured in tiny millimeters of tissue removed or changed. All of this goes towards artistic judgment. You can be assured that Dr Jacobs will bring this philosophy of subtle surgery to the performance of your procedure.
A WORD ABOUT FEES
Fees will vary widely among various surgeons. Talent, skill, judgment, experience and technique also varies significantly between surgeons. Patients sometimes choose the least expensive surgeon only to end up with fair, poor or terrible results – and then have to pay additionally to have corrective surgery, if it is possible at all. Please accept some words of wisdom: when it comes to surgery, like many things in life, you do get what you pay for! The best suggestion is to visit several doctors, check their credentials, review their patient photos and choose the one with whom you feel most comfortable and confident. The fee, while important, should be the least of your considerations.