Every year, half
a million people who are interested in improving the appearance of their noses
seek consultation with facial plastic surgeons. Some are unhappy with the noses
they were born with, and some with the way aging has changed their nose.
For
others, an injury may have distorted the nose, or the goal may be improved
breathing.
But one thing is clear: nothing has a greater impact on how a person
looks than the size and shape of the nose. Because the nose is the most defining
characteristic of the face, a slight alteration can greatly improve one's
appearance.
If you have wondered how nose surgery, or rhinoplasty, could improve your
looks, self-confidence, or health, you need to know how rhinoplasty is performed
and what you can expect.
During rhinoplasty, a surgeon adds to or removes portions of the nasal bone,
cartilage or both to change the size or shape of the nose.
As with all facial plastic surgery, good health and realistic expectations are
prerequisites. Understanding nasal surgery is also critical. Since there is no
ideal in rhinoplasty, the goal is to improve the nose aesthetically, making it
harmonize better with other facial features.
Skin type, ethnic background, and age are important factors to be considered
in discussions with your surgeon prior to surgery.
Before the nose is altered, a
young patient must reach full growth, usually around age fifteen or sixteen.
Exceptions are cases in which breathing is severely impaired.
Before deciding on rhinoplasty, ask your facial plastic surgeon if any
additional surgery might be recommended to enhance the appearance of your face.
Many patients have chin augmentation in conjunction with rhinoplasty to create a
better balance of features.
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Making The Decision For Rhinoplasty
Whether the surgery
is desired for functional or cosmetic reasons, your choice of a qualified facial
plastic surgeon is of paramount importance. Many facial plastic surgeons are
trained in both ear, nose, throat, and facial cosmetic surgery, which provides
you, the patient, with the highest level of training and expertise.
Your surgeon
will examine the structure of your nose, both externally and internally, to
evaluate what you can expect from rhinoplasty. You are most likely to be pleased
with the results of your surgery if you have a realistic idea of what nasal
surgery can and cannot do.
You can expect a thorough explanation of the surgeon's expectations and the
risks involved in surgery.
Following a joint decision by you and your surgeon to
proceed with rhinoplasty, the surgeon will take photographs of you and discuss
the options available. Your surgeon will explain how the nasal structures,
including bone and cartilage, can be sculpted to reshape the nose and indicate
how reshaping the chin, for example, could enhance the desired results.
After conducting a thorough medical history, your surgeon will offer
information regarding anesthesia, the surgical facility to be used, and the
costs for the procedure.
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Understanding The Surgery
The definition of
rhinoplasty is, literally, shaping the nose. First, incisions are made and the
bone and cartilage support system of the nose is accessed. The majority of
incisions are made inside the nose, where they are invisible. In some cases, an
incision is made in the area of skin separating the nostrils.
Next, certain
amounts of underlying bone and cartilage are removed, added to, or rearranged to
provide a newly shaped structure. For example, when the tip of the nose is too
large, the surgeon can sculpt the cartilage in this area to reduce it in size.
The angle of the nose in relation to the upper lip can be altered for a more
youthful look or to correct a distortion.
The tissues are then redraped over the new frame and the incisions are
closed. A splint is applied to the outside of the nose to help retain the new
shape while the nose heals. Soft, absorbent material may be used inside the nose
to maintain stability along the dividing wall of the air passages called the
septum. Alternatively, soft nasal supports that permit nasal breathing
post-operatively can be placed.
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What To Expect After The Surgery
Immediately after
surgery, a small splint will be placed on your nose to protect it and to keep
the structure stable for at least five to eight days. If packing is placed
inside the nose during surgery, it is removed the morning following the surgery.
Your face will feel puffy,especially the first day after surgery. Pain
medication may be required. Your surgeon will advise you to avoid blowing your
nose for seven days after surgery. In the immediate days following surgery, you
may experience bruising and minor swelling in the eye area. Cold compresses
often reduce the bruising and discomfort.
Absorbable sutures are usually used
that do not have to be removed. Nasal dressing and splints are usually removed
six or seven days after surgery.
It is crucial that you follow your surgeon's directions, especially
instructions to keep your head elevated for a certain period after surgery.
Some
activities will be prohibited in the weeks after the procedure. Sun exposure,
exertion, and risk of injury must be avoided. If you wear glasses, special
arrangements must be made to ensure that the glasses do not rest on the bridge
of the nose. Tape and other devices are sometimes used to permit wearing glasses
without stressing the area where surgery was performed.
Follow-up care is vital for this procedure to monitor healing. Obviously,
anything unusual should be reported to your surgeon immediately. It is essential
that you keep your follow-up appointments with your surgeon.
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Who is rhinoplasty for?
Rhinoplasty is for people who want to change the size or shape of their nose.
Rhinoplasty can:
Straighten the bridge of the nose
Reshape the tip of the nose
Reduce or add to the overall size of the nose
Change the angle between the nose and upper lip
Rhinoplasty can also repair defects following an injury, correct a birth
defect or improve some breathing difficulties.
