Please visit our Photo Gallery Page for examples of Rhinoplasty
RHINOPLASTY IS ONE OF DR. HUBBARD'S AREAS OF GREATEST EXPERTISE
Double Board Certified in this field, Dr. Hubbard has multiple journal and book chapter publications as well as regional and national presentations on the latest advancements in rhinoplasty. Dr. Hubbard has taught surgeons nationally and internationally on the latest techniques in rhinoplasty and has performed this procedure in 6 countries.
Rhinoplasty is the most sophisticated and demanding of precision of all plastic surgery procedures. Although Dr. Hubbard completed both Ear, Nose, and Throat (5 years) and Plastic Surgery (3 years) training programs followed by another year of cosmetic surgery training, state of the art rhinoplasty requires much more long term dedication than these rigorous programs alone. That is why in 1986, Dr. Hubbard began attending rhinoplasty-dedicated meetings by national and world experts. These are intense symposia covering detailed analysis of nasal shapes, deformities, surgical planning, and execution. By the late 1990's, Dr. Hubbard became an instructor at these meetings and had multiple publications in the field including descriptions of his own advanced procedures.
The rhinoplasty consultation is the first step in the process involving careful analysis of appearance and breathing. Dr. Hubbard will address each of your concerns and will discuss in great detail the surgical options available to you. When appropriate, Dr. Hubbard will use photo imaging to aid in this discussion. Dr. Hubbard's goal is to educate you in the most advanced techniques available in modern rhinoplasty to achieve natural and aesthetically balanced results. Combining artistry and surgery, the nose can be shaped to fit the face.
Rhinoplasty General Information
Rhinoplasty is the surgical sculpting or shaping of the nose that simultaneously maintains or improves breathing. The nose is the most complex structure that is addressed in plastic surgery and the variations in the shape of a patient's nose are some of the most extreme in the body. Further, each patient's desires, goals, and needs are unique. The process of rhinoplasty begins with a thorough discussion of both the patient's motivations and their internal and external nose anatomy. A discussion then follows about what can be reasonably and realistically accomplished. Computer video imaging assists in decision making and communication. Drawing all this information together, a unique plan for the patient's needs is developed using a number of the many hundreds of surgical maneuvers available for the nose.
The demand for precision with this surgery is great as the structures manipulated are among the most delicate tissues of the face. Dr. Hubbard's great interest in rhinoplasty results from time spent as an Ear, Nose, and Throat specialist in the 1980's. It has led to teaching advanced rhinoplasty techniques to other surgeons, multiple journal articles, and presentations in the 1990's. Since 2000, Dr. Hubbard has given two national presentations on nose surgery and has published two textbook chapters on rhinoplasty. The art of rhinoplasty has become a passion of Dr. Hubbard's and has earned him the respect of his colleagues nationwide.
Indications: Unattractive feature(s) of the nose. Nose that does not fit with other facial features or difficulty breathing through the nose.
Intended Results: More attractive shape or size of the nose. Improvement in breathing.
Procedure Description: Anesthesia is either general or local with sedation done on an outpatient basis. Incisions are inside the nose except one that may cross the skin between the nostrils. If nostril reshaping is done another incision may be at the edge of the nostril. The specifics of this procedure vary greatly depending on patient needs. Commonly, work is done on the septum (septoplasty). Breathing can be improved with surgery on the turbinates (swellings on the sidewalls of the airway).
Revision Rhinoplasty: Dr. Hubbard performs many cases that are revisions of rhinoplasty that were done elsewhere. These procedures are highly individualized and vary from small touch-ups to complete rhinoplasties.
Recuperation and Healing: An external splint is in place for one week. If packing is placed inside the nostrils, it is small and light and removed in 1-2 days. Initial discomfort is easily controlled with oral medication. Sutures on the inside dissolve and those on the outside are removed in 4-6 days. One can return to work in a week although some bruising and swelling persist. Almost all bruising is gone at 2 weeks but 20% of swelling persists for 4-6 months and a smaller amount resolves in up to a year.
Other Options: Since the apparent nose size is relative to facial proportions, Cheek or Chin Implants can enhance the result of rhinoplasty.
Insurance Information: All insurance policies vary but if there is a true breathing problem, Dr. Hubbard will attempt to facilitate insurance coverage as much as possible.
Computer Imaging
Computer imaging is the application of sophisticated computer software on a patient's digital photo to demonstrate potential surgical changes. It is an extremely valuable communication tool between Dr. Hubbard and his patients. He personally demonstrates surgical changes so there can be feedback from the patient, and together plans can be finalized. Not all views can be seen on the computer and the computer cannot show the exact surgical result, but the vast majority of patients find this exercise reassuring that Dr. Hubbard has a good idea of what they desire in this surgery.
