Rhinoplasty Specialist (“Nosejob”)

Many people who choose to have a rhinoplasty procedure have endured years – or even a lifetime – of self-criticism and, too often, teasing. Even if the joking is good-natured and even if you feel super-confident in other aspects of your life, insecurity regarding a feature as prominent as the nose can take a toll on your mental health and even distract you from the things you love.

Regularly recognized as a top surgeon in the field, Dr. Mendelsohn has performed more than 1,200 rhinoplasty procedures. He and his team understand that a rhinoplasty does more than change the shape of your nose – it changes your outlook on life.

We will take the time to thoroughly understand your concerns, such as the overall size, length or width of your nose, a hook or bump on the central nose or a bulb on the end of the nose. Using detailed illustrations and photos of your face taken from multiple angles, Dr. Mendelsohn will demonstrate how a rhinoplasty procedure will bring your facial features into complementary proportions.

Just as every face and definition of beauty is different, every rhinoplasty treatment is personalized to create natural results that look, and feel, like you.

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Rhinoplasty - Procedure

The Process
After Treatment
FAQ
The Process

 

What to Expect the Day of Rhinoplasty:

 

  • This outpatient procedure takes one to two hours and is performed in a private operating room in our surgery center, which is accredited by the Accreditation Association for Ambulatory Health Care.
  • You will receive monitored anesthesia care for this procedure.
  • Well-hidden incisions are made inside the nostrils and occasionally across the lower mid-section of the nose.
  • Excess bone and cartilage are removed, reshaped or redistributed, and the skin is arranged over this new structure.
  • The septal cartilage in the middle of nose also might be molded to allow for better breathing.
  • No packing is required.
  • A splint is applied over the nose, which will remain in place for a week to hold the tissues in place and decrease swelling.
After Treatment

 

Rhinoplasty Postoperative Instructions

 

  • The pain will be minimal to moderate and is easily controlled with medication.
  • You should sleep and rest with your head elevated for a week after the procedure.
  • You may shower the day after the procedure.
  • The day after surgery, you will come in for a checkup.
  • You may experience some congestion and nasal drip for two to three days.
  • Your sutures will be removed six days after the procedure.
  • Mild to moderate swelling will peak two days after the surgery and then quickly fade over the next three weeks. You may also have minor swelling that slowly resolves over the next six to twelve months.
  • You may have minimal bruising around the eyes and cheeks, which will peak two days after surgery before fading quickly over the next three to five days.
  • You may return to many normal acivities within the first week, and most by the end of three weeks.
FAQ

 

How do I Prepare for rhinoplasty surgery?

 

Who is a good candidate for rhinoplasty surgery?

 

How young is too young to have rhinoplasty?

 

How long before I see results of rhinoplasty surgery?

 

How long does it take to recover from rhinoplasty?

 

Will there be pain following the rhinoplasty procedure?

 

Will there be significant bruising following rhinoplasty procedure?

 

When will I notice the final results of a rhinoplasty procedure?

 

How long before I can apply makeup after a rhinoplasty?

 

How is a rhinoplasty procedure performed?

 

How long does the actual rhinoplasty surgery take?

 

When can I return to normal actives following rhinoplasty surgery?

 

Can other procedures be performed the same time?

 

How much does rhinoplasty surgery cost?

 

What is the difference between “open” and “closed” rhinoplasty?

 

Is rhinoplasty covered by insurance?

 

What is the difference between cosmetic and reconstructive rhinoplasty?

 

What is Dr. Mendelsohn’s philosophy towards rhinoplasty?

 

Will rhinoplasty improve breathing?

 

Will insurance cover rhinoplasty?

 

Are other procedures able to be performed at the same time as Rhinoplasty surgery?

TrueSelfies - True Rhinoplasty Patient Stories

Real patients share their full journey of transformation, from considering a treatment to taking action and enjoying the life-changing impacts.

Advanced Answers in Under 5 Minutes

Advanced Answers

You’ve got specific questions about our procedures, and we’ve got Advanced Answers – provided by our experts in less than five minutes.

