Rhinoplasty in Miami with Leonard M. Hochstein, M.D.

Rhinoplasty is a very common procedure performed by myself in the Miami and Ft. Lauderdale area. During my initial consultation I am often asked how the technical surgery is performed and if “the bones need to be broken”. I would like to address these questions now as far as my technique and a few insights into the procedure.

How Rhinoplasty Surgery Is Performed

The anesthesia is administered first. I prefer to use general anesthesia because it allows me better control of the airway which is administered by Dr. Livschutz. Once the patient is asleep I inject a solution containing anesthetic to deaden any postoperative pain and epinephrine or adrenaline to constrict the blood vessels so that there is less bleeding. Once this is done the nose is cleaned and packed to prevent any blood being swallowed.

The surgery begins with an incision along the internal nostril rim. This is an excellent way to hide the scar so that no external sign of surgery is seen. This incision is performed in both nostrils. The first structure I encounter is the cartilage of the tip of the nose which can create a bulbous appearance. I use fine scissors to dissect away the cartilage from the overlying skin and remove the excess leaving a rim which is symmetric on both sides. Once this is performed I check to see that the bulbous tip is no longer present and that it now has a more sculpted appearance. Once I am satisfied with this I separate the skin from the septum or the cartilage present in the center of the nose. This cartilage helps determine the length of the nose and also if there is any deviation. If the nose is long I remove the excess at the bottom using serrated scissors which allow a precise cartilage removal. If there is a prominent nasal spine which can cause the appearance of the lip curving into the nose I remove it using a bone crusher. Once these steps are performed I have a good idea as to the final tip shape and length of nose. This is important because the bridge will now be addressed to match the tip.

The next step is to address the bridge. I free the overlying skin from the cartilage and bone below and access the situation. The lowermost portion of the nose is cartilaginous. It has a triangular shape with the side cartilages meeting the central septum in the middle. I separate these structures and the use the serrated scissors the remove the excess as determined by the tip being sure to develop a slight depression above the tip although I keep that straight in men. The next structure encountered is the nasal bones. I use a chisel to remove a little less than what I plan to remove and the use a fine rasp to remove the extra. I do this to decrease the risk of having any sharp edges on the bone. Once this is done I have a very good idea of the final nose shape and make any minor adjustments as necessary. The patient is now ready for the breaking of the bones.

Let me take a few moments to explain why this is necessary other than to narrow the nose itself. As I mentioned above the nose is a triangular structure. If the roof of the structure is remove when the bone is cut away it leaves an open space where they no longer meet. By breaking the bones they can collapse and meet again in the center.

The breaking is performed using a stab incision and a curved chisel which is a very careful , precise and gentle step. Once this is performed the skin incisions are closed using absorbable sutures which will not need to be removed but rather fall out after a few days.

A final assessment is made as far as nostril size and symmetry and skin adjustments are made as necessary. A splint is then applied and the patient awakens from the operation.

Leonard M. Hochstein, M.D.

|| Back to Top ||