Facial balance centers on the nose, and Dr. Neurohr draws from his wide range of experience and skills to achieve the proper proportions that make each patient’s nose look like the best one that is meant for them. Natural results in rhinoplasty require a deep understanding of structure, function and variations of the nose, and its unique relationship to each face. The passage of air for breathing, the drainage outlet for the sinuses and for tears are a few of the functions of the nose. If any of these are not working properly, it creates a medical problem. Interestingly, a poorly functioning nose, often, does not look right on a person’e face because of its inherent design.
When Dr. Neurohr examines each patient, he totally focusses on their thoughts and feelings about their unique problems before he thoroughly examines the nose. This requires both a subjective as well as an objective assimilation of information which he processes and analyses to create a customized plan designed to satisfy the patient’s concerns. He informs them of their options and the limitations involved in order to gain a clear understanding of expectations before surgery.
The architecture of the nose is intriguing because it comprises many different types of tissue in its structure. The general shape is that of a pyramid, the foundation of which is bone, and supported by cartilage. Skin of various thicknesses cover the outside, and a glistening mucosa lines the inside. The object of rhinoplasty is to modify all, or some, of these structural elements so they work together, harmoniously, to achieve improvement in the function and appearance of the nose. Dr. Neurohr accomplishes this by not only removing excesses that cause nasal humps, and bulbs, and hooks, but also by adding back materials to create better structural integrity and aesthetic appeal to the nose.
For example, some people are born with underdeveloped parts of their noses. Others are left with inadequate structural elements after previous surgery or trauma. Dr. Neurohr employs cartilage as the primary grafting material to bolster deficiencies in the nose, both primarily and secondarily. It can come from the nose itself, or from the ears. In some complex cases, Dr. Neurohr will find a section of cartilage on the ear which has the same shape and contour desired to correct a defect of the nose. He “harvests” that specific cartilage and makes a graft to fill the problem area, thus, restoring a crucial piece to the nasal mosaic, completing the aesthetic puzzle.
Depending on the complexity of the case, rhinoplasty can take anywhere from one and a half hours to four or five hours. It is usually done under IV sedation anesthesia, but in more severe airway obstruction cases, a general anesthetic is required. Dr. Neurohr usually uses an open technique, where he makes a small incision across the columella, which is located between the nostrils. An external splint is usually applied over the nose at the completion of the operation to secure the tissues an place, and to minimize discomfort. If nasal airway corrections are done on the septum or turbinates, internal splints are placed as well. After surgery, breathing through the nose is temporarily very limited. Patients go home after surgery, and are required to “take it easy,” i.e. rest for a few days because it takes some time to heal. The sutures are removed in 4-5 days, and the splints are removed in 5-7 days. Swelling impairs nasal breathing for about 2 weeks. Subtle healing changes occur for a whole year, but the results are readily seen immediately when the splint is removed, and then, again after 3-4 weeks when the swelling diminishes. Patients often will have black eyes for 5 days to 3 weeks, depending on the case. They can usually drive in 5 days and return to work around that same time if some bruising and swelling is not an issue. If it is, then, they usually return to work in 3 weeks. Still, it takes 3-6 months for the tissues to soften, and for the subtle visual effects to take place.
Sound artistic judgement is central to successful rhinoplasty surgery. There is no one solution for every case, and Dr. Neurohr is keenly aware if this. He always strives for perfection by careful consideration of every case, through his depth of knowledge and experience in managing problems of the nose, and his technical finesse, utilizing a wide spectrum of surgical tools which he judiciously employs. Dr. Neurohr loves the challenge of rhinoplasty. From the most simple case, to the most complex, he puts the patient’s interest first, and does his very best to give them the very best result possible.