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Introduction Rhinoplasty, or surgery of the nose, is one of the most complex procedures performed by Plastic Surgeons. Each individual part of the nose influences the others and can have a significant effect on both function and appearance. Dr. Granzow is double board certified in both Plastic Surgery and also Otolaryngology - Head and Neck Surgery, the two specialties which focus most on the nose and its function. This unusual dual background allows him to achieve the highest aesthetic results while at the same time maximizing both breathing and airway. He has performed numerous procedures on a large variety of patients seeking both aesthetic and functional improvement. Dr. Granzow knows that a superior result will present a natural and unoperated look and, at the same time, maintain or improve breathing. He performs the vast majority of his procedures through an endonasal, or "closed" approach, although an "open" approach may be used if needed. This endonasal approach allows shaping of the nose and airway via incisions which are hidden within the nose, achieving a final result without visible external scars. Every patient is individually evaluated to account for the unique characteristics of each case. No two procedures are the same, and great care is taken to match the final appearance to the patient's own unique features.
If you’re considering rhinoplasty… Rhinoplasty or surgery to reshape the nose is one of the most common plastic surgery procedures performed, with more than 250,000 procedures performed each year in the United States. Rhinoplasty can reduce or increase the size of the nose, change the shape of the bridge or tip, adjust the width of the nose and change the angle between the nose and the upper lip and face. Rhinoplasty can be performed to improve the appearance, breathing and/or both. It can be performed for aesthetic reasons or to correct the results of a birth defect or injury. Dr. Granzow is meticulous in his approach to rhinoplasty and has completed residencies and is Board Certified both by the American Board of Plastic Surgery and also the American Board of Otolaryngology – Head and Neck Surgery (ear, nose and throat surgery) The information included here will give you a better basic understanding of the procedure and what you generally can and cannot expect. It is a general guide only and specific questions may be directed to Dr. Granzow during your consultation and to our office. Please feel free to ask any questions at any time and to inform yourself as much as possible about this and any other procedure.
The best candidates for rhinoplasty The best candidates for rhinoplasty are people who are looking for improvement, not perfection, in the way they look. It is helpful to have specific and realistic goals in mind for the improvement of the appearance and breathing, although it is not necessary to know every detail about how you would like your nose to change. Dr. Granzow has significant experience in all types of rhinoplasties and will spend considerable time with you in consultation going over exactly what your goals are and how they might be accomplished. He will specifically review the goals with you and also go over the fine points of your specific situation and your specific procedure with you so that together with you he can achieve the best appearing and most natural result possible.
Planning your surgery During your consultation, Dr. Granzow will specifically go over how you would like your nose to look. He will also specifically go over any breathing difficulties you might have and will go over the factors that can influence the procedure and the results. These factors include the structure of your nasal bone and cartilage, the shape of your face, the thickness of skin, your age and your expectations. He may perform specific evaluation of the breathing to optimize that as well. He will go over the surgical plan he will use also. During your visit you should make sure that you tell Dr. Granzow about any previous nose surgery or injuries that you have had, even if it was many years ago. You should also inform him if you have any allergies or breathing difficulties or any history of nasal or sinus infections. You should let him know about any medications, vitamins or other drugs which you might take and if you smoke. Do not hesitate to ask him any questions. He will be happy to review each one in detail with you. While insurance will rarely cover cosmetic surgery, most insurance plans may cover some or all of the functional parts of your procedure. Our office is quite accustomed to working very closely with most insurance companies and we will assist you in maximizing the coverage for your particular case.
Preparing for your surgery Our office will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, and taking or avoiding certain vitamins or medications. You should stop smoking for at least two but preferably four weeks before and after surgery. While you are making preparations, be sure to arrange for a responsible adult to drive you home after surgery and to be with you at home for at least the first night after surgery.
Where your surgery will be performed Most rhinoplasties performed by Dr. Granzow are performed on an outpatient basis, meaning that you will arrive at the surgery center or hospital the morning of your surgery and return home the same day. Most surgeries are performed in outpatient surgery centers in fully accredited outpatient surgery centers, although a hospital is certainly an option if required or requested by the patient.
Types of anesthesia Dr. Granzow usually performs the rhinoplasty under general anesthesia, meaning that you will be completely asleep during the procedure. In unusual cases, light sedation or local anesthetic may be used instead.
Typical steps for your surgery include: Step 1: Anesthesia You will brought to the operating room and made comfortable in the surgical suite. The anesthesiologist will provide you anesthesia and ensure that you are completely asleep during the procedure. Your bed will be comfortably padded. Once you are asleep, the nose and face are gently washed with sterile solution and a small amount of additional anesthetic medication is injected to facilitate the procedure. Step 2: The Incision Dr. Granzow performs most surgeries using a closed procedure, meaning that the incisions are hidden within the nose. In the rare instance that it is needed, an open procedure can be performed and an additional small incision is added across the columella. The columella is the narrow strip of tissue that separates the nostrils. Dr. Granzow will meticulously raise the skin and soft tissue from the underlying structure of the nose. Great care is taken to stay within the avascular planes. This allows for better visualization of the structures, quicker healing and less bleeding. Significant bleeding is rarely encountered during a properly performed rhinoplasty procedure. Dr. Granzow will then perform the necessary steps and adjustments on each individual nasal structure and carefully sculpt each piece so that it provides harmony to the overall structures, not only the nose but also the face. Step 3: Reshaping of the nose structure Dr. Granzow may use portions of the inner wall of the nose, called the nasal septum, to further refine and shape the outside portions of the nose. In rare cases, cartilage from the ear or another portion of the body may be required as a structural support for the nose. Dr. Granzow will carefully shape the dorsum, or bridge of the nose, and then also adjust the delicate tip structures if needed and align them for proper position and proportion. During the procedure he will also address the septum or inside wall of the nose to straighten this and to improve the breathing. Nasal turbinates, which are small bones which can be found on either side of the nasal airway, are also often addressed in a conservative and physiologic way to improve the breathing as much as possible while preserving the function of the overlying nasal lining. The structures are then carefully sutured into place to allow them to sit properly together. Almost all sutures are dissolvable sutures. The specific type and size of the suture will vary considerably according to the portion of the nose where it is needed. It is not unusual for Dr. Granzow to use three, four or five different types of sutures to properly perform the procedure. Step 4: Closing the incision Once the structures have been completely addressed, Dr. Granzow carefully closes each incision and will suture the sides of the septum together. This meticulous closure allows for better healing and makes nasal packing unnecessary in the vast majority of cases. Certain specific technical consideration will call for the need for nasal packing in a small minority of cases. Step 5: Applying the dressing After the procedure is finished the nose is carefully cleaned on the inside and on the outside. The nasal structures are carefully and meticulously compressed to reduce the swelling and special tapes are placed on the surface of the nose along with a custom-molded nasal splint to further improve the shaping and reduce the swelling of the nose which will occur after surgery. Again, in Dr. Granzow’s hands, internal nasal packs or splints are unlikely to be used as these structures are held in place firmly with meticulously placed sutures. These sutures will dissolve on their own with time. Step 6: Seeing the results The nasal splint and tapes will be in place for approximately one week. A small dressing will accompany you home over the bottom of the nose which will usually be required only for the first several hours or the day after surgery. You will receive specific postoperative instructions from our office for after surgery. The splint will be removed at about a week after surgery. Most swelling will resolve in the first few weeks after surgery. However, some small amounts of swelling may persist for many months or even a year or more after surgery. The most subtle changes may take a year or more to see following surgery. Important facts about the safety and the risks of nose surgery A decision of rhinoplasty is extremely personal and you will have to decide if the benefits will fulfill your goals and if the risks and potential complications are acceptable. During your consultation, Dr. Granzow will go over the specifics of your case. Please feel free to ask any questions at any time before or after surgery. Dr. Granzow has significant experience performing these procedures and will gladly go over any details with you. Rhinoplasty is a safe procedure but does carry risks. Complications are uncommon but may include rupture of small surface vessels of the nose, infection, poor wound healing, bleeding, asymmetry, changes in sensation (numbness), changes in breathing, nasal septum perforation (a hole in the nasal septum), pain, unfavorable scarring, skin contour irregularities or discoloration or extrusion of the sutures. Due to the complex nature of rhinoplasty, a revisional surgery may be required although this is unlikely. Such a revision is typically small and usually a small touchup which is typically much smaller than any original procedure. Questions? Dr. Granzow and his office staff are happy to answer any questions which you may have regarding rhinoplasty or any other procedure. The answers to many questions may also be found in our frequently asked questions. Please feel free to call our office or contact Dr. Granzow at any time.
Cosmetic Procedures
Breast Augmentation Reconstructive Procedures
Breast Reconstruction
Before surgery, these rhinoplasty patients have large, slightly hanging noses, with a hump and an enlarged tip. 
Incisions are made inside the nostrils or at the base of the nose, providing access to the cartilage and bone, which can then be sculpted into shape. 
The surgeon removes the hump using a chisel or a rasp, then brings the nasal bones together to form a narrower bridge. Cartilage is trimmed to reshape the tip of the nose. 
Trimming the septum improves the angle between the nose and upper lip. 
A splint made of tape and an overlay of plastic, metal, or plaster is applied to help the bone and cartilage of the nose maintain their new shape. 
After surgery, the patient has a smaller nose, a straighter bridge, a well defined nasal tip, and an improved angle between the nose and upper lip. |
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