Rhinoplasty in Albany & Syracuse, NY

rhinoplasty bookRhinoplasty, commonly referred to as a nose job, can be one of the most rewarding experiences in a patient’s life. Rhinoplasty surgery can help balance facial features, as well as remove any nasal obstruction to improve breathing.

The Williams Center for Plastic Surgery offers patients in Albany and Syracuse, NY state-of-the-art, individualized rhinoplasty options for beautiful, natural results with minimal down time. Dr. Edwin Williams, double board certified, exclusive facial surgeon offers scarless rhinoplasty options that utilize state-of-the-art techniques.

You can be confident you'll be in good hands with double-board certified facial plastic surgeon Dr. Edwin Williams:

  • 25 years of experience and counting! Learn More!
  • A respected national educator on advanced rhinoplasty.
  • An expert in closed rhinoplasty techniques.
  • Great results you can see for yourself!
    See our Photo Gallery.
  • Dr. Williams MD
  • ABFPRS
  • American-College-of-Surgeons
  • AAFPS
  • the-rhinoplasty-society

The Consultation

During the consultation with Dr. Williams, he will explain the procedure, recovery process, as well as any questions you may have about your rhinoplasty surgery. Because each nose is unique to the individual, Dr. Williams breaks down the different features a patient may want to correct during their procedure:

*Results May Vary

Crooked Nose

Some patients are born with crooked nasal bones and nasal septal cartilage and through the process of growth and puberty the nose actually grows more crooked. Other patients have a crooked nose that results from nasal trauma. Many patients with a crooked nose also have nasal obstruction and difficulty breathing due to a deviated septum and crooked external nasal anatomy. This problem requires a clear understanding of the nasal bone anatomy and septal cartilage and often requires a reconstructive effort where by the deviated septum is corrected and cartilage grafting using spreader grafts is used to re-build the nose in a more midline position.

Crooked Tip/ Nasal Base

When referring to a crooked tip nasal base, we are talking about the cartilaginous nature of the lower two thirds of the nose which concerns the nasal septum, the nasal base, and other significant support mechanisms for the nose.  Patients with a crooked tip typically find breathing difficult as air flow in the lower part of the nose goes through nasal valves that are poorly supported.

Evaluation of the crooked tip and nasal base first starts with a consultation with an experienced rhinoplasty and nasal reconstruction specialist. If a patient has a crooked nasal base and tip, it is very likely that the nasal septum is involved and most of the time a patient also has a deviated nasal septum in conjunction with poor support in the other major support mechanisms of the nose. Think of the septum as the center poles of a tent supporting the entire nose from top to bottom. When the tip of the nose is crooked, it is usually the result of either the septum being disfigured and/or the lower lateral cartilages being involved. An experienced rhinoplasty specialist should be able to give the patient some insight as to what is the primary culprit. To fix and address this problem an experienced rhinoplasty surgeon will typically remove, cut and subsequently rebuild the nose and lower lateral cartilages with cartilage obtained from the septum. Think of cutting out the bad pieces and recycling cartilage to rebuild the nose straighter, stronger and more symmetrical.

The Williams team uses the endonasal/closed technique instead of the traditional open rhinoplasty. The “scarless” approach we use is less invasive and requires less recovery time. This and many of the other questions that you may have can be found in the Frequently Asked Questions section of Dr. Williams’ Famous Fireside Chats where he answers your questions about rhinoplasty.

To request a consultation in the New York area, contact the Williams Center for Plastic Surgery online or by phone at 1-800-742-2797.

Saddle Nose

The saddle nose deformity or a saddle nose typically refers to a nose  with a scooped-out appearance.

Saddle nose deformity may be caused by certain diseases affecting the nasal septum i.e. Wagner’s Granulomatosis.  Here the nose or the nasal septum experiences a loss of support in the midsection of the nose resulting in a slope or saddle deformity.

Another common condition that can result in a saddle nose deformity is a septic perforation. The septic perforation is defined as a hole in the nasal septum. The nasal septum is basically a partition between the right and left side of the nose. If the perforation or hole is large enough, it can affect the support of the mid-aspect of the nose resulting in saddling or collapse in the mid-aspect of the nose.

