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Nose Surgery - Rhinoplasty and Nasal Airway Surgery
Dr. Kridel's Philosophy on Rhinoplasty
|Dr. Kridel in Vogue Magazine, where he was
the only facial plastic surgeon noted for Texas.
||Dr. Kridel voted top doc for women by H Texas Magazine.
|Dr. Kridel named as a Super Doctor in Texas Monthly Magazine.|
It's not a beguiling feature, the nose.
So, it's not at all surprising that thousands of Americans seek improvements in this prominent feature every year. When your nose is out of proportion with other features, it seems to dominate the scene.
That's why one of today's most sought-after cosmetic surgical procedures is the one that's intended to change the size or shape of the nose.
When you set out in search of information, you may know little more than your goal--to make your nose smaller, narrower, or wider. And it's absolutely true that these are realistic goals--certainly, a good facial plastic surgeon can straighten a crooked nose, eliminate unsightly humps, reshape the tip, and improve the angle between nose and upper lip. Furthermore, if you're having trouble breathing, he can perform reconstructive procedures inside your nose to enhance airflow.
In planning this type of surgery, Russell W. H. Kridel, M.D., Houston's premier facial plastic surgeon, will study the contour and shape of your face, your skin's texture and thickness, and your other features. Once he has done this, he'll have in mind a nose that suits your face and balances with your features.
Do you know why a perforated septum is difficult to repair? Find the answer to that and more in the section below.
Questions & Answers
What is a rhinoplasty?
If you want your nose to look and or function better, an experienced surgeon can accomplish this by doing a rhinoplasty (also called a 'nose job'). Deformities inside the nose can impair breathing and cause headaches or sinus trouble, but Dr. Kridel can operate on your nose to correct such problems.
He may remove excess bone or cartilage during nose surgery, or he'll augment areas of the nose that lack enough bone or cartilage. Afterward, he will reshape and rearrange remaining tissue and cartilage, fixing external and internal deformities.
On occasion, patients will bring in a movie-star photo to show Dr. Kridel the kind of nose job they want. But, it's important not to confuse nose surgery with the act of shaping clay or PlayDoh. In performing a rhinoplasty, Dr. Kridel is working with set criteria--the contour and shape of your face; the texture and thickness of your skin; the inclination of your chin, lips, and forehead; the depth of angle between forehead and nose; your height; and the way your tissue heals.
Sometimes during rhinoplasty, he will suggest correcting a receding chin at the time of nose surgery to provide harmony of the facial features (see section on Chin Augmentation).
In the case of a nose that's very crooked or one that has been injured, a second nose procedure may be necessary six months to a year later for further refinement.
What should I expect?
- You will have incisions. In some rhinoplasties, Dr. Kridel places all incisions inside the nose. In other cases, he must make external incisions, which he painstakingly hides in natural folds or inconspicuous areas.
- Don't worry about pain. With the anesthesia and surgical methods used today, pain and discomfort are rarely problems.
- Do expect some swelling and bruising. But, Dr. Kridel's techniques keep swelling and bruising to a minimum.
- You'll be discharged from Dr. Kridel's office facility to rest at home the day of surgery. If you choose to have your surgery in the hospital, you'll probably go home the day following the procedure. Be sure to abide by the detailed instructions you are given for care of your nose during postoperative healing.
- The days of painful "packing" are long gone. Dr. Kridel doesn't usually "pack" the nose after surgery, which provides a more comfortable postoperative period with reduced swelling. He will place splints of soft material inside your nose to hold the newly repositioned tissue in place. About seven days after surgery, he will remove your nasal dressings.
- You can return to work or school a week after surgery. By then, your nose will look good (and it will continue to improve over months to come until you see the final result "settle in" after about a year).
- Observe temporary restrictions on physical activity.
- After he removes your dressings, return to the office for post-op visits so that Dr. Kridel can monitor your progress.
What if I had a nose job long ago, and I never liked it?
Then you need an expert in "revision rhinoplasty." If you don't like the nose job you had, a redo is often a good solution. And while you're at it, choose a surgeon who is known for doing more revisions than anyone else in Houston.
