Rhinoplasty / Surgery of the Nose – St. Louis

When addressing surgery of the nose, Dr. Michele Koo, MD, FACS, Board Certified Plastic Surgeon, emphasizes the harmony of the nose with the chin and the remainder of the face.

As one of the most popular procedures in plastic surgery, rhinoplasty is designed to increase or decrease the size of the nose and various components of the nose.

Rhinoplasty is also one of the most technically demanding procedures. I focus on proportional and aesthetic balance to the face when evaluating a patient for nose surgery. I will perform a thorough examination and listen to your concerns and devise a detailed surgical approach based on your desires. I typically make my incisions inside the nose leaving you without any external scars, and can refine the tip and dorsum of your nose to place it in balance with the rest of your face.

I meet with each patient individually to discuss the desired outcome as well as discuss realistic expectations given a patient’s unique nasal structure. Rhinoplasty can be done to correct:

• Nose size in relation to other facial features
• Nose width at the bridge
• Nose profile
• Nasal tip, bulbous, drooping or upturned
• Nostrils that are large, wide or upturned
• Nasal asymmetry and deviation (Septoplasty)

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Rhinoplasty Procedure

Rhinoplasty is performed to reshape, reduce or augment a person’s nose, remove a hump, narrow nostril width, change the angle between the nose and the mouth, or to correct injury, birth defects, or other problems that affect breathing. Results depend on the patient’s nasal bone and cartilage structure, facial shape, skin thickness and age (teenagers should have had their growth spurt), as the procedure can be fully customized for each individual patient. Insurance may cover rhinoplasty if it is done for reconstructive or medical reasons, but likely not for cosmetic purposes.

Nose surgery can be done with a “closed” approach where all of the incisions are internal, or with an “open” approach that also includes a small incision across the columnella (the skin at the base of the nose between the nostrils). While the preferred method is the closed approach since it leaves no external visible scarring, the open approach can often allow for better access to the nasal structures delivering better results.

I use one of the two techniques and makes the necessary incisions to access the inner structures of the nose. Once the incision is made, I gently lift the skin to reveal the underlying bone and cartilage. I gently reshape and contour to the desired contour and then re-drape the skin over the nose. In some cases, cartilage will be grafted from other areas of the body. Most commonly, cartilage is grafted from the septum (the partition in the middle of the nose) and is used to augment the size of the nose.

If the nostrils need to be corrected, incisions are made at the base of the nostril along the natural fold of the nose to manipulate the size. This allows me to change the nostril size and shape while still minimizing any visible scarring.

Rhinoplasty Results

Results from nose surgery can be difficult to see immediately following the procedure due to swelling and bruising, but as inflammation subsides, the results will become more apparent. Most patients will wear a splint for 5-7 days following the procedure. Swelling will generally subside after 2-4 weeks, and most patients can return to light activity after 3-5 days. Patients can resume strenuous activity after 4-6 weeks.

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