Podcast - Rhinoplasty Guests

Podcast

Follow Your Beauty Podcast – Follow Your Nose! Josh Episode 2

Let's Have Lunch - Rhinoplasty Education during COVID

Let’s Have Lunch the Social Way

A Virtual Consultation with Dr. Mendelsohn

Facial Analysis. Getting started with Facial Plastic Surgery

In The News

In The News!

Click here for Other Media Appearances.

Non-Surgical Rhinoplasty (Nose) Offers a Minimally Invasive Procedure

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Nose Jobs are the Third Most Popular Cosmetic Surgery in the US

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Follow Your Beauty Podcast – Follow Your Nose! Josh Ep2

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Cincinnati Rhinoplasty Expert Explains Nose Job Procedure

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Live Rhinoplasty Surgery Techniques - Graphic

Video of Live Procedure – Graphic in Nature

Dr. Mendelsohn reviews live Rhinoplasty surgical techniques.  While these videos are graphic, they are very informative and useful to review for a better understanding of the steps in achieving a natural and more aesthetic outcome.

 

Making the Marginal Incision

Making the Transcolumella

Positioning the Columella Strut

Closing

Taping and Splinting

3D Rhinoplasty Animation

Video of Live Procedure – Graphic in Nature

Rhinoplasty Terminology

  • In the old days of purely “reductive” closed rhinoplasty, plastic surgeons would perform a rhinoplasty by simply removing cartilage, removing bone and thereby narrowing and shrinking the nose.
  • With time, the unpredictable nature of scar tissue contracture would end up distorting many of these noses. The results were unnatural appearing noses.
  • With today’s techniques, the rhinoplasty surgeon utilizes more grafts and struts and below is a list of useful terminology for today’s open approach.

GRAFTS IN RHINOPLASTY:

Columellar Strut Grafts

These are cartilage grafts that are placed between the medial crura of the Lower Lateral Cartilages (LLC) and provide support to the tip. Sizes can vary. Positioning and shape can affect rotation of the tip and projection. Very strong columellar struts can be fashioned from rib cartilage to allow building of the tip in revision rhinoplasty or in significantly short & under-projected noses.

Plumping Grafts

Pieces of cartilage placed at the naso-labial junction, usually beneath a columellar strut to “open up” the naso-labial angle in patients with ptotic (droopy nasal tips)

Pre-maxillary Grafts

Larger sheet of cartilage or fascia or implants placed at the naso-labial junction as the foundation for the base of the nose, in patients with severely under developed pre-maxillas.

Shield Type Tip Grafts

Cartilage grafts in various shapes, widths, and lengths (typically resembling a medieval armored shield) placed over the medial crura of the Lower Lateral Cartilages (LLC) extending to the domes or even above. Used to modify the tip and create new and better tip defining points. Can be used to increase projection if the graft extends above the domes of the LLC. Can be used to create a more refined and narrow tip. Can be used in a layered or stacked manner to de-rotate the tip in short, upturned noses. Very commonly used in thick skin Rhinoplasty patients to create better tip definition.

Cap Grafts

Cartilage grafts in various shapes, widths, and lengths (typically resembling a medieval armored shield) placed over the medial crura of the Lower Lateral Cartilages (LLC) extending to the domes or even above. Used to modify the tip and create new and better tip defining points. Can be used to increase projection if the graft extends above the domes of the LLC. Can be used to create a more refined and narrow tip. Can be used in a layered or stacked manner to de-rotate the tip in short, upturned noses. Very commonly used in thick skin Rhinoplasty patients to create better tip definition.

Blocking Grafts

Small oval shaped cartilage grafts placed on the upper back portion of an extended shield type tip graft to add support and prevent the upper end of the shield graft from bending backward. Used in cases where extended shield grafts are used and placed above the lower lateral cartilage domes for added projection and length.

Alar Batten Grafts

Larger oval shaped cartilage grafts placed over or under the lateral portion of the lower lateral cartilages and extending to above the pyriform aperture bone. Used to support the lateral ala (nostrils) and prevent pinching or collapse. Can be used for cosmetic purposes but often used for functional purposes to prevent dynamic alar collapse during inspiration.

