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RHINOPLASTY

"There is no other procedure in aesthetic surgery that requires as much surgical planning and execution to obtain good results as rhinoplasty.

Concepts

Rhinoplasty is the most frequent facial cosmetic surgery intervention and its objective is to redefine the shape and/or size of the nose. It may be the most technically demanding cosmetic surgery intervention, requiring both aesthetic and functional knowledge on the part of the surgeon. In order to obtain good results in rhinoplasty, it is required a great experience, a precise technique and a great number of operated patients.

 General Overview

Rhinoplasty is a surgery in which the shape of the nose is modified. The reason for rhinoplasty may be to change the appearance of the nose, improve breathing, or both.

The upper part of the nose structure is bone and the lower part is cartilage. Rhinoplasty can modify bone, cartilage, skin, or all three. Talk to your surgeon about whether rhinoplasty is right for you and what it can accomplish.

Why it is performed

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Rhinoplasty can change the size, shape, or proportions of the nose. It may be done to repair deformities caused by an injury, correct a birth defect, or improve certain breathing difficulties.

Risks

Like any major surgery, rhinoplasty carries risks such as:

 

  • Bleeding.

  • Infection.

  • Adverse reaction to anesthesia.

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Other possible risks specific to rhinoplasty include, but are not limited to, the following:

 

  • Difficulty breathing through the nose.

  • Permanent numbness inside or around the nose.

  • Possibility of an asymmetrical appearance of the nose.

  • Pain, spots, or swelling that may persist.

  • Scars.

  • Hole in the septum (perforation of the septum)

  • Need for additional surgery.

 

Talk to your doctor about how these risks may affect you.

How to prepare yourself

Before scheduling rhinoplasty, you should meet with your surgeon to discuss the important factors that will determine if the surgery can work well for you. In general, this meeting will cover the following:

 

  • Your medical history. The most important question your doctor will ask you will be what your motivation for surgery is and what your goals are. Your doctor will also ask you questions about your medical history (including history of nasal obstructions, surgeries, and medications you take). If you have a bleeding disorder (such as hemophilia), you may not be suitable for rhinoplasty.

 

  • A physical examination. Your doctor will do a complete physical exam, which includes all necessary lab tests (for example, blood tests). They will also check your facial features, and the inside and outside of your nose.​ The physical exam helps the doctor determine what changes need to be made and how physical features (such as skin thickness or cartilage strength at the end of the nose) can affect the results of the surgery. In addition, a physical examination is essential to determine the impact of rhinoplasty on breathing.

 

  • Photographs. A person in your doctor's office will take pictures of your nose from different angles. Your surgeon may use a computer program to manipulate the pictures and show you what kinds of results are possible. Your doctor will use these photos to make pre- and post-procedure evaluations, for reference during surgery, and for long-term reviews. Most importantly, the photos allow you to talk specifically about the goals of the surgery.

 

  • A conversation about your expectations. You should talk to your doctor about your motivations and expectations. Your doctor will explain what rhinoplasty can and cannot accomplish and what the results might be. It's normal to be a little embarrassed when talking about your appearance, but it's very important to be honest with your surgeon about your wishes and goals for surgery.​If you have a small chin, your surgeon may discuss with you the possibility of surgery to increase the size of your chin. This is because a small chin gives the impression that the nose is larger. It is not necessary to have chin surgery in this case, but it can help balance the facial profile.

 

When surgery is scheduled, you should ask someone else to drive you home if the surgery is outpatient.

 

During the first few days after anesthesia, you may experience memory failure, slower reaction times, and alterations in your mental faculties. Therefore, coordinate with a family member or friend to accompany you for a night or two and help you with personal care tasks as you recover from surgery.

 

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Food and medicine.

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Avoid medications containing aspirin or anticoagulants for two weeks before and after surgery. These medications may increase bleeding. Take only medications approved or prescribed by your surgeon. Also, avoid over-the-counter herbal remedies and supplements.

 

If you smoke, quit. Smoking slows the healing process after surgery and may make you more prone to infection.

What you can expect

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Rhinoplasty does not have an ordered series of steps. Each surgery is unique and tailored to the anatomy and specific goals of the person being operated on.

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During Surgery

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Rhinoplasty requires local anesthesia with sedation or general anesthesia, depending on the complexity of the surgery and the surgeon's preferences. Talk to your doctor before surgery about which type of anesthesia is right for you.

 

Local anesthesia with sedation. This type of anesthesia is usually used in an outpatient setting. It is limited to a specific area of the body. The doctor injects an anesthetic into the nasal tissues and silks you with a medication that is injected through an intravenous line (IV). This will stun you, but it won't put you to sleep completely.

 

General anesthesia. You receive the medicine (anesthetic) by inhaling it or through a small tube (intravenous line) that is placed in a vein in your hand, neck, or chest. General anesthesia affects the whole body and makes you unconscious during surgery. General anesthesia requires a breathing machine.

 

Rhinoplasty can be performed inside the nose or through a small external cut (incision) at the base of the nose, between the nostrils. The surgeon will probably readjust the bone and cartilage under the skin.

 

The surgeon can change the shape of the cartilage or bones of the nose in a variety of ways, depending on how much should be removed or added, the structure of the nose, and the materials available. For small changes, the surgeon may use cartilage taken from a deeper part of the nose or ear. For major changes, the surgeon may use cartilage from a rib, implants, or bone from other parts of the patient's body. After these changes are made, the surgeon places the tissue and skin of the nose again and sutures the incisions in the nose.

