Vancouver Nose (Rhinoplasty) Surgeon – Dr. Ritchie Younger
If you ask most surgeons which facial surgery procedure is the most daunting, they’ll likely say nose rhinoplasty. With rhinoplasty, the surgeon’s skill and experience, as well as an intimate knowledge of nasal anatomy, are all crucial for a successful outcome. Not only is it important to get it right aesthetically, but you also have to consider the airway. Appearance and airway go hand in hand.
As one of Vancouver’s leading facial plastic surgery experts, Dr. Ritchie Younger has been performing successful rhinoplasties for over 30 years — bringing out a more refined and balanced appearance in thousands of happy, satisfied patients. In fact, 70% of Dr. Younger’s patients have come to him for help after previous unsuccessful nose surgeries elsewhere. With Dr. Younger and the Younger Facial Centre team, you can rest assured that you are in very capable, professional and experienced hands.
It is very important to have a board certified surgeon with vast experience in rhinoplasty to ensure a good result. Anyone considering a rhinoplasty should check the credentials of their surgeon and make sure they perform a substantial number of them every year. Ask the surgeon questions about breathing and nasal appearance and assess whether the answers given demonstrate the surgeon’s knowledge of this complex procedure. With a qualified surgeon, breathing and nasal airways seldom need to be compromised when improving the shape of the nose externally.
A classical rhinoplasty can modify the shape, size, and position of the nose as well as the effects of aging. Yes, noses do age! Essentially, the overall goal of a classical rhinoplasty procedure is to create a balance between your nose and the rest of your face. Classical rhinoplasties are typically performed on patients from their 20s to 80s.
A classical rhinoplasty can be performed on its own, or in combination with other procedures like nasal airway revision or functional septorhinoplasty. These are performed to improve airflow or to fix an injury.
Pre-surgery – your rhinoplasty consultation and assessment
During the preliminary consultation, Dr. Younger will examine the structure of your nose and the texture, colour and elasticity of your facial skin. Photographs will be taken for a pre-operative, in-depth study of your face and nose. With our Computer Imaging System, we can show you what results you can expect.
Your personal history and individual risks will also be examined, especially those related to medical conditions such as high blood pressure, a tendency to scar, smoking, and any deficiency in blood clotting. Dr. Younger will take a thorough medical history, as well as assess your mental and emotional attitudes toward the surgery. A realistic attitude is vital to success.
Dr. Younger will answer your questions and concerns about your nose appearance and function as well as address any questions you may have regarding the recommended surgery. We encourage our patients to be proactive and prepare questions ahead of time. Visual aids such as photos and examples of noses that you like and do not like are also very valuable.
Successful facial plastic surgery outcomes result from thorough planning and a good rapport between patient and surgeon. As such, Dr. Younger may require more than one session to completely assess your needs.
About the classical rhinoplasty surgery
The nose consists of skin-covered cartilage and bone, which may need to be modified. It is also common to change or improve the airways. This may involve a few steps of surgical alterations, therefore the surgery may have to be done under general anesthetic, where you are put to sleep.
Depending on your requirements, the surgical approach may differ. Sometimes, the Rhinoplasty is based on what is called a “totally closed” approach with the outside of the nose left untouched. In other instances, Dr. Younger has to open the nose up and make some cuts in the skin to better access to the cartilages and the bones.
Incisions are placed directly on the inside of the rim of the nostrils, where they are invisible. In some cases, a very short incision may be made at the base across the skin between the two nostrils. The soft tissues of the nose are then separated from the underlying cartilage and bone. The offending structures are sculpted and the remaining cartilage and bones are reshaped and refined to attain the shape of the desired nose.
The surgical parts of the classical rhinoplasty usually take 1 to 2 hours, depending on the amount of work required.
Healing time after rhinoplasty surgery
After your rhinoplasty surgery, some swelling and bruising of the nose and eyelids can be expected. You will wear a splint for 5 to 8 days and will be advised to stay home from work for approximately one week.
The swelling usually subsides within the first few days to a couple of weeks. Significant improvement may be noticed as soon as the splint is removed from the nose. Several weeks to months must pass before you are fully healed. Even though initial improvements are immediate, the final results take awhile to be fully appreciated. Clients are advised that it can take any time from 8 to 36 months for the nose cartilage and skin to settle completely.
The good news is that the post-operative risks are minimal if you follow proper care like abstaining from sun exposure, too much physical exertion, and nasal injury.
At Younger Facial Surgery Centre, we call the supreme rhinoplasty the “go-big-or-go-home” rhinoplasty. It is a term we use when a nose requires major surgery to alter its form or its function. A supreme rhinoplasty can be a life-changing event for many clients. By changing the appearance of the nose in a significant way, all facial parts become better balanced. Clients look completely different and start viewing themselves in a very positive light.
