If you're considering 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.
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
 |
| Before
surgery, these rhinoplasty patients have large,
slightly hanging noses, with a hump and an enlarged
tip. |
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. 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.
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 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.
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 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.
Types of anesthesia
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.
The surgery
 |
| If
your nostrils are too wide, the surgeon can remove
small wedges of skin form their base, bringing them
closer together. |
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.
 |
| 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. |
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.
After your surgery
 |
| 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. |
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.
 |
| Trimming
the septum improves the angle between the nose and
upper lip. |
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.
 |
| 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. |
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
 |
| 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. |
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.
