Rhinoplasty Beverly Hills, CA (Nose Job)

It is generally advised that rhinoplasty not be performed on younger patients until the nose and face have nearly completed their growth. Additionally, the emotional maturity of the individual is a very important factor and this must be assessed by Dr. Frankel.

The consultation will include in-depth discussion about your desires regarding your nose. A detailed medical history with emphasis on nasal function and an examination will follow. Computer imaging will be used to aid in communication and offer them the opportunity to have input into their aesthetic goals. A detailed explanation of the surgical process, acute post operative period, and the long term healing will also take place.

Your rhinoplasty will most likely be performed at the Lasky Clinic Surgical Center, which is situated within the same building as Dr. Frankel’s office. On rare occasions surgery might be done at a hospital or another facility if specific situations require so.

Incisions are made either within the inside of the nose or both inside of the nose and one small one under the tip of the nose. The skin is then separated from the underlying bone and cartilage, which is then sculpted to the desired shape. The skin is redraped over the new framework and the incisions are closed.

Rhinoplasty generally takes between one and two hours to complete.

Incisions may be solely confined to the inside of the nose, which is referred to as closed rhinoplasty. Sometimes an additional small incision under the tip of the nose is also required, which is referred to as open rhinoplasty. Open rhinoplasty may be preferred in some cases if it can provide better exposure and an overall better result. Other cases, however, can be performed with closed rhinoplasty.

Surgical incisions will results in scars. However, for closed rhinoplasty the incisions are confined to the inside of the nose and result in no visible scarring. Open rhinoplasty includes an additional small incision under the tip of the nose which will result in a well-concealed, fine-line scar that will fade with time.

Patients may experience some discomfort during the first few days after surgery, but this can be controlled with prescription pain medication.

You must have a family member or friend drive you home on the day of surgery.

It’s best to have a family member or friend accompany you home or to your place of recovery for the evening.

Patients are typically able to return to work within one to two weeks after rhinoplasty.

To prevent bleeding and increased swelling, avoid extreme physical activity, including athletic activities and intercourse. After 24 hours, you are encouraged to go for light walks and strolls. Light cardio, such as an elliptical machine or spin bike on a low resistance can begin on post-operative day seven (7). Do not engage in any heavy cardiovascular activity (running), any activity that involves straining (weight lifting) or anything that involves bending over (yoga, pilates) for at least three (3) weeks, unless otherwise instructed.

The stitches are typically removed within six or seven days after surgery.

Insurance typically does not cover rhinoplasty procedures performed solely for cosmetic purposes. In cases where breathing problems are being treated, some degree of coverage may be provided.

Yes, we offer financing for surgery. We accept Care Credit, Alphaeon Financing, and VISA and MasterCard.

It is important to avoid taking certain medications, vitamins and herbs two weeks prior to your surgery, as some medications may cause you to bleed more than normal. A list of these will be provided by our Patient Coordinator.

It is usually necessary to remove tissue to shorten a nose. Tissue removed may include cartilage or internal lining. There are specific instances when a nose can be shortened by changing the shape of the tip cartilages, rather than removing anything to rotate the tip up.

Yes, that is quite common.

Nasal packing is simply used to minimize bleeding or dripping from the nose after surgery. It is also helpful in compressing the internal tissues to prevent collections and swelling. Packing is generally comprised of a soft absorbent material or strips of gauze. Dr. Frankel rarely uses nasal packing, but occasionally will use stents, which are firm pieces of silicone, to stabilize the internal structure of the nose and prevent internal adhesions from forming.

Swelling is a normal and expected part of the healing process, and may take 18 months. Usually, the acute swelling subsides and the nose begins to look normal within three weeks. With time, the nose becomes thinner, smaller and more refined at the tip, as the edema resolves.

I cannot speak to how other doctors operate on noses. I am a very experienced and versatile rhinoplasty surgeon and have a multitude of techniques to draw on to accomplish my goals. Sound surgical techniques are published and available to all surgeons, yet very few study all of them and utilize them. I pride myself on being able to adapt and utilize whatever maneuvers are necessary to reach the desired final outcome.

When a long nose is shortened the rhinoplasty usually changes the way it looks from both the facial profile and the front.

While computer imaging can be employed to photos sent via the internet and communication can be productive, it is always relevant to examine the patient to determine the specific characteristics of the skin, cartilage, bone and other related features.

Revision rhinoplasty is the process of improving on the aesthetics and function of a nose that has already been done. I can almost always help these cases, even after several prior rhinoplasties.

Before/after photos should reflect multiple views of a patient, not just a single angle. I usually don’t take photos for six months but I prefer to wait for one year to see the final result.

Noses that are twisted can be straightened by a variety of maneuvers, including breaking the bones and re-setting them, straightening the cartilage, applying sutures, and camouflaging things with grafts. Sometimes a combination of these procedures is necessary to achieve a straight nose.

There is usually very little post-op bleeding from repair of a broken nose.

I have my patients wear a splint or cast for six days.

Although it becomes more and more difficult to repair a nose that’s been broken several times, it can be done.