In most circumstances, clients with an interest in this type of rhinoplasty have an aesthetically imbalanced or very large nose which demands a highly skilled surgeon to substantially change the nasal shape and physiology. During a supreme rhinoplasty, both the bones and cartilages need to be aggressively altered. This involves major surgery and requires clients to be put to sleep during the operation.
With bigger surgical interference, the tissues will swell and bruise more than other, smaller operations. The face will be bruised for 7 to 10 days with patients starting to be socially presentable in 10 to 12 days. It takes a minimum of a full year to heal completely and for the altered nose to settle into its new permanent state. Some clients will experience subtle changes for up to 36 months when the tissue and bone have healed and settled completely.
“The Supreme Rhinoplasty procedures are often home runs in the surgical world. These are the patients who love us the most, because we turn someone who’s anything from subtly concerned to completely obsessed to about their nose, into someone who loves looking in the mirror. Especially clients who have been bullied because of their nose during childhood, find this procedure to be life altering. As a surgeon, I think these clients usually are the most gratifying ones. We love to see people like this.” – Dr. Ritchie Younger
Revision rhinoplasty is something that is becoming more common in nasal surgery. Currently, 70% of rhinoplasties that Dr. Younger performs are a revision of another surgeon’s work. Over the last 30 years, Dr. Younger has performed thousands of revision rhinoplasties with excellent results. They are typically required because of issues with appearance, nasal airways or inadequately addressed alignment by the primary surgeon.
Some of the most common revisions that Dr. Younger performs are to improve airways, create nasal symmetry or create a better balance of the nose size in relationship to the rest of the face. In general, revision rhinoplasty surgeries are complex and take 1 to 3 hours to perform under general anaesthetic.
Downtime is typically 5 to 7 days. Healing time increases in relation to the number of previous rhinoplasties. It could take years for a nose to heal completely when previous surgeries have created scar tissue and problems with blood supply.
Dr. Younger never performs any type of rhinoplasty until at least one year has passed from the previous surgery. There will be other surgeons who take on cases like this in a shorter time frame, but this is not something recommended by Dr. Younger.
Subtle Refinement Rhinoplasty
Subtle refinement rhinoplasty is a procedure for clients who are not completely happy with the look of their nose, but who want a change that only requires a small surgical adjustment. Typically these procedures are faster and have less downtime than a full rhinoplasty.
Similar to classical rhinoplasty, a subtle refinement rhinoplasty focuses on the skin covering the bones and cartilage in the nose. Typically, all of these need to be altered and worked on, particularly the cartilage, which can be subtly too big or out of place. Also, the bones may need to be minimally moved or altered. The subtle refinement rhinoplasty can sometimes be done with local freezing.
Following the procedure, the client may experience some swelling and slight bruising. It may put them out of action for 3 to 5 days, and it takes a couple of months to heal completely. Typically, Dr. Younger performs this type of rhinoplasty for individuals who are frequently in the public eye such as TV anchors, actors, and models — people whose livelihood may be compromised by a longer downtime with bruising.
Nasal Airway Revision/Enhancement
The nasal airway revision or enhancement is becoming a more frequent procedure in our clinic. The main reason for this is the rise of unsuccessful previous rhinoplasties performed by non-expert surgeons without adequate experience in cosmetic surgery of the nose.
The nose is an organ primarily designed to let people breathe. Sometimes, less-experienced surgeons focus too much on the aesthetic external appearance of the nose during surgery thereby compromising the nasal airways. Whenever the anatomy of the nose is altered (nasal anatomy is the structure that is made up by the nasal skin, the cartilages and the bones) the ability of the patient to breath may seriously deteriorate. Dr. Younger frequently sees people who have difficulty breathing through their nose following aesthetic surgery, which is, unfortunately, an unnecessary complication.
When these clients come to see Dr. Younger, he will surgically do whatever he can to help them. The surgery frequently requires different types of grafting which means taking a piece of bone or cartilage that is moved to the nose from another place in the body. Grafting could come from bone from a rib, cartilage from the ears or cartilage from the posterior part of the nasal septum. The goal is to make room in the nasal airway by recreating the anatomical parts that have been completely removed or decreased in size.
In circumstances where the client has very bad airway issues, the surgery is done under general anaesthesia with the client put to sleep. The surgical part of the nasal airway enhancement may take anywhere from 1 to 2 hours.
The downtime due to swelling and pain following nasal airway enhancement surgery is about 3 to 4 days, but it can take months for the nose airway to open up and heal entirely. Complete settling of bones and tissues can take as long as 12 to 18 months.
The functional septorhinoplasty or sport rhinoplasty, most frequently involves someone who has breathing issues due to a crooked nose following a trauma or sports injury like hockey, basketball, volleyball or even a childhood accident at the playground.
