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Nose Surgery (Rhinoplasty)

Nose surgery, or rhinoplasty, is a cosmetic surgery procedure that enhances the shape, size and appearance of your nose. Rhinoplasty is a very delicate procedure and is typically performed for two reasons, to enhance appearance and to correct breathing problems. The majority of rhinoplasty procedures are performed to reduce the size and shape of the nose. Rhinoplasty is often performed in conjunction with other procedures, such as chin and cheek implants, to improve the overall balance between the nose and other facial features.

• How is rhinoplasty performed?
• How long does rhinoplasty take?
• What type of anesthesia is used?
• Where is this procedure performed?
• How do I prepare for rhinoplasty?
• What precautions are necessary during recovery?
• What are the possible complications after rhinoplasty?
• What results can I expect after rhinoplasty?
• Choosing the right surgeon

How is rhinoplasty performed?

The procedure can be performed in a variety of ways. The most common procedures performed are the reshaping of the tip, changing the width of the nose, narrowing the nostrils and changing the angle of the nose in relation to the upper lip and chin. Essentially there are two types of surgery for Rhinoplasty- the "closed technique" and the "open technique". In a "closed rhinoplasty" procedure, the plastic surgeon makes an incision inside the nostrils and performs the surgery from within the nose. During an "open rhinoplasty" procedure, a small incision is made across the columella (the tissue area between the nostrils), and inside the nose as well. Through these types of incisions, the nose's framework of bone and cartilage is sculpted to create the desired shape.

Rhinoplasty is usually performed through incisions made inside the nose in order to avoid visible scarring. A small percentage of people require external incisions to reduce the size of the nostrils. These incisions are placed in the skin's natural creases to make them as inconspicuous as possible. In certain cases, a small incision will be placed on the columella to provide more complete operative exposure. Rhinoplasty can reshape the nose by repositioning the bones or by applying cartilage to different areas of the nose. Cartilage may be removed from the tip of the nose giving it a more shortened appearance. In some cases, an implant or cartilage from another part of the body may be added to obtain your nose's ultimate shape. The skin and soft tissues of the nose are subsequently redraped over this new framework creating a natural appearance.

Breathing partially depends on the structure inside your nose, including the condition of the nasal septum as well as the nasal turbinates. During your consultation, your surgeon will examine the internal aspects of your nose and evaluate if a breathing problem exists. To correct breathing problems, your surgeon may need to perform a septoplasty to straighten your septum (cartilage that divides the inside of your nose), or perform a turbinectomy to reduce the size of your turbinates (tissue along the sides of the nasal wall).

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How long does rhinoplasty take?

The length of time depends on the type, difficulty and scope of the procedure(s) performed. Typically, this procedure usually takes one to one and a half hours to complete. Additional procedures, such as a septoplasty or turbinectomy, can take an additional half hour, while chin or cheek implants can take an additional hour.

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What type of anesthesia is used?

Rhinoplasty is usually performed using local anesthesia along with a light sedative to make you feel drowsy and relaxed. General anesthesia may also be used, causing you to be asleep during the whole procedure.

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Where is this procedure performed?

Rhinoplasty is usually performed on an outpatient basis, in the surgeon's office-based surgical suite, an outpatient surgical facility or hospital.

When can I return home and resume normal activities?

Most patients return home the same day, although complex procedures may require a short hospital stay. Typically patients can resume normal activities within seven days.

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How do I prepare for rhinoplasty?

During your initial consultation, your surgeon will discuss the changes that you would like to make to your appearance. Since the appearance of your nose is a matter of personal perception and preference, you will need to discuss your concerns in detail so your surgeon can determine the appropriate alternatives. Your surgeon may also point out other problems areas. For example, some patients who want rhinoplasty also have weak chins or flat cheekbones. In these cases, chin or cheekbone implants might be considered as a part of the operative plan. You also should make arrangements ahead of time for someone to drive you to and from your procedure and to assist you with your daily activities during your recovery period.

Prior to your surgical procedure, the surgeon will perform a complete health history and physical. Knowledge of your allergies, medications and previous surgeries should be brought to your surgeon's attention at this time. Specific instructions to assist you in preparing for this procedure will be given to you after the health history and physical is complete. Depending on your individual health status, the instructions may include guidelines regarding your diet, alcohol intake, smoking and which medications to take or avoid. Your experience will be much smoother if you remain compliant with your surgeon's instructions.

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What precautions are necessary during recovery?

You should rest for the first 12 hours after your nose surgery. At the end of the procedure, tape and a protective splint are applied over your nose. These can normally be removed after seven days. Your surgeon will give you specific instructions regarding rest, sleeping positions, sun exposure, bathing and breathing techniques.

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What are the possible complications after rhinoplasty?

The complications associated with rhinoplasty are minimal. The most common complication is a small amount of bleeding from the nostrils immediately following the procedure. Please note that this is expected. The bleeding usually stops in one or two hours. It is always important to be informed about the possible complications before any surgery. Be sure to discuss any concerns you may have with your surgeon.

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What results can I expect after rhinoplasty?

About one hour after the procedure you may experience slight pain, as the anesthesia wears off. You will be given pain medication, which will relieve the discomfort. Swelling and bruising of the nose and around the eyes is common after surgery and will last for several days. Since the inside of the nose will be swollen as well, breathing will be difficult for the first few days following the procedure. Breathing will improve as swelling subsides.

Swelling and discoloration of the face usually last two to three days. Reduction in swelling and bruising begins on the fourth or fifth day. Any stitches outside of the nostrils, will be removed after five days. Stitches inside of the nostrils usually do not need to be removed, as they resolve by themselves. Rhinoplasty is performed to improve the aesthetic look as well as the internal function of your nose. Most people are very pleased with their results after the procedure and begin to enjoy their new look.

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