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Associates in Plastic Surgery, PLLC.Associates in Plastic Surgery, PLLC. 4001 Kresge Way, Suite 220 Louisville, KY 40207


by F. Ryan Wermeling, MD

The nose is a complex scaffold of bone, cartilage and skin. Rhinoplasty involves carefully manipulating all of these structures to improve breathing and/or the shape of the nose.

Rhinoplasty, Rhinoseptoplasty (sometimes called a septorhinoplasty), and Septoplasty are various nasal surgical procedures that are done to improve the appearance of the nose and/or the ability to breathe through the nose. Nasal deformities may be present at birth or may develop with growth and aging. Traumatic injuries, such as a broken nose, or changes from previous surgeries may result in significant deformity that can be reconstructed. Patients may choose the benefits of cosmetic improvement or functional improvement in the nasal airway, or a combination of both.

Nasal aesthetics are central to how we appreciate the attractiveness of the face. The balance of elements of the nose from any point of view affects not only the attractiveness of the nose, but also the overall balance and aesthetics of the entire face. Understanding nasal aesthetics and the interdependence with the rest of the face is as important as the technical skill and experience required to perform this elegant and complex operation. Rhinoplasty is generally considered among the most difficult and challenging procedures in plastic surgery because small changes can have important consequences in the appearance or airway function.

Dr. Wermeling begins with a thorough consultation to understand the patient's goals and carefully evaluates size and shape of the various nasal elements, the overlying skin, the internal airway, and the relationship to other facial features. Planning and surgical precision are of critical importance. Dr. Wermeling's goal is to achieve as natural a result as possible, without an overly operated appearance.

Who is a Candidate?

  • A patient with a nose that is cosmetically unattractive or does not have a pleasing balance with other facial features. A Rhinoplasty is the surgical procedure that corrects or enhances the external parts of the nose.
  • A patient with overly prominent features of the nose.
  • A patient who wants removal of a hump on the bridge of the nose, refinement of a round nasal tip or elevation of a drooping tip.
  • Someone whose nose is crooked, too wide, too long, excessively projecting, or flat may be improved.
  • A patient that has a structural deformity affecting the air passages. The nasal septum (the cartilage separating the right and left internal nasal passages) may be deviated and cause nasal airway obstruction. Correction of a deviated septum alone is called a Septoplasty or Submucous Resection of the septum (SMR). A crooked nose may worsen this disorder; and, therefore, require correction at the same time, which is a Rhinoseptoplasty. Turbinates are internal airway parts of the nose that help to add moisture and filter inspired air. These structures can be enlarged for many reasons and contribute to airway obstruction. When this occurs, Dr. Wermeling will recommend their removal as part of the nasal surgery. Other problems, such as narrowed passages and airway collapse, may require placement of cartilage grafts for structural support. Occasionally, scar tissue or bony prominences will need to be removed.

Insurance Coverage

When reconstructive nasal surgery is done to restore normal airway function or appearance, insurance benefits may cover some of the costs associated with these surgical procedures. Dr. Wermeling's office will assist in obtaining pre-authorization from your insurance company.

Intended Result

  • A more attractive nasal shape with the nose in better proportion to other facial features.
  • Maintenance of the patient's individuality.
  • Correction of breathing difficulties caused by fixed anatomical obstruction.
  • Realistically, there are limitations in achieving the final goal and the ultimate outcome will vary from patient to patient due to the characteristics of the individual's skin, cartilage, and bone.


  • Cosmetic rhinoplasty may be done with local anesthesia and intravenous sedation in the safety of an accredited outpatient surgery facility. Another option is to use general anesthesia, which may be used based on the patient's request or physician recommendation.
  • Cosmetic rhinoplasties have incisions hidden within the nostrils, inside the nose. More complex nasal operations often require a small incision in the narrow strip of skin between the nostrils. This tiny scar is barely visible, yet it allows the surgeon to "lift" the nasal skin and directly view all of the cartilage and bone requiring correction. This is termed an open rhinoplasty. To narrow flaring nostrils, small incisions can be placed in the groove where the nostril meets the cheek.
  • Septal cartilage and bone or other obstructing tissues can be relocated or removed, as required.
  • Cartilage and bone grafts, if required, are most often taken from within the nose. Ear cartilage is another possible source of graft material to rebuild the underlying architecture.
  • After the underlying framework of cartilage and bone has been modified, the skin is redraped.


  • An external cast or nasal splint will be placed immediately after surgery. The nose may be packed for 24 to 48 hours. The cast or splint is usually removed in 7-10 days.
  • Initial discomfort is easily controlled with oral medications.
  • The majority of swelling and bruising subsides progressively over 2 to 4 weeks.
  • External sutures (if any) are removed in 4 to 6 days. The internal sutures will dissolve.
  • Return to work may be possible in about 7 to 14 days, depending on the nature of your responsibilities.
  • While the visual improvements and better breathing should be apparent relatively soon after the swelling diminishes, a realistic approximation of your final result is evident in 3 months. The final result will continue to evolve and refine for 12 to 24 months.
  • Areas of sensitivity or numbness will slowly resolve. Temporary conditions that may occur, but will improve over the first several months, are stiffness of the tip of the nose, nasal drainage, lumps and irregularities.
  • Dr. Wermeling will personally see you for post-operative care at prescribed intervals to evaluate your progress and answer questions. His follow up care will go on for the following year or more as the healing tissues mature to the ultimate improvement.