A well-known and highly respected authority on nasal surgery, Dr. Kridel often lectures on revision rhinoplasty, and he even edited a textbook on this subject (he wrote three chapters for the book). Dr. Kridel is a popular presenter on all aspects of facial plastic surgery.
"Looking at the psychological aspects of revision nose surgery," says Dr. Kridel, "I've found that one of the problems is not that something was technically wrong with the first surgery but that the doctor actually failed to understand what the patient wanted. They didn't communicate successfully."
Usually, someone who wants a revision is a patient who has never been happy with his results or who has had a hard time breathing ever since he had nose surgery. Also in need of revision work are noses that healed in an irregular manner and overdone noses that have an operated look because too much was removed.
Why are revisions so difficult?
" The goal with a revision is improvement rather than perfection," Dr. Kridel points out. "People need to understand that secondary (revision) rhinoplasty is harder to perform than the first time around. Prior to any surgery, there are layers of tissue planes that have natural separations between the different types of nasal tissues, and as the surgeon operates, he can easily dissect or separate the layers to get to different structures. After a first surgery, though, these planes no longer exist, making any subsequent surgery more difficult." He adds, "It's almost as if someone has put glue into the nose because the skin is stuck to the cartilage and to the bone."
Dr. Kridel explains that if the problem with your previous nose job is that you don't think enough was done--a lump remains or it's irregular, for example--this will be easier to correct than nose surgery that removed too much. "It's easier to take away than to add," says Dr. Kridel.
On the other hand, if your nose is too small, too short, turned up, or pinched, a revision will be more difficult . "Natural structures and especially shaped tissues may have been removed and will need to be replaced with grafts from elsewhere," Dr. Kridel explains. "These grafts must be molded to take on not only the shape but also the function of the previously removed tissue."
Despite the difficulty of revisions, patients usually benefit, especially if their expectations are realistic. "Few surgeons like to do secondary rhinoplasties because these are so technically difficult," says Dr. Kridel, who does revisions on patients who have been referred to him by doctors all over the world.
If you're stopped short of seeking a second nose job by the memory of having your nose packed after surgery, you'll be glad to hear that today, Dr. Kridel uses only minimal packing because he makes the stitches inside your nose. Pain isn't a problem because procedures are much improved over those used in the past.
Dr. Kridel often does revisions to correct a dysfunctional airway --in other words, the person can't breathe well. This can result from a problem that existed prior to your first surgery or one that came from having your nose changed. If your nose was made smaller or the tip drooped after surgery, you may have more trouble breathing than you did before.
What is required in such cases can be correction of a deviated or crooked septum (the partition between the nostrils), and trimming of your turbinates (structures deep inside the nose on the sides). You may also need a graft to resupport the tip.
Although you may have already had surgery on your septum, a revision septoplasty may be necessary to improve your breathing. Dr. Kridel must enter scar tissues, which makes this a difficult procedure.
Even more serious is a septal perforation or hole in the dividing partition. This can happen after previous surgery; signs are bleeding, crusting, nasal obstruction, and drainage. A perforated septum is hard to repair because it represents not one hole but three--a hole through the septal cartilage and a hole in each side of the membrane that covers the septum.
If your first surgery roughened the tissue lining in two opposing or touching areas--and these later healed together--it may have formed a scar band or web, and the upshot is that this has left your nasal airway blocked. In a case like this, Dr. Kridel must open the web and place thin, soft plastic sheeting in the nose to prevent the web from reforming. (This sheeting is left in place for about three weeks after surgery.)
Although revisions are hard to do, new techniques make the operations more exact and predictable, which means results are far better than in the past. Dr. Kridel performs about 200 nasal surgeries each year, and about 30 percent of these are patients whom other doctors have referred for revisions.
What are some of the reasons why people have nose surgery?
"If your nose doesn't fit with the rest of your features, if it's too big, too long, too wide, humped, or hooked, it may affect your self-image, hurting your self-confidence," explains Dr. Kridel, who spends much of his time working with that individually distinctive anatomic mold of bone, cartilage, and skin that not only gives you a sense of smell but also acts as the air passageway for breathing.
