This is the technical term for what is otherwise known as a “nosejob.” Whether done in Madison, WI or anywhere else, rhinoplasty may be performed for cosmetic, reconstructive, or functional reasons.  When done for functional reasons, the so called nose job may improve airflow. After trauma, the rhinoplasty surgeon may reposition displaced bones to improve airflow, and shape.  When performed for cosmetic reasons, nose reshaping or re-contouring is used to change the appearance of the nose. This may be a subtle refinement, or a dramatic improvement. Any or all of the areas of the nose may be addressed, including the top (radix or root),  the upper bony part (nasal bones), the softer middle (vault), and the tip. Even the nostrils may be reshaped. Parts of the nose may be augmented, reduced, or reshaped, asymmetry may be corrected.

References for rhinoplasty definition...

Dr. Gerzenshtein performs rhinoplasty under general anesthesia in most cases. Less complicated nose reshaping surgery cases limited to a given nasal region may be done with a regional nerve block, and sedation in one of the Wisconsin or Wisconsin offices.

References for rhinoplasty anesthesia...

If your rhinoplasty surgery is performed under general anesthesia, then the answer is a definitive yes. Most people who receive local (and/or regional block) and intravenous sedation will also be asleep, though breathing on their own.

A surgical facility, a hospital, or in some cases a physician’s office may serve as the stage for rhinoplasty. The American Society of Plastic Surgeons (ASPS) 2004 data on cosmetic surgery procedures performed by members shows the following distribution:  62% - office, 21% - hospital, and 17% - ambulatory surgical facility. The Madison area is no different. Since most cases are performed under general anesthesia, Wisconsin and Wisconsin hospitals and surgical centers serve as operating facilities.

Though some surgeons will only get an imaging study when there is a breathing problem, most complicated, and secondary revisional rhinoplasty patients will need the so called CAT scan. In short the answer depends on the patient.

References for imaging in rhinoplasty...

To the layperson the only discernible difference between open and closed rhinoplasty is a very well concealed ¼ inch scar at the base of the front underside part of the nose, between the nostrils. Surgeons joke that the scar may be noted only by a patient’s dog, or lover. The remainder of the incision is made inside the nose in both cases. Some surgeons perform one type of rhinoplasty exclusively. The more versatile surgeon can utilize both techniques with the following logic. The closed technique works well in less complicated cases, typically in removing a hump. The open technique is performed when correcting significant asymmetry, deviation, or when needing to do fine tip work. Open rhinoplasty and closed rhinoplasty are the two types of rhinoplasty procedures available. Open rhinoplasty is used to achieve great symmetry when doing tip work, while closed rhinoplasty is generally done for hump reduction.

References for distinctions between open and closed rhinoplasty...

Endonasal Rhinoplasty is just a fancy term for nose surgery done through an internal incision. It may sound better, and more technologically advanced, but in the end it is just a simple closed rhinoplasty in Madison, WI or anywhere else.

References for endonasal rhinoplasty...

Any surgical procedure carries with it three types of problems. The first is related to anesthesia; general, and less commonly local. The second category is common to all surgical procedures. This is the risk of bleeding, infection, loss of soft tissue, loss of skin, numbness, etc. The third is specific to the particular surgery being performed. In the case of rhinoplasty, this would be asymmetry, changes in appearance over time, etc.

References for risks or complications involved in rhinoplasty (nose reshaping)...

Each physician you see will have their own style of communication, this is independent of the location of the practice, be it in Madison, Wisconsin or Beverly Hills, California. I prefer to identify what particular features of the nose bother my patient most. Since everyone’s idea of the perfect nose varies widely, I like to hear what my patient would change about their nose. This gives me an idea as whether their expectation is realistic, and what features I would need to address. Most alterations are possible, but a patient’s nose must fit their face. If I believe a patient’s desires may leave them with a nose that does not fit their face I will explain this to the patient, and emphasize what I think would be an appropriate course of action. The patient is then evaluated for airflow problems, general medical problems, and undergoes a physical examination of the nose and associated structures. I explain the rhinoplasty surgery plan, all of the possible risks and complications, and also talk about what I think the outcome would be. If there are adjunctive procedures that would improve the patient’s appearance I discuss such measures.

