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Rhinoplasty

  • 1-2.5 Hour Surgery
  • Back to Work: 1-2 Weeks

At our Denver practice, we understand that the nose is one of your most critical facial structures, with respect to both your facial balance, and your airway function. Board-certified plastic surgeon Dr. Paul Steinwald performs nasal refinement surgery, technically called rhinoplasty, to improve airflow (the “septoplasty” component), correct post-traumatic external nasal deformities, and/or improve cosmetically undesirable features of the nose. Often, he addresses several of these issues for his patients during the same surgery.

Because the structures of the nose are among the most complex and delicate of any feature, we take a precise and conservative approach to nose surgery. Rhinoplasty can produce highly satisfying results for those who have long been unhappy with the aesthetics of their noses, or those struggling with breathing difficulties or injury.

Am I a Candidate for Rhinoplasty?

A rhinoplasty is intended to improve the shape and function of the nose. A bump can be reduced, the nasal tip can be refined, and many other concerns can be addressed.

Rhinoplasty incisions are made inside the nostril and, typically, across the narrowest part of the columella between the nostrils. This is what’s known as an “open” rhinoplasty. In exchange for the small external incision, an open rhinoplasty is more precise, and allows more complex maneuvers than would be possible in a “closed” rhinoplasty without the external incision. Once the incisions are made, the bony and cartilaginous framework of the nose is exposed. Cartilage and bone can be removed, reshaped, or added to enhance the nasal form.

Many different techniques exist to reshape the nose into a more aesthetically pleasing structure given the wide variability in preoperative shape.

A rhinoplasty consultation will include a physical exam and computer modeling to illustrate what can be achieved surgically.

Fact & Fiction About Rhinoplasty

Rhinoplasty is considered by many plastic surgeons to be the most challenging operation.

The nose is made up of a mucosal lining, cartilage, bone, and skin. Each of these structures is affected by the tissues adjacent to it, and, in, turn, affects other tissues. Compounding the matter is the fact that the nose is not just supposed to be pretty, it actually has to function. Finally, the aftereffects of a rhinoplasty may not be seen for years. We learned this after watching the destructive rhinoplasty techniques of the 80’s result in nasal collapse over the ensuing 10 to 20 years. Modern rhinoplasty preserves the natural structure of the nose to the greatest extent possible in an effort to provide support for long-lasting results.

You cannot simply choose a nose out of a magazine.

A number of factors influence what might be considered the “ideal” nose for a given individual. Facial shape and size, ethnic background, and the structural aspects of the nose itself all impact the surgical plan. Because of this, patients cannot expect to have a nose that looks like anyone else’s, unless they happened to look a lot like that person in the first place. We utilize the Vectra XD 3-D imaging system to help plan the operation and communicate that plan to the patient. This ensures that patient and surgeon are on the same page, and is the best way to verify that the patient’s expectations are realistic.

Nasal packing is rarely necessary or beneficial.

Many surgeons continue to pack the nose with gauze at the end of the procedure despite the fact that research has shown a lack of benefit and significant risk and discomfort associated with it. We virtually never pack noses after rhinoplasty.

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How to Choose a Surgeon

  • Review many impressive before-and-after photos.
  • Find a surgeon who specializes in cosmetic plastic surgery.
  • Seek a surgeon who upholds the proper credentials.
  • Make sure the surgeon uses only an accredited, state-of-the-art surgical facility.
  • Decide, if upon meeting the surgeon, you make a connection.

Identifying Good Rhinoplasty Results

  • The nose should have a straight dorsum, or perhaps a slight curve, based on patient preference. The bridge of the nose should approximate a straight line in men, and may have a slight, gentle curve in women. The “scooped” appearance of an overdone dorsum is to be avoided.
  • Projection of the tip should be proportionate to the length of the dorsum. In most rhinoplasties, the length of the nose is altered minimally if at all. The projection of the tip off of the facial plane is commonly changed, however, and should be increased or decreased as necessary to achieve classic proportions within a person’s ethnicity.
  • The nose should fit the face and look natural. Above all else, the surgical result should look like it is a nose the person could have been born with. This requires a delicate balance.

