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Rhinoplasty

A facial cosmetic procedure, rhinoplasty is usually performed to enhance the appearance or reconstruct the nose. There are 2 types of surgeries: closed rhinoplasty and open rhynoplasty, during which an otolaryngologist, a maxillofacial surgeon or a plastic surgeon creates a functional, facially proportionate and aesthetic nose. The procedure involves separating the nasal skin and the soft tissues from the osseo-cartilaginous nasal framework, correcting them as needed, suturing the incisions and applying a package or a stent (sometimes both) to keep the corrected nose in place, ensuring the proper healing of the surgical incision.

Slight defects of the nose are corrected and modified with non-surgical rhinoplasty, with the help of subcutaneous injections of biologically inert fillers. Apart from enhancing facial harmony and the proportions of the nose, rhinoplasty can also correct impaired breathing caused by structural defects in the nose. Correction of a deviated septum is achieved by adjusting the nasal structure to produce better alignment. Nose surgery that is done to improve an obstructed airway requires careful evaluation of the nasal structure. Other issues that rhinoplasty can change include:

  • nasal asymmetry
  • nose size in relation to face balance
  • nose profile with visible bumps or depressions on the bridge
  • large, wide or upturned nostrils
  • enlarged, bulbous, drooping, hooked or upturned nasal tip

Rhinoplasty Techniques

Approaches for rhinoplasty surgery can be either through the nostrils (intranasal) or by the use of a small incision on the underside of the nose (external). The surgery employs reduction, augmentation or refinement of a patient’s nose. Reduction rhinoplasty for example involves the removal of a nasal hump, together with re-breaking the nose to reduce the width. Nasal cartilages and bones are modified, or tissue is added during a nose job.

Septhorhinoplasty is a related procedure performed for people with nasal obstruction, which removes any internal obstructions, stabilizes structures that may be blocking nasal breathing and improving the appearance of the nose. When the tip of the nose is asymmetrical, depressed or the nose itself needs building up, surgeons use augmentation, which can be achieved by using tissue moved from another part of the patient’s body. Skin, cartilage from the ear or rib, and synthetic materials can be used, but there is a greater risk or rejection and infection when synthetic materials are used.

Rhinoplasty Surgery Steps

A rhinoplasty surgery includes the following steps:

  • anesthesia
  • the incisions
  • reshaping the nose structure
  • correcting a deviated septum (if the case)
  • closing the incisions
  • recovery and results

Medications are administered for your comfort during the surgical procedure. The anesthesiologist usually uses a mixture of a gas and intravenous medication. The surgery is performed either using a closed procedure, or using an open procedure, where an incision is made across the columella, the narrow strip of tissue that separates the nostrils. Through these incisions, the surgeon will gently raise the skin covering the nasal bones and cartilages, gaining access to reshape the structure of the nose.

When reshaping the nose structure, an overly large nose may be reduced by removing bone or cartilage. Sometimes a nose job may require the addition of cartilage grafts, commonly used from the septum for this procedure. Occasionally, cartilage from the ear or rarely a section of rib cartilage can be used. In the event of a deviated septum, surgeons can straighten it and reduce the projections inside the nose to improve breathing.

Once the surgeon finished sculpting the underlying structure of the nose to the desired shape, he will reposition the nasal skin and tissue, closing the incisions. A small plastic splint will be applied to the outside of the nose to minimize swelling and to help the nose maintain its new shape as it heals. After the operation, the front of your nose can be a bit tender for a few weeks and it will be blocked both sides for 10-14 days after your surgery. Drops or spray may be prescribed by your doctor to help with this issue.

It may take up to 3 months for the breathing to become clear again. Bruising and swelling around the nose and eyes will be common in the first week and can last for 2 weeks, depending on your body. Most of the swelling subsides after 2 weeks, but skin and soft tissues over the bone and cartilage may take a bit longer to settle. Final results of surgery may be judged after one year, when fine swelling settles.   

Risks and Safety

Prior to surgery, your plastic surgeon will explain in detail the risks associated with surgery and you will be asked to sign consent forms to ensure that you fully understand the procedure and any risks or potential complications. The following complications have been recorded:

  • excessive bleeding that can lead to a blood transfusion or a need for blood products
  • failure to resolve coexisting sinus infections
  • nasal obstruction due to failure to straighten the septum or later re-deviation of the septum
  • chronic nasal drainage or excessive dryness
  • crusting of the nose or sinuses
  • possible need for revision surgery if the cosmetic result does not meet expectations
  • need for allergy evaluation, treatment or environmental controls
  • septal perforation
  • permanent numbness of the upper teeth, palate or face
  • prolonged pain, impaired healing and the need for hospitalization

Studies have shown that up to 10% of people may have some reservations about the end results and about 5-10% of patients need further operations in the future.

Preparing for Consultation and Surgery

Cosmetic concerns and your expectations should be fully discussed prior to surgery. During the initial consultation, the surgeon will make recommendations and inform you about any particular limitations set forth by the structure of your nose, face and skin. You will need to share information with your surgeon regarding your medical conditions, drug allergies, previous and current medications and medical treatments, vitamins, herbal supplements, alcohol, tobacco and drug use.

Photographs are usually taken before surgery to help with preoperative planning and after surgery to document postoperative results. Before the surgery, preoperative laboratory studies will need to be done several days in advance and usually, the anesthesiologist will call the night before surgery to review your medical history. Other things you need to consider before your surgery:

  • aspirin should not be taken within 10 days of the date of the surgery
  • non-steroidal anti-inflammatory medications should not be taken within 10 days of the date of the surgery
  • no food or liquids should be consumed within 6 hours prior to the time of the surgery
  • smokers should make every effort to stop smoking
  • any illness prior to the day of surgery should be reported to the surgeon’s office as soon as possible

Am I a Candidate for Rhinoplasty?

You may be a good candidate for rhinoplasty if your facial growth is complete, you are physically healthy, you do not smoke and you have a positive outlook and realistic goals in mind for the improvement of your appearance. Your surgeon will aim to produce a nose that looks natural, but he or she may not be able to say exactly how your nose will look after the operation. It is very important to discuss your expectations with your surgeon. Although 90-95% of patients are happy with the results of their procedure, some people request more surgery if they are unhappy with the result.

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