 

If the wall between the two parts of the nose (septum) is tilted or crooked (deviated), the surgeon may also correct it to improve breathing.

 

After surgery, you will be in a recovery room, where the staff will monitor you until you wake up. You could leave later that day, or if you have other health problems, you could spend the night there.

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After surgery

You will need to stay in bed with your head elevated above chest level to reduce bleeding and swelling. The nose may become congested due to swelling or splints placed inside the nose during surgery.

In most cases, internal bandages remain in place one to seven days after surgery. The doctor also attaches a splint to the nose to provide protection and support. It is usually left in place for a week.

 

Mild bleeding and drainage of mucus and old blood are common during the days following surgery or after the bandage is removed. Your doctor may place an "absorbent pad" under your nose. This is a small piece of gauze held by a tape to absorb the drainage. Change the gauze as directed by your doctor. Do not place the absorbent pad snugly against your nose.

 

To further reduce the chance of bleeding and swelling, your doctor may ask you to follow some precautions for several weeks after surgery. Your doctor may ask you to do the following:

 

  • Avoid demanding activities such as aerobic exercise and jogging.

 

  • Take baths instead of showers when you have bandages on your nose.

 

  • Don't blow your nose.

 

  • Eat high-fiber foods, such as fruits and vegetables, to avoid constipation. Constipation can cause tension, which puts pressure on the surgical site.

 

  • Avoid intense facial expressions, such as smiling or laughing.

 

  • Brush your teeth gently to limit upper lip movement.

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  • Wear clothing that closes and opens at the front. Do not wear headwear, such as T-shirts or sweaters.

 

  • Also, do not wear glasses or sunglasses over your nose for at least four weeks after surgery to prevent pressure on your nose. You can place your glasses so they rest on your cheeks, or stick your glasses to your forehead until your nose has healed.

 

  • Use sunscreen with a sun protection factor (SPF) of 30 when outdoors, especially on the nose. Too much sun exposure can cause irregular color changes of the nose skin.

 

  • Temporary swelling or purple eyelids may occur for two to three weeks after nose surgery. It takes longer for the swelling to go away. Limiting your daily sodium intake can help the swelling go away faster. Don't put ice or cold compresses on the nose.

Results

Very small changes in the structure of the nose, often measured in millimeters, can make a big difference in the appearance of your nose. Most of the time, an experienced surgeon can achieve results with which both of you are satisfied. But in some cases, those small changes aren't enough, and you and your surgeon may decide to do a second surgery to achieve greater changes. If that's the case, you should wait at least a year for follow-up surgery, since the nose can undergo changes during that time.

Frequently Asked Questions

How is rhinoplasty different from septoplasty?

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Rhinoplasty is a surgery to change the shape of the nose. Since breathing and the shape of the nose are related, sometimes rhinoplasty is performed not only to change the way the nose looks, but also to improve nasal breathing.

Septoplasty is a surgery to improve breathing by straightening the inner wall of the nose that divides the nasal passages on the right and left sides (nasal septum). If the septum is twisted, it can make it difficult to breathe through the nose. Septoplasty is usually combined with rhinoplasty.

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Is rhinoplasty a simple operation?

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No. Rhinoplasty is a challenging operation. This is due to several factors. First, the nose is a complicated three-dimensional shape found in the middle of the face. Generally, the changes made during rhinoplasty are very small. But these changes can significantly affect the appearance of the nose and its function. Since the changes are small, so is the margin of error.

Swelling and the placement of local anesthesia on the skin distort the nose during surgery, and hide many of the small changes that have been made. Rhinoplasty also has no standard planning or established order of steps. Doctors customize each operation according to the patient's needs.

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Do I need to stay in hospital?

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Almost everyone who has a rhinoplasty can leave the hospital safely the same day after surgery. In rare cases, you may stay in the hospital overnight if you have a lot of nausea or other medical problems that need to be supervised.

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How long is the recovery period?

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Program not to attend work or educational establishment or fulfill other obligations for one week. You will feel better gradually, day by day, in the first week. A week after surgery, people usually feel like they are themselves again.

After surgery, there will be some swelling. It may take several months for the swelling to go away, although patients no longer notice it after a couple of months. In general, they return to most of their activities after a week, and after two to four weeks they resume all of their activities.

 

 

Are there risks?

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All surgeries have risks. Fortunately, the risks of rhinoplasty are small and complications are rare. Your doctor will explain in detail the risks and benefits of surgery before the operation.

 

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Does insurance pay for rhinoplasty?

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Sometimes insurance pays for rhinoplasty, but that depends on the policy. Before scheduling surgery, your doctor's office will help you obtain prior written authorization from the insurance company. Although it is not a guarantee of coverage, it is the only way to confirm that rhinoplasty is a covered benefit. Sometimes insurance pays for part of the nose surgery, but not the rest. In those cases, you can contact the sales office for a quote on the operation.

 

 


Is rhinoplasty painful?

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It's not for most people. One day after surgery, most people rate their pain between 0 and 4 out of 10.

 

 


How long will I have bruising?

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Bruising is rare. If you get some small bruises, they usually last about a week.

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