Correction of a bulbous tip is very common, and requires a great deal of pre-op planning. There are many ways to deal with the bulbous tip, and the way I choose will depend on factors that relate to what the underlying cause of the problem is. I often remove some cartilage, cut and re-connect cartilage, as well as use grafting techniques, along with sutures, to achieve my goals.

Ultimately, the question of balancing the nose with the other facial features is one of judgment, and each surgeon will have a slightly different aesthetic sense. There are never any guarantees the patient will love his/her nose, however with the use of computer imaging, I can discuss this more fully with each patient ahead of time in an attempt to understand what he/she hopes to achieve.

Not all rhinoplasty involves breaking the nose and there are many instances in which I do not need to do this. I only break the nose when it is essential to obtain the proper balance or result that the patient requests.

When a bump is removed or made smaller, there typically is no persistent pain or tenderness in the area after healing is complete. On occasion, people may have some sensitivity, but those are rare cases.

The term finesse rhinoplasty refers to a situation in which the patient needs only a very minor or subtle change to refine the nose. Whether or not someone is a good candidate for such a procedure depends on how much the patient thinks such a change would benefit him/her, how confident the surgeon is that he/she could execute such a result, and what the risk/benefit ration is to doing so.

I prefer not to perform computer imaging over the internet if I have not yet examined the patient. There are just too many factors that would be assumed, and it may be a worthless endeavor or even one that is inaccurate.

While the mechanics of the surgery may be the same for men and women rhinoplasty, the aesthetic goals are very different and so the two operations are inherently different from the start.

If I consult with a patient and we have a disagreement about what should be done, how to accomplish our goal or what is possible, then I prefer to refer that patient to another surgeon who may be more appropriate for that particular patient. I will not operate on this patient because I feel he/she may not be content with the result, even if I do my job well.

A droopy nasal tip needs support and often times projection. There are a myriad of ways to provide these things and the ultimate choice depends on various other factors about the nose and the patient’s desires.

When fixing dependent (droopy) tip, the columella needs attention because if it is not considered, it may become more visible. It is usually quite straightforward to adjust things to compensate for excess columellar show, it just cannot be forgotten.

The nasal tip will only look different if it is changed during surgery. Not all rhinoplasty involves manipulating the tip.

I am a board certified Facial Plastic and Reconstructive Surgeon, and my training and experience have prepared me to be a good judge of facial aesthetics overall and how the nose balances with respect to the other features.

Yes, we offer financing for surgery. We accept Care Credit, Alphaeon Financing, and VISA and MasterCard.

A tip plasty is when the entire procedure is limited only to the nasal tip. There is no bony work or other manipulation. A finesse rhinoplasty just refers to a case where the changes are very subtle. A tip plasty is usually a type of finesse rhinoplasty.

It is not always necessary to break the nose to remove a hump, though it usually is. The breaking of the nasal bones should be an irrelevant point to the patient, since he/she is not going to feel it or suffer as a result. It is just another part of the surgery, and the surgeon should not be limited by a patient request to not break the nose. There is more post-operative bruising and swelling from this maneuver, but that is the only difference.

Straightening a twisted nose is difficult and often requires multiple different things be done to achieve the desired result. It is never determined until the case is being performed as to just what will be needed to fix the problem.

Increaing tip projection does not result in any added scarring or any scarring at the nostril rims at all.

Flat noses generally require that cartilage be added to them to build them up and to increase projection. Narrowing the nose also gives the illusion of it not looking so flat. I almost always use the patient’s own tissue (ear cartilage, rib cartilage or septal cartilage), but occasionally I will use a synthetic implant.

All patient information is private unless I have written position to discuss it or show it.

I will never operate on any patient unless I have previously met with them in consultation. Any surgeon that would do so is suspect.

If the procedure is for functional improvement and medically necessary to correct a problem, then insurance can be applied. We often work with insurance companies in these instances, and they usually require that we pre-authorize the case with them beforehand.

Whenever a graft is used in rhinoplasty, there is potential for visible or palpable irregularities, usually at the edges. This is especially true for grafts on the nasal dorsum because the skin is thinner in this area. I do my best to thin the grafts, soften them and bevel the edges, and sometimes I may use other techniques, such as covering a graft with soft tissue, to make it blend in. If such issues exist, then some fine tuning may be necessary to correct it.

A bump on the nose may be the result of trauma or just because the nose is shaped that way. There are some subtle differences in treatment of these two entities, but they should both be amenable to correction.

I often perform chin augmentation at the same time as rhinoplasty. Oftentimes, it is necessary to use a chin implant to correctly balance the way a nose looks on the face. Sometimes, I am able to leave a stronger nose by using a chin implant. Chin implants are extremely powerful in achieving facial harmony, and they are relatively easy to perform, low risk, and can always be removed if the patients don’t like them.

No, after healing, you should not have a visible scar after rhinoplasty.

To widen a narrow nose, there are several procedures that I perform, including lowering the profile, rotating the tip, placing spreader grafts, out-fracturing the nasal bones, and using onlay grafts. The procedures I use depend on the specific nose.

A nose that sticks out too far is overprojected, and there are number of ways to bring it in closer to the face. When the tip is deprojected, I must also bring down the profile to compensate and keep the nose balanced.