Meet Our Surgeons

Board-certified plastic surgeons Dr. Steven Vath, Dr. Andrew Wolfe, and Dr. Paul Steinwald lead our patient-centered practice with warmth, honesty, and respect. Their combined expertise and credentials have placed us among Colorado's premier aesthetic centers.

Rhinoplasty FAQ

Can any cosmetic surgeon perform rhinoplasty?

Rhinoplasty is best left to a board-certified plastic surgeon who specializes in these complex procedures. Many excellent plastic surgeons refer rhinoplasty patients to specialists such as Dr. Paul Steinwald. He is not only certified by the American Board of Plastic Surgery, but has many years of experience with all types of nasal issues.

What is a closed rhinoplasty and what does it correct?

Post-traumatic (or natural) nasal deformities such as a dorsal hump on profile view, a widened dorsal bridge, deviation of the tip or crookedness of the nose in general often require fracture and resetting of the bones and/or cartilage through small internal incisions (a “dorsal rhinoplasty”). Dr. Steinwald then resets the nasal pyramid in a more neutral, cosmetically pleasing position.

What is an open rhinoplasty and what does it correct?

Non-traumatic cosmetic issues of the nose may include several of the aforementioned bony/cartilaginous deformities, as well as tip irregularities such as a boxy, bulbous or asymmetric tip, or irregular or widened nostrils. Correction of these issues usually requires extending the inner nasal incisions across the area between the nostrils via an “open-tip rhinoplasty,” to directly access and reshape the cartilage irregularities (via trimming and/or suturing) that are responsible for the appearance of the lower nose.

Can I have nose surgery to improve my breathing?

Patients who have suffered nasal trauma may have functional issues such as poor airflow or chronic sinusitis. The former is often due to buckling or fracturing of the midline nasal septum, either due to congenital development or following trauma. Resection of a majority of this structure (a submucous resection of the nasal septum, or “SMR”) through small intranasal incisions usually results in dramatic functional improvements. These procedures are usually performed under general anesthesia, with nasal packing removed the next day.

Will I have scars?

If you have a closed rhinoplasty, all your scars are concealed within your nostrils and none are visible. If you have an open rhinoplasty, you’ll have an incision across the strip of flesh between your nostrils. After several weeks of healing, the fine scar will fade and typically become almost undetectable.

Can I combine my rhinoplasty with other procedures?

Yes. Dr. Steinwald specializes in facial plastic surgery and often combines other procedures with nose surgery. Dr. Steinwald can evaluate your features during a candid consultation and make recommendations about any other options that may serve your goals.

Where is the surgery performed?

Our surgeons perform rhinoplasty at Apex Surgical Facility, our accredited surgical center, which is outfitted with state-of-the-art safety equipment and staffed by our experienced team.

What kind of anesthesia is used?

Rhinoplasty typically requires general anesthesia, and takes about 1 to 3 hours depending on the degree of correction. Open tip work alone may be done under IV sedation.

What is the recovery like?

For closed rhinoplasties, an external splint is in place for 4 to 5 days. If you only undergo a “tip rhinoplasty,” bruising is usually minimal and splinting not necessary.

Most discomfort is manageable with prescription and over-the-counter pain medications. We ask patients to keep their heads elevated even when sleeping for several days after surgery, which helps to reduce swelling and bruising. Carefully applying icepacks can also help.

Most patients return to work or other daily activities within 1 to 2 weeks. Many feel well enough to return to work soon but may have cosmetic bruising, depending on the extent of the procedure. After 2 weeks, most of the swelling and visible bruising subside. Some minor residual swelling may persist for many months, and it may take 6 months to a year for final results. Patients can return to light exercise after a couple of weeks and gradually return to more activity after about a month. It’s important to avoid sports or activities that may damage the nose.

Learn More About

Financing Your Procedure

Getting Started

Our rhinoplasty specialist Dr. Paul Steinwald applies techniques that are current yet proven to provide natural-looking results that speak for themselves. To learn what cosmetic nose surgery can do for you, request your consultation using our online form or simply call (303) 278-2600. The Center for Cosmetic Surgery has two offices conveniently located in the Denver metropolitan area. One is located just outside of Denver in lovely Golden, Colorado, immediately off 6th Avenue West and the other is located downtown in Cherry Creek, Denver.

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