Would you like to improve your nose by giving it a more desirable shape? Do you find your nose to be too short or long, lacking a nasal bridge, or too wide? There is a solution to help you improve your profile.
What Makes Dr. BYUN’s Rhinoplasty Approach Different?
World famous plastic surgeon Dr. BYUN, an architect of beauty, is an expert in hiding all incisions and sutures. All incisions are made inside of the nose and along the nasal area. Dr. BYUN can use your own cartilage for projection and height. Often times, a reduction/addition of the tip in height and projection will make your face more balanced. The corrected tip will be more proportionately appealing. Dr. BYUN also uses a personalized approach, which means your rhinoplasty will be specific to you, addressing your detailed concerns and solutions. Dr. BYUN’s rhinoplasty technique varies and depends on the anatomy, as well as the patients’ goal. However, for the last 25 years, Dr. BYUN has only been utilizing Closed or Preservation Rhinoplasty Techniques. A good rhinoplasty is when the nose becomes part of your face. Your new nose should disappear right into your pretty face, complimenting your other features, and not taking away from them.
Open Versus Closed Rhinoplasty
Rhinoplasties are one of the most complex procedures that plastic surgeons perform. It improves the position of oversized, crooked, or asymmetrical noses, and refines specific features of the nose like the nasal bridge, nostrils, or tip. Rhinoplasties can also help the patients ability to breathe.
Plastic surgeons can perform a rhinoplasty two different ways: the Open Technique and the Closed Technique. Though the open and closed approaches are similar, they differ in how the surgeon accesses and exposes the nasal framework (e.g., the bone and cartilage of the nose). This important distinction affects the ease of the procedure and the quality of the result. Each approach has its own set of advantages and drawbacks.
To help you become more informed about the available rhinoplasty options, Dr. Michael BYUN breaks down the differences between open rhinoplasty and closed rhinoplasty here.
Open Technique Rhinoplasty is performed through a small incision across the columella, the strip of skin separating the nostrils. The nasal skin is carefully separated from the underlying bone and cartilage before making the necessary surgical modifications. Visible scarring across the columella is possible with open rhinoplasty. However, as long as the incision is precisely planned, and the patient takes good care of the incision, and the incision heals well, scarring across the columella should fade significantly over time. Once the scar has completely healed, it should be barely visible. The biggest benefit to an open rhinoplasty pertains to the surgery itself. An open technique allows great visibility for the surgeon and access to the structures of the nose that need to be reshaped.
Closed Technique Rhinoplasty, is performed through incisions created within the nostrils. No part of the incisions can be seen externally. Because the incisions offer less exposure and access to the underlying bone and cartilage, closed rhinoplasties require a particularly experienced plastic surgeon with a specific skill set. As stated earlier, there are no visible scars from closed rhinoplasty because the incisions are hidden within the nostrils. In addition to no visible scarring, closed rhinoplasties can result in slightly less swelling after surgery than open rhinoplasty. These are also a few of the reasons why skilled plastic surgeon Dr. BYUN always performs a Closed Technique.
This phrase has become very popular over the last few years, but Dr. BYUN has been doing it for the last 25 years. This technique is very intricate, and requires a lot of skill. Similar to the Closed Technique Rhinoplasty, this technique does not peel the skin off of the nose. It is also done via small incisions inside the nose, rather than outside. The bone of the nose is isn’t shaved either. When the bone is shaved, irregular swelling usually occurs. With the Preservation Technique, a softer nasal contour is made by removing the structures under the nasal dorsum (the bridge of the nose). This improves nasal projection, achieving the desired results of the patient.
Whether you undergo an open or closed rhinoplasty, it is important that you feel completely confident in the expertise and skill of your surgeon. You can rest assured that you are in good hands with Dr. BYUN. Recognized as one of the leading plastic surgeons in Chicago, Dr. BYUN is extremely talented and respected. He would be happy to explain your rhinoplasty options during an in-person consultation. Contact our plastic surgery practice to request a private consultation.
Rhinoplasty Procedure Details
We have provided a sample copy of an Operative Report. The procedure is subject to change per the patients needs.
