There is no plastic surgery procedure more complex than primary rhinoplasty (cosmetic surgery of the nose) with perhaps the exception of revision rhinoplasty. Improving the results of rhinoplasty surgery done previously has many challenges, due to a number of factors, most important being the unknown status of the supporting structures from prior maneuvers and the scarring that can result from the prior surgery.
As a specialist in rhinoplasty, with over 20 years of experience in this field, Dr. Epstein performs a large number of revision cases, with approximately one-third of the three to four rhinoplasty surgeries he performs weekly done to repair work done previously. Using his background both in facial plastic surgery and Otolaryngology, Dr. Epstein is able to work not only on improving the appearance of the nose, but also to reinforce the structural support mechanisms to assure the best possible breathing passages and long lasting cosmetic results.
Nearly every revision procedure he performs is by the external or “open” approach. This provides unsurpassed visibility of the nasal structures, allowing for the most natural and aesthetic correction, while at the same time maintaining the supportive attachments of the nose, assuring stability. With the external approach, a single incision is made right along the bottom of the nose, which then heals as a fine line scar barely if at all detectable.
Some of the more common problems seen with prior rhinoplasty include: asymmetry, especially of the tip; crookedness; underprojected (too short) nasal tip; unnatural sharp edges or angles of the tip and other areas; wide inadequately narrowed bridge; nasal obstruction due to a deviated septum; areas of collapse; and many others. Through a combination of sculpting, suturing, rasping, and resetting of the bones and cartilage, it is possible to nicely improve the nose to look more natural and aesthetic. With his experience, Dr. Epstein is also able to use a variety of grafts, either of the patient’s own cartilage (from the septum or the ear) or a special fabric called GoreTex®. Many people are familiar with GoreTex® as something used to make ski clothing, but this fabric has an outstanding 20 plus year track record of being used in vascular, heart, hernia, and of course plastic surgery. In Dr. Epstein’s hands, GoreTex® can provide natural appearing and natural feeling results.
No matter whether it is a primary or revision rhinoplasty, Dr. Epstein’s approach is to create a nose that is in harmony with the rest of the face, and is attractive most importantly to the individual. In order to facilitate communication between surgeon and patient, Dr. Epstein utilizes computer imaging to provide a visual component to the dialogue, showing the patient what is both a realistic and aesthetic result of the surgery based upon the patient’s expressed goals. The patient will receive these imaging photos by email usually within two days of the consultation, and has the opportunity to provide feedback on what is liked and what changes are desired. This back-and-forth communication is invaluable in the planning of the procedure.
Rhinoplasty is an outpatient procedure usually performed in Dr. Epstein’s accredited office operating rooms under twilight sedation. Provided safely by his anesthetist of more than 15 years, twilight sedation assures that the patient neither feels nor remembers anything, yet breathes on his/her own. Dr. Epstein also has privileges at South Miami Hospital, located across the street from the office, where procedures are performed when requested or medically indicated.