Rhinoplasty – Nose Reshaping

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.

QUICK FACTS

IDEAL RHINOPLASTY CANDIDATE

Prominent nasal bump, wide nose, nasal tip needs refinement

RHINOPLASTY ADVANTAGES

Improvements and enhancements of nasal appearance
Improvement of airways and breathing

RHINOPLASTY TECHNIQUES

Closed Rhinoplasty (Internal Approach Rhinoplasty) / most commonly used at the HAPSI
Open Rhinoplasty (Open Structure Rhinoplasty)

RHINOPLASTY STATISTICS

Length: 2 to 3 hours, discharge home on same day
Back to Work: 7 to 8 days
Return to Exercise: 4 to 5 days (light cardio), 2 to 3 weeks (more strenuous exercise)

Your Personal Consultation

During the initial consultation, you may be asked to look in a mirror and point out exactly what you would like to see improved. This will help your plastic surgeon to understand your expectations and determine whether they can realistically be achieved.

Am I a good candidate for rhinoplasty?

Rhinoplasty can enhance your appearance and your self-confidence, but it won’t necessarily change your looks to match your ideal. 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 a natural 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. Age may also be a consideration. Most surgeons prefer not to operate on teenagers until after they’ve completed their growth spurt. We only provide rhinoplasty and cosmetic surgery to patients over 18 years old.

Some of the indications that you may be a good candidate for rhinoplasty are:

your nose appears too large for your face
there is a bump on the nasal bridge when viewed in profile
your nose seems too wide when viewed from the front
the nasal tip droops or plunges
the tip is thickened or enlarged
your nostrils are excessively flared
your nose is off-center or crooked
previous injury has made your nose asymmetrical

How will my plastic surgeon evaluate me for rhinoplasty?

You should come to the consultation prepared to discuss your medical history. This will include information about any medical conditions you may have, medical treatments you have received, previous surgeries including repair of nasal injuries, and medications that you currently take. Your plastic surgeon may also ask whether you have difficulty breathing through your nose, suffer from allergies that may cause nasal stuffiness, or are a chronic user of nasal spray. It is important for you to provide complete information. In evaluating you for rhinoplasty, your plastic surgeon will conduct a routine and painless examination of your internal nasal structures. Your skin quality as well as the size and shape of your nose and its relationship to your other facial features will be carefully studied. In some instances, your plastic surgeon may recommend surgery of your chin, making it either more or less prominent, to improve facial balance. This procedure can be done at the same time as your rhinoplasty. 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 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. Don’t hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results.

How should I prepare for surgery?

If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti- inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions. Be sure to arrange for someone to drive you home after surgery and to stay with you at least the first night following surgery.

The day of your Rhinoplasty Surgery

Your rhinoplasty will be performed in a JCI Accredited hospital. Medications are administered for your comfort during the surgical procedure. Usually light general anesthesia or intravenous sedation are used for patients undergoing nose reshaping. For your safety during the operation, various monitors are used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood. When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. There may be some discomfort, but this can be controlled by medication which you may continue taking at home. Depending on the surgical technique used, a splint may have been placed on the bridge of your nose for the purpose of holding the tissues in place until they have stabilized. The splint will protect your nose while you sleep and shield it from accidental bumps. Frequently, you may also have a small triangular bandage beneath the tip of your nose. Packing or soft internal splints are sometimes used inside the nostrils, especially if work has been done to improve your breathing. You probably will be permitted to go home after a few hours, although some patients may stay overnight in the hospital or surgical facility.

Rhinoplasty Anesthesia
As mentioned, rhinoplasty is usually performed under light general anesthesia, however this also depends on the extent of the procedure.

Rhinoplasty surgical technique
Rhinoplasty usually takes an hour or two, though complicated procedures may take longer.

Surgical steps:

Incision
In most instances, all of the incisions will be placed inside your nose, where they will not be visible. Sometimes a very short incision is made across the vertical strip of tissue that separates the nostrils, called the columella. This technique is called an “open rhinoplasty.” Whatever incisions are used to reshape your nose, they will ultimately be very inconspicuous. In most cases, we use the closed rhinoplasty technique.
Skin detachment
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.
Framework technical modifications (Bone and/or cartilage)
This is the most critical and artistic step in rhinoplasty. Changes here must be subtle and natural and not severe to create the “operated” nose appearance. Through the small incisions described previously, work is done on the cartilage and bone that form the new framework of your nose. Sometimes, the position of certain bones may need to be altered slightly in order to make your nose look narrower and straighter. If your nose needs to be built up in some areas, this can be done using nasal cartilage, or perhaps bone or cartilage from another site. The nature of the sculpting will depend on your problem and your surgeon’s preferred technique. Alterations may be made to increase or decrease the nasal bridge, reduce the size or width of the nose, narrow the nostrils, change the angle between the nose and upper lip, or reshape the tip.
Incision closure
Finally, the skin is redraped over the new framework. 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.

Open versus Closed Rhinoplasty

Patients often get confused about what type of rhinoplasty technique is best for them- Open versus Closed Rhinoplasty. To decide which type of rhinoplasty is best, you need to first understand the differences between open and closed rhinoplasty.

Closed rhinoplasty technique (most frequently used by our surgeons).

