Healthy individuals with realistic expectations are good candidates for rhinoplasty. Dr. Sweeney’s goals are to achieve a significant improvement in a patient’s appearance, as well as meet realistic patient expectations. It is imperative to understand that there is no such thing as perfection when it comes to cosmetic surgery. Dr. Sweeney can discern when operating may not be appropriate—particularly if an individual’s desired outcome is unrealistic.

Rhinoplasty candidates may range in age from the mid-teens to the elderly. However, rhinoplasties should not be performed until teenagers have reached skeletal maturity, which usually occurs around age 15 for females and age 17 for males. Prior to this, injury to the septum or nasal growth plates can affect facial development. There is no upper age limit for a rhinoplasty, and Dr. Sweeney frequently performs rhinoplasties in combination with facelifts. As we age, the nasal tip begins to droop and can make the nose appear longer. Raising—and sometimes narrowing—the tip will achieve a more youthful appearance, which better matches the rejuvenated face, forehead, and eyelids of patients in their 60s, 70s, and 80s.

We at the Orlando Face and Body Plastic Surgery do our best to select patients who have realistic expectations. I will not attempt surgery unless I feel I can get a significant improvement. A photo of your nose will be uploaded to our imaging software, and I will do a computer rendering of what you may look like. The vast majority of the time I will achieve 80-90% of the changes I show you on the computer. Again, if I do not feel like I can get an 80-90% improvement on a primary rhinoplasty, I will not operate. Revision rhinoplasties are much more difficult and sometimes an improvement of only 50% is considered a satisfactory result.

The majority of my patients present for cosmetic rhinoplasty and not because of nasal airway obstruction. Rhinoplasties usually involve making the nose smaller, less projected, and narrower. Smaller noses do not breathe as well as larger noses. An exception is when a nose is broken and very deviated, therefore significantly blocking the airway. I will do everything possible to straighten the inside and outside of your nose, so hopefully the rhinoplasty will not negatively affect the airway. Having a smaller nose that also breathes better is not always possible, so if a better airway is more important, leave your nose big and wide.

On a final note, plastic surgery is not an exact science. If you stare at any nose long enough, especially in a magnifying mirror, you will find some slight asymmetries. All faces are asymmetrical to begin with. If you are a “perfectionist” and expect a “perfect result”, you may be disappointed. Patients with Body Dysmorphic Syndrome will never be happy. So please consider this information before scheduling your rhinoplasty surgery.

There are two generally accepted surgical approaches when performing rhinoplasties—the closed technique and the open technique. The closed technique involves an incision inside the nostrils only. This approach avoids an external scar and results in slightly less swelling; however, as one can imagine, the surgeon’s visibility is limited. The open technique involves an incision on the columella, which is the central bridge of skin between the tip of the nose and the upper lip. Most surgeons tend to make this incision in the middle of the columella—where it is most visible. However, Dr. Sweeney places his incision at the base of the columella in the upper lip junction—where there is a natural crease. While this incision is more difficult to make, the scar is rarely noticeable, regardless of skin type. Dr. Sweeney has implemented the open approach in thousands of patients, with minimal—if any—scar complaints.

At the Orlando Face and Body Plastic Surgery, Dr. Sweeney performs the closed approach for rhinoplasties that require minimal tip changes. There is no such thing as a simple rhinoplasty, as even minute changes can be difficult to achieve. The majority of Dr. Sweeney’s rhinoplasties are complex revisions, ethnic cases, or traumatic cases, which often require the exposure the open technique provides. This technique provides greater access to straighten a deviated septum, as well as to release the upper lip, which is often pulled upward by an over-projecting nasal tip. Similarly, cartilage grafts and implants are more precisely placed with the open rhinoplasty. Additionally, Dr. Sweeney’s revision rate is much lower with the open approach. These advantages far outweigh the disadvantage of slightly more swelling, which is only temporary.

There is a fine balance between making a nose smaller and narrower without compromising function, of which plastic surgeons and ear, nose, and throat specialists should be aware. Dr. Sweeney will often straighten a deviated septum or reduce enlarged turbinates, which may be unexpectedly diagnosed at the time of surgery, at no additional charge. If there is a chance that making a nose cosmetically smaller will significantly interfere with breathing, Dr. Sweeney will prioritize airway if possible.

During the patient’s initial consultation, Dr. Sweeney will carefully analyze the patient’s nose and review his or her medical history. He will need to know details of previous nasal trauma and surgeries, as well as any nasal airway, sinus problems or allergies he or she may have. The patient will have his or her photograph taken and placed on an imaging computer. Dr. Sweeney will use computer animation to change the patient’s image in small, gradual steps, until he achieves his or her desired changes.

Approximately two weeks prior to the surgery date at the Orlando Face and Body Plastic Surgery, the patient will have a preoperative consultation with Dr. Sweeney and his office staff. At this visit, the patient and Dr. Sweeney will again review the proposed changes and examine the computer-generated image together. The patient will also have an opportunity to ask any questions prior to reading and signing the operative consent forms. Additionally, all aspects of the postoperative care will be comprehensively reviewed, and final payment will be due at this time.

Day of Surgery – Dr. Sweeney will meet with the patient briefly before he or she is given any anesthesia to ensure all parties are still in agreement. Our nursing staff will review a surgical checklist, and the patient will be taken into the operating room. A board-certified anesthesiologist or anesthetist will administer anesthesia. Written instructions will again be discussed with the patient’s caregiver before they are discharged.

Day 2 to 6 Post-Operation – The patient returns to Orlando Face and Body Plastic Surgery to have the cast and outside sutures removed. If splints were used to stabilize the septum, those may be removed during this visit. Even with the swelling, the patient should have a good idea of what their nose will look like.

One Month Post-Operation – If the patient lives close, Dr. Sweeney would like to examine the nose to make sure he or she is healing as expected. Out-of-state patients can email photographs to the office in order to help us evaluate their postoperative results.

3 – 6 Months Post-Operation – At this visit, most patients will have their postoperative photos taken. If there is still a small amount of swelling, postoperative photos would be taken a few months later.

Annually – Dr. Sweeney recommends patients follow-up at the Orlando Face and Body Plastic Surgery—at no charge—every year, or as able, in order to together assess the surgical results. This allows Dr. Sweeney and his staff to better evaluate patient outcomes and continue to refine his surgical techniques in the future.