What is
Rhinoplasty?
Rhinoplasty, or surgery to reshape the nose,
is one of the most common 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.
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Effects
of Rhinoplasty
A rhinoplasty is an operation, which may be done
for several reasons. The most common
indications are to overcome as part of the
treatment of nasal obstruction, if there is
deformity of the external nose, accompanying
a deformity of the internal nose. The other
main indication is cosmetic improvement. The
two of course are not mutually exclusive and
may well go together if there is gross
deformity of the nose or a desire to improve
the aesthetic appeal requires very careful
consideration on the part of both surgeon
and patient. It is important that the
patient has a very clear idea of what they
do and do not want and an informed
consultation with the surgeon as to what is
and what is not possible. Each operation has
to be tailored to the wants of the
individual and adapted to the current
anatomy. I would be pleased to discuss
cosmetic changes to the shape of the nose
without any obligation.
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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.
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Your
Consultation
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 and anesthesia he or she will
use, the type of 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.
Check with your insurer, and obtain
pre-authorization for your surgery.
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.
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The Rhinoplasty
Procedure
Rhinoplasty may be performed in a surgeon's
office-based facility, 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.
Rhinoplasty can be performed under local or
general anesthesia, depending on the extent
of the procedure and on what you and your
surgeon prefer.
With local anesthesia, you'll usually be
lightly sedated, and your nose and the
surrounding area will be numbed; you'll be
awake during the surgery, but relaxed and
insensitive to pain. With general
anesthesia, you'll sleep through the
operation.
Rhinoplasty usually takes an hour or two,
though complicated procedures may take
longer. During surgery the skin of the nose
is separated from its supporting framework
of 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.
Many plastic surgeons perform rhinoplasty
from within the nose, making their incision
inside the nostrils. Others prefer an "open"
procedure, especially in more complicated
cases; they make a small incision across the
columella, the vertical strip of tissue
separating the nostrils.
When the surgery is complete, a splint will
be applied to help your nose maintain its
new shape. Nasal packs or soft plastic
splints also may be placed in your nostrils
to stabilize the septum, the dividing wall
between the air passages.
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Recovery
After surgery-particularly during the first
twenty-four 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 by your
surgeon. Plan on staying in bed with your
head elevated (except for going to the
bathroom) for the first day.
You'll 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 a bit better. In
any case, you'll feel a lot better than you
look. Most of the swelling and bruising
should disappear within two weeks or so.
(Some subtle swelling-unnoticeable to anyone
but you and your surgeon-will 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. Your surgeon will probably ask you
not to blow your nose for a week or so,
while the tissues heal.
If you have nasal packing, it will be
removed after a few days and you'll feel
much more comfortable. By the end of one or,
occasionally, two weeks, all dressings,
splints, and stitches should be removed.
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.
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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Risks
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. As for scarring, when 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 visible.
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.
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Frequently Asked
Questions
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