References for a rhinoplasty consultation expectations...

Generally speaking, the answer is no. Most surgeons prefer to do rhinoplasty under general anesthesia. If anesthesia is given to a patient with even a partially full stomach, regurgitation of stomach contents into the lungs may occur, and this is very serious. In some cases, limited nasal work may be done without general anesthesia. Even in cases such as this, it is preferable not to eat since there is always a chance for general anesthesia if the case becomes more complicated during surgery or if there is persistent bleeding, or other unforeseen complication.

References for eating before rhinoplasty surgery...

A surgical facility, a hospital, or in some cases a physician’s office may serve as the stage for rhinoplasty. The American Society of Plastic Surgeons (ASPS) 2004 data on cosmetic surgery procedures performed by members shows the following distribution:  62% - office, 21% - hospital, and 17% - ambulatory surgical facility. The Madison area is no different. Since most cases are performed under general anesthesia, Wisconsin and Wisconsin hospitals and surgical centers serve as operating facilities.

References for rhinoplasty surgical facilities...

The sequence of operative maneuvers in rhinoplasty may change from surgeon to surgeon. As a general rule, once adequate anesthesia is established, either open or close incisions are made by Dr. Gerzenshtein,  and the desired parts of bone and/or cartilage are appropriately reshaped. Once Dr. Gerzenshtein completes nasal sculpting, the skin is redraped, and the incisions closed. The patient recovers in an outpatient setting in the greater Madison area.

References for rhinoplasty sequence...

There are many options available to Dr. Gerzenshtein. Patient’s own tissue is a good option, though use of bone and some types of cartilage can result in warping and asymmetry in the years after surgery. More recently, alloderm, available here in Madison, a natural product has been used successfully, without the need for harvesting tissue from the patient, and subjecting another area to surgery.

References for augmentation rhinoplasty...

The uncomplicated primary (first time) rhinoplasty is usually done at a Madison surgical center, and takes Dr. Gerzenshtein between 1 and ½ hours and 3 hours. The more complicated, and secondary nose surgery can take up to 6 hours, and will usually be done at a Madison area, or Wisconsin area hospital..

References for rhinoplasty duration...

As long as goals are realistic and expectations appropriate, rhinoplasty as performed by Madison plastic surgeon Dr. Gerzenshtein can achieve dramatic results. The nasal bridge may be shaped in a number of desireable ways. The nose may be narrowed, widened, shortened, or lenghtened, dropped, or raised. The nasal tip may be reshaped to a more aesthetically pleasing form. The dynamic function of the nose may also be improved through alteration of the external or internal valves. In summary, the nose may be improved in many ways, but clear pre-operative objectives must be set to achieve the most personal result, as beauty is very much a reflection of a patient's perception, likes and dislikes.

References for rhinoplasty capabilities...

Though all rhinoplasty patients recover at their own pace after nose reshaping, there are some general trends. The initial pain subsides over the course of two to three day. Swelling and discoloration may worsen after a rhinoplasty over the course of the same several days. It is a good idea to have someone at home to assist the patient in the immediate postoperative period. Strong pain medication will be needed in the first two weeks after rhinoplasty. Thereafter, normal, non-strenuous activities and work or school may be resumed. Swelling and bruising may persist for up to two months after nose reshaping surgery. Heavy exertion, and any activity, or contact sport that may result in injury should be avoided for first two  post-operative months, as should sun exposure.

References for rhinoplasty recovery...

From a purely functional standpoint, unless your profession requires exertion and/or contact, normal activity may be resumed within seven to ten days after nose reshaping surgery. If it is important for you to maintain your privacy with respect to your surgery, post-rhinoplasty swelling will prevent your return for two to three weeks. In women, bruising may be camouflaged with makeup.

References for rhinoplasty downtime...

Congestion, inability to breathe through swollen air passages, the taste of blood are all problems that most rhinoplasty patients are bothered by more than pain. Pain is normal with any surgery, and is no worse with rhinoplasty.

References for postoperative pain in rhinoplasty...

Some patients may feel nauseous, and as a result not very hungry after the procedure. There are no restrictions on food consumption post-operatively, though it is wise to start with light liquids and proceed as tolerated.