Patient Case Study
PREOPERATIVE DIAGNOSIS: Nasal Asymmetry
POSTOPERATIVE DIAGNOSIS: Nasal Asymmetry
OPERATION: Rhinoplasty, infracture of the nasal bone through a silicone augmentation and the spreader graft, the lower lateral cartilage through the intranasal closed technique.
INDICATION: The patient is ___ year old male who once to improve the nasal features. He has a slightly bulbous tip with a low dorsum and then a wide spreading nasal bone.
After induction of local anesthesia in a supine position, the patient was prepped and draped in the usual sterile fashion. 5 ml of 1% Lidocaine with epinephrine was injected to the area and a throat pack and nasal pack were utilized. Intracartilaginous incision was made bilaterally intranasally where the subperiosteal dissection was done along the nasal bone. Using the Converse scissors, the tip of the nose was also dissected retrograde from the incision where the customized soft silicone was inserted to the dorsum of the nose. The strut was also intruduced in between the medical crura of the lower lateral cartilage where 1.5 cm with the 0.5 small strut was insterted to give him better projection. Infractures were done bilaterally using the 3 mm osteotome with the fenestrated technique and the ostectomy was performed with good hemostasis obtained. The nasal symmetry was good where the supratip and infratip break angle was acceptable with good increase in height which balances his face well and this was closer to the size that we discussed prior to the surgery. The incision was closed using 4-0 Vicryl. Good hemostasis was obtained. Aquaplast was applied to stabilize the infracture. He was extubated and transferred to the Recovery Room in good standing.
Gauze packing in the nose can be removed after 24 hours by gently pulling it out, unless instructed differently by Dr. BYUN. Avoid hanging your head forward. Do not remove any cast or tape on the surgical area. These will be removed by Dr. BYUN at your post operative check up. Cleanse any uncovered incisions 3-4 times a day using clean gauze soaked in saline water. (found at your local pharmacy). If you do not have a cast and only bandages covering your nose then it is acceptable to get your face wet, but avoid doing so if possible. If there is a cast, do not allow the cast to get wet.
You must not blow your nose for two weeks. You may gently clean just inside the nostril with a moist Q-tip and saline water. If you have to sneeze, do so with your mouth open. Bruising alone the lower eye area is expected and is normal. Do not wear eye glasses or sun glasses until after receiving permission from Dr. Byun. Failure to adhere to this precaution may result in adverse effects following surgery.
What Is The Recovery Time For Rhinoplasty?
Many sutures inside the nasal are dissolvable. Some sutures will be taken out during your one week follow up. You may endure some swelling, which will decrease 100% in 4-6 weeks. You will experience some redness, bruising, and minimal pain for about 8-10 days. Although, you may return to work 2 weeks following the date of the procedure.
Why Choose Dr. BYUN For Your Rhinoplasty? What To Expect When Working With Dr. BYUN?
A Rhinoplasty may be right for you if you are dissatisfied with the appearance of your nose, or have breathing difficulty due to the structure of your nose. If you have a realistic expectation of what modern surgical techniques can do and are excited to share your vision in a collaborative partnership with your doctor, then Dr. BYUN is the right surgeon for you. Not only is Dr. BYUN a Board-Certified Plastic Surgeon, but he also knows that achieving beautiful, satisfying results require listening closely to the patient, and matching their expectations with realistic outcomes.
Am I a Candidate for a Rhinoplasty?
Rhinoplasty may be right for you if you are dissatisfied with the appearance of your nose, have a realistic expectation of what modern surgical techniques can do, and are excited to share your vision in a close collaborative partnership with your doctor. Dr. BYUN knows that achieving a beautiful, satisfying result requires listening closely to the patient, and matching expectations with outcomes.
What Can a Rhinoplasty Change?
Rhinoplasty is effective at addressing a wide range of cosmetic concerns and medical issues. The profile of your nose can be changed dramatically by making it smaller, larger, narrower, more symmetrical, or simply more aesthetically pleasing. The tip and nostrils can also be resized. Conditions such as a deviated septum, injury or problems breathing through nasal passages can also be addressed. Sometimes the most noticeable change results from a subtle surgical modification. That is why extraordinary skill and a meticulous attention to detail are essential traits in any plastic surgeon performing rhinoplasty.