There are many causes of a septic perforation including but not limited to trauma and far beyond the purpose of this discussion. Suffice it to say, septic perforations are another known cause of saddle nose deformity.

Another cause for saddle nose deformity is trauma. Trauma to the nose and especially trauma to the nasal septum can result in a compromise in the blood supply of the nasal septum by various mechanisms. This can result in a loss of support and weakening of the nasal septum whereby there is settling in the mid-aspect of the nose resulting in a saddle.

Finally and unfortunately, surgery performed poorly, can also result in a scooped out or saddle nose deformity. When surgery is performed poorly without good attention to detail and leaving a nose strong and supported it can often result in settling and the saddle nose deformity.

Fixing the saddle nose deformity, first starts by receiving the opinion of a very experienced rhinoplasty specialist. Saddle nose deformities are complex and often have other symptoms associated with the cosmetic deformity. Symptoms that can be associated with a saddle nose deformity are difficulty breathing, bloody noses and nasal collapse. An experienced plastic surgeon should be able to put together a plan whereby to revise or rebuild the nose. There are many ways that a saddle nose deformity can be repaired by an experienced rhinoplasty surgeon. Almost all approaches require harvesting some additional support or cartilage to support the nose. The ideal situation is when there is sufficient septal cartilage remaining in the nose for the rhinoplasty surgeon to use to rebuild the saddle. Unfortunately, in many circumstances this is not the case whereby ear cartilage can be used by the surgeon to rebuild the nose. Ear cartilage in many circumstances is not sufficient because it does not provide enough structure or support and in which case rib cartilage is the preferred option. Experience revision rhinoplasty specialists often harvest rib cartilage from an inconspicuous area to help rebuild the nose.

This and many other questions can be answered in more detail in Dr. Williams’ Famous Fireside Chats where he answers the question about saddle nose deformity.

You can be confident you'll be in good hands with double-board certified facial plastic surgeon Dr. Edwin Williams:

  • 25 years of experience and counting! Learn More!
  • A respected national educator on advanced rhinoplasty.
  • An expert in closed rhinoplasty techniques.
  • Great results you can see for yourself!
    See our Photo Gallery.
  • Dr. Williams MD
  • ABFPRS
  • American-College-of-Surgeons
  • AAFPS
  • the-rhinoplasty-society

Drooping Nose

A drooping nose hangs downward.  Sometimes it involves a dropping tip made worse in patients with a large profile or bump on the nose.  A rhinoplasty patient concerned about a drooping nose or tip is strongly advised to consult a highly skilled and trained rhinoplasty specialist.   This is first done by obtaining a consultation and communicating your goals to the doctor.   Most rhinoplasty specialist do a great deal of listening first to understand what the patient’s goals and desires are during the consultation process. For example, some patients only have cosmetic concerns to be addressed whereby patients also have breathing issues and many patients with a drooping nose have some sort of breathing difficulty on one side or another.  Another important part of the consultation should include computerized imaging whereby the surgeon can alter the images which functions as a wonderful communication tool between the doctor and the patient in the process of agreeing upon a desired goal or outcome.

Reputable surgeons will not guarantee outcomes but will seek computerized imaging as a wonderful tool for communication. Reputable surgeons are very careful not to show the patient an image that they do not feel is achievable.

Fixing a drooping tip often consists of a couple of things. Many times the tip of the nose needs to be rotated or brought upward slightly as well as adding or rebuilding support to the tip of the nose so that it does not simply drop or fall again. With a patient where there is a large contributing component that is a result of a prominent bump or dorsum, this should be addressed at the same time so that the patient is left with a very balanced approach, which also make the nose fit the face better and looks more natural. For the average patient who has a drooping tip, I typically will need to build a stronger tip and this is done by harvesting cartilage from the nose. Think of it as recycling as an experienced surgeon can take cartilage from areas in the nose whereby the cartilage is unnecessary and reorient them to another area to rebuild or regain support.

