Procedures offered at our center in Spokane: rhinoplasty (nose reshaping or nose job) surgery, nasal reconstructive rhinoplasty, revision rhinoplasty, nonsurgical rhinoplasty, ethnic rhinoplasty, nasal fracture repair, and nasal breathing repair (functional nasal reconstruction).

Rhinoplasty in Spokane (“Nose Job”)

Rhinoplasty or nose reshaping (nose job) is usually performed to improve the appearance of a nose that is out of harmony with the face. This may be because it is too large, small, crooked or simply unbalanced. The goal of rhinoplasty is to create a nose that appears completely natural and compliments the other parts of the face. When done properly, it can enhance a patient’s appearance and boost their self-confidence. A ‘surgical’ appearing nose is often a concern of patients seeking rhinoplasty, and outdated practices can contribute to this outcome. Dr. Sand utilizes the most up-to-date techniques to help provide a natural and harmonious result.

Rhinoplasty can be performed to reshape the nose for both cosmetic and functional purposes. These two goals are intertwined for the rhinoplasty surgeon and both are at play in every procedure. Aesthetic goals for the nose often include either reducing or enlarging the nose, reshaping the bridge or tip, or adjusting the angle between the upper lip and the nose. Functional or corrective procedures seek to improve nasal breathing or repair nasal form after injury.

A ‘Perfect Nose’

A ‘perfect nose’ is in harmony with the eyes, lips and chin and serves to balance all of the attributes of the face. No single ‘perfect nose’ exists, but an ideal nose can be found for each individual. Age, ethnicity, skin thickness and several other factors serve to mold this ideal.

Pre-Operative Imaging

Prior to undergoing rhinoplasty surgery, a patient’s possible outcome can be visualized with the use of computerized pre-operative imaging. This helps with communication regarding the patient’s desires for their nasal procedure as well as expressing what is possible with rhinoplasty surgery. Dr. Sand uses imaging systems to help patients ‘see’ their result and reach their goals.

The Rhinoplasty Surgery

Performing rhinoplasty requires a high degree of surgical skill and involves fine rearrangement of the delicate cartilaginous and bony framework of the nose. The procedure typically takes 2-3 hours, but can take longer for more complicated cases. The procedure begins by lifting the skin of the nose from its underlying framework. This allows for veiled bony and cartilaginous structures to be visualized and sculpted, providing strength where it is needed and adjusting the form as appropriate. Tissue grafts are sometimes used in this step to optimize results. Once the sculpting has been completed, the skin is re-draped and shaped around the bony and cartilaginous structures. Dr. Sand utilizes a ‘soft touch’ rhinoplasty technique, which seeks to maintain natural structural integrity to the nose by reducing unnecessary trauma. This results in a more natural appearance with a lower probability of long-term complications.

After Your Rhinoplasty Surgery

Approximately 7 – 10 days after surgery, Dr. Sand will remove your sutures/splints (if you have any), and take off your nasal cast to ‘reveal’ your new nose. Expect the nose to be improved but temporarily swollen. The swelling will improve dramatically over the subsequent weeks. Dr. Sand often instructs his patients perform nightly taping for 2-3 weeks following the procedure to help accelerate the healing process. He will continue to closely follow your healing process over the next year.

Nasal Reconstructive Surgery

Nasal form and function can be disrupted by trauma or skin cancer removal. Dr. Sand offers reconstructive techniques that can restore nasal function as well as nasal shape.

Revision Rhinoplasty

Many patients have undergone previous rhinoplasty and may have been left with areas of irregularity, decreased function or the need for reconstruction. Dr. Sand is trained in multiple revision techniques, which can help restore nasal balance and function as necessary. Often this requires cartilage borrowed from the ear or rib to help rebuild and reshape the nose. If grafting will be needed, this would be discussed during your consultation with Dr. Sand.

Nonsurgical Rhinoplasty (“Nose Job”)

Some nasal irregularities including a nasal deviation or dorsal hump can be corrected utilizing dermal filler, which is why it is sometimes called Filler Rhinoplasty. The result is immediate but temporary. For patients who wish to ‘try out’ what a surgical rhinoplasty could offer or are interested in a quick fix prior to an event, nonsurgical rhinoplasty may be an excellent choice. This option can be discussed with Dr. Sand during your consultation.

Ethnic Rhinoplasty

Nasal form is greatly impacted by ethnicity, age, skin thickness any many other factors. A ‘perfect nose’ is different in every patient and the nose that you have should fit your face and your ethnicity. Dr. Sand seeks to listen to your desires and help provide you with what is possible surgically to lead to a natural and harmonious result.

Nasal Fracture Repair

Nasal bone fractures are some of the most common facial fractures. Signs and symptoms can include bleeding from the nose, a crooked nose, or a palpable bony step-off. When this occurs, it can impact both nasal breathing and appearance. Not every nasal fracture requires an intervention, but one should be evaluated to see if a repair is necessary. When an injury occurs, a repair is best attempted within 2 weeks of the injury but it can be done beyond this time frame. If you are concerned you may have broken your nose, please call to schedule a consultation.

Nasal Breathing Repair (Functional Nasal Reconstruction)

Nasal breathing is an intricate interplay between the cartilage, bone and soft tissue of the nose. Deviation of the nasal septum, nasal blockage, narrowing of the nasal ‘valves’, allergies, turbinate hypertrophy, or weakness of the nasal cartilages may all play a role in restricted nasal breathing. A complete examination of all of these interplaying factors occurs during your consultation. Directed repair of these items can greatly improve nasal breathing. If you are concerned with your nasal breathing, please call to schedule a consultation.

Most Common FAQs

A: Dr. Sand utilizes both computerized imaging software to help you ‘see’ what nose reshaping can provide for you. This is performed at the time of your consultation to help you visualize the expected result. Additionally Dr. Sand has pre- and post-surgical photographs in the photo gallery.

A: There are numerous factors that go into the cost of the procedure. This will depend on the amount of work to be done, if it is a revision procedure, if additional grafts (ear, rib) need to be harvested, and if there is a functional or breathing component that insurance covers. Anesthesia and facility fees are also a component of the total cost, but may be partially covered by insurance. It is difficult to provide a precise procedural cost without an office examination. After your consultation with Dr. Sand, you will be provided with a quote for the cost of the procedure.

A: Many people have heard stories about nasal packing following rhinoplasty. Dr. Sand does not find it necessary to pack the nose after rhinoplasty. It some situations he may utilize a thin silastic sheeting to help with nasal healing that is removed after 1 week. Patients are able to breath through their nose after the procedure, but it often feels congested.

A: Recovery from nasal surgery can depend on the type of surgery performed. Typically, a nasal cast, sutures and possibly nasal splints are usually placed during surgery and then removed at 6-7 days post-operatively. Nasal packing is rarely, if ever, used. Most patients are able to breath through their nose immediately following surgery, and often better than before. In general, one should expect 7-10 days of bruising following nasal surgery. Swelling following surgery can last for weeks to months and does require patience during the healing process to achieve the final product. Depending on the extent of the surgery, and whether a closed or open approach was utilizing, the recover may differ. A closed approach may lead to less swelling and bruising, but some times an open approach is necessary. Icing in the first 2-3 days is very important and often arnica and be utilized to help reduce bruising. Nasal saline spray is helpful during the healing to keep the nasal cavity moist. For persistent bruising, IPL (intense pulsed light) skin treatments can be performed to help accelerate the elimination of the bruising.