Is a Rhinoplasty the Same For Male and Female Patients?
In general, men seek a more prominent nose, and women a smaller and more refined version. Some of this has to do with basic anatomy. Women’s features and bone structure provide the skeletal context for a petite nose. The prominent chins and more expansive facial dimensions of men make a longer, larger nose feel at home. Male noses tend to feature higher bridges, larger nostrils and thicker skin. Female noses typically have a delicate slope from the bridge and a slightly greater upward angle at the end.
These are characteristics that patients usually want to enhance, rather than reverse. For example, men may want to highlight straight, sleek lines, while female patients routinely prefer to accentuate naturally graceful arcs and inclines, along with a subtle upturn of the tip.
When it comes to the actual surgical procedure, these gender differences are mostly irrelevant. The thicker skin of the male nose slightly affects healing, but surgical techniques are the same for men and women.
What Other Variables Need to be Considered for a Rhinoplasty?
Very thin skin is not well suited to hiding the underlying structure of the nose; grafts and changes to the bone may be visible. Conversely, very thick skin may not be sufficiently elastic to conform to the sleeker profile of a smaller nose. If you have had a rhinoplasty before, the earlier reshaping of cartilage and bone, along with the accumulation of scar tissue, will make the surgery more challenging.
Age is also a factor. Physiologically, surgeons are able to perform successful rhinoplasties on males around the age of 16 and older, and females by about age 15. Psychologically, it is prudent to wait longer to allow time for greater emotional maturity. In cases of medical necessity, however, a procedure to address a serious functional impairment should be performed as soon as practical, whatever the age of the patient.
At the other end of the age spectrum, changes in skin, cartilage and even the way your body heals are correlated with aging, and are complicating variables to consider. By age 60, optimal rhinoplasty outcomes are more difficult to achieve. The ideal age for the procedure ranges from the late teens through the early 30s.
Should I Consider Rhinoplasty Revision?
Patients who had a disappointing experience with rhinoplasty often turn to Dr. BYUN to achieve the desired aesthetic result. The first step in the revision process is to wait until swelling has subsided. This will require several months. Only then will you be able to observe the final result, as inflammation distorts the appearance of your nose and surrounding tissue. Tissue is also less likely to heal properly when it is inflamed.
In general, Dr. BYUN suggests that a patient waits at least a year after the initial rhinoplasty before undertaking a revision. This waiting period can be longer for patients with thick skin, or it can be much shorter for patients whose nose suffered serious deformities in the original surgery, such as twisting, pinching, collapse or retraction. This type of structural damage may actually worsen with time and become harder to reverse the longer revision surgery is delayed.
What Is The Recovery Time For Rhinoplasty?
Most of the time, sutures are dissolvable. However, if they are not, the sutures will be removed at the 1-week follow-up appointment by Dr. BYUN’s nurse. You can expect to have swelling and bruising. Most of the bruising will be gone after 1 week and swelling decreases significantly in 4-6 weeks. You may return to work 1-2 week(s) following the date of the procedure.
What Are The Details Of A Rhinoplasty Procedure?
Rhinoplasties are performed under local or general anesthesia on an outpatient basis (meaning patients go home the same day). Recovery takes about 4-10 days, during which the patient should avoid unnecessary facial movements, limit talking, and only eat soft foods. Tape will be in place for 1 week, but sutures won’t be removed as they will dissolve internally (sometimes, non-dissolvable sutures need to be placed, in which case they will be removed at the 1-week follow-up appointment by Dr. BYUN’s nurse).
Why Are My Results Uneven?
Post-op asymmetry is NORMAL. Pre-existing asymmetry will continue since the human anatomy of left vs. right does not always match. Human tissue is naturally asymmetric. For Rhinoplasty, nostrils can be different since the base of the bone (Premaxillary Bone) projection is different.
Will I Be In Pain?
You will not feel anything during the procedure, since anesthesia will be used. However, after the anesthesia wears off, you will feel some pain and discomfort. It is highly recommended that you start off taking Extra Strength Tylenol, every six (6) to eight (8) hours, alternating with Motrin. Please DO NOT MIX pain relief medications together at the same time. If you are experiencing a higher level of pain, please take the prescribed pain medication (Norco, or other prescribed pain medication).