According to Dr. Younger, the functional septorhinoplasty is one of the most difficult rhinoplastic surgeries since it often requires the straightening of a crooked nose. It involves reconfiguring the cartilage in the bones to make things straighter and opening the airways. Dr. Younger generally performs functional septorhinoplasties under general anaesthesia where the client is put to sleep.
Following functional septorhinoplasty, Dr. Younger normally does minor skin injections with steroids to reduce swelling and facilitate an even healing process. The first phase of healing may take 1 to 2 months, but similarly to other complex surgeries, it may take 8 to 36 months for things to settle down completely.
Dr. Younger has published multiple articles on functional septorhinoplasty involving a crooked nose and emphasizes that it is one of the most difficult rhinoplasties to perform. If you see a surgeon who says that your nose is crooked and that it will be easy to fix, you should reconsider. This surgeon may not have the right qualifications to perform this type of surgery. A crooked nose is extraordinarily difficult to align and you would benefit from being operated on by a board certified facial plastic surgeon who does a lot of rhinoplasty surgery. Otherwise, the likelihood of you getting a great result is low.
Augmentation rhinoplasty is for clients who want a nose that is somewhat larger. Sometimes, they are also looking to subtly change the nose shape.
Augmentation rhinoplasty usually means augmenting the dorsum of the nose to make these a little bit bigger. The procedure may also simultaneously include creating a more defined nose tip as well as a reduction of the nostril size. These procedures combined, create a nose that is more balanced with your face.
This category of procedures may also entail the removal of a previously used implant in the nose. Over the last 30 years, Dr. Younger has treated some 100+ clients with unsuitable nose implants. These typically originate from non-board certified surgeons in foreign countries and are not approved by Health Canada. Since these implants are not of medical grade product, they sometimes get infected and cause pain, or in some extreme cases, rejection of the implant. In some very unfortunate cases, unsuitable implants have perforated the skin on the nose tip and started to protrude throughout the tip of the nose.
If you have an implant that is causing you problems, this is something that Dr. Younger can resolve through an augmentation rhinoplasty. Most commonly, Dr. Younger removes the implant first and then wants you to wait for at least a year before he proceeds to reconstruct the nose. He then simultaneously augments its natural size, but without an implant. In these circumstances, rejection can be avoided by using natural products from the body. Cartilage grafts are most commonly used i.e., rib cartilage grafts.
Similarly to regular rhinoplasties, you will experience some swelling and bruising of the nose and eyelids after an augmentation rhinoplasty. You wear a splint for 5 to 8 days following the procedure and are advised to stay home from work for approximately one week. Again, clients are advised that it can take any time from 8 to 36 months for the nose cartilage and skin to settle completely.
Tip refinement involves changing the anatomy of the nose tip. In a lot of circumstances, the cartilage of the nasal tip is too big for the patient, which in addition to the thick skin on the nose, makes the tip look aesthetically disproportionate with the rest of the face. A tip refinement, although subtle, can dramatically change the balance between your face and your nose, without compromising your breathing.
A tip refinement by Dr. Younger is typically focussed on reducing the size and thickness of the nose cartilage. An alternative, sometimes used by Dr. Younger, is to use cartilage from either inside the nose or the ear. These changes the configuration of the nasal tip makes its appearance smaller. In some clients with thick nasal skin, Dr. Younger may even have to thin the skin very carefully to help define the nose shape somewhat.
Surgery on the nasal tip can typically be done under local anesthetic; you do not necessarily have to be put to sleep except in certain circumstances. You will have a splint for 5 to 6 days. Typically, you can go back to work after a week. The exception is with clients with extra thick skin, who will spend longer time healing. As with many rhinoplasties, it can take up to 8 to 36 months for the nasal skin to fully contract down over the new envelope. The results albeit small can, however, be quite striking by improving the overall impression of the nose.
Junior Rhinoplasty or Rhinoplasty for the young, can be controversial but there are some important guidelines for reshaping the nose in young people who are still growing and developing physically.
Dr. Younger abides by strict rules for rhinoplasty in younger clients. He does not do anything to the nose that will affect the growing portions of the face or the nose. Scientific studies show that young women can be operated on if their faces coitally mature by 14 to 15 years of age. Young males have faces that take longer to mature, and need to be somewhat older; Dr. Younger typically wants them to wait until they are about 20 or 21 years of age.
Junior Rhinoplasty is usually performed on a female client with a somewhat large nose, who has reached their late teens. The clinical assessment includes a comparison of her (or him) to first-degree relatives (parents or siblings), to see if the nose seems to have reached its final size.
By putting the nose into better balance with the rest of the face, these clients often get great results. Typically this procedure is done surgically under general anaesthetic. Reducing the size of the cartilage in the nose demands surgery for 1 to 2 hours. These procedures can be done either through the nose or through the exterior with incisions.
Swelling and bruising take 5 to 7 days to resolve, while it may take a year for the nose to find its final shape.