Total Nose Approach

Revision Rhinoplasty with Balloon Sinuplasty – the Total Nose approach

The form and function of the nose and sinuses has been the focus of the Nose and Sinus Institute of Boca Raton for well over three decades.

“While you’re there, how about fixing the outside of my nose?” has become a frequent question from patients who present to our office with long standing functional issues with their nose and sinuses, most often resulting in recommendation for a  balloon sinuplasty. The subject gets confusing, especially since the function and appearance of the nose are often related.  In this blog, we hope to answer some questions regarding this.

The concept of The ‘Total Nose’ approach was developed in this office over three decades ago.  It arose shortly after minimally invasive sinus surgery was introduced into the United States in 1985.  It actually started in Austria and was brought to this country at the Johns Hopkins Hospital where it was presented as a national course to thought leaders in the specialty.  Prior to that time, patients suffering with severe functional nasal or sinus issues, such as obstruction, congestion, headaches, recurrent infections, etc. and who did not respond to ongoing medical management, had very few options.  Surgery for chronic sinusitis was a big deal.  It often involved large incisions around the eyes, under the lip, or across the scalp.  Patients would be hospitalized for 5 to 7 days with their nose packed.  Minimally invasive sinus surgery changed all of that.  Now patients could undergo a quick relatively painless procedure and be discharged the same day.  Balloon sinuplasty, introduced in 2005, has even further minimized patient discomfort and operating time.  Computer assisted balloon sinuplasty, first performed in the United States at the Nose and Sinus Institute of Boca Raton in 2014, brought the precision of this procedure to an even higher level.

One of the great benefits of minimally invasive sinus surgery is the ability to correct external issues as well at the same sitting.   Patients appreciate the convenience of one less surgery, and from the surgeon’s standpoint, it makes sense if someone is interested in having rhinoplasty or revision rhinoplasty surgery, to perform it during the same operation that addresses the sinuses.  One obvious advantage of the total nose procedure is saving the added anesthesia time when compared to two separate surgeries.  The other advantage has to do with overall expense. By combining the procedures, the patient decreases their financial responsibility for the cosmetic aspects of the procedure.  The first hour of any procedure is the most expensive for both the facility as well as anesthesia.  This is because the first hour includes getting the patient ready for surgery and performance of the beginning of anesthesia.  Subsequent hours are significantly less.  The added time that rhinoplasty or revision rhinoplasty takes is therefore at a much lower hourly rate.

Who is a candidate for the Total Nose Approach?

In the particular group of patients whom we are discussing here, that is those patients who presented primarily for functional issues with their nose, the surgeon will determine whether the outside of the nose has a role in the functional issue.  Sometimes, the lateral wall is weak and collapses when the patient inhales through their nose.  These are often the patients who will achieve some relief from using Breathe Rite strips.  Very often, patients just don’t like the appearance of their nose and see this as an opportunity to take care of ‘two birds with one stone.’  In either case, the patient should select a surgeon who not only is proficient in minimally invasive sinus surgery and balloon sinuplasty, but also regularly performs rhinoplasty surgery.   Finding a surgeon with significant experience in the total nose approach is important.

There are other considerations in deciding upon a total nose experience.  Rhinoplasty cost becomes a factor both for primary rhinoplasties as well as the revision rhinoplasty.  Rhinoplasty surgery typically adds three to four hours to the operating time.Revision rhinoplasty is  even longer.  In either situation, the total nose procedure combining minimally invasive sinus surgery and rhinoplasty or revision rhinoplasty surgery is performed in the outpatient setting, done with no internal packing required afterwards and results in surprisingly minimal postoperative pain.

Nathan E Nachlas, MD is double board certified in Facial Plastic and Reconstructive Surgery and Otolaryngology/ Head and Neck Surgery.  He was the Chief Resident of the Department of Otolaryngology/Head and Neck Surgery at the Johns Hopkins Hospital in 1985 when minimally invasive sinus surgery was introduced.   He completed his Facial Plastic and Reconstructive Surgery Fellowship in Beverly Hills. California before moving to Boca Raton, Florida in 1987.  Combining his rhinoplasty training with the new minimally invasive sinus techniques he described the ‘Total Nose Approach’ which has now been performed for over three decades.  For further information, please contact Sandy Friedman, the Director of Patient Relations for the Nose and Sinus Institute of Boca Raton, at 561-939-0909.

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