Nose Surgery (Rhinoplasty)

Each year across the United States, half a million women and men seek consultations with facial plastic surgeons to improve the appearance and function of their noses. Some people are unhappy with the noses they were born with and some are unhappy with the way aging has changed their nose. For others, an injury may have distorted the nose or the goal may be improved breathing.

Rhinoplasty literally means shaping the nose. The goal is to improve both the form – making it harmonize better with other facial features--and function of your nose. Skin type, ethnic background, and age are important factors to be considered.

A unique ‘structural approach’ is used to reshape the nose, giving your face a balanced look, as well as making your nose stronger and more functional. In more common approaches to rhinoplasty, tissue removal is emphasized, which actually weakens your nose.

During the pre-surgical consultation, your nose, both externally and internally, will be examined and evaluated. The surgeon will explain how the nasal structures can be reshaped to improve both the form and function of your nose. For some patients, reshaping the chin at the same time may enhance the desired results.

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, since a lot depends on the individual patient and the surgeon. Please ask your surgeon about anything you don't understand.

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 you 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 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, a bit later for boys. It's important to consider teenagers' social and emotional adjustment, too, and to 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.

After surgery, small burst blood vessels may appear as tiny red spots on the skin's surface; these are usually minor but may be permanent. Other possible risks specific to rhinoplasty include but are not limited to:

  • Difficulty breathing through your nose
  • Permanent numbness in and around your nose
  • The possibility of an uneven-looking nose
  • Pain, discoloration or swelling that may persist
  • Scarring
  • A hole in the septum (septal perforation)

In about one case out of ten, a second procedure may be required-for example, to correct a minor deformity. Such cases are unpredictable and happen even to patients of the most skilled surgeons. The corrective surgery is usually minor.

Planning Your Surgery

Good communication between you and your physician is essential. In your initial consultation, the surgeon will ask what you'd like your nose to look like, evaluate the structure of your nose and face, and discuss the possibilities with you. He or she will also 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 to be used, the facility where the surgery will be performed, the risks and costs involved, and any options you may have. Most insurance policies don't cover purely cosmetic surgery; however, if the procedure is performed for reconstructive purposes, to correct a breathing problem or a marked deformity, the procedure may be covered.

Be sure to tell your surgeon if you've had any previous nose surgery or an injury to your nose, even if it was many years ago. You should also inform your surgeon if you have any allergies or breathing difficulties; if you're taking any medications, vitamins, or recreational drugs; and if you smoke.

Don't hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results.

Preparing For Your Surgery

Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, 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 may be performed in an outpatient surgery center or a hospital. It's usually done on an outpatient basis, for cost containment and convenience. Complex procedures may require a short inpatient stay.

Types of Anesthesia

Rhinoplasty is performed under general anesthesia, so you will be sleeping for the entire procedure.

The Surgery

Rhinoplasty may be done inside your nose or through a small external cut (incision) at the base of your nose, between your nostrils. Your surgeon will likely readjust the bone and cartilage underneath your skin.

Your surgeon can change the shape of your nasal bones or cartilage in several ways, depending on how much needs to be removed or added, your nose's structure, and available materials. For small changes, the surgeon may use cartilage taken from deeper inside your nose or from your ear. For larger changes, the surgeon can use cartilage from your rib, implants or bone from other parts of your body. After these changes are made, the surgeon places the nose's skin and tissue back and closes the incisions with sutures.

If the wall between the two sides of the nose (septum) is bent or crooked (deviated), the surgeon can also correct it to improve breathing.

After the surgery, you'll be in a recovery room, where the staff monitors your return to wakefulness. Most patient’s are able to go home the same day.

After Your Surgery

After the surgery you need to rest in bed with your head raised higher than your chest, to reduce bleeding and swelling. Your nose may be congested because of swelling or from the splints placed inside your nose during surgery.

In most cases, the internal dressings remain in place for one to seven days after surgery. Your doctor also tapes a splint to your nose for protection and support. It's usually in place for about one week.

Slight bleeding and drainage of mucus and old blood are common for a few days after the surgery or after removing the dressing. Your doctor may place a "drip pad" — a small piece of gauze held in place with tape — under your nose to absorb drainage. Change the gauze as directed by your doctor. Don't place the drip pad tight against your nose.

To further lower the chances of bleeding and swelling, your doctor may ask that you follow precautions for several weeks after surgery. Your doctor may ask you to:

  • Avoid strenuous activities such as aerobics and jogging.
  • Take baths instead of showers while you have bandages on your nose.
  • Not blow your nose.
  • Eat high-fiber foods, such as fruits and vegetables, to avoid constipation. Constipation can cause you to strain, putting pressure on the surgery site.
  • Avoid extreme facial expressions, such as smiling or laughing.
  • Brush your teeth gently to limit movement of your upper lip.
  • Wear clothes that fasten in the front. Don't pull clothing, such as shirts or sweaters, over your head.

In addition, don't rest eyeglasses or sunglasses on your nose for at least four weeks after the surgery, to prevent pressure on your nose. You can use cheek rests, or tape the glasses to your forehead until your nose has healed.

Use SPF 30 or greater sunscreen when you're outside, especially on your nose. Too much sun may cause permanent irregular discoloration of the skin of your nose.

Some temporary swelling or black-and-blue discoloration of your eyelids can occur for two to three weeks after nasal surgery. Swelling of the nose takes longer to resolve. Limiting your dietary sodium will help the swelling go away faster. Don't put anything such as ice or cold packs on your nose after surgery.

Your nose changes throughout your life whether you have surgery or not. For this reason, it's difficult to say when you have obtained your "final result." However, most of the swelling is gone within a year.

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. It will be several weeks, however, before you're entirely up to speed.

Your surgeon will give you more specific guidelines for gradually resuming your normal activities. They're likely to include these suggestions: 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 or propped on your cheeks for another six to seven weeks, until your nose is completely healed.

Your surgeon will schedule frequent follow-up visits in the months 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 doctor.

Your New Look

In the days following surgery, when your face is 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've 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. They may say they don't see a major difference in your nose. Or they may act resentful, especially if you've changed something they view as a family or ethnic trait. If that happens, 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.

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Nose Surgery (Rhinoplasty)