Rhinoplasty surgery is one of the most complex procedures a plastic surgeon can perform, because it deals with the most delicate structures of the face. Over the years, many patients have trusted Dr. Edward J. Gross as a specialist in rhinoplasty, also called a nose job, in the Orlando area. Here, we provide answers to some of the most common questions our Orlando patients ask about rhinoplasty.
Dr. Gross is a double board-certified facial plastic surgeon who is committed to patient education. Request a consultation today, or call our office at (407) 333-3040.
How many rhinoplasties, or nose jobs, does Dr. Gross perform each year?
Dr. Gross consistently performs more than 100 rhinoplasty procedures per year, nearly 10 times the average of a general plastic surgeon.
How long does the rhinoplasty (nose surgery) take, and what kind of anesthesia is used?
Dr. Gross performs rhinoplasty in approximately 2 to 3 hours depending on the complexity and the condition of the nose. Rhinoplasty is done under general anesthesia at Primera Surgery Center as an outpatient surgery with at home recovery for 1 week.
How accurate is the computer imaging session?
Dr. Gross has more than 2 decades of experience with computer imaging and approximates his surgical outcomes very closely with those provided on the imager. Barring any unforeseen problems, most patients will be very satisfied with the final results Dr. Gross simulates on the computer imager. Dr. Gross will examine each patient individually and advise each patient about whether their expectations are realistic, based on this comprehensive analysis. These images are emailed to the patient containing a standard disclaimer.
How much does rhinoplasty cost?
At Dr. Gross' Orlando practice, the cost of a rhinoplasty procedure depends on what type of procedure he performs as well as other factors. On average, the cost ranges from $7,500 to $8,500 (surgeon fee only), but your costs may differ. Your consultation fee is put toward the cost of your surgery, which also includes VISIA™ skin analysis, all follow-up treatments for a year, and photographs.
Is financing available for cosmetic rhinoplasty?
Yes. Financing can be arranged through CareCredit®.
Is there a lot of bruising afterward, and how long will the swelling last?
This depends again on how complex the procedure is, but in general most of our patients experience limited discoloration and swelling around the eyes, and this is resolved within 1 week. This is due to the experience and skill of our surgeon. "Delicate care in surgery and handling the tissues gently is critical for rapid healing," Dr. Gross says. We also prescribe homeopathic arnica to reduce swelling and bruising.
I have trouble breathing through my nose; will cosmetic rhinoplasty help my breathing?
Yes, this is possible. The condition described may be associated with a deviated septum or a bent internal framework of the nose. "Most of the time, this results from trauma such as a broken nose, but many of my patients cannot recall an episode where this might have occurred," Dr. Gross says. Another treatable condition is called turbinate enlargement. Careful examination is needed to determine the best course of treatment for each patient. Septal repositioning and turbinate cautery may be recommended. Dr. Gross will correct breathing problems at the time cosmetic rhinoplasty is performed. Keep in mind that Dr. Gross is one of only a very few doctors with dual board certification and training to handle both the cosmetic and breathing portions of your surgery. Although we do not accept insurance, Dr. Gross may advise you on the benefits of correcting your breathing problems during surgery.
Where are the incisions placed during nose surgery?
Dr. Gross places most of the incisions for rhinoplasty hidden in the inside of the nostril. External incisions may be hidden in the creases where the nose meets the cheek. An incision can also be hidden under the nasal tip for open rhinoplasty. This incision heals beautifully, leaving no visible scar.
When will I see my final results from surgery?
It takes most patients about a full year for all of the swelling to subside, especially at the tip. This may take longer following more extensive "tip plasty" with nostril narrowing. Post-op swelling may remain longer for revision rhinoplasty patients or those with previous trauma, thicker skin, or nostril narrowing. However, most patients see immediate pleasing results when the cast is removed at the end of the first week. The typical patient returns to work or school at the end of one week with very little sign of nose surgery. "Remember, 90% of the nose swelling is gone at 2 months, which leaves about 1% reduction per month thereafter (for the swelling to resolve). Be patient," Dr. Gross says.
Will the bump regrow on my nose after my nose surgery?