Lengthening a short nose is very difficult, but it can be done by using a patient’s own cartilage to elongate it, or by creating the illusion of length with various maneuvers. It is more difficult to lengthen a nose that was shortened as a result of prior surgery than one that is naturally short.

To narrow a nose, I often fracture the nasal bones and bring them in. I also occasionally narrow the middle part of the nose by removing some of the nasal septum or upper lateral cartilages. The tip cartilages can be narrowed by removing cartilage or by using sutures to change their shape, and the base of the nostrils can be narrowed by removing some soft tissue. Occasionally it is necessary to build up the height of the nasal dorsum to make the nose look narrower.

When an overprojected nasal tip is deprojected, the nostrils will automatically change orientation. There are a number of ways to deproject a nasal tip, and this can be done equally well via an endonasal (closed) or open technique.

If the end of your nose points upward, it can be re-oriented to point forward by using sutures to change its shape or grafts to elongate it. Sometimes, removing some septum or membrane can also accomplish the same goal as well.

Pug noses can be fixed by using various techniques that strengthen and elongate the nose, as well as those that increase nasal tip projection. This is a common problem that should respond well to advanced rhinoplasty techniques.

A revision rhinoplasty is a secondary operation that serves to improve upon or correct problems that still remain after prior rhinoplasty. I have performed many revision rhinoplasty operations on patients who have had five or six prior nasal surgeries. I find revisions more technically difficult, but also more rewarding for myself and the patient.

Children who have yet to fully mature may be adversely affected by a rhinoplasty because their faces have yet to become fully developed and may continue to change. In this scenario, the rhinoplasty yields a result that may initially look good, but not as the jaw bone grows or other facial features change. Additionally, the nasal septum serves as a secondary growth center for the mid face and it may be impacted by surgery, interfering with mid-facial development (although the recent science on this suggests it may not be so important).

No, more of your nostrils will not be visible from the side after rhinoplasty.

There are different ways of taking down a bump on the nasal dorsum. It can be rasped or filed down, which can be done manually or with a power tool. It can also be removed with an instrument called an osteotome, that is like a chisel.

I perform over 95 percent of my rhinoplasty operations in my office at Lasky Clinic. We have a fully accredited outpatient surgery center and use excellent, top quality anesthesiologists who are very accustomed to working with me on a daily basis. This relationship between anesthesiologist and surgeon is very important in creating trust, and results in a safer, more efficient operation, as well as a more comfortable experience for the patients.

Whenever a rhinoplasty is performed, it will result in swelling that takes many months, if not a year to go away.

If a patient has a very narrow nose, but also has a very thin face, then it may be advisable to forego nasal surgery. This is a very important point, as the nose must balance with the other facial features and it must fit into context of the rest of the person.

If someone has already had several rhinoplasties, and he/she is are still unhappy, the nose may still be able to be fully corrected. This necessitates finding the right surgeon and allowing him/her to carefully examine you and create a surgical plan. There are cases that should be left alone, but these are the rare ones. In my experience, I usually can improve the nose, and the post-operative course is usually easier for these patients than their prior surgeries.

Surgery that involves the nasal tip must be done with precision and foresight as to what the effects of healing will be. Wound healing and scar contraction often impacts the way the tip heals and, as such, these need to be considered when operating on the tip.

Swelling post operatively often stays longer at the tip because it is the most dependent (lowest) part of the nose, and also because the skin there is thicker. Additionally, I rely on the healing process to help create the desired tip shape, and this process takes time.

My office has several arrangements with nearby hotels whereby we can get a discount for patients. These hotels are all nearby and at various price points.

If a patient is traveling to me for surgery and will be flying, then I advise he/she stays for at least 9 nine days. The reason for this is that the cabin pressure on planes will cause swelling to occur, and the nose will then take longer to acquire its desired shape. Rarely, this may impact the final result. There is no medical risk to flying earlier, and often patients do it and I have seen no ill effects thus far, but ideally I would have them wait.

If a patient has any acute problems after rhinoplasty that need urgent attention, they would occur within the first week. Otherwise, the problems that develop over time are less in need of immediate attention and can be addressed by me at a later date or via the internet with correspondence. If a patient requires a medical visit, I will contact a colleague in the patient’s vicinity and have him/her evaluated.

If the nose is twisted at the lower part, it implies that the cartilage is misshapen. This may be due to the septum or the tip cartilages, and generally can be straightened with good results.

Nostril asymmetry is extremely difficult to fix, especially if it is due to congenital factors where the nostril attaches to the face. Asymmetries that result from tip cartilage variability are less difficult to repair.

A good surgeon will take into account all of the views of the nose when operating to keep it looking natural and balanced.

All medical information is kept private and no unauthorized person is allowed access to it whatsoever.

Noses become twisted from a variety of causes such as trauma or tumors. Oftentimes the nose is injured when someone is very young or even at birth, and only becomes curved as that person ages and the cartilage bends more and more. Cartilage tends to distort more with age and the soft tissue support diminishes. Certain people have larger nasal septums and occasionally they are too large for the soft tissue envelope that encloses them which results in a twisted or curved nose.