RHINOPLASTY

If you’re considering rhinoplasty…

Rhinoplasty, or surgery to reshape the nose, is one of the most common and complicated of all plastic surgery procedures. Rhinoplasty can reduce or increase the size of your nose, change the shape of the tip or the bridge, narrow the span of the nostrils, or change the angle between your nose and your upper lip. It may also correct a birth defect or injury, or help relieve some breathing problems.

If you’re considering rhinoplasty, this information will give you a basic understanding of the procedure: when it can help: how it’s performed; and what results you can expect. It can’t answer all of your questions here, since a lot depends upon examining each individual patient. Please ask about anything you don’t understand.

Click here for Before and After Patient images

THE BEST CANDIDATES FOR RHINOPLASTY

Rhinoplasty can enhance your appearance and your self confidence, but it won’t necessarily change your looks to match your ideal, or cause other people to treat your differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.

The best candidates for rhinoplasty are people who are looking for improvement, not perfection, in the way they look. If you’re physically healthy, psychologically stable, and realistic in your expectations, you may be a good candidate.

Rhinoplasty can be performed to meet aesthetic goals or for reconstructive purposes- to correct birth defects, reconstruction after cancer surgery, or breathing problems.

Age may also be a consideration. Many surgeons prefer not to operate on teenagers until after they’ve completed their growth spurt-around 14 or 15 for girls and a bit later for boys. It’s important to consider teenagers’ social and emotional adjustment, too, and make sure it’s what they, and not their parents, really want.

ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK

When rhinoplasty is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Nevertheless, there is always a possibility of complications, including infection, nosebleed, or a reaction to the anesthesia. You can reduce your risks by closely following your surgeon’s instructions both before and after surgery.

As for scarring, when a rhinoplasty is performed from inside the nose, there is no visible scarring at all. When an “open” technique is used, or when the procedure calls for the narrowing of flared nostrils, the small scars on the base of the nose are usually not noticeable.

Sometimes a revision procedure may be required to correct a minor deformity. Such cases are unpredictable and can happen even to patients of the most skilled surgeons, with an uneventful post-operative course. The corrective revisionary surgery is usually minor and can be performed in the office under local anesthesia.

PLANNING YOUR SURGERY

Good communication between you and your surgeon is essential. In your initial consultation, describe what you’d like your nose to look like. Your surgeon will evaluate the structure of your nose and face and discuss the possibilities with you to explain the factors that can influence the procedure and the results. These factors include the structure of your nasal bones and cartilage, the shape of your face, the thickness of your skin, your age, and your expectations.

Your surgeon will also explain the techniques and anesthesia, the facility where the surgery will be performed, and the risks and costs involved.

NOTE: Be sure to tell your surgeon if you have had any previous nose surgery or an injury to your nose, even if it was many years ago.

PREPARING FOR SURGERY

You will be given specific instructions on how to prepare for surgery, including guidelines on eating and drinking, taking or avoiding certain vitamins and medications, and washing your face. Carefully following these instructions will help your surgery go more smoothly.

While you’re making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.

WHERE YOUR SURGERY WILL BE PERFORMED

Rhinoplasty is performed in an outpatient surgery center for cost containment and convenience. Complex procedures may require an overnight stay.

TYPES OF ANESTHESIA

Rhinoplasty is performed with general anesthesia. With general anesthesia you will sleep through the operation.

THE SURGERY

Rhinoplasty usually takes 2-4 hours, though complicated procedures may take longer. During surgery the skin of the nose is separated from its supporting framework of the bone and cartilage, which is then sculpted to the desired shape. The nature of the sculpting will depend on your problem and your surgeon’s preferred technique. Finally, the skin is redraped over the new framework.

Most plastic surgeons perform rhinoplasty with an “open” procedure, especially in more complicated cases. A small incision is made across the columnella, the vertical strip of tissue separating the nostrils.

When the surgery is finished, a splint will be applied to help your nose protect and maintain its new shape. Nasal gauze packs or soft silicone splints may be placed in your nostrils to stabilize the internal structures.

AFTER YOUR SURGERY

After surgery, particularly during the first 24-48 hours, your face will feel puffy, your nose may ache, and you may have a dull headache. You can control any discomfort with the pain medication prescribed. Plan on staying in bed with your head elevated and applying ice compresses on your eyes.

You may notice that the swelling and bruising around your eyes will increase at first, reaching a peak after two or three days. Applying cold compresses will reduce this swelling and make you feel better. In any case, you’ll feel better than you look. Some subtle swelling, unnoticeable to anyone but you and your surgeon, may remain for several months.

A little bleeding is common during the first few days following surgery, and you may continue to feel some stuffiness for several weeks. Do Not Blow Your Nose, but, if you have to sneeze, put your finger under your nose and open your mouth.

If you have nasal packing, it will be removed after a few days and you’ll feel much more comfortable. By the end of 1-2 weeks, all dressings, splints, and stitches should be removed. The stitches inside your nose will dissolve over two weeks.

GETTING BACK TO NORMAL

Most rhinoplasty patients are up and about within two days, and able to return to school or sedentary work a week or so following surgery when their splint is off. It will be several weeks, however, before you’re entirely up to speed.

Avoid strenuous activity (jogging, swimming, bending, sexual relations- any activity that increases your blood pressure) for two to three weeks. Avoid hitting or rubbing your nose, or getting it sunburned, for eight weeks. Be gentle when washing your face and hair or using cosmetics.

You can wear contact lenses as soon as you feel like it, but glasses are another story. Once the splint is off, they’ll have to be taped to your forehead for additional six to seven weeks, until your nose is completely healed.

You will have follow up visits in the weeks after surgery to check on the progress of your healing. If you have any unusual symptoms between visits or any questions about what you can and can’t do, don’t hesitate to call.

YOUR NEW LOOK

In the days following surgery, when your face may be bruised and swollen, it’s easy to forget that you will be looking better. In fact, many patients feel depressed for a while after plastic surgery-it’s quite normal and understandable.

Rest assured that this stage will pass. Day by day, your nose will begin to look better and your spirits will improve. Within a week or two, you’ll no longer look as if you just had surgery.

Still, healing is a slow and gradual process. Some subtle swelling may be present for months, especially in the tip. The final results of rhinoplasty may not be apparent for a year or more.

In the meantime, you might experience some unexpected reactions from family and friends. Try to keep in mind why you decided to have this surgery in the first place. If you’ve met your goals, then your surgery is a success.

Before surgery, these rhinoplasty patients have large, slightly hanging noses, with a hump and an enlarged tip.
If your nostrils are too wide, the surgeon can remove small wedges of skin form their base, bringing them closer together.
Incisions are made inside the nostrils or at the base of the nose, providing access to the cartilage and bone, which can then be sculpted into shape.
The surgeon removes the hump using a chisel or a rasp, then brings the nasal bones together to form a narrower bridge. Cartilage is trimmed to reshape the tip of the nose.
Trimming the septum improves the angle between the nose and upper lip.
A splint made of tape and an overlay of plastic, metal, or plaster is applied to help the bone and cartilage of the nose maintain their new shape.
After surgery, the patient has a smaller nose, a straighter bridge, a well defined nasal tip, and an improved angle between the nose and upper lip.