No, typically the bump will not regrow on your nose; however, we recommend our patients follow strict guidelines to avoid contact sports following surgery and perform compression exercises on the nose to reduce this possibility.
Will I have packing inside my nose?
No. Packing is not required in our center. By not packing the nose, there is far less swelling and discomfort after surgery, which leads to a quicker recovery. Dr. Gross performs cosmetic rhinoplasty with advanced techniques and sutures the internal nasal tissues back in place, which eliminates the need for packing. "Our patients experience minimal discomfort and bruising during their recovery," says Dr. Gross. Arnica is prescribed to our patients to minimize bruising and swelling.
What is tip plasty?
Any modification of the tip of the nose is considered tip plasty. Dr. Gross reshapes, sutures, and trims the cartilage at the tip of the nose for a more refined tip, which is less round or bulbous.Tip plasty is an advanced form of technique in rhinoplasty and requires a great deal of experience and training. Many plastic surgeons don't address the tip because of its complexity and challenges. However, Dr. Gross performs tip plasty on a routine basis as it leads to more harmonious results. This is also where the art of rhinoplasty comes into play, and Dr. Gross has a very keen eye and sound aesthetic judgment when reshaping and balancing the tip. Weak tips, boxy tips, bifidity, droopy tips, and amorphous tips can be improved with these techniques: De-projection, rotation, projection, tip support, grafting, stabilization sutures, cephalic trim, dome binding, de-fatting.
What is Kenalog®-10 and does it help reduce swelling?
Kenalog-10 is a medical corticosteroid used to treat thickened or asymmetrical areas of the nose after rhinoplasty. It reduces inflammation and scar tissue and helps refine the tip. Dr. Gross will usually recommend this at 6 months to a year after surgery, depending on certain factors. It is placed into the skin via tiny injection with a very small needle. Results are seen at 3 to 4 weeks after the injection and last indefinitely. Generally, 2 to 3 injections will suffice.
I have a wide nose. I heard about an osteotomy — will that help? And will you break my nose?
A wide nasal bridge can occur from trauma or more commonly from hereditary features within a family. By performing the needed osteotomies to narrow the bridge, this can be corrected. The nasal bones are carefully reset or fractured in a controlled fashion to close the wideness of the bridge (after the necessary excess bone has been removed). Dr. Gross performs osteotomies routinely in both primary and revision nose surgery and has a great deal of experience with this maneuver. Additionally, a refined and narrowed nasal bridge that matches the tip is aesthetically more pleasing. Controlled osteotomies result in a narrower and straighter nose, which is less traumatic than breaking the nose. Once the nasal bones are cut, they are repositioned, and a cast is applied at the end of surgery. The key here is experience.
What are internal splints and what are they used for?
Internal splints are occasionally placed during surgery to correct a deviated septum or to keep the nose straight during healing. These are made of a thin Silastic® sheeting and are also known as"surfboards." They are removed in the clinic at the 1-week visit.
What are turbinates, and what do they do?
Turbinates are nasal membranes that warm, humidify, and clean the air we breathe through the nose. When they become chronically swollen or congested, the nasal breathing is obstructed. When this occurs, it is best to cauterize and permanently shrink them. Turbinate cautery is performed during rhinoplasty and improves breathing long term.
What is cartilage grafting? Will I need it?
The nose needs structural integrity for proper form and function. When it has been weakened by injury, prior surgery, by hereditary features, or from birth defects, support must be added. This is done by harvesting cartilage from within the nose, or when not available, from behind the ear. Cartilage grafts are then placed to shore up weak areas of the nostril, lift the tip, or open the air passages. They are also used to cushion areas of the nose and to soften any sharp edges. Dr. Gross performs cartilage grafting in more than half of the cases he operates on. "This adds a bit more time and complexity to the operation but results in long-term stability and successful outcomes," he says.
What are compression exercises?
These are fingertip compressions of the nose bridge and tip that are recommended following cast removal. Compression exercises reduce swelling, straighten the nose, and maintain symmetry. They should be performed 2 or 3 times a day for 2 minutes each. Dr. Gross and our staff will review this after the 1 week follow-up visit.
"I prefer individualized treatment of each segment of the nose to give a balanced, refined look without compromising function."