Rhinoplasty is any surgery done to reshape the nose. Commonly rhinoplasty is performed to reduce or increase the bridge of the nose, change the shape, size, and angle of the tip; change the shape of the nostrils, straighten a crooked nose and improve breathing, shorten or lengthen the nose, and alter the projection of the nose. Also the nose is commonly involved in trauma, thus rhinoplasty is often necessary to correct post-traumatic deformities.
More so than any other procedure, rhinoplasty must be tailored to the individual because each person has unique features to their nose and commonly their own concept of nasal aesthetics. It is also important to evaluate the rest of the face when planning rhinoplasty in order to create a balanced look. The chin especially has a major impact on facial aesthetics and the appearance of one’s nose.
Rhinoplasty techniques can be divided into two major categories, “open” and “closed,” based on the incisions used. The goal of both techniques is to separate the skin of the nose from the underlying bone and cartilage framework. This is then sculpted to create the desired shape.
In open rhinoplasty, the incisions are made inside the nostrils and connected with an incision at the bottom of the nose across the tissue that separates the nostrils (columella). This allows the skin envelope to be lifted completely off the framework which offers the best visibility. The disadvantage is a small potentially visible scar across the columella.
In closed rhinoplasty the incision across the columella is not made; incisions are only made inside the nostrils. This produces invisible scars but visibility for the surgeon during the operation can be limited and some techniques are not possible. Often the decision depends on your surgeon’s preferred technique and the nature of the changes that need to be made. Often surgeons can perform either technique and will choose the best one for you.
If you have flaring of the nostrils, this may require additional incisions on the outside at the base of the nostrils. If you have breathing problems, your nose is crooked, or cartilage is needed to build up your nose, the surgeon may also perform a septoplasty. The septum is the vertical cartilage that separates the two nasal cavities inside your nose. Any incision for a septoplasty is made inside the nose. In some circumstances like revision procedures, this cartilage from the septum is not enough to build up the nose and cartilage may also be needed from other locations like the ear or ribs, which requires additional scars.
Who are good candidates for rhinoplasty?
Rhinoplasty can improve your appearance and self-image but it can’t necessarily change your look to meet your ideal. The best candidates for this surgery are healthy mature individuals who are unhappy with the appearance of their nose and are looking for an improvement not perfection.
Variety in each person’s anatomy limits the degree of changes that are possible. For instance, very thick nasal skin limits the amount of definition that can be achieved when sculpting the nasal framework. Rhinoplasty is often appropriate for patients as young as 15 or 16 if they have completed their growth spurt and can also be suitable for any ethnicity.
Rhinoplasty is performed to fix deformities due to trauma or birth defects. It is commonly but not always indicated for breathing problems. For instance people with significant obstruction from nasal allergies would not benefit from rhinoplasty. Also, anyone who has had rhinoplasty within the past year is not a good candidate for another procedure.
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What is the
day of my
You will need to begin fasting 8 hours prior to your procedure which means you cannot eat or drink anything at all during this period including chewing gum or water. If you have been instructed to take any medications in the morning this is permitted with a few sips of water.
Depending on how extensive, rhinoplasty can be done with local anesthesia and sedation which means you are very sleepy but time to time you may be slightly aware of what is happening. However, many surgeons prefer general anesthesia. The surgery takes about 3 to 4 hours but can be longer in some cases. You will likely have tape and a splint placed over the nose and you may have packing or a soft silicone splint inside the nose. After surgery, you will stay in the recovery suite until you are ready to go home.
How do I
Within 1 month of surgery, all patients greater than 50 years old or with medical problems should have a medical evaluation by their physician or a primary care provider. Depending on your health this may require blood tests, an EKG, etc. You will be given a list of medications, vitamins, and supplements to refrain from taking at least two weeks before and after surgery. You should also stop smoking for at least 1 month before and after surgery.
Rhinoplasty is usually an outpatient procedure. If you and your surgeon have decided that you will go home, you will need to arrange for someone to drive you. Your surgeon will give you a prescription for the medications you will need after surgery so these can be obtained ahead of time.
What are the
All surgical procedures carry some uncertainty and risk and this operation is no different. Although there are many possible complications, the good news is that the combined risk of having any major complication is still rare as long as your surgeon is properly trained and the procedure is performed in a well-equipped facility. The following represents some of the major complications but is not meant to be comprehensive.
Major bleeding is a rare complication after surgery and usually can be controlled with various medications. Nasal packing is rarely necessary. Infection is also quite rare. Scarring usually is not problematic.
With closed rhinoplasty, the scars are invisible. Even with open rhinoplasty, the very small external scar is rarely noticeable. The scars necessary to reduce the size of the nostrils can be more problematic if not done properly.
Occasionally a second procedure may be necessary to correct a minor deformity or to make small adjustments depending on the case. However this is rarely done prior to 1 year from the time of the original procedure as swelling tends to persist and the nose continues to change during this healing period.
What is the
the recovery process for rhinoplasty?
You may feel some discomfort for a few days after surgery but this is well controlled with the medication prescribed by your surgeon. You may have bruising under the eyes which resolves in about a week. For the first few days after surgery you may have some bloody drainage from your nose and feel stuffy; this is normal.
You should feel pretty good in 1-2 days but it is important to refrain from any strenuous activity for at least the first week after surgery. Patients are encouraged to begin showering 1-2 days after surgery. You should keep your head elevated at all times for the first week. All sutures (if the open technique is used) and dressings will be removed a week after surgery. Initially, your nose will appear significantly swollen but most of the swelling will be gone in 3-4 weeks.
The majority of people are able to return to work after 1 week but this depends on your job. You will have to refrain from any exercise for 3 weeks but then you may steadily increase your activity. Also glasses should not be worn or taped up to the forehead for 3-4 weeks. You should avoid hitting or aggressively rubbing your nose for two months.
Although you will look close to your final result at 1-2 months, the swelling from this operation can take a full year or even longer to fully resolve. This means that your nose will continue to change slightly during this time but it won’t be noticeable to others.
Nevertheless this slow healing process can be frustrating at times. You must keep in mind that things will improve and you must be patient. No revision procedure should be attempted until this process is complete.
It is important to follow up with your surgeon as directed so that any potential complications can be detected and treated early. For the most part these are rare and you will spend most of your time enjoying your new look.