Patients may require reconstructive rhinoplasty if they have lost all or part of their noses to an accident, skin cancer, or another serious illness. During the treatment, a surgeon rebuilds the nose using skin grafts, flap techniques, and other advanced methods. Due to the complex nature of this procedure, patients may require multiple surgeries over a period of several months. Additionally, reconstructive rhinoplasty is a specialized procedure, and patients should look for surgeons who have extensive experience in this area.
Case 29: Major concerns for this patient were widening of the tip with a marked lack of projection which made his nose feel flat and washed out. Nostril thickness and rounding was also something he wanted addressed. In this case, irradiated donor rib cartilage was used to project and support the tip along with alar base reduction removing a significant amount of nostril flare to create a natural tip and nostril contour that is ethnically appropriate. Fat transfer to the cheeks helps to balance out his flat mid-face to strengthen the cheek contour which can be seen nicely on the profile view.
Case 47: This patient’s primary surgery left her with valve collapse, nostril notching, persistent tip rounding and hanging columella. Secondary surgery involved correction of these issues with repositioning and reconstruction of the tip cartilages to improve tip contour. Although she is still a little swollen in the after photos, she is already happy with her new nose.
Private surgical suites, usually located in the surgeon's office, carry the least expensive facility fees. Usually ranging in cost from $1,000 to $3,000 per procedure, a private surgical facility can offer many advantages. The doctor is very familiar with the facility, and is likely working with the same staff members who have assisted in many previous surgeries. I operate in a certified private surgical facility where my patients enjoy the ultimate privacy and personalized care. In this setting, I am able to hand-pick each of my staff members personally, from nurses to anesthesiologists.
Like facelift surgery, brow lift surgery eliminates sagging skin and reduces deep creases. However, brow lifts specifically target the forehead and the area between the eyebrows. The doctor creates an incision along the hairline or the crown of the head. Then he or she lifts the underlying muscles to reduce frown lines, vertical creases, sagging eyebrows, and hooded brows.
If the rhinoplasty is necessary to improve breathing, rather than for aesthetic purposes, there is a possibility that the repair may be covered by insurance. An obstructed airway is usually caused by a deviated septum, and operating is necessary to restore normal air flow. Physicians will refer patients with this problem to facial plastic surgeons, who are able to determine the impairment and who will receive authorization by the insurance company to operate.
Ethnic rhinoplasty uses the same methods as other forms of nose reshaping surgery. Typically, ethnic rhinoplasty refers to procedures performed on individuals of African American, Afro-Caribbean, Asian, Hispanic, and Middle Eastern descent. These patients typically have softer nasal contours, and the doctor takes special care to preserve the unique features of a these patients' faces.
After the patient is sedated, the surgeon creates tiny incisions inside the nostrils or on the columella. Then he or she carefully lifts the skin to access the underlying bone and cartilage. The surgeon can then remove or graft tissues, as needed. Typically, a doctor uses conservative methods to minimize the impact to the surrounding tissues while still achieving the desired results. When the reshaping process is complete, the doctor lays the skin back down over the new contours of the nose and closes the incisions.
Surgical facilities: If a doctor does not have his or her own operating facilities, the procedure will take place at a hospital or ambulatory surgical center. These locations charge separate fees, which will vary depending on location, reputation, and equipment. Again, many patients are willing to pay slightly higher costs to enjoy greater safety and comfort. 
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