Closed Rhinoplasty: No skin incision present

With a closed rhinoplasty approach an intra-nasal or internal incision is made and the nasal skin is separated away from the underlying cartilaginous framework. Then the plastic surgeon looks through this incision and then shapes the nasal bone and cartilage. Because the nasal skin is not pulled back, the plastic surgeon has to be skilled in analyzing the contour of the nose by palpating the nose and by paying attention to subtle contour changes. Many of the techniques that are used to refine the nose through an open rhinoplasty technique are also modified for a closed rhinoplasty technique.

Advantages of Closed Rhinoplasty: Shorter Surgery Time, Better Circulation to the nasal tip skin, Less nose swelling, Faster Recovery, Better for Nasal Implant placement.

Disadvantage of Closed Rhinoplasty: Requires more skillto refine nasal tip, Requires more skill to perform Revision Rhinoplasty

Closed Rhinoplasty

Open rhinoplasty: Skin incision present at the lower nose

With an open rhinoplasty technique an incision is made on the lower part of the columella which extends into the nostrils. Then the skin of the nasal tip is lifted up thus exposing the underlying nasal cartilages including the alar cartilages, septum, and the nasal bridge or dorsum. This open nose surgery approach gives the facial plastic surgeon excellent visualization of the nasal framework as well as the ability to finely manipulating the nasal tip cartilage. It also makes it easy to introduce, place, and secure nasal cartilage grafts. Because of its improved visualization open rhinoplasty is utilized more often in revision rhinoplasty or redo nose surgery.

Advantages of Open Rhinoplasty: Allows refinement of nasal tip in most difficult cases, Allows easy placement of cartilage graft, Enables execution of complex maneuvers necessary for Revision Rhinoplasty, Easier approach for plastic surgeons.

Disadvantage of Open Rhinoplasty:Prolonged swelling of the nose, Poor circulation to the nasal tip skin, Nasal skin incision scar over the columella, Prolonged surgical time, Less preferable for placement of Nasal Implants.

Open Rhinoplasty

After your rhinoplasty

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.

How will I look initially?

It is important to realize that the amount of time it takes for recovery varies greatly among individuals. The first couple of days after surgery, you should restrict your activities and sleep with your head elevated. This will help to minimize swelling and reduce the possibility of minor bleeding, which is not uncommon. Remember, you must not take aspirin or certain anti-flammatory medications. Generally, bruising around the eyes and cheeks is most apparent during the first three days following surgery. Most discoloration will disappear within a week. A few days after surgery, you can begin to use makeup as a concealer, if desired. Noticeable swelling may last for several weeks. Minor residual swelling, most frequently affecting the nasal tip, may continue for many months, but generally this should not be apparent to others. If packing was used, it will either dissolve by itself or be removed three to seven days after surgery. Stitches may also be removed at that time. You may need to continue wearing the nasal splint for up to a week, during which time you should avoid getting it wet.

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.

Results of Your Rhinoplasty

The goal of rhinoplasty is a nose that looks natural and blends harmoniously with your other facial features. Since the healing process is gradual, you should expect to wait up to one year to see the final results of your rhinoplasty. You are likely, however, to begin enjoying your new look within weeks of your surgery. Occasionally, a touchup may be desired to further improve the results. If this is the case, the additional procedure is usually less extensive than the original operation.

When can I resume my normal activities?

Straining, bending and lifting should be avoided during the early postoperative period. In many instances, you may be able to return to work within a week or ten days after surgery. Most normal activities including exercise can usually be resumed within three weeks. It will be a few months before you can expose your reshaped nose to direct sunlight. Your nose will be sensitive during this time, and you must be conscientious about using a sunblock to protect your skin. If the bones of your nose were altered, it may be a number of weeks before you can wear glasses without special support such as tape.

How long will the results last?

In most instances, the results of rhinoplasty are permanent, except for possible changes associated with the normal aging process.

Understanding 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. Rarely, a second procedure may be required-for example, to correct a minor deformity. Such cases are unpredictable and may happen even to patients of the most skilled surgeons. Every year, many thousands of people have their noses reshaped, experience no major problems and are pleased with the results. Anyone considering surgery, however, should be aware of both the benefits and risks. The subject of risks and potential complications of surgery is best discussed on a personal basis between you and your surgeon, or with a staff member in your surgeon’s office. Some of the potential complications that may be discussed with you include hematoma (an accumulation of blood under the skin that may require removal), infection and reactions to anesthesia. Numbness of the skin following rhinoplasty may occur but is usually temporary. Occasionally, if the surgical outcome needs further improvement, additional surgery may be necessary. You can help minimize certain risks by following the advice and instructions of your plastic surgeon, both before and after your surgery.

RELATED PROCEDURES

Rhinoplasty is most often performed as an isolated procedure. A septoplasty, turbinectomy, or internal valve reconstruction (which are functional procedures within the nose) may be advised and performed at the time of rhinoplasty to improve pre-existing functional impairment of the nose. As rhinoplasty is geared primarily to achieve facial balance and symmetry, occasionally, a chin augmentation (chin implant) may be suggested and can be combined with your rhinoplasty procedure as indicated. For those individuals who desire additional cosmetic enhancements, your rhinoplasty may also be combined with fat transfer (autologous fat grafts), blepharoplasty (eyelid lift) or other cosmetic procedures.

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