Rhinoplasty, or nose surgery, is one of the most common plastic surgery procedures performed. During a rhinoplasty, the surgeon is able to reshape, reduce or augment a patient's nose to improve appearance.
A rhinoplasty may be performed as a reconstructive procedure to correct a birth defect, a repair surgery to remedy an injury such as a broken nose, or simply for cosmetic reasons. Sometimes the procedure is performed in conjunction with endoscopic sinus surgery for patients with ongoing sinusitis or with a septoplasty, a procedure to correct a deviated septum. In these cases, the operation effectively treats health and breathing problems, as well as improving the patient's appearance.
Candidates for Rhinoplasty
Candidates for rhinoplasty should be at least 13 years old since it is important that patients have finished their facial growth before proceeding with this surgery. Patients considering rhinoplasty should be in overall good health and should not be smokers. It is important that individuals desiring a rhinoplasty have realistic expectations. While the surgical procedure may improve their self-confidence, it should not be viewed as a cure-all for personality or relationship issues and should not be undergone for reasons of social pressure.
Goals of Rhinoplasty
There are several specific goals of rhinoplasty surgery. Some facilitate breathing as well as improve facial appearance. During a rhinoplasty, the surgeon may accomplish one or more of the following:
- Remove a hump on the nose
- Modify the bridge of the nose
- Reshape the tip of the nose
- Reshape or resize the nostrils
- Repair the nose after an injury
- Opening breathing passages
- Increase or decrease the size of the nose
Rhinoplasty is usually an outpatient procedure performed under IV sedation or general anesthesia and takes from 1 to 2 hours. Surgeons typically use one of two techniques when performing nasal surgery. In a closed rhinoplasty, incisions are made within the nostrils. In an open rhinoplasty, the incision is made across the columella, the tissue between the nostrils. With both methods, the surgeon gently lifts the soft tissues covering the nose, then sculpts the bone and cartilage to the desired shape.
If additional cartilage is needed to augment the nose, it is frequently taken from the patient's septum. If larger sections of tissue are required, cartilage may be surgically removed from the ear or other parts of the body as well. If the patient has a deviated septum, the surgeon will adjust the septum and the inner structures of the nose to improve breathing. The tissues are then redraped and stitched closed. If the patient desires nostril reshaping, this is done as the final stage of rhinoplasty.
Recovery from Rhinoplasty
Immediately after surgery, the patient's nose and eyes are usually bruised and swollen. Splints and some packing material will remain inside the nose for a few days. During this period, the patient may experience some nasal pain or a dull headache, as well as some bleeding and drainage from the nose. Most patients feel like themselves within a few days and are able to return to regular activities in about a week.
To increase patient comfort and decrease bleeding and swelling, rhinoplasty patients are advised to follow these post-surgical directives:
- Avoid strenuous activities
- Take baths instead of showers
- Avoid blowing the nose
- Avoid constipation
- Avoid exaggerated facial expressions
- Brush the teeth gently
- Avoid pulling clothing over the head
- Use sunscreen of SPF 30 or higher
- Limit dietary sodium
- Do not use ice packs
While the patient usually looks and feels fine after a week or two, there may be minimal swelling for as much as a year after the rhinoplasty procedure.
Risks of Rhinoplasty
Complications associated with rhinoplasty are rare and, when they occur, usually minor. There are, however, more serious risks involved with any surgical procedure which may include infection or an adverse reaction to anesthesia. In the case of a rhinoplasty there is also the possibility of:
- Recurring nosebleeds
- Difficulty breathing through the nose
- Permanent numbness in or around the nose
- Persistent pain or discoloration of the skin on the nose
- Perforation of the nasal septum
It is also possible that the patient will not be satisfied with the results of a rhinoplasty and at times a second surgery, called a revision rhinoplasty, may be performed at a later date.