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How do you prepare for rhinoplasty?
Before scheduling rhinoplasty, you need to meet with your surgeon to discuss
the important factors that determine whether the procedure is likely to work
well for you. This meeting generally includes:
1. Your medical history. Your doctor asks
questions about conditions you have or have had, as well as any current
medications.
2. A physical examination. Your doctor
conducts a complete physical examination, including any laboratory tests, such
as a blood test. He or she also inspects your skin and the inside and outside of
your nose.
3. Photographs. Someone from your doctor's
office takes photographs of your nose from different angles. Your doctor uses
these photos for before-and-after assessments, reference during surgery and
long-term reviews.
4. A discussion of your expectations. You
and your doctor should talk about your motivations and expectations. He or she
explains what rhinoplasty can and can't do for you and what your results might
be.
Before rhinoplasty You may also need to:
Avoid medications containing aspirin or ibuprofen for two
weeks before and after surgery. These medications may increase bleeding. Take
only those medications approved or prescribed by your surgeon.
Avoid exposing your skin to the sun for one week before
surgery and two to three months after surgery. Too much sun may cause permanent
irregular coloration in the skin of your nose.
Avoid applying makeup or facial cream the morning of the
surgery.
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How is Rhinoplasty performed?
Rhinoplasty is usually done inside the nose, with the surgeon readjusting the
bone and cartilage underneath the skin. The surgeon usually makes cuts inside
the nostrils. Sometimes he or she makes cuts in the septum between the nostrils.
Then the surgeon separates the skin from the underlying bone or cartilage and
mucous membranes, and follows a series of steps to cut, trim or augment (build
up) the nasal bone or cartilage.
The surgeon can augment the nasal bone or cartilage in several ways,
depending on how much needs to be added, the structure of the nose and available
materials. For small changes, the surgeon may use cartilage harvested from
deeper inside the nose or from the ear. For larger requirements, the surgeon can
use implants or bone grafting.
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What can you expect during rhinoplasty?
Rhinoplasty requires local or general anesthesia, depending on the complexity
of the surgery and your surgeon's preferences.
Local anesthesia, usually used in
an outpatient setting, is anesthesia limited to a specific area of your body.
Your doctor injects the pain-numbing medication into your nasal tissues and
sedates you with medication injected through an intravenous (IV) line. This
makes you groggy but not fully asleep.
For general anesthesia, you inhale the analgesic or receive it through an IV
line. This type of anesthesia affects your entire body and induces a temporary
state of unconsciousness. Discuss with your doctor beforehand which kind of
anesthesia is best in your case.
Rhinoplasty usually takes one to three hours. After the surgery, you will be
in a recovery room, where the doctor's staff monitors you for any complications.
You might leave later that day or, if the procedure is done in a hospital, you
might stay overnight.
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What are the results of Rhinoplasty?
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 cotton packed inside your nose during surgery. In most
cases, the dressings remain in place for one to seven days after surgery.
Your
doctor also tapes a splint or plaster cast 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 procedure or after removing the dressing.
Your doctor may place a
"drip pad" (small gauze held in place with tape) under your nose to absorb
drainage. Change the gauze as directed by your doctor.
To further decrease the chances of bleeding and swelling,
your doctor may ask
that you follow these precautions for several weeks after surgery:
1. Avoid strenuous activities such as aerobics and jogging.
Don't swim. 2. Don't bend down from your waist unless you flex or bend your knees.
3. Don't lift anything weighing more than 20 pounds.
4. Sleep with your head raised higher than your chest.
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.
Some temporary swelling, black-and-blue discoloration of your eyelids and
numbness can occur for two to three weeks after nasal surgery. Rarely, this may
last up to six months, and subtle swelling may take a year to resolve entirely.
Because of the slow healing process, you might not see the final results of your
surgery for up to a year.
Very slight changes to the structure of the nose — often measured in
millimeters — can make a large difference in how your nose looks. Most of the
time, an experienced surgeon can get results both of you are satisfied with. But
in some cases, the slight changes aren't enough, and you and your surgeon might
opt for a second surgery for further refinements.
If this is the case, you must
wait at least a year for the follow-up surgery, because the nose can undergo
changes during this time.
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What are the risks of rhinoplasty?
As with any major surgery, rhinoplasty carries risks such as bleeding,
infection and an adverse reaction to the anesthesia. Other possible risks
specific to rhinoplasty include:
1. Recurring nosebleeds
2. Difficulty breathing through the nose
3. Reduced sense of smell
4. Numbness in and around the nose
5. Possibility of an uneven-looking nose
6. Scarring
Talk to your doctor about how these risks apply to you. Understanding what's
involved in rhinoplasty and weighing the benefits and risks can help you decide
if this procedure is a good option.
Every year, half
a million people who are interested in improving the appearance of their noses
seek consultation with facial plastic surgeons. Some are unhappy with the noses
they were born with, and some with the way aging has changed their nose.