How Long Does The Recovery Take? When Can I Go Back To Work & Exercise?
Depending on both the surgery and your own physiology (your body’s healing), most patients have a downtime of two (2) to three (3) weeks before returning to daily activities such as exercising. During the first ten (10) days, we ask that you do not do any activity that increases your heart rate. This is to help the healing process, since the blood clot that has stopped the bleeding from the surgery dissolves in about seven (7) days. After ten (10) days, increase activity by ten percent (10%) each week as tolerated. Stop activity if you see a dramatic increase in swelling when you wake up the following day. At the one (1) week post-op visit you will be provided with healing instructions and what specific activities are allowed. Patients can usually return to work after one (1) week.
What Does The Healing Process Look Like?
Bruising, Swelling, and Stitches (which can pucker) are all NORMAL. Tissue firmness is NORMAL. Your body may not heal symmetrically, meaning one side may take longer to heal than the other, this is NORMAL. Any previous asymmetry may remain.
Why Are My Results Uneven?
Post-op asymmetry is NORMAL. Pre-existing asymmetry will continue since the human anatomy of left vs. right does not always match. Human tissue is naturally asymmetric. This applies to Breasts, Face, Eyes, and even the Nose.
Why Is My Swelling Lasting Longer On One Side?
This is very common. The function of your Lymphatic System (which acts as a highway of Arteries, Veins, and Lymphatic Channels) is to filter out fluid from particular areas of the body. Lymph Nodes, Bone Structure & Tissue Shape are different from right to left, so when it comes to draining, the “clearance rate” of the swelling is also entirely different on each side. The heart is located on the left side of the body and distributes blood throughout the body using different paths & pressures. The drainage of the heart is not completely linear; thus, another reason why Lymphatic Clearance is different on each side.
How Soon Can I Take A Shower?
We recommend waiting forty-eight (48) hours to shower. Make sure you are steady on your feet. Do not soak the incisions and pat them dry when done.
Can I Get My Sutures Wet?
After forty-eight (48) hours, stitches can get wet. It is highly recommended, however, that only normal saline (over-the-counter medical cleaning solution) is used to clean the stitches. DO NOT use any cleansers or alcohol products on the suture site. Picking or pulling at the sutures is not approved and can cause damage. Pat the sutures dry if need be.
How Often Can I Apply Heat And Cold Packs?
Hot packs are NOT recommended due to a side effect of increased inflammation which can further delay the healing process. However, cold packs are recommended with frequent usage in fifteen (15) minute intervals.
What To Do If I Become Constipated?
Reduce Norco usage, walk around, and take an over-the-counter medication like Colace or MiraLAX. It is recommended that you start using an over-the-counter stool softening medication one (1) day before surgery and continue taking it until you no longer need to be taking Norco for pain.
How Soon Can I Get On A Plane?
Every case is unique. Typically, short distances (short domestic flights) are okay. However, we recommend that you wait until you see Dr. BYUN’s team at the one (1) week follow-up appointment for final approval. Please keep in mind that extra swelling can occur due to pressure changes in the plane.
Post Operative Information & Care for Rhinoplasty
MEDICATIONS TO HELP WITH NAUSEA
ZOFRAN (or OTHER ANTI-NAUSEA MEDICATION): Take one (1) Zofran tablet (or other anti-nausea medication) as prescribed on your way home from surgery.
MEDICATIONS TO HELP WITH INFECTION
KEFLEX (or OTHER ANTIBIOTIC MEDICATION): Start the antibiotics as prescribed (make sure to consume food when taking any antibiotics as it can cause nausea). It is crucial to complete the ENTIRE course of antibiotics.
MEDICATIONS TO HELP WITH PAIN
TYLENOL & MOTRIN: Start with two (2) extra strength Tylenol (take every 6-8 hours). You may take Motrin instead of Tylenol if preferred. Do not take Tylenol and Norco within the same 6-8 hour window. Taper off medications as tolerated.
