What is Rhinoplasty?

Rhinoplasty is the surgery of the nose. The goal of well-done rhinoplasty is to correct an external deformity to create harmony with existing facial features. Following rhinoplasty, the nose should appear natural both when animating and in repose. It has often been said that well-done nasal surgery is seen in the eyes of the patient. As the spatial relationship between the eyes and the nose is interrelated, altering the nose has a profound effect on the appearance of the eyes. Each person and their facial features are unique; therefore, each procedure is individualized to create balance with the patient’s facial features.

The surgical objectives are to create a nose that not only looks good but functions well. Nasal airway compromise can result from mechanical obstruction of the septum but can also result from nasal allergies. Nasal septal reconstruction addresses the mechanical component of nasal airway compromise. As one of approximately 200 surgeons in the country certified by both the American Board of Plastic Surgery as well as the American Board of Otolaryngology (ENT), Dr. Hewell has the advanced skills and experience to correct complex nasal deformities including severe airway compromise.

About the Procedure:

There are two approaches to corrective nasal surgery. The classical endonasal approach is performed entirely from within the nose. No external scar is created. The open (external) approach leaves a scar across the columella, which is the narrow part of the nose between the nostrils. Being classically trained, Dr. Hewell and Dr. Fischer prefer the endonasal approach for the majority of patients. The advantages of this approach are numerous, including no external scar, a natural appearing nose, minimal swelling and bruising, and a rapid recovery time. The majority of patients can return to work within 1-2 weeks of surgery. In addition, it is the opinion of Dr. Hewell and Dr. Fischer that the open (external) approach many times results in an unnatural stiffness to the normally supple nasal tissue, particularly with animation.

Anesthesia for this procedure is customized for each patient. Nasal surgery is commonly performed under sedative anesthesia in our AAAASF accredited surgical facility. Other alternatives include general anesthesia.

A small, inconspicuous nasal splint is placed following the procedure and is left in place for 6 days. Dr. Hewell and Dr. Fischer do not pack the nose. Coapting quilting sutures obviate the need for uncomfortable packing that results in increased swelling and difficulty breathing. A small wick of telfa is placed in each nostril after surgery and is removed by the patient 3-4 hours after the procedure.


Dr. Hewell and Dr. Fischer feel there are many advantages including no external scar, more rapid healing, less bruising and swelling, and a more natural appearing nose.

Healing time is typically 1-2 weeks; however, there will be continued refinement over several months.

Pain after this procedure is minimal and easily managed by oral pain medication. Most patients report little to no pain the day following the procedure.

Yes. It is important to protect the nose from trauma for 3 months following the procedure.

Yes, every effort is made to individualize the treatment to create a non-surgical appearing nose that is in harmony and balance with your facial features.

As an adjunct to balancing facial features, a subtle, well-placed chin augmentation is performed in select patients to achieve an elegant result.

Every effort is made to educate the individual patient regarding what can realistically be achieved with surgery. For select patients, our advanced 3-dimensional photographic system (Vectra®) allows for imaging.

Procedures 3



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