I perform both endonasal (closed) and external (open) rhinoplasty.  In my experience, the closed approach is more suitable for some noses, while the open technique is more suitable for others.  For example, in my practice the patient who requests simply hump removal may undergo endonasal rhinoplasty, while the patient with a severely twisted nose often requires - for technical reasons - an open approach for the best result.  

In any given year, approximately 35-65% of my rhinoplasties are performed via the open, and about 35-65% via the closed approach. (It all depends upon the kind of noses my patients bring with them that year!)  However, this number is not nearly as important as what we decide to do for you, the patient, after examining your nose.  The approach we pick is based on what I think will provide the best outcome for you, and based upon our detailed discussion about the technical aspects of your procedure.

In the two patient examples at the top of this page, the female patient underwent an open approach because her nose was  twisted and needed straightening.  If she had only needed profile changes, I might have undertaken a closed approach. The male patient  at the top of this page underwent a closed approach.  Can you tell?!

Fortunately, there are no major disadvantages to either approach.  However, each approach has special advantages for specific situations. Since every nose is different and has unique surgical requirements, I discuss the options with each patient and am happy to describe my surgical plan in detail. 

Question: Where are the incisions?
Answer: The incisions are just inside your nostrils, where they are hidden from view.  The exception is the open rhinoplasty, where an additional small (3 to 4mm) incision is made across the tissue between the nostrils.

Question: What is the recovery period?
Answer: The "recovery period" is approximately one week.  It takes just a few days to recover from anesthesia.  There is typically some swelling and some slight bruising that is dramatically reduced  by 1 week.  Patients wear a small nasal bandage for 6 days.

After I remove the small nasal bandage (or "splint"), most patients are presentable in public.  Most of my patients return to work the very next day after nasal splint removal.  As noted in the "patient instructions" below, there are restrictions on activity for a few more weeks after that. And of course, there is continued healing and reduction of swelling that continues to take place, quickly at first and then gradually for at least a year.

Question: Will insurance cover my surgery?
Answer: If your requests are of a functional nature (for example, you cannot breathe through your nose), of if you suffered a relatively recent, documented nasal fracture, many insurance companies will cover surgery required to correct these problems.

However, any requests that relate simply to change of appearance are generally not covered by insurance companies, and do require a cosmetic surgery fee. We will not discuss our fees over the Web or over the phone, but in general patients have found our fees to be reasonable and fair.

Question: Can I see examples of your work?
Answer: YES. I have provided only two examples here on this web page, but should you come to see me in consultation then I would be happy to review an album of my before and after photos of patients who have kindly given me permission to use their pictures for this purpose.  Also, some patients wish to hear from some of my previous rhinoplasty patients to talk about their experience - we are happy to accomodate this request.

Question: Do you do a lot of this kind of surgery?
Answer: YES. Rhinoplasty comprises approximately 50% of my surgical practice.

Question: What are some of the more common requests from patients?
Answer: Noses come in all shapes and sizes and we see virtually every variation!

Some of the common problems that we see are noses that are too big. Many patients have a "bump" on their nose that we can reduce or eliminate for them. Many patients have broken their noses, and now the nose is twisted, or it has a new bump, or it has a "boxer's nose" appearance. Some of these patients simply want "their old nose" back, others want additional improvements.

Many patients have a large, bulbous tip this can make their nose look "bottom-heavy" and unbalanced. Some patients have a droopy nasal tip. Lifting the tip a little can make a tremendous difference in these patients.

Some patients have noses that are too long, while others have noses that are too short. Some patients have noses that are too wide, less common is the patient with a nose that is too narrow.

Some patients are generally happy but have an especially subtle problem. Plastic surgeons call this a nose that requires a "finesse" rhinoplasty.

Some patients have asymmetries in their nose that can be improved or corrected. We also treat patients who have had a cleft lip and palate repair but have a nasal abnormality that persists.

Some patients have had a rhinoplasty before but are unhappy with the result. This is called "revision" rhinoplasty. It seems that more than any other type of patient, the revision rhinoplasty patient comes from far and wide for surgery, perhaps because they place special priority on finding a surgeon who they feel confident in.

Question: I have heard that you teach rhinoplasty to other board-certified doctors? Where do they come from?
Answer: I am the director of the University of Pennsylvania Aesthetic & Functional Rhinoplasty Course.  This course has attracted surgeons from over 38 states and 11 countries. 

I have also published a textbook on the subject of rhinoplasty.  Surgeons have come from  as far away as Sweden and Japan to study rhinoplasty from me and to observe my techniques.

Question: Is this outpatient surgery?
Answer: YES

Question: Do you do computer imaging?
Answer: YES.  This is done in the office.

Question: Is there any nasal packing?
Answer: If we only make a changes to the outside of your nose, then NO. But, if I do some work for nasal breathing that requires straightening the septum, then small nasal packs are placed inside each nostril and are removed the VERY NEXT MORNING.

Question:  What kind of advanced technology and modern techniques do you use to achieve faster healing and more precise surgery?  
Answer: I have designed a number of specialty instruments for rhinoplasty.  These instruments are smaller to allow me to perform more exact surgery.  

For example, the "standard" osteotome  (bone knife) for cutting the nasal bones is relatively large - too large in my opinion.  We were able to measure the thickness of the nasal bones (only 2.5 to 3 mm) and have introduced a 2.5 mm and 3.0 mm guarded osteotome (manufactured by Microfrance), that we now use exclusively.   We find that there is the least amount of trauma when these small instruments are used,  and subjectively patients seem to have less bruising and heal faster.

In the operating room, I use the Becker/Toriumi Rhinoplasty Instrument Set, manufactured by Medtronic Corporation and especially designed  for minimally traumatic rhinoplasty surgery.