NORCO (or OTHER PRESCRIBED PAIN MEDICATION: If pain is not controlled with extra strength Tylenol or Motrin, take one-two (1-2) tablets of Norco instead (take every 6-8 hours). DO NOT DRIVE if you’re taking Norco as it can cause drowsiness and other side effects. Norco has Tylenol in its composition – AVOID TAKING NORCO WITH TYLENOL and/or MOTRIN in the same 6-8 hour window.
METHODS & MEDICATIONS TO MINIMIZE BRUISING AND SWELLING
ARNICA TABLETS & BROMELAIN (over the counter): Take one (1) week before and continue for one (1) week after surgery.
ICE THERAPY: Fifteen (15) minutes on, fifteen (15) minutes off. Icing is most important in the first forty-eight (48) hours post-surgery. Icing will still be effective after that forty-eight (48) hour period and is still recommended.
COMPRESSION: Firm but gentle wrapping with ace bandages.
METHODS TO ENHANCE RECOVERY
PROTEIN INTAKE: Protein can be ingested in any form; powder, shakes, bars or foods high in protein.
HYDRATION: Increase water intake (i.e., Pedialyte hydration packets to put in water) & Electrolyte drinks (i.e., Vitamin Water).
CLEANING WOUNDS TWO (2) to THREE (3) TIMES A DAY: Not cleaning enough can cause infection while cleaning too much can take away good, healing tissue and prolong recovery.
MINIMIZE STRESS: Stress leads to inflammation and can delay healing.
METHODS TO DECREASE NAUSEA
HYDRATION: Hydrate the day before with clear fluids. NO FOOD or WATER 8 hours prior to surgery, but you may hydrate before the 8 hours
MEDICATIONS, CHEWS & FOODS
Take anti-nausea medications (Zofran, or other prescribed anti-nausea medication).
Try ginger candy or a flat ginger ale drink.
Avoid strong scents and smells, or food odors.
Eat slowly and in small portions.
Do not lie down flat after your meal for two (2) hours.
Return to normal foods slowly (please refer to the steps below):
- Start with CLEAR LIQUIDS (water)
- Move into a SOFT DIET (applesauce, pudding, etc.)
- Return to a REGULAR DIET
IMPORTANT: A full diet can be introduced ONLY when the others are successfully tolerated.
IMPORTANT: Start with room temp food – the hot temperature of the food may cause nausea.
ACTIONS TO AVOID AFTER SURGERY
AVOID HEAT THERAPY: Heat expands the tissue and can ruin the surgical work.
AVOID TOO MUCH ACTIVITY: Increasing heart rate and blood pressure can worsen swelling and fluid build-up.
AVOID MASSAGING THE SURGICAL SITE unless told to do so by our medical team.
AVOID TAKING BANDAGES / ACE WRAP(S) OFF: DO NOT remove bandages until after forty-eight (48) hours, or as instructed by our medical team. If ACE wraps are not worn correctly, original surgical results may not be maintained.
AVOID LAYING ON ONE SIDE: Laying on one particular side can cause an increase in swelling on one side of the body, can worsen asymmetrical appearances, and delay the healing process.
ON THE WAY HOME: Take anti-nausea medication.
UNTIL ONE (1) WEEK FOLLOW UP: Start antibiotics (take with food like yogurt / applesauce / crackers) and start pain management.
PAIN MANAGEMENT OPTIONS
Tylenol Extra-Strength & Motrin: 1-2 tablets / capsules, alternating every 6-8-hours.
Intolerable Pain: Norco, or other prescribed pain medication (take with food and as directed).
DO NOT drive. DO NOT mix Norco with Tylenol and Motrin. Norco can slow down digestion, take with stool softener.
Start stool softener as directed: Colace, MiraLAX, or fiber supplements.
Apply Ice to and around the surgical area.
MONITOR SWELLING: The first three (3) days are the worst. The swelling subsides in four to six (4-6) weeks.
Start foot exercises – ten (10) times every hour, this helps to prevent clots.
Start breathing exercises – ten (10) times every hour, take a deep breath in, hold for ten (10) seconds and exhale.
Perform these exercises at your own pace, helps prevent lung collapse and pneumonia from general anesthesia.
