Rhinoplasty is surgery
that changes the shape of the nose. The motivation for rhinoplasty may be to
change the appearance of the nose, improve breathing or both.
The upper portion of
the structure of the nose is bone, and the lower portion is cartilage.
Rhinoplasty can modify bone, cartilage, skin or all three. Talk with your
surgeon about whether rhinoplasty is appropriate for you and what it can
achieve.
When planning
rhinoplasty, your surgeon will consider your other facial features, the skin on
your nose and what you would like to change. If you are a candidate for
surgery, your surgeon will develop a customized plan for you.
Sometimes part or all
of a rhinoplasty is covered by insurance.
Why it's done
Rhinoplasty can change
the size, shape or proportions of your nose. It may be done to repair
deformities from an injury, correct a birth defect or improve some breathing
difficulties.
How you prepare
Before scheduling
rhinoplasty, you must meet with your surgeon to discuss important factors that
determine whether the surgery is likely to work well for you. This meeting
generally includes:
·
Your medical history. The most important question your doctor will ask you is about
your motivation for surgery and your goals. Your doctor will also ask questions
about your medical history — including a history of nasal obstruction,
surgeries and any medications you take. If you have a bleeding disorder, such
as hemophilia, you may not be a candidate for rhinoplasty.
·
A physical exam. Your doctor will conduct a complete physical examination,
including any laboratory tests, such as blood tests. He or she also will
inspect your skin and the inside and outside of your nose. The physical exam
helps your doctor determine what changes need to be made and how your physical
features — for example, the thickness of your skin or the strength of the
cartilage at the end of your nose — may affect your results. The physical exam
is also critical for determining the impact of rhinoplasty on your breathing.
·
Photographs. Someone
from your doctor's office may take photographs of your nose from different
angles. Your surgeon may use computer software to manipulate the photos to show
you what kinds of results are possible. Your doctor will use these photos for
before-and-after assessments, reference during surgery and long-term reviews.
Most importantly, the photos permit a specific discussion about the goals of
surgery.
·
A discussion of your expectations. You and your doctor should talk about
your motivations and expectations. He or she will explain what rhinoplasty can
and can't do for you and what your results might be. It's normal for people to
feel a little self-conscious discussing their appearance, but it's very
important that you're open with your surgeon about your desires and goals for
surgery. Sometimes your surgeon may speak with you about performing a surgery
to augment your chin. This is because a small chin will create the illusion of
a larger nose. It's not required to have chin surgery in those circumstances,
but it may better balance the facial profile.
Food and medications
Avoid medications
containing aspirin or ibuprofen (Advil, Motrin IB, others) for two weeks before
and after surgery. These medications may increase bleeding. Take only those
medications approved or prescribed by your surgeon.
If you smoke, stop
smoking. Smoking slows the healing process after surgery and may make you more
likely to get an infection.
What you can expect
Rhinoplasty is not a
procedure with a set series of steps. Each operation is unique and is
customized for the specific anatomy and goals of the person undergoing the
procedure.
Rhinoplasty may be
done inside your nose or through a small external incision at the base of your
nose, between your nostrils. Your surgeon will likely readjust the bone and
cartilage underneath your skin.
Your surgeon can
augment your nasal bone or cartilage in several ways, depending on how much
needs to be added, the structure of your nose and available materials. For
small changes, the surgeon may use cartilage harvested from deeper inside your
nose or from your ear. For larger requirements, the surgeon can use cartilage
from your rib, implants or bone from other parts of your body.
During the surgery
Rhinoplasty requires
local anesthesia with sedation or general anesthesia, depending on the
complexity of the surgery and your surgeon's preferences. Discuss with your
doctor beforehand which kind of anesthesia is best in your case.
·
Local anesthesia with sedation. This type of anesthesia is usually used
in an outpatient setting and is limited to a specific area of your body. Your
doctor injects a pain-numbing medication into your nasal tissues and sedates
you with medication injected through an intravenous (IV) line. This makes you
groggy but not fully asleep.