References for eating after rhinoplasty...

The ability to function in the face of normal post-operative pain, and swelling depends on the individual patient undergoing rhinoplasty. As a rule, however, a friend or family member should remain with the patient for at least the duration of the first post-operative night.

References for assistance after rhinoplasty...

My patients are typically seen twenty four to forty eight hours after rhinoplasty.  Packing is removed at this visit. Weekly visits follow for the next two weeks. The patient is then seen at three, six, and 12 months after surgery. This is my regimen and it varies from surgeon to surgeon. If you live longer than 30 minutes from the Janesville facility, for instance in Madison, WI , the schedule may be modified.

References for followup appointments after nose reshaping surgery...

That depends on the type of nasal splint in question. External splints are used almost always, because some type of nasal bone reshaping is done as part of the rhinoplasty more often than not. When only nasal tip work is done, they may not be employed. When used they routinely stay on for two weeks. Internal splints are not used routinely. Typically, they are used in cases of the deviated nose or septum, where the partition of the two sides of the nose was reset. When used they are removed between postoperative day five and seven.

References for nasal splints after rhinoplasty...

Internal stitches are used in both open and closed rhinoplasty, are absorbable, and do not need removal. External sutures are used only in cases of open rhinoplasty. They are removed between day five and seven.

References for suture removal after rhinoplasty...

If bone repositioning was not done, glasses may be worn as usual. For all other rhinoplasty cases, glasses my rest on top of the external nasal splint while it is in place. After the splint is removed, glasses should not be allowed to rest directly on the nose for one month, or a total of six weeks from the time of rhinoplasty.

References for glasses worn after nose surgery...

The standard answer for many surgical procedures, nasal or otherwise, is six weeks. Contact sports should be avoided at least that long.

References for exercise after rhinoplasty surgery...

This is only partially true. Results are seen within one month, but there is still substantial swelling present. Even with this factor in play, patients notice a significant improvement in the shape of their nose. At six months, the appearance of the nose is remarkably close to what it would be after one year. At this point, only close comparison of photos would show the difference between six months, and one year. By one year, most of this swelling is gone, so that the final result is stable at one year. This is true of rhinoplasty performed by me in Janesville, Madison, or by other surgeons elsewhere.

References for timing for thinoplasty outcomes...

Revision rhinoplasty is a procedure for correcting a previous nose reshaping procedure. It is also known as a secondary rhinoplasty. Because of previous dissection and alterations, the procedure is a bit more complicated and is generally longer.

Reference for revision rhinoplasty...

Nasal packing is typically comprised of Vaseline gauze, or cotton. It is used in some, but not all rhinoplasty cases to control bleeding or to hold the partition between the two chambers of the nose in a stable position. It stays in for up to two days.

References for nasal packing after rhinoplasty...

If the procedure is performed for a severe deficit, the psychological benefits would far outweigh any potential problems, so that in such cases there is no minimum age. For a more cosmetic rhinoplasty, it is best for hormonal changes and growth to be in its final stages, typically very little growth takes place after the age of 18. Older individuals may have rhinoplasty at any age, medical condition permitting.

Reference for appropriate age in patient selection for nose reshaping surgery...

Anyone with real concerns about the function or appearance of their nose makes a good candidate. Unrealistic expectations, deficits that only the patient can see, psycho-emotional instability, the belief that one’s entire life rests on undergoing the procedure are all red flags.

Reference for appropriate candidates for rhinoplasty...

A minority of patients experience more discharge. This typically persists for half or a year, but may last longer.

Reference for rhinorrhea after rhinoplasty...

