What happens during Nasal Surgery?
Rhinoplasty is either performed using general anesthesia or a local anesthetic with IV sedation in a community-based outpatient surgery center. Dr. Velargo uses either a closed rhinoplasty or open rhinoplasty technique depending on your case.
Most of the work is done through the nostrils from the inside of the nose (closed rhinoplasty). A closed rhinoplasty may need to be converted to an open rhinoplasty with a small incision made on the collumela below the tip of the nose. With time, this incision becomes inconspicuous. Usually, a severely deformed nose or cases of revision rhinoplasty dictate an open approach to rhinoplasty. Dr. Velargo will counsel you on the approach necessary during your consultation.
A question often asked by patients contemplating rhinoplasty is: “Do you have to break my nose?” In Dr. Velargo’s technique, he makes an incision into the nasal bones when they need to be repositioned, thereby eliminating the more antiquated technique of “breaking” the bones and resetting them. He feels this technique allows for better control of the operation and reduces the patient’s anxiety about having surgery. Incisions into the bone are necessary to narrow the nose or reconfigure the nasal structure after “hump” removal.
Excess bone and cartilage are removed from the bridge of the nose to remove “humps”. Dr. Velargo takes care to not remove too much, which could damage the nasal structure or create an unnatural scooped-out appearance. When the size of the nose is too large, excess bone and cartilage are removed as necessary.
As mentioned earlier, septoplasty is often performed in conjunction with rhinoplasty. This procedure involves removing the mucous membrane lining from the cartilaginous and bony septum. The deviated or “crooked” portions are identified and removed with care to preserve an adequate amount for nasal support and structure. The excised cartilage is saved for later use as cartilage grafts.
The mucous membranes are then reapproximated and sutured together, eliminating the need for deep nasal packing. This technique has been one of the greatest advances in nasal surgery, reducing much of the undesirable post-operative discomfort that packing has caused patients.
If the nose needs to be enhanced or strengthened, cartilage grafting will probably be used to build up that area. The cartilage can be taken from the septum, other parts inside of the nose, or from the ear. If Dr. Velargo thinks that ear cartilage will be necessary, he will discuss this with you in greater detail during your consultation. Rest assured that your ear will not look different after the operation, and the resulting scar will be inconspicuous. This technique is often used to support the tip, open the airway, strengthen the nostrils, or build up the bridge of the nose, among other things.
If it is necessary to make flaring or wide nostrils smaller, an incision can be made in the crease where the side of the nostril adjoins the upper lip and cheek. Because this is located in a natural body fold, the scar is practically invisible within a few weeks.
If simultaneous Endoscopic Balloon Sinuplasty to open the sinus passages is indicated, a small camera is inserted into the nose, and a balloon catheter is introduced into the main sinus openings. The sinus openings are dilated with the balloon, and the sinus cavities are cleaned and washed out.