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Facial Plastic Surgery


Rhinoplasty is the surgical procedure for changing the appearance of the nose. In this procedure, incisions are placed just inside the rim of the nostrils and, occasionally, across the skin between the nostrils. The soft tissues of the nose are then carefully separated from the underlying cartilage and bone. Excess bone and cartilage are appropriately adjusted to give a balanced, harmonious appearance to the face.  When rhinoplasty is performed to relieve obstructions inside the nose, or in conjunction with surgery to reconstruct the nasal passages, the procedure is called septorhinoplasty. In this procedure the obstruction is removed through internal incisions and the interior of the nose is restructured.


Boxy Tip

These procedures usually last from two to three hours, depending on the amount of work to be done. A small splint is usually placed on the external nose for a few days and a light internal dressing may be applied. After the procedure, some swelling and bruising of the nose and eyelids can be expected. The swelling usually subsides within the first several days, and the bruising subsides within a few weeks. There may be mild discomfort for a short time after surgery, but significant pain is quite rare. Any discomfort is usually controlled quite easily with medication


Nonsurgical Revision Rhinoplasty

             Minor to moderate asymmetries can occur either immediately or years after a  rhinoplasty procedure.  Dr. Ende may be able to correct these irregularities with a simple injection of Radiesse®.  Although this is not the answer to every rhinoplasty issue, this is often all it takes to improve symmetry.


Boxy Tip Rhinoplasty

             A boxy tip can detract from an otherwise aesthetically pleasing nose or can be just one part of a larger issue.  Dr. Ende can modify your tip by removing soft tissue from between the cartilage and binding the cartilages back together.  The natural tripod appearance to the nasal base is then restored.  Not only does this eliminate the boxy or squared off appearance of the nasal tip, but it adds strength and projection to the nose for years to come.


Saddle Nose

             A saddle nose deformity can be the result of trauma, prior rhinoplasty, prior septoplasty, as well as many other conditions.  Dr. Ende has several ways to reconstruct your nose to eliminate this scooped out appearance.  Dr. Ende can take cartilage through a small incision behind your ear to fill in the hollowed area.  Other options include cadaver cartilage, your own rib, or even implants such as gortex or silicone.  Dr. Ende will discuss all of these options at your consultation to determine which is right for you.


Post – Traumatic Nasal Deformity

             The nasal bones can shift permanently after nasal trauma.  These fractures often pull the entire nose out of alignment.  Dr. Ende has specific techniques designed to not only significantly straighten your nose, but also improve your breathing.


Straightening The Nose On Frontal View

             The type of modification needed depends on the location of the desired change.  For deviations or wideness on the frontal view, the nasal bones must be moved.  Controlled, precise breaks are created in the nasal bones, which are then secured in place with tape and a nasal splint.


Tip Refinement

             Patients seek consultation to refine their nasal tips.  Often the nasal tip is bulbous, and lacks definition.  Nasal tips may also have a droopy appearance which can be corrected with upward rotation.  Dr. Ende can remove a strip of cartilage (Cephalic Trim) which often leads to a dramatic change in tip definition, rotation, and eliminates bulbosity.  Many other special techniques exist to modify the nasal tip, and Dr. Ende will discuss all of the options with you.


The Wide Nose

             If the face is divided into fifths, the ideal nose should be no wider at its base then a line dropped from the corner of the eye.  Dr. Ende can narrow the base of your nose without performing unsightly Weir excisions.  Often an incision can be placed inside the nose and along the base, completely eliminating the need to make Weir incisions on the side of your nose.  Weir incisions are almost never inconspicuous and often blunt the crease between your cheek and nose.


Nasal Obstruction

             Patients often seek consultation with Ear Nose and Throat doctors (ENTs) for difficulty breathing through one or both sides of their nose.  Many want to combine nasal valve reconstruction with cosmetic surgery of the nose since they are undergoing surgery any way.  In some instances the same phenomenon that is causing the nasal obstruction, is also causing the nasal deformity.  Dr. Ende will often perform septal work, spreader grafts, or batten grafts to improve your breathing along with sculpting you a more aesthetically pleasing nose.


Make My Nose Cute Dr. Ende

             This is one of the most common statements made by patients seeking nasal surgery with Dr. Ende.  Dr. Ende will discuss options with you to achieve your aesthetic ideal.  Dr. Ende will perform image modifications of your pictures with specialized computer software to show you what your nose might look like and to make sure that his goals are the same as yours.


Nasal Asymmetries

             Minor to major nasal asymmetries can be improved or eliminated through a rhinoplasty procedure.  Dr. Ende is skilled in many different techniques which can drastically change the structure of your nose.  On the other hand, many techniques exist to simply provide camouflage.  Often a combination of techniques is used to achieve the desired results.


The Nasal Hump

             A discussion about rhinoplasty would not be complete without mentioning the nasal hump.  As seen on a profile view, humps can be both large and small and may be due to bone or cartilage.  Techniques to eliminate the hump while avoiding a scooped out, ski sloped, and unnatural appearance may include both cartilage trimming or bone shaving.  It is often necessary to break the nasal bones after shaving them to avoid an open roof or flat appearance to the nose.


Cleft Lip Rhinoplasty

             Patients with cleft lip and palate typically undergo rhinoplasty at the time of their cleft lip repair around 3 months of age.  This is only the first step in a series of surgeries that these patients must undergo throughout their lifetime.  A secondary rhinoplasty is almost always necessary during the high school years to eliminate the remaining nasal asymmetry.




Patients depicted have given their permission to appear. Photos are for illustrative purposes only and do not constitute a promise or representation of any particular outcome or experience.  Each patient’s experience, recovery and results will be unique depending on their skin, age, health and other individual factors.

Twisted and droopy tip repair, and hump removal