·
General anesthesia. You receive the drug (anesthetic) by inhaling it or
through an IV line — a small tube placed in a vein in your hand, neck or chest.
General anesthesia affects your entire body and induces a temporary state of
unconsciousness. General anesthesia requires a breathing tube.
After the surgery,
you'll be in a recovery room, where the staff monitors your return to
wakefulness. You might leave later that day or, if you have other health
issues, you might stay overnight.
After the surgery
After the surgery you
need to rest in bed with your head raised higher than your chest, to reduce
bleeding and swelling. Your nose may be congested because of swelling or from
the splints placed inside your nose during surgery.
In most cases, the
internal dressings remain in place for one to seven days after surgery. Your
doctor also tapes a splint to your nose for protection and support. It's
usually in place for about one week.
Slight bleeding and
drainage of mucus and old blood are common for a few days after the surgery or
after removing the dressing. Your doctor may place a "drip pad" — a
small piece of gauze held in place with tape — under your nose to absorb
drainage. Change the gauze as directed by your doctor. Don't place the drip pad
tight against your nose.
To further decrease
the chances of bleeding and swelling, your doctor may ask that you follow these
precautions for several weeks after surgery:
·
Avoid strenuous activities such as aerobics and jogging.
·
Take baths instead of showers while 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 you to strain, putting pressure on the surgery
site.
·
Avoid extreme facial expressions, such as smiling or laughing.
·
Brush your teeth gently to limit movement of your upper lip.
·
Wear clothes that fasten in the front; don't pull clothing, such
as shirts or sweaters, over your head.
In addition, don't
rest eyeglasses or sunglasses on your nose for at least four weeks after the
surgery, to prevent pressure on your nose. You can use cheek rests, or tape the
glasses to your forehead until your nose has healed.
Use SPF 30 sunscreen
when you're outside, especially on your nose. Too much sun may cause permanent
irregular discoloration in the skin of your nose.
Some temporary
swelling or black-and-blue discoloration of your eyelids can occur for two to
three weeks after nasal surgery. Swelling of the nose takes longer to resolve.
Limiting your dietary sodium will help the swelling go away faster. Don't put
anything such as ice or cold packs on your nose after surgery.
Your nose changes
throughout your life whether you have surgery or not. For this reason, it's
difficult to say when you have obtained your "final result." However,
most of the swelling is gone at a year.
Results
Very slight changes to the structure of your nose — often
measured in millimeters — can make a large difference in how your nose looks.
Most of the time, an experienced surgeon can get results both of you are
satisfied with. But in some cases, the slight changes aren't enough, and you
and your surgeon might opt for a second surgery for further refinements.
Frequently Asked Questions
How is rhinoplasty different from septoplasty?
Rhinoplasty is a surgery to change the shape of the nose.
Because both breathing and the shape of the nose are interrelated, sometimes a
rhinoplasty is performed not only to change the way the nose looks but typically
it's also performed to improve nasal breathing too.
A septoplasty is a surgery to improve breathing by straightening
the wall inside the nose that divides the nasal passages into a right and a
left side (nasal septum). When the septum is crooked, it can make it harder to
breathe through the nose. A septoplasty is often combined with a rhinoplasty.
Will I need to stay in the hospital?
Nearly everyone who has rhinoplasty is able to safely leave the
hospital after surgery. In very rare cases, you may stay in the hospital for
one night if you are having a hard time with nausea or have other health
problems that need to be monitored.
How long is the recovery period?
Plan to take a week off from work, school or other obligations.
You will feel progressively better each day during the first week. By the one
week appointment, people usually feel like they are themselves again.
After surgery, there will be some swelling. The swelling can
take many months to resolve although most people stop noticing it after a
couple of months. People are typically back to performing most activities after
a week and resuming all activities after two to four weeks.
Are there risks?
All surgeries have risks. Fortunately, the risks for rhinoplasty
are small and complications are rare. Your doctor will talