Dr. David Kirn


Perhaps no other operation embodies the essence of plastic surgery better than rhinoplasty – a “nose job.”

Rhinoplasty is commonly performed, is impossible to hide, and is a source of great concern for both the patient and the surgeon. There are many reasons patients seek rhinoplasty; to improve breathing, to repair damage from trauma, and to reshape the nose to improve appearance. While my practice addresses each of these concerns, the majority of our patients come seeking cosmetic improvement and thus this article will focus on that need.

Cosmetic rhinoplasty is performed as an outpatient procedure and requires only one or two hours in surgery. Pain is usually minimal, but patients do complain of difficulty breathing through the nose for a few days after surgery, not unlike having acold. Although use of nasal packing was common in the past, we rarely, if ever, use packing in modern practice.

Most patients who come seeking rhinoplasty have had it on their mind for quite a while. Surgeons consider rhinoplasty in components, and so should you. Rather than simply thinking: “my nose is too big,” start breaking that down a little. Is it too wide; is it too long; is there a hump; is the tip too large? Then start to imagine if the dominant component was corrected, would the other components all blend together in an appealing manner? For example, if you imagine a hump removed, would the tip be in proportion? This line of thinking will pay a dividend when you meet with a surgeon.

Due to the subjective nature of what constitutes success in cosmetic rhinoplasty, as well as the many factors which can affect final shape and healing, rhinoplasty carries a higher revision rate than most other plastic surgery procedures. The best way we have found to ensure surgeon and patient are envisioning the same goals is computer imaging. Photographs of the patient are digitally modified to simulate the effect of the procedure. Experienced surgeons will ensure the surgical goals are realistic. Computer imaging has been the most useful tool in rhinoplasty planning in our practice. Both the original and modified photographs accompany us to the operating room to serve as a guide during the procedure. The imaging process also allows the patient to observe how changes in one component of the nose can affect the appearance of other areas. Again, the need for component thinking is important. Photographs provide us a better perspective on our appearance than a mirror and lend a more realistic analysis.

What is the right amount of change? The nose should remain in balance with the face. As stated many times in these articles, the best surgery looks like no surgery has been done, and is completely natural in appearance. Ethnicity must be taken into account with rhinoplasty and the nose must look like it belongs on the face. Here again, computer imaging helps determine this delicate balance.

A common misconception of patients is that the nose is like modeling clay and, in the hands of a good sculptor, can be molded into any desired shape. In reality, the nose has a complex structure and represents a delicate interplay between bone, cartilage, skin, and mucosa. The structural and functional aspects of the nose must be maintained and frequently they set the limitations on what can be accomplished.

One year is usually required before the shape of the nose is considered to be final following surgery. So, patience is important both for the patient and surgeon. If you are thinking about rhinoplasty, it is important to not only choose a surgeon with expertise and experience, but also one you can relate to as it will be a long journey. Selecting a surgeon certified by the American Board of Plastic Surgery is also a wise choice, especially for cosmetic rhinoplasty.

Dr. David Kirn is a Board Certified Plastic Surgeon who is devoted to advanced techniques in Cosmetic Surgery of the Face, Breast, and Body. In private practice since 1998, he is located in a state of the art facility which includes a full service skin care center. The practice is focused on personalized patient care and attention to detail. Where possible, Dr. Kirn utilizes minimally invasive procedures. The goal is to deliver quality clinical results while minimizing patient recovery time. Examples of this include a no-drain tummy tuck, armpit incision breast augmentation with gel or saline implants, fat grafting, and a short scar facelift. In addition, Dr. Kirn and nurse-injectors Carey Sanders, RN and Shirley Ramsey DNP, APRN, offer a full spectrum of non-surgical treatments such as Botox®, Dysport®, Dermal Fillers, Kybella®, & Laser.