Make sure to check out Dr. Williams’ Famous Fireside Chats where you can find more information and answers straight from the doctor himself!

Large Nose

What exactly is a large nose?  Most “large noses” are out of proportion or balance with the rest of the face.

In the case of a patient with a less than strong facial bone structure or one with a small face may have a nose better suited for someone with a strong bone structure or larger facial features.  Also, someone with a large nose may have a nose tip that is projected or they have a bump (medically referred to as a convex dorsum).  Lastly, we often consider a large nose as one that is wide in the mid-section or bottom of the nose.

There are many causes of a large nose including large nasal bones or overdeveloped or cartilaginous lower nose or both.  Also, the entire nose can appear large if the patient’s nose has a side base and/or flaring nostrils.  For the best Rhinoplasty outcomes, the surgeon must consider all these factors to ensure that result is a smaller and more balanced nose that compliments both the face and while retaining its ethnicity.  That is, someone of  European descent, female with a height of 5’2″ will have a different desired outcome that that of a 6’3″ African-American male.  Discussing the differences and the expected results with an experienced Rhinoplasty surgeon can ensure your nose is balanced and natural looking while preserving any characteristic including ethnicity.

Once you decide to go through with your Rhinoplasty, you will meet with a Rhinoplasty specialist who will put your photo on a computerized imager, ask you what you’d like to change and what he sees as a surgeon and develop an approach that will have your nose, whether large or big, that will balance your features for an improved appearance.  Computerized imaging is a valuable tool in the Rhinoplasty consultation as it helps the patient image realistic results and helps the surgeon and patient to better communicate.

Addressing a large nose versus a smaller nose is quite different because this usually involves removing cartilage or tissue.  This removal is often rebalanced by adding back some cartilage.

Patients are often curious about how the skin of a larger nose can support their new smaller nose.  Interestingly, I do not have to cut the skin away as it re-drapes easily to fit the smaller underlying structure.  However, there are some limitations on this when it comes to thicker skin and larger noses.

Dr. Williams likes to utilize the endo-nasal/shut approach (more usually alluded to as scarless rhinoplasty) to customary open rhinoplasty. He feels that this approach is less traumatic than the open approach which requires longer recuperation.

This and a large number of alternate inquiries that you may have can be found in the Frequently Asked Questions segment of Dr. Williams’ Famous Fireside Chats where he answers your inquiries regarding rhinoplasty.

Nasal Hump

The nasal hump or bump as we discussed in the large nose situation involves the bridge of the nose which consists of bone and cartilage tissue.  In the middle third of the nose, cartilage is found in the underlying nasal septum and the medial aspect of the upper lateral cartilages.  In consultations, patients often point to the bridge or bump of their nose as their main concern.  I may see possible additional factors to consider including a crooked nose or deviated nasal septum and/or a drooping, broad, or asymmetrical nasal tip which I address with the patient.

You can be confident you'll be in good hands with double-board certified facial plastic surgeon Dr. Edwin Williams:

  • 25 years of experience and counting! Learn More!
  • A respected national educator on advanced rhinoplasty.
  • An expert in closed rhinoplasty techniques.
  • Great results you can see for yourself!
    See our Photo Gallery.
  • Dr. Williams MD
  • ABFPRS
  • American-College-of-Surgeons
  • AAFPS
  • the-rhinoplasty-society

Dr. Williams’ feels strongly that the Rhinoplasty patient’s result is a nose that naturally suits their face based on gender, height and ethnicity.  To achieve this the surgery must address the nasal hump along with any structural reorientation.

Preferring the endonasal or closed approach (also called scarless Rhinoplasty) to traditional open Rhinoplasty, Dr. Williams believes this approach reduces recovery time as it is less traumatic to the system than the open approach.

Questions and answers regarding both the open and closed approach are located in the FAQs section of Dr. Williams’ Famous Fireside Chats.

Pinched Nasal Tip

Referred to as a pinched tip, this occurs when the lowest section of the nose is very narrow and results in a less than aesthetically balanced nose.  Ideally, the nose should be the same width from top to bottom.

