Rhinoplasty in
Denver, CO

Tip rhinoplasty is a very common procedure in Dr. Shah’s rhinoplasty practice. The tip of the nose can vary greatly from one person to the next. A nasal tip that doesn’t blend into the rest of the nose or the rest of the face can cause visual disharmony. In this day and age of the “selfie,” this disharmony can make your photos unappealing. Nasal tips can be rather bulbous, squarish, round, downward pointing, upturned, pointy, indistinct, shifted to one side and/or elongated. A tip rhinoplasty changes the appearance of the tip of the nose by either adding, reshaping, or removing some of the cartilage of the lower lateral cartilages. Tip rhinoplasty can be performed as part of primary rhinoplasty, but it is often performed just by itself when a patient is comfortable with the upper half of the nose. It is primarily considered a cosmetic operation, but when a previous rhinoplasty turns out subpar, tip rhinoplasty is often necessary to rebuild a poorly supported and functioning tip structure. The physical makeup of the tip itself varies by gender and ethnicity. With ever blending populations, people often come into my office with exotic looking noses that are a blend of their varying ethnicities. Cultural leanings also affect what people might want their nasal tip to look like. Tip rhinoplasty is performed by manipulating the existing cartilage structures. Cartilage grafting from other sources like the septum, ear (concha), or rib may also be necessary to support and define the tip and the nasal valves (internal and external). Tip rhinoplasty may be performed through either the open approach or the closed approach. The open approach, which uses an incision on the skin of the columella (fleshy divider of the nostrils), is typically considered the most accurate method for working difficult tip issues.

A functional rhinoplasty is a nose surgery designed to improve the function of the nose (i.e. the ability to breathe easily) without significant changes to the appearance of the nose. In most cases, however, many patients need a combination of both functional and rrimary rhinoplasty. After all, often times the issues are related. Some signs that you may be suffering from an inadequate, obstructed nasal airway include: breathing with your mouth open, having a difficult time smelling scents, and nasal congestion. If left untreated these symptoms could develop into more serious issue such as: nosebleeds, obstructive sleep apnea, hypertension, sinus pressure headaches, reoccurring sinus infections, and even heart disease.

There are internal and external functional rhinoplasty procedures. External rhinoplasty procedures would be used to improve a nose that is collapsed, pinched, deviated or twisted. In these situations, the general framework of the nose is unsupported or distorted.

Internal functional rhinoplasty procedures, where there are no outer nasal alterations, would include:

• Septoplasty – This is a procedure to correct a deviated septum. A deviated septum is defined by the bending, twisting, or deviation of the cartilage wall which divides the left and right nasal passages so that one or both are blocked. Septoplasty surgically straightens this wall creating much easier air flow.
• Turbinate Reduction – The turbinates are mucous membrane-covered sections of bone which line the entire length of the nasal cavity. There are three sections: superior turbinate, middle turbinate and the last, and most likely to develop enlargement issues which contribute to airway blockage, is the inferior turbinate. A partial reduction of some to the turbinate tissue is all that is required to unlock the air flow.
• Nasal Polyp Removal- Nasal polyps are small, round growths that are benign and can block the nasal passage. These can be entirely removed surgically. They do need to be evaluated by a pathologist as they could contain a malignancy.
• Nasal Valve Collapse- The nasal valve is the narrowest part of the nose’s airway and it’s lined with membrane that are designed to shrink and swell as they regulate air flow. In very thin noses or in noses which have experienced trauma or disease, the nasal valve may actually collapse. Patients with short nasal bones will need middle vault support procedures to correct nasal valve collapse during rhinoplasty surgery.

Rhinoplasty procedures are typically performed in fully-accredited outpatient surgery centers. Dr. Manish Shah uses board-certified anesthesiologists with an M.D. Dr. Manish Shah prefers to use full general anesthesia because he believes it allows for better control of the patient’s airway. This maximizes safety. No one, but Dr. Shah, touches the patient during rhinoplasty. Dr. Shah, though he loves to teach, is the only person who will be operating on your nose. Dr. Shah’s patients typically experience very little bleeding or post-operative bruising. Postoperative nausea and vomiting after rhinoplasty are also fairly rare. Pain control is fairly easily established, and most patients stop their narcotics by their second post-operative day. A patient will rarely wake up with nasal packing. If extensive work is done to straighten a deviated nose, Dr. Shah will often leave temporary internal splints to help mold the airway and insure that breathing will ultimately be improved after the surgery. All patients have an external molding splint left on for at least 7 days after surgery. This helps stabilize the skin and keep any surgically fractured nasal bones in place.

The first week is typically the hardest week for the patient. They will be sleeping with their head elevated. They will be applying ice packs to reduce bruising and swelling. They are not allowed to get their faces wet, so hair washing is a bit difficult to do. Dr. Manish Shah recommends bathing during this first week. A cool mist humidifier at the bedside is very soothing for the face and throat after rhinoplasty. After this week, you will typically have your external splint and any external sutures removed. At this point, you will be taught the second phase of your care. You will be allowed to rinse out your nose with saline spray and use oral decongestants to unclog your airways. You will be taught night-time taping techniques and soft tissue massage to help mold your nose. You will not be able to use eyeglasses, sunglasses, or ski goggles for 2 months to avoid shifting fractured nasal bones. Your nose may swell after the splint is removed, but with time it will decongest. The upper part of the nose settles in after about 3 months. The bones are at their hardest at this point. For the next 5 – 6 months after this, most patients don’t notice big changes. Finally, around 10 – 12 months after surgery, the tip of the nose finalizes its cosmetic outcome. Patients must realize that patience is mandatory because it will be at least 1 year before they see how their rhinoplasty surgery turned out.