Revision Rhinoplasty
Revision rhinoplasty refers to redoing cosmetic and/or functional nose surgery after previous unfavorable results. This is a category of nose surgery that is best handled by surgeons with special expertise and considerable experience in rhinoplasty. Dr. Hubbard is referred patients from surgeons in other cities and states for such nose problems. These patients can now benefit from more advanced techniques.
Why is revision rhinoplasty often so much more difficult? There are a number of reasons. These noses all have considerable scar tissue in multiple areas changing the character of the structures. Further, there has almost always been both cartilage and bone removed in an attempt to improve appearance. Often, cartilage must be replaced to overcome the weakness and possible collapse that may have resulted from older aggressive rhinoplasty techniques. Modern techniques involve less removal of tissues so results are more predictable and actually more natural in appearance. The goal is a more attractive nose that does not reveal any signs of prior surgery.
How is revision rhinoplasty performed? It begins with freeing up the old scar tissue and then repositioning the skeleton of the nose - both cartilage and bone. This almost always is accompanied by adding grafts usually of cartilage from the nose, or if necessary, ear or rib. Fortunately, cartilage can be removed from either site with usually no change in appearance. Grafts strengthen weakened areas, straighten crooked regions, and fill in sites that are too low. They even greatly improve breathing in some cases. Grafts are the ultimate sculpturing surgical procedure in all of medicine.
Nasal Stuffiness & Rhinoplasty
Although any rhinoplasty can affect breathing, this should be quite unusual. Often it is improved. I frequently carry out special maneuvers during surgery to maintain breathing as normal or improve matters considerably. Some rhinoplasty maneuvers can double or triple airflow! It is also important whenever a hump is removed from the bridge; to consider adding small pieces of cartilage that maintain good breathing and also make for better long-term appearance! Turbinate (structure that projects from the lateral wall of the nose into the nasal cavity) surgery is easily performed at the same time as rhinoplasty and can permanently cure chronic nasal congestion in many individuals. Always discuss breathing with your rhinoplasty surgeon.
Tip Rhinoplasty
Tip rhinoplasty is an outdated term and outdated concept from over twenty years ago. Back then, surgeons did not recognize two very important tenants about modern rhinoplasty:
1. Any surgery on the tip of the nose is likely to affect other aspects of the nose. Thus, committing oneself to working on the tip alone risks unwanted changes to other parts of the nose.
2. Most "tip rhinoplasty" techniques of the past used destructive techniques that cut, removed, or weakened too much cartilage of the tip. Surgeons found these techniques attractive as they were rapid, but all too often years later these surgeries resulted in irregularities, distortion, collapse, and even breathing problems. Tip Rhinoplasty is rarely indicated anymore.
The Problem of the Nasal Tip Drooping on Smile
In recent years we have greatly increased our knowledge of what controls nasal tip position and why it moves. The nasal tip often moves when we smile but it actually moves throughout our life as the changes of aging involve the nose. Many say the nose grows with age and this is true only in that the tip drops and makes the length of nose greater. The tip drops because supporting structures of it weaken with time. The nose has a powerful muscle called the depressor septi that pulls down on the tip, especially when we smile. Some individuals with a strong depressor septi muscle will avoid a full smile or cover their nose and mouth when smiling.
As outlined in my chapter on controlling the tip and also in my chapter on the long nose, we now have good surgical options to improve this problem with the tip dropping with smile and even with age. Some of these techniques are outlined in my article on controlling nasal tip position and movement. These are ways of holding the tip in a good position reliably after surgery. Further improvement with those individuals that have a strong lip muscle that pulls the tip down is a procedure that specifically weakens only that tiny muscle and leaves the other lip muscle fully intact. This small muscle weakening procedure is easily performed with a rhinoplasty.
Latest Publications
Over the past 6 years, Dr. Hubbard has developed a surgical technique that leads to significantly better cosmetic results with certain nose reconstructions. The details and results of his surgical technique were recently published in Plastic and Reconstructive Surgery, the most prestigious national and international journal of his specialty.
Dr. Hubbard has completed two updated chapters for the second edition of Dallas Rhinoplasty: Nasal Surgery by the Masters, one of the most authoritative texts in modern rhinoplasty.
Please view the photo galleries on the menu bar to see examples of Dr. Hubbard's surgery patients. If you would like to have more information on the many types of nose concerns that rhinoplasty can address, click on the following link to view Dr. Hubbard's website dedicated specifically to nose surgery. http://www.rhinoplastyvirginiabeach.com
Please visit our Photo Gallery Page for examples of Rhinoplasty or click on the following links for information on other procedures.
 Before Rhinoplasty |
 After Rhinoplasty |
 Before Rhinoplasty |
 After Rhinoplasty |
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