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