Rhinoplasty surgery is the facial surgery that Dr. Moss performs most frequently. For patients considering rhinoplasty, Boston Plastic Surgeon, Dr. Richard A. Moss suggests that patients also examine their chin. Rhinoplasty patients also find that the visual prominence of their nose is often affected by the weakness of their chin.

When someone has an aquiline nose, i.e., a nose that is downward turning like an eagle’s beak, together with a weak chin, correcting both problems can give a result that is very much better than could be achieved with either procedure alone. An example of a patient with this problem is shown below. This combined surgery is done as an outpatient basis under general anesthesia (you’re asleep) and takes about 2 1/4 hours to complete.

The chin implant is done first since, because the implant is a foreign body, it is very desirable to minimize its exposure to air. The surgery is done through an incision that is beneath the chin. The implant is made of solid silicone and comes anatomically shaped. After it is placed on the front of the jaw, it is pinned into position with titanium screws. This is done to prevent later migration of the implant. Titanium is used so that should special radiological studies be required for any reason in the future (usually unrelated to the surgery), i.e., CAT scans or MRI’s, titanium will provide the least interference with those studies.

The incision for the rhinoplasty is usually made transversely through the columella, e.g., the tissue separating the nostrils. When the bump on the nose is small, it is reduced using hand rasps; when the bump is large it is done with electrically powered rasps. The nasal bones are then broken so they can be moved into proper position. Very often when the chin is increased in size, less has to be removed from the nose. At the end of the procedure a nasal cast is placed. The nose is not packed.

In the post-operative period, there is remarkably little pain. The cast and any external stitches are removed about 5 days later. Most people are able to drive after 3 to 4 days and can return to work after 10 to 14 days. It is important to understand that the result will not be final until one year from the surgery.

Dr. Moss has also found that for many of his breast augmentation patients in Boston, rhinoplasty surgery is a popular addition. Many of these women, who are young and in shape want to make an improvement in both their body and facial appearance. This combination makes a lot of sense in light of the fact that on a national basis, breast augmentation and rhinoplasty surgery are the two most popular cosmetic surgery procedures in the United States.

Learn More About Nasal Plastic Surgery in Boston

• See Nose Reshaping Before and After Pictures
• Read Rhinoplasty Information on Our Web Site

Dr. Richard Moss, Boston cosmetic surgeon, attends a rhinoplasty course at University of Pennsylvania. Read more about Boston Rhinoplasty surgery.
The University of Pennsylvania, School of Medicine recently held its annual Rhinoplasty course. The course directors were from the Division of Facial Plastic Surgery of The University of Pennsylvania Health System and The University of Virginia Medical Center. The distinguished guest faculty, all of whom had extensive experience in rhinoplasty surgery were from Pennsylvania, New York, Virginia and Florida.

Dr. Moss has twenty five years experience in performing rhinoplasty surgery. He always obtains his continuing medical education in subjects pertinent to cosmetic surgery. Dr. Moss has a special interest in rhinoplasty surgery. Prior to completing a residency in plastic surgery he completed a residency in otolaryngology (ear, nose, & throat) and became board certified in otolaryngology.

When questioned about rhinoplasty surgery and the recent course, Dr. Moss replied that he was very excited about the course. I felt it confirmed that the results that I have been obtaining are excellent, while at the same time gave me some ideas as to how I might refine some of my techniques.

Dr Moss went on to explain that, Rhinoplasty surgery is far more complex than most patients realize. Patients usually think in terms of modeling a nose from clay, rather than remodeling a very complex living structure beneath their skin. To further complicate matters is the fact that these structures have a functional purpose, such as breathing and smell. Patients also need to be able to sneeze and blow their nose. That’s asking a lot of one small body part, and when a surgeon make changes so that someone’s nose looks better, it is still important that all the function remains.

This is why, Dr. Moss explained, it is so important that patients choose surgeons who are properly trained in rhinoplasty surgery. You should always ask for a board certified plastic surgeon or a fellowship trained facial plastic surgeon. Because I am board certified in both plastic surgery and otolaryngology, I have a very strong background in both the functional and cosmetic aspect of the nose.

When asked what in particular was presented that he found interesting, Dr. Moss stated, that the course started with a presentation on a meticulous nasal analysis. This is so important for a good result, Dr. Moss pointed out. Small structural changes made to the nose can result in large differences in appearance. Therefore, before a surgeon begins to develop a surgical strategy, an accurate analysis of the patient’s nose needs to be made. For example, Dr. Moss explains, you would determine the nose is twisted or straight from a frontal view. Similarly, from a lateral, (side) view, you would determine if the dorsum is straight, concave or convex.

The skin type is also very important, Dr. Moss further elaborates. Thick skin can make it difficult for structural changes to be seen, while really thin skin will reveal even the slightest of irregularities. All of this information needs to be taken into account when a surgeon informs a patient of what can realistically be achieved

The course also examined the use of computer imaging and how it can be used to reinforce to a patient what can realistically be achieved and what cannot. Dr. Moss explained that initially many surgeons, including him were concerned that patients would expect a nose to look precisely what the computer image showed. Many surgeons were hesitant to use computer imaging for this reason. However, the trend today, Dr. Moss explained, is that computer imaging is actually helpful in providing patients with a realistic idea of what their result will look like. The trend is that by at least providing the patient with a picture they can understand and process, a surgeon is better off than just having a patient imagine what the result will be. This is because some patients, Dr. Moss explains, will form a vision of a result that may not be achievable.

In addition computer imaging will allow a surgeon to give a patient choices when possible. Surgeons today are willing to allow a patient to define what they are looking for. Some patients, Dr. Moss explained, want to keep more of an ethnic look, while others may not. I have found in my own experience, that there have been times I have performed a change on a picture of a patient’s nose through computer imaging, only to hear the patient say, That’s not what I want.’ At that point, I can clarify what the patient wants, and therefore have a happier outcome. In all cases, Dr. Moss further explains, you do want a nose that fits the face.

Dr. Moss further elaborated; The current thinking among plastic surgeons is to create cosmetic changes that are individualized to each face and its characteristics. It is no longer the trend to give all women that little button nose, as was so commonly seen in the 60’s and 70’s. In fact the course dealt with how to revise the noses of women, who had a rhinoplasty 30 or 40 years ago. It is far more difficult to revise the nose of a patient who has had more of the internal structures removed, than someone who still has a little too much remaining. Because of this, Dr. Moss explained, I am always conservative when performing a rhinoplasty. I would much rather have to take just a little more off, in a revisional rhinoplasty, than have to start augmenting the existing nasal structures, which have been surgically altered. I find that my patients who want to enhance their result with one more little shave off the dorsum are accepting of the small cost involved for the second procedure. I myself do not usually charge for this second procedure; however the patient is responsible for hospital and anesthesia charges.

Learn More About Nasal Plastic Surgery in Boston

• See Nose Reshaping Before and After Pictures
• Read Rhinoplasty Information on Our Web Site