Interviewer: What to know if you're considering a cosmetic rhinoplasty. We'll talk about that next on The Scope.
Announcer: Health information from expects, supported by research. From Ï㽶ÊÓƵ of Utah Health, this is TheScopeRadio.com.
Interviewer: Dr. Eric Cerrati is a plastic surgeon at Ï㽶ÊÓƵ of Utah Health that specializes in cosmetic and reconstructive surgery of the face and neck. Dr. Cerrati, when a patient comes to you for a cosmetic rhinoplasty, what are some of the common things that they're trying to address or take care of?
Dr. Cerrati: So usually that's kind of grouped in two to three different categories. The first one is your patient who's never had a rhinoplasty before and is really trying to address maybe some family features of theirs that they want to alter, say like a bump on the nose or a wide nasal base or that sort of thing. The next group is probably someone who has had rhinoplasty in the past and as a result has had some scar contracture leading to some asymmetry, whether it's in the kind of the distal part of the nose or the nasal tip. And then the last group I would say that has . . . after rhinoplasty, you have nasal obstruction that kind of results from that, from the first surgery.
Interviewer: Got you. What about somebody who's just had a nose that's may have been dislocated through, I don't know what could happen, they got hit or something of that nature and now as a result the nose is crooked?
Dr. Cerrati: Oh no, definitely yeah. Traumatic injuries are definitely a common cause for having rhinoplasty surgery.
Interviewer: Got you. So what can you do with this type of surgery when it comes to when a patient comes in? Most of the time are you able to help address their issues, or are there some times you just really can't?
Dr. Cerrati: So a lot of times yes, we can get the symmetry back, get the nose back in the midline, and fortunately form and function kind of go hand in hand. So when we improve their breathing, we also improve the appearance of their nose. But then if it's a purely cosmetic case, where we're really just trying to alter the external appearance, I would say that patients need to be careful, that there are risks involved, and that you're trying to chase the perfect physical feature, it gets very difficult.
There are definitely patients that we tell them that we don't think it's the best idea to undergo surgery. One, if a patient's had a lot of nasal surgery and say that they're missing a lot of cartilage in their nose and would require big reconstructive case, if their nose is functioning fine and they can breathe out of both sides and that's really just a small physical feature that they're chasing, I personally don't think that's a great idea and I would not recommend surgery to that patient.
Another situation where I wouldn't recommend surgery is if a patient has unrealistic expectations or if there's something that I just won't be able to achieve a surgery.
Trusting Your Surgeon's Technique
Interviewer: So what are some of the common questions that you get when it comes to this type of a procedure that we haven't discussed so far?
Dr. Cerrati: So commonly, a lot of patients ask about a closed rhinoplasty or an endonasal rhinoplasty versus the open or external rhinoplasty. Usually patients, by the time that they're considering the surgery, have kind of googled and come across a lot of these terms. Endonasal rhinoplasty, you can address a lot of these features, external appearance, and even function with that approach. Usually when you start altering say the tip or really going for correcting fine asymmetrical issues with the nose, really an external approach gives you better visibility and allows you to really address the problem better.
Interviewer: And the internal one is more useful for . . .
Dr. Cerrati: You can still accomplish a lot of things. It's just harder to get to, say, the tip of the nose.
Interviewer: Got you. And what's the preferred method? Is it the internal version because you have less scarring, or what's the advantage of that over the external?
Dr. Cerrati: So for the patient, really they're pretty equal. It's really surgeon's preference in which way a surgeon's been trained in. Endonasal rhinoplasty was very popular say 10, 15 years ago, and most surgeons were trained that way back then. Now, kind of the external approach, the pendulum has kind of swung the other way and most surgeons now are doing the external approach. For the patient really, if your surgeon is comfortable with either approach, they can get you the same result either way. With the external approach, you do have a very small incision. However, I would tell patients that after two or three months that incision essentially heals and becomes invisible.
Rhinoplasty Recovery
Interviewer: After a procedure, how long does it take to kind of get back to your normal everyday life, go back to work, that sort of thing?
Dr. Cerrati: So I tell all my patients that for the first week really to take it easy. You'll have a cast on your nose. A lot of times you'll have bruising and swelling around the eyes. At the end of that first week, the cast comes off, the bruising and swelling starts to resolve, and probably midway through the second week or the end of the second week you're really back to all your normal activities and feel pretty fine.
Interviewer: And after a procedure, a cosmetic procedure, how long do those results last? You had mentioned that sometimes things can change a little bit after you've had one and you might have to get another one. So explain that a little bit.
Dr. Cerrati: So hopefully the results last a lifetime, especially in the nose when you're addressing the underlying structures. What I see with the revision rhinoplasty is a lot of times if, say the first surgeon takes way too much of the structure of the nose, too much of the cartilage, then over time the nose will start to warp and you'll get scar contracture. And that can lead to asymmetry in the nose and also lead to breathing problems.
Interviewer: And if somebody comes in and they need additional support in the nose, how do you do that exactly?
Dr. Cerrati: So there's a couple different places where you can get extra cartilage in order to rebuild the different areas of the nose. A lot of times the most common is the nasal septum, the cartilage there itself. It's right there in the nose, and there's really no other extra incisions for the patient. Another common one is the ear, which you make a small incision in the back of the ear and really take out the cup portion of the ear. All the external structure of the ear is maintained, so there's no change in the form or the function of the ear. And then lastly there's the option of using rib cartilage. So where your rib comes around and connect your sternum, there's actually a section of cartilage there that can be used to rebuild the nose as well.
Choosing a Surgeon and Asking the Right Questions
Interviewer: And when looking for the right doctor to do a rhinoplasty procedure, that would be really important. I'd imagine there's a certain level of trust that a patient wants because after all it is your face. It's the first thing everybody sees. How do you recommend finding the right doctor for that procedure?
Dr. Cerrati: So I'd recommend looking at your surgeon's training. Being board-certified by the American Board of Facial Plastic and Reconstructive Surgery or the American Board of Plastic Surgery is very important. There's a lot of different paths that people can get to in order to get that board certification. For myself, I did a five-year residency in head and neck surgery, just really concentrating on operating above the shoulders. And then I did an additional year fellowship sponsored by the American Academy of Facial Plastic and Reconstructive Surgery, just operating on the face specifically.
Interviewer: So it sounds like just have a conversation with the doctor you're talking about and just ask them, "What path did you take? What preparation did you use to get here?"
Dr. Cerrati: Absolutely, and ask him how many procedures they do and you'll get an idea of how comfortable they are and kind of what their background is.
Interviewer: Yeah, and then what about the personal relationship? Like if you feel a connection or you don't, is there anything you recommend on that? I know some doctors, if you don't feel the connection with the surgeon, you should maybe look elsewhere.
Dr. Cerrati: Absolutely. I mean, you have to be comfortable. If this person's going to be operating on your face and external appearances, it's very important that you feel comfortable. So no matter how good they are or how good their credentials are, the number one thing is you need to feel comfortable with that person.
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updated: July 17, 2019
originally published: November 7, 2017