Your nose is the focal point because it's the mid-face feature, Dr. Kridel points out. "So, whether it is dainty or grandly proportioned, straight as a model's or crooked as a prizefighter's, it's the center of all attention that people pay to your face. That's why its aesthetic appeal is important."
By the same token, it's no fun to have breathing problems, which can make you listless and miserable. Fortunately, both appearance and function can be fixed simultaneously.
What kind of nose is in style today?
So, what's the right nose for you? Styles have changed over the years. The '50s-era turned-up nose (a' la Debbie Reynolds) is no longer in vogue. Today, people want a nose that looks natural. Men usually seek a stronger-looking nose, and women ask for a nose that is feminine and fits their overall appearance.
Each year in the United States, hundreds of thousands of people have nose jobs. They are all ages, 14 to 75; they have different goals--improved breathing or a better appearance or both; and they come from all walks of life, blue collar to homemakers to CEOs. "Recently, a 25-year-old patient of mine told me that her only regret was that she waited so long to have it done. She told me it made a huge difference in her life."
The patient said, "I went from being shy and unsure of myself to having lots of dates and modeling jobs. The funny thing was, my nose had bothered me since I was nine, but it took me quite a few years to get up the courage to see a doctor."
What is a septoplasty?
SEPTOPLASTY AND TURBINATE SURGERY are types of functional surgery to correct chronic breathing problems caused by structural abnormalities inside the nose. Some patients are primarily interested in improved function because they are tired of not being able to breathe well. While Dr. Kridel is improving the nasal airway, he can make subtle changes in the appearance of your nose. Tell him what you want, and he'll explain to you what is "doable."
One doctor recommended septorhinoplasty to me, so what does this procedure entail?
SEPTORHINOPLASTY is a combination of functional and cosmetic procedures that will simultaneously improve breathing and appearance. Often, a large or misshapen nose hides an interior that is equally irregular.
What happens when I go in to have nose surgery?
Typically, nose surgery takes about two hours and requires light anesthesia. Dr. Kridel will make incisions inside the nostrils, leaving no visible scars outside the nose. In some cases, he makes a small incision or two in the natural creases along the sides or base of the nose. These heal quickly and become practically invisible.
After surgery, the doctor puts a small plaster cast on your nose and places a small dressing inside. If extra support is needed, he may use plastic splints (to be removed in 10 days). Few people complain of pain or discomfort with nose surgery. If necessary, you can take pain medication. Because the tissues inside your nose are swollen, you should expect to breathe through your mouth for about two weeks. Black eyes aren't uncommon for several days. Although some swelling lasts for weeks, you'll see a dramatic improvement in your nose soon after surgery. As the swelling subsides, your nose will look better and better. In about three months, the final result will be apparent. Caveats:
- For six weeks, don't wear eyeglasses without using a special eyeglass support of suspending them with tape. Wait two weeks before resuming most normal activities--three weeks, before exercise. If you're into contact sports, diving, and weight-training, delay these for six weeks.
- If you need to take a trip, it's okay to fly a week after surgery.
Why is it important to choose a surgeon who does nose surgeries frequently?
Dr. Kridel does nose surgery on about 200 patients a year, but many doctors rarely perform such surgeries. That's why it's important to ask the surgeon you're considering how many he does . If he does one or two per month, you should definitely compare his results with those of a doctor who does nose surgery frequently.
Look at before and afters of nasal surgeries he has done. To make an educated decision, you need to see results from previous surgeries. Remember that any plastic surgeon can do nose surgery, but not all of them can do it well.Dr. Kridel specializes in this procedure and has spearheaded many innovative nasal techniques. For that reason, he is invited to lecture on the subject at courses and meetings attended by his peers. Furthermore, his outstanding results and techniques draw doctors from all over the world to study with him ( 22 have done fellowships in Houston under Dr. Kridel).
It's extremely important to choose your plastic surgeon carefully. As a facial plastic surgeon who is also board-certified in otolaryngology, Dr. Kridel does facial work exclusively, giving him extensive experience in facial procedures such as nose surgery. He understands not only aesthetics (the way the nose looks) but function, too.