The usual cause of a pinched nasal tip is a congenital, one that a person is born with.  Many but not all people with a pinched tip find breathing somewhat difficult.  In my experience, such a tip can also be the result of trauma as I have seen in my patients.  However, the most common cause of a pinched tip unrelated to birth or trauma is the result of a poorly executed rhinoplasty.  Removing too much cartilage from the tip of the nose is often the result of an inexperienced surgeon’s attempt to create a more refined tip.  Due to aging and scar contracture (referred to as the “shrink wrap effect”) and the passage of time, the lower part of the patient’s nose can appear even more narrowed or pinched often called a pencil tip.

Correcting the pinched tip in most individuals, first starts with obtaining a consultation with a very experienced rhinoplasty specialist. The rhinoplasty specialist will not only evaluate the inside of the nose but the outside of the nose as well to determine the causes and a plan for fixing the pinched tip. Many times this will require harvesting cartilage from either the septum or ear to help rebuild the tip of the nose so that it is much more balanced and in alignment with the nose from top to bottom. Before discussing this specific plan, most reputable surgeons will include computerized imaging so that they are able to effectively communicate with the patient to obtain a desirable and achievable goal.

Dr. Williams uses the endonasal/closed method (scarless rhinoplasty) to the more common open rhinoplasty. He finds it to be a less traumatic technique with a better recovery time.

Make sure to visit our Frequently Asked Questions section of Dr. Williams’ Famous Fireside Chats for more answers and information.

Refine Nasal Tip

A poorly defined nasal tip (or bulbous tip) is a common reason a person considers rhinoplasty.  Often referred to as a thick, full or wide tip, the rhinoplasty specialist’s goal is to address the entire nose by retaining an aesthetically pleasing width and a slight divergence to the tip’s defining point.  While the lower part of the nose is bulbous (wide) the upper part of the nose may be narrow.

For the female patient, the lack of refinement on the tip in the lower third part of the nose is the reason they are pursuing rhinoplasty.

In the initial consultation,  the rhinoplasty specialist will examine the skin’s thickness and the inside and outside of the nose.  The thickness of the skin is a significant factor in rhinoplasty.  Thick skin can influence the ability to refine the nasal tip.  However, there are cartilage sculpting and grafting techniques that can improve this.  Experience is critical here as it is essential that just the right amount of cartilage is utilized or the result can be an unsupported tip or a tip so narrow as it makes breathing difficult.  An experienced plastic surgeon must seriously consider these ramifications.

Most rhinoplasty surgeons will explain the procedure to their patients using CGI or computerized imaging.  This also helps ensure the patient has a clear understanding of achievable results and the constraints of the surgery.

At the Williams center, who chose to use the endonasal/closed approach (known also as the scar-less rhinoplasty) instead of the traditional open rhinoplasty technique which we believe requires more recovery time and is a bit more traumatic approach.

For more information, please review Dr. Williams’ Famous Fireside Chats. Here, the Doctor answers some of your most common surgical questions and concerns!

The Rhinoplasty Procedure

You may be a good candidate for a rhinoplasty if you:

  • Are in generally good health
  • Are dissatisfied with the appearance of your nose and/ or have difficulty breathing properly
  • Have realistic expectations

During the procedure, general anesthesia will be administered. There are two types of rhinoplasty: open and closed. Dr. Williams will discuss with you during the consultation which would be best for your needs. In an open rhinoplasty, the incisions within the nostrils are joined by incisions at the base of the nostrils. This will give Dr. Williams more surgical accuracy with the procedure, but will leave a nearly-invisible scar at the base of the nose. On the other hand, incisions are confined to the inner nostrils and will leave no scar. This also means that Dr. Williams will be somewhat restricted in what he may safely perform.

Cost of a Rhinoplasty

The cost of rhinoplasty depends on several factors. Probably the first and foremost is whether the patient is undergoing a first time or primary rhinoplasty as compared to a revision or second or third time rhinoplasty.

When a patient has had an unfavorable result and seeks rhinoplasty for a second or third time, this surgery is considered more difficult, risky and requires a more experienced surgeon. This will actually affect the cost to the patient as the latter procedure is not only more complicated but takes more time.