Rim Grafts

Cartilage grafts placed at the alar rims to provide support and prevent pinching or collapse in rhinoplasty patients with thin nostril skin. May be used to correct minimally retracted alar margins.

Composite Grafts

Usually cartilage grafts harvested from the ears with the skin also attached to the cartilage. These are used to correct vestibular stenosis as well as correct moderate to severely retracted or notched alar margins.

Spreader Grafts

Cartilage grafts placed between the upper lateral cartilages and the dorsal septum. Very useful grafts in prevention of some post-operative Rhinoplasty deformities as well as correction during revision Rhinoplasty. Sutured into placed.

Cosmetically spreader grafts can be used to:

-Help straighten a crooked nose
-Open a pinched middle vault and fix an “hour glass shaped” nose
-Help de-rotate an over rotated nose when used as a D.A.R.T.
-Lengthen a short nose when extended beyond the caudal septum
-Prevent “inverted V deformities” post rhinoplasty
-Create nice “brow-tip aesthetic lines”

Functionally used to:
Spreader grafts can improve breathing by opening the internal valve area between the dorsal septum and the upper lateral cartilages.

Onlay Grafts

Cartilage or fascia grafts placed over the middle vault, or dorsum to add bulk, width, or height. Can be crushed or morsalized cartilage. Not “functional” grafts usually but mostly cosmetic.

Radix Grafts

Cartilage, diced cartilage, or fascia grafts placed at the radix to increase the height of the radix and the “nasal starting point.” These grafts may show their edges in thin skinned rhinoplasty patients.

Caudal Septal Extension Grafts

Very useful and powerful grafts placed to increase the length of the septum and nose. Used in ethnic patients with short noses or in revision rhinoplasty cases. Usually this graft is taken from rib cartilage but thick septum or double layer ear cartilages can also be used.

Lateral Wall Grafts

Cartilage grafts to replace over aggressively reduced Upper Lateral Cartilages in Revision Rhinoplasty

Temporalis Fascia Graft

Soft tissue graft used in patient with very thin skin to help camouflage and create a smoother nose. Can be used at the tip, dorsum or radix. Alloderm, which is a cadaveric a-cellular dermal graft, can also be used as an easier, but more expensive alternative.

SUTURE MATERIAL IN RHINOPLASTY:

Vicryl

An absorbable braided suture that can be used in Rhinoplasty but not the best choice. It can cause inflammation, infection, or extrusion (spitting of the suture).

Monocryl

A fantastic mono-filament (non-braided) absorbable suture that can be used in Rhinoplasty. Often used in a 5.0 size for dome defining sutures.

PDS

A fantastic mono-filament (non-braided) absorbable suture that can be used in Rhinoplasty. Often used in a 5.0 size as dome defining sutures, or 6.0 for securing tip grafts. Takes a few weeks to months longer than Monocryl to absorb.

Plain Gut & Fast Absorbing Gut

Quickly absorbing sutures used in Rhinoplasty to close internal incisions. Fast Absorbing Gut dissolves quicker than Plain Gut but the two are very similar. Used in 3.0, 4.0, 5.0 and 6.0 sizes.

Chromic and Mild Chromic

Quickly absorbing sutures used in Rhinoplasty to close internal incisions.

Prolene

Permanent mono-filament suture that can be used in certain areas of the nose during Rhinoplasty. It is often unnecessary and can be substituted with PDS. The suture is not removed if used internally.

Nylon

Permanent mono-filament suture that is often used in a 6.0 or 7.0 size to close external Rhinoplasty columella incisions. The suture is removed in 3-7 days if used externally.

Ethibond

Permanent braided Polyester suture used by some Plastic Surgeons in Rhinoplasty. High risk of infection and post Rhinoplasty problems.

GRAFT MATERIAL IN RHINOPLASTY:

Septal Cartilage

A large portion of the Septal Quadrangular Cartilage can be harvested and used during rhinoplasty. In revision rhinoplasty, this cartilage is often missing and unavailable, as it may have been used during the previous Rhinoplasty surgeries. Septal cartilage is the first choice of cartilage for most Facial Plastic Surgeons.

Septal Bone

A portion of the perpendicular plate of the ethmoid bone, at the back-top end of the septum, can be used for graft material although not ideal.

Ear (Auricular) Cartilage

A greatly versatile source of cartilage for grafts. Incisions can be placed in front or behind the ear(s). Cartilage can be harvested from various parts of the ear and used in rhinoplasty and revision rhinoplasty. Under skillful hands, no major cosmetic deficits should be noticed with the ears after surgery.

Ear Composite Graft

Powerful grafts taken from the ear including cartilage and attached skin. Used to correct “soft tissue triangle defects” as well as retracted nostrils and vestibular stenosis. Very technically challenging grafts to place and do not always survive.

Post Auricular Fascia

Soft tissue taken from behind the ear to help camouflage areas, in thin skinned rhinoplasty patients.

Temporalis Fascia

Strong soft tissue layer covering the temporalis muscle, used to camouflage areas in rhinoplasty patients with thin skin. It can also be used to augment the radix.

Rib Cartilage

Large, strong cartilages harvested from the ribs 5,6,8,9,or 10. Used when abundant cartilage and building material is needed in rhinoplasty or revision rhinoplasty. Often used to build up the bridge or lengthen the tip. Frozen or Irradiated cadaver rib may also be used. When carved properly, these cartilages have a minimal risk of warping.

Bone

Bone from the ribs, skull, scapula or hips can be used in major reconstructive cases.

IMPLANT & ALLOPLASTIC GRAFTS USED IN RHINOPLASTY:

Mersilene Mesh

Permanent implant that resembles “cheese cloth.” Often used in general surgery to fix hernias. Can be layered and used nicely as a chin implant.

-Not a good option in the nose due to risk of acute or delayed infection.

Gore-Tex (PTFE)

Permanent soft plastic implants. Comes in sheets or in pre-formed strut type implants.

-Not a first option in the nose due to risk of acute or delayed infection.

Silastic (Silicone)

Pre-made implants in different shapes and sizes. Very commonly used for Asian rhinoplasty.

– Not a good option in the nose due to risk of acute or delayed infection as well as shifting.

Medpore

Pre-made implants in different shapes and sizes. Very commonly used for Asian Rhinoplasty.

– Not a good option in the nose due to risk of acute or delayed infection as well as shifting. Very difficult to remove once in place for a few weeks.

Surgicel

Cellulose sheets used for hemostasis. Used abroad for radix grafts as a “Turkish Delight” which is diced cartilage wrapped in Surgicel. Temporalis Fascia is a much better alternative.

SUTURE TECHNIQUES IN RHINOPLASTY:

Single Dome Stitch

Mattress type stitch placed at the dome of the Lower Lateral Cartilage to bend the dome into the desired, more defined shape. The suture material most commonly used are 5.0 PDS, 5.0 Monocryl, 5.0 Clear Prolene, or 5.0 Clear Nylon

Double Dome Stitch

Mattress or simple type stitch placed between the two domes of the two Lower Lateral Cartilages to bring them together and create more symmetry. Plastic Surgeons must be careful to avoid cinching the suture down too tight to prevent a “uni-tip” appearance

Alar Spanning Stitch

Simple type stitch placed between the cephalic, lateral aspects of the Lower Lateral Cartilages to reduce tip convexity. Must be used carefully as it can create alar rim retraction.

Wright Stitch

Suture placed to correct a deviated caudal septum. It essentially pulls the deviated septum to the other side of the anterior nasal spine

Septal-Columellar Stitch

Suture placed to position the tip in relationship to the rest of the nose by placing a suture from the septum to the columella. It is also used in “Tongue-In-Groove” maneuvers to suspend a “hanging columella.” There are many other stitches used in Rhinoplasty to attach grafts or bend and manipulate cartilages. There are also other less commonly used grafts and suture materials in Rhinoplasty and Revision Rhinoplasty that can be used in certain situations.

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