Many people mistakenly believe that nose reshaping is done for cosmetic reasons only. In fact, many people who would benefit from a functional rhinoplasty would also get the side effect of a more balanced nose. This is because the septum, which lies at the root of many upper airway breathing difficulties also happens to form a very important structural component of the nose that impacts enormously on the external appearance of the nose. Deviation of the septum can cause significant breathing difficulties – a problem of much more import than the external appearance of the nose. Addressing this lopsided culprit, which by the way is often covered by most insurance carriers, will greatly aid nasal airflow, and fortunately, also improve nasal shape. In addition, in some cases of trauma, where the nasal bones have been misplaced, nasal airflow is also significantly compromised. Resetting the displaced bones will usually take care of the problem, and again, improve nasal shape. How is this done? Depending on the complexity of the problem, and the surgeon’s preference, the surgery may be performed through an open or closed approach. From a simplified perspective the only thing that separates the two approaches with respect to the final appearance is the presence of a small, usually imperceptible (except to the dog or the lover of the patient) scar at the top of cupid’s bow. From the surgeon’s standpoint, however, the addition of that small opening can greatly facilitate exposure, and help precise matching of one side to the other in the more involved case. To conclude, form is function and function is also form when it comes to nose surgery, fix your breathing, fix your nose.

There are several causes of the deviated nose. Most commonly, it is the result of trauma, motor vehicle accidents with facial trauma, altercations, falls, etc. Some people are born with a naturally divergent nose. In some cases, technical misadventures, or more commonly scarring after a rhinoplasty may cause this problem. Many times it is just a cosmetic nuisance, but it may also be significant enough to cause upper airway compromise, or breathing difficulties.

References for asymmetric nose...

Septoplasty is the technical term for reshaping the partition between the two chambers of the nose. It is done for two main reasons – to straighten the crooked nose, or to relieve breathing difficulties.

Septoplasty reference...

This is the technical term for combining the straightening of the partition between the two nasal cavities with nose reshaping. It is usually, but not always, done through an open rhinoplasty approach.

Reference for septorhinoplasty...

It is possible to get financing for any surgical procedure, cosmetic or reconstructive. The details depend on your surgeon.

Reference for rhinoplasty financing...

If the rhinoplasty is performed before growth is complete it is quite possible for the nose to continue to grow. This is the reason that rhinoplasty at an early age should be reserved for patients with significant defects.

References for nasal growth after rhinoplasty...

The American Board of Plastic Surgery (ABPS) IS THE ONLY BOARD specialty recognized by the American Accreditation Council for Graduate Medical Education (ACGME). This is the regulatory body overseeing resident education in ALL medical specialties including internal medicine, general surgery, etc. Any board which is not recognized by this entity is not subjected to its rules and regulations. The ACGME therefore does not recognize anyone trained in any program recognized by such an ARBITRARWIY defined board. The truth of the matter is that if anyone wanted to set up the American Board of Facial Upper Outer Eyelid Lash Surgeons, they could do so without any problems, without even so much as a medical degree. To the general public it would seem as though anyone trained in a “program” recognized by such a “board” has special training in the upper out part of the eyelid, and the upper outer eyelid surgeon would bask and revel  in the fruits of this flagrant lie. The truth is that ACGME plastic surgery training takes from 6 to 8 years  and encompasses all of plastic surgery, in its every detail. Surgeons not trained in such a manner typically have one year of so called “plastic” surgery and think themselves expert. Because they claim to be specialists in a particular area, an implication is made that they underwent plastic surgery training followed by specialty training. This is another blatant lie.  Of course the public is unaware of any of this because the industry is only regulated on the postoperative lawsuit end. Don’t get me wrong, there are a few cosmetic surgeons, who are not plastic surgeons, who are quite good; there are exceptions to every rule. There is also a fair amount of ASPS surgeons who are quite bad, again not the rule. But to say that one NEEDS a surgeon who has this board certification not recognized by the ACGME is a preposterous flagrant lie. Another important consideration that is often ignored is the ethical character of the “surgeon.” Let’s suppose someone is not certified by the American Board of Plastic Surgery, let’s also suppose that they are really good with their hands, and have done many, many aesthetic procedures. How many people would have had to be their “first,” in any given procedure before they accumulated enough experience to obtain good, reproducible results. Would you really want a “physician” of such limited moral fiber to do your surgery? The bottom line is this; what you need is an honest physician, who is safe, gets good results, and is strongly endorsed by his or her patients, not someone who couldn’t get into a plastic surgery program, not someone who realized late in their career that aesthetic surgery is lucrative and decided to take a shortcut, and not the founder of the American Board of the Middle Upper Lip Cosmetico - Aesthetic Surgery.