IMPORTANT: If you have the urge to vomit / sneeze / cough let it out.
IMPORTANT: If you’re continuously vomiting, call the office.
All incisions are inside of the nose and along the nasal area.
After surgery, you will have a splint, tape directly onto the skin, and possibly gauze inside the nostrils.
You may remove the gauze inside the nostrils by gently pulling it out. DO NOT remove the tape directly on the skin and the splint.
CARE WITH SPLINT ON
Clean the nostril rim with Q-tip and saline.
Apply a small amount of Bacitracin/Neosporin inside the nostrils.
*Splint stays on for 7 days, or until really loose. It will be removed by our nurse / doctor in the 1-2 week follow-up appointment.
ONCE SPLINT DRESSING IS OFF
Use brown steri-strips tape to:
- Apply tape along the swollen areas.
- Apply tape to tip of nose to bring tip up.
- Apply tape on the face to isolate the use of the upper lip.
*See below for a photo demonstration on taping.
Pinch & mold, thumb underneath with index finger to mold the tip sharp.
No pulling down on the upper lip for at least 3 months (as it pulls the nasal tip down).
Leave a little space between upper & lower lip to prevent use of the upper lip.
WHAT TO AVOID AFTER SURGERY
AVOID Moving Upper Lip Muscle as this pulls the nasal tip downward.
AVOID Bending Over and Strenuous Activity for at least 2-weeks.
AVOID the use of a straw / spoon – prop up the upper lip with your finger.
DO NOT make “O” or “Too” sounds with the mouth.
AVOID wearing clothing that needs to be pulled over your head.
AVOID fully closing the mouth – keep lips slightly open, relax oral muscles and press tongue on the pallet.
AVOID refraining from Yawning / Sneezing: let it out! Do not hold it back, because straining can undo the work.
AVOID Bending & Lifting heavy objects for 2 weeks.
*Dr. BYUN and his team will advise you on when you may resume activities.
*Activity can increase your heart rate which disrupts the healing process.
*Do what feels comfortable. If it hurts, STOP!
Be Kind to Yourself and Trust the Healing Process
SWELLING is part of the healing process, as you heal, you will notice a reduction in swelling.
BE PATIENT it may take up to 6 months to see any results.
BLEEDING within the first 24-48-hours is NORMAL. If you’re bleeding after 48 hours, apply pressure and call our office.
BRUISING can appear away from the surgical site, this is NORMAL. It will change colors as it heals.
PAIN will lessen as time passes, and much of this muscle ache goes away within 1 week.
NO Exercise or Increasing Heart Rate – you can return to exercising / activity after the 3rd or 4th week, with Dr. BYUN’s clearance.
1-WEEK FOLLOW UP APPOINTMENT
The nurse will remove anything adhering directly on the skin (i.e. tape) and teach you how to re-tape to ensure correct muscle memory as you heal. We will assess the area and remove any sutures, if needed.
UNTIL FULL RECOVERY
Puckering / Wrinkling / Elevations At Incision Areas are NORMAL and they will go away as you heal.
Sensations / Numbness / Tingling are NORMAL because of new nerves awakening after repair, it may take up to 6 months to return.
Bruising is NORMAL. It will change color from purple to shades of green & yellow. It can take 2-3 weeks.
The purpose of this document is to demonstrate how to tape the nose and face after a Rhinoplasty procedure. Taping the nose and face is an important part of the aftercare and healing process and ensures for everlasting beautiful results.
(colored tape is for demonstration purposes only, steri-strips are tan colored)
Step 1: Cut one steri-strip tape in half.
Step 2: Use one of the cut strips and place it under the tip of the nose.
Step 3: Gently bring the ends of the tape up onto the sides of the nose, bringing the nose tip upwards. Press and hold the ends to secure the skin.
Step 4: Use an uncut steri-strip and place it on top of the tip.
Step 5: Gently bring the ends over the first tape and press and hold to secure it.
In The Media
Six things to be aware of before going under the knife.
Dr. Michael BYUN is a serious doctor with seriously comprehensive experience unlike many of his peers, setting him heads and shoulders above the rest.
Chicago magazine profile of Dr. BYUN.