The second and third components to cost have to do with the surgeon’s experience and the geographic location. Naturally, given the same level of skill and experience, a surgeon operating in Manhattan will likely charge a larger fee than a surgeon in a small city because of the cost of living and the cost of doing business in that particular local.

Third and last, a more experienced surgeon will typically charge more than a less experienced surgeon.  This is to be expected given the many years of experience that the surgeon has and the likelihood of achieving a satisfactory or more desirable outcome.

You can be confident you'll be in good hands with double-board certified facial plastic surgeon Dr. Edwin Williams:

  • 25 years of experience and counting! Learn More!
  • A respected national educator on advanced rhinoplasty.
  • An expert in closed rhinoplasty techniques.
  • Great results you can see for yourself!
    See our Photo Gallery.
  • Dr. Williams MD
  • ABFPRS
  • American-College-of-Surgeons
  • AAFPS
  • the-rhinoplasty-society

There are a couple of other factors that go into the cost of rhinoplasty which include the operating room fees and anesthesia. This and some of the other questions can also be answered in Dr. Williams’ Famous Fireside Chats where he answers this question in a little more detail.

Complications Following Rhinoplasty

Most experienced and reputable surgeons will discuss potential complications and risks following rhinoplasty. It is very rare to have complications from a rhinoplasty executed well in the hands of an experienced rhinoplasty surgeon. There is always the possibility for some bleeding or infection but these complications are rare.

One risk commonly discussed with the patient is the possible need for revision or touch-up surgery. In doing your research you will find that approximately 5 to 10 percent of patients request or need a touchup type of procedure. In the hands of an experienced rhinoplasty surgeon, this percentage is probably considerably lower and the need for a touch-up type procedure is typically minor and often performed in the office. While most experienced rhinoplasty surgeons are perfectionists, even in the most experienced hands this is not a perfect procedure as the surgeon is blending their talents, skills and individual anatomic variances of a patient toward the goal of an ideal outcome.

The most likely complication is an unhappy patient where expectations have not been met. This can almost completely be avoided by clear communication between the patient and the surgeon in a lengthy and detailed consultation. During the consultation, most reputable surgeons will not only explain to the patient what they can do but also explain those things in which they feel that the surgery cannot achieve.

This and many other questions can be answered in more detail in Dr. Williams’ Famous Fireside Chats where he answers the question about complications following rhinoplasty.

Packing and Post-Operative Recovery

Many surgeons will pack the nose after rhinoplasty. Dr. Williams uses the endonasal scarless approach and feels that the need for large packing is overrated and unnecessary.

Many years ago surgeons believed that large amount of packing held the nose into position. It is Dr. Williams’ opinion that if the nose is not exactly in position after a well performed rhinoplasty, packing will not hold it in position. It is for that reason he uses very limited dressing in each nostril which is similar to a very light tampon. This can be removed the next day. This is important since many patients feel the most uncomfortable aspect of rhinoplasty has to do with the packing. The recovery for most patients consists of between two and seven days of bruising.

This and many other questions related to recovery are covered in a very detailed Famous Fireside Chats video where Dr. Williams shows how the nose is dressed after rhinoplasty and splint removal that occurs at one week.

Recovery

After the surgery, you can expect stitches to be removed three days later and the cast one week later. Patients are usually able to return to work in one to three weeks, depending on the job and the level of activity. Patients should not perform strenuous activity for three to four weeks, but light activity can be resumed after one week. Swelling and bruising can be expected post-surgery, but the majority of the swelling will fade after two weeks.

To request a consultation in the New York area, contact the Williams Center for Plastic Surgery online or by phone at 1-800-742-2797.

Rhinoplasty FAQs

What is The Cost of Rhinoplasty?

The cost of rhinoplasty depends on several factors. Probably the first and foremost is whether the patient is undergoing a first time or primary rhinoplasty as compared to a revision or second or third time rhinoplasty.

