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Toronto Rhinoplasty (Open Rhinoplasty)

Open Rhinoplasty Background

Open Rhinoplasty is the most common approach to nasal surgery. It is performed through incisions on the inside of the nose, as well as a single 4 or 5 mm external incision on the undersurface of the narrow area between the two nostrils. This type of approach allows visualization of the involved structures during surgery to make the alterations according to the plan that you make with Dr. Goldberg. The alternative approach is Closed Rhinoplasty, but this is not appropriate for all patients and requires careful consideration between you and Dr. Goldberg.

Dr. Goldberg Rhinoplasty
Achieving natural results from your rhinoplasty procedure requires your surgeon to understand the intricacies of facial surgery. Dr. Goldberg possesses unique qualifications in this area:
  • Surgical Skill & Training He is one of only a few Canadian plastic surgeons to have undergone a fellowship as a Craniofacial Surgeon requiring extensive additional training in facial surgery.
  • Experience & Surgical Judgment In addition to years of performing cosmetic rhinoplasty on patients from all ethnic backgrounds, his surgical skills are honed through his extensive experience performing intricate facial reconstructive plastic surgery which is often even more complex than cosmetic procedures.
  • Personal Care & Commitment Since 2008 he has been a surgeon volunteer with Operation Smile, a worldwide children's charity that helps treat severe facial deformities such as cleft lip rhinoplasty.


The Procedure

The operation is most often done under general anesthetic as same-day surgery. The operation takes approximately 3 hours, and you are usually allowed to go home within 2 hours after surgery. Long lasting local anesthetic is injected after you are asleep to prevent sensitization of the nerves during the procedure, and this significantly reduces discomfort after surgery. You are also given intravenous medication to reduce swelling and prevent nausea after surgery. After the incisions are made and the relevant structures are visualized, reduction and alteration of the cartilage and bone of the nose are performed according to the plan made between you and Dr. Goldberg. At the end of surgery dissolving sutures are used to stitch the internal incisions, 5 or 6 non-dissolving miniature sutures are placed in the one small external incision. Packing is sometimes placed inside the nose to reduce bleeding. Dr. Goldberg uses a patented type of packing with integrated breathing tubes, which allows you to breathe through your nose even while the packs are in place. Finally, a padded split (cast) is placed on the top of the nose to protect the shaping that was done in surgery.

Recovery

Dr. Goldberg prescribes several medications to ensure your comfort. These usually include Celecoxib and Percocet to control inflammation and pain, Ondansetron to prevent upset stomach, and Lorazepam (Ativan) to help with sleep if you need it. You will be seen in 2-3 days after surgery for a check-up, and to remove the packs from your nose (if any were inserted). Once the packs are removed you will also be prescribed nasal sprays that reduce swelling, improve nasal breathing, and help cleanse the internal incisions. Swelling will involve the nose and the area around the eyes, and usually increases over the first 3 days. It then rapidly subsides over 1 to 2 weeks, at which point you will be able to see the improvement in the shape of your nose. Approximately 15-20% of the swelling remains and it takes 9 to 12 months to subside and for your body to re-absorb this extra fluid. For more details please refer to the standard care sheet given to our patients.

Risks

There are general risks with Rhinoplasty such as bruising, bleeding, infection, and risks associated with general anesthetic. There are functional risks such as reduced nasal airway and dryness in the nose. Cosmetic risks include irregularities that may be visible or felt by touch only. It is possible, though uncommon, to worsen deviation. Approximately 15% of all Rhinoplasty patients will undergo revision surgery at some point. This may be to address minor irregularities such as a small bump of bone that can be felt, or as major as a complete Revision Rhinoplasty.

Alternatives

Some minor nasal deformities can be addressed by Filler Products, though their role is very limited. There are no other non-surgical alternatives. Closed Rhinoplasty is an option for some people.

Benefits

Rhinoplasty is a reliable procedure that can dramatically improve the appearance and balance of your face. With good communication between you and Dr. Goldberg you will be able to direct a personalized plan for surgery that will address your goals and fulfill your needs. Also, it is an operation that can greatly improve your nasal breathing, restoring function and improving your ability to breathe during sleep and while participating in sports.



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