Procedures » Nose Surgery (Rhinoplasty)
Gregory S. Keller, MD , Specialist Facial Plastic and Rhinoplasty Surgeon, Santa Barbara and Los Angeles (Westwood-UCLA),CA
Rhinoplasty (Nose Surgery) in Santa Barbara and Los Angeles (Westwood)
Rhinoplasty (nose surgery) is one of the most demanding procedures in Facial Plastic Surgery. The nose is a complex organ that sits in the middle of the face. It is responsible for both appearance and airway function. Any rhinoplasty procedure upon the nose is a delicate balance of surgery for both form and function.
Our approach to rhinoplasty involves preserving a patient’s look, while forming a beautiful nose. One of our patient’s mothers recently proclaimed that, “I am so happy that I still can see that it is my daughter and that her nose is beautiful”. Producing this type of result demands that a surgeon not “stamp out” each rhinoplasty with the same technique. A master surgeon is able to utilize different techniques to mold each patient’s individual rhinoplasty.
To alter the nose via a rhinoplasty implies a modification of its three dimensional anatomy. While many surgeons will discuss the artistry of the process, the experienced surgeon is aware of what modifications to each part of the nose’s anatomy will produce a given result in each individual patient. By combining various modifications from a past experience that utilizes many different techniques, a master surgeon can provide the best possible nose surgery with the fewest number of problems.
The nose is structured by paired cartilages and bone. The wrap-around tip cartilages form the nostrils and tip of the nose. A common problem is an enlargement of these cartilages that produce a “bulbous”, “box”, or widened tip that lacks definition. Sculpting of these cartilages used to involve wide excisions of the body of these cartilages, but today, more surgeons are relying on various types of cartilage folding and suturing to mold these cartilages and provide definition.
Another common problem is that of a “hump” or “bump” when viewed from the side or profile. This is a result of an enlargement of the paired middle cartilages and the paired nasal bones. While it is often necessary to remove some of the excess structure, it may also be possible to produce a better structure by “filling in” areas that are lower to “even out” the hump. Sometimes both maneuvers may be necessary.
Problems include a deviated or twisted nose that is the result of trauma or genetics, a tip that dives downward, a deviated septum or center cartilage, or a myriad of other problems, all relating to each patient’s underlying anatomy. Other causes of patient dissatisfaction involve the relation of the nose position to the forehead, the lip and the underlying bony structure of the face.
Rhinoplasty surgery may be performed “open” or “closed”. Most of our surgeries are performed using internal incisions only, but we sometimes find a need to make a discrete incision in the crease between the nose and the lip structures. Again, the mastery of many rhinoplasty techniques with an appropriate application to each patient can produce a superior result.
The nose also sits in relation to the rest of the face. If there a patient has a small chin and a sloping forehead, the face fades away from the nose and forces the nose to “stand out”. Like a “pied piper” the nose leads the face and moves ahead of the eyes, forehead, brow, chin, and neck. Depending on the patient’s desires and their dentition, a chin implant, cheek implant, or orthognathic surgery may improve the situation.
Other ancillary procedures are neck liposuction, particularly in the younger individual. Often the removal of a “blob” of fat under the chin can, together with a rhinoplasty, produce a geometrically improved result.
Many surgeons are reluctant to perform revisions of rhinoplasties that have produced an unhappy patient. They are also reluctant to perform the difficult rhinoplasty.
We perform these procedures with excellent results. Having said that, these are more difficult procedures for which a patient must have a reasonable expectation of the outcome and the risks are definitely greater.
Imaging of a patient with a program designed to simulate the results of rhinoplasty is another issue in nasal surgery. While we do perform this service for patients, we caution them that imaging is a process of communication and not a prediction of results. No imaging program or process that relies on two dimensional drawing can duplicate what a master surgeon can do to sculpt the paired cartilages and bones of the nose. Nonetheless, the process may assist the patient in giving the surgeon an idea of the patients overall desires (shorter, longer, up turned, straight, etc).
There are many options in rhinoplasty. A natural result that produces an attractive nose and face requires an experienced surgeon.
Choose Your Surgeon Carefully
Techniques used in the Rhinoplasty (Nose Surgery) were developed by Gregory S. Keller, MD, FACS over the last 25 years. Dr. Keller is a board-certified facial plastic surgeon whose practice is exclusively confined to facial aesthetic surgery in Santa Barbara and Los Angeles (Westwood-UCLA), California .
While all surgeons and physicians are outstanding individuals with impressive credentials, Dr. Keller’s qualifications are singular in the field of facial plastic surgery. Experience counts! Dr. Keller has devoted 25 years of his life to the field of facial plastic surgery and has perfected his specialty over this period of time.
He is internationally recognized by his peers as a “Master” for his unique and innovative contributions to facial plastic surgery and is a Castle-Connolly rated “Top Doctor”, an honor bestowed on only a few physicians nation-wide by peer selection. This year (2007) he was selected by Strathmore’s “Who’s Who” as the Facial Cosmetic Professional of the Year, 2007.
An excellent and meticulous surgical technician, Dr. Keller is the co-director of the facial plastic surgery fellowship at UCLA. He has taught rhinoplasty techniques to twelve UCLA post-graduate fellows and numerous residents, who are now in private practices and universities throughout the United States .
Dr. Keller is widely recognized for the excellence of his work. He has discussed his techniques and innovations on Good Morning America, Discovery Health, KABC, the Wellness Hour, Extra, “E”, and others, to name a few. His patients include many well-known actors and actresses, studio heads, corporate executives, billionaires, inventors, authors, and other personalities. His patients come from India , England , Canada , Korea , France , and all over the world.
Dr. Keller is on the editorial board and has been the New Technologies Editor for the AMA Archives of Facial Plastic Surgery. Working in the laser and technologies field for 25 years, Dr. Keller is able to integrate these advanced technologies into his rhinoplasty techniques to improve patient care, satisfaction, and recovery.
Call our offices at 1-800-423-8627. Ask for a consultation so that we can discuss your individual problems and desires with you. Or ask for a “Discussion with Venessa Campos”, our patient care coordinator, who can answer many of your questions and ensure that everything is arranged for you prior to your arrival.
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Facelift and Necklift, Rhinoplasty