When a patient has had an unfavorable result and seeks rhinoplasty for a second or third time, this surgery is considered more difficult, risky and requires a more experienced surgeon. This will actually affect the cost to the patient as the latter procedure is not only more complicated but takes more time.

The second and third components to cost have to do with the surgeon’s experience and the geographic location. Naturally, given the same level of skill and experience, a surgeon operating in Manhattan will likely charge a larger fee than a surgeon in a small city because of the cost of living and the cost of doing business in that particular local.

Third and last, a more experienced surgeon will typically charge more than a less experienced surgeon.  This is to be expected given the many years of experience that the surgeon has and the likelihood of achieving a satisfactory or more desirable outcome.

There are a couple of other factors that go into the cost of rhinoplasty which include the operating room fees and anesthesia.  For more detailed information take a look at Dr. Williams’ Famous Fireside Chats.

What Anesthesia is Used in a Rhinoplasty?

Depending on the discretion of the surgeon and the preference of the patient, twilight and/local or general anesthesia is used in Rhinoplasty.   Most patients prefer not to be awake and most surgeons prefer their patients to be asleep. This is performed by a separate and credentialed anesthesia provider.

Outpatient anesthesia is usually performed so that in approximately 30-60 minutes following the surgery, the patients are able to go home.  This is discussed in greater detail in Dr. Williams’ Famous Fireside Chats on Anesthesia Twilight or General Anesthesia.

Where are the Incisions in a Rhinoplasty?

The incisions for rhinoplasty vary depending on the surgeon. There are basically two different approaches that are used and are broadly categorized as either the open approach or the closed approach. The closed approach is often referred to as the endonasal approach and some individuals refer to it as the scarless rhinoplasty since there are no incisions on the outside of the nose.

The advantage of the open approach by some surgeons is that they feel they can see things better and more precisely perform their surgery. The disadvantage to the endonasal or closed approach is the steep learning curve and the difficulty in execution. Dr. Williams performed most of his rhinoplasty using the open approach for the first ten years of his career but now performs almost exclusively performs the endonasal or closed approach which he feels is much better for the patient.

This is covered in more detail in his Famous Fireside Chats series entitled “The Great Debate Open vs Closed Rhinoplasty.”

What Should I do About Contact Lenses or Glasses Following Rhinoplasty?

It can be a challenge to wear glasses after your rhinoplasty surgery, as a splint or cast is placed on the nose.  I typically encourage patients to place a small piece of tape on the middle of the glasses and suspend them from their head.

Contact lenses can be used after about one week once the splint is removed.

How is Computerized Imaging Used in Rhinoplasty?

With computerized imaging the patient’s photo or images are taken digitally and then manipulated or modified by the surgeon to show the ideal possible outcome for the patient.

This has been used by Dr. Williams for almost 25 years and has been found to be extremely valuable and useful communication tool when used correctly.

This is also addressed more thoroughly in Dr. Williams’ Famous Fireside Chat addressing computerized imaging and rhinoplasty.

The answers to these and many other frequently asked questions can be found in chapter 7 of Dr. Williams’ book “Rhinoplasty Everything you need to know about Fixing and Reshaping your Nose”.   In this book Dr. Williams answers 35 of the most frequently asked questions.  He also answers these concerns in his YouTube series -Fireside Chats.

Can a Rhinoplasty Fix My Breathing?

Many patients have difficulty breathing and that is one of the factors motivating the patient to pursue rhinoplasty. This can be a combination of the patient having difficulty with a deviated nasal septum, incompetent or stenos nasal valves as well as a twisted or crooked nose.

A competent rhinoplasty specialist is an expert at evaluating the breathing as well as the overall appearance of the nose. Patients undergoing rhinoplasty should have this aspect of their anatomy evaluated carefully and if there is difficulty breathing, this should certainly be addressed at the time of cosmetic rhinoplasty.

Click here to learn more about correcting and fixing breathing during cosmetic rhinoplasty in one of Dr. Williams’ Famous Fireside Chats!

To request a consultation in the New York area, contact the Williams Center for Plastic Surgery online or by phone at 1-800-742-2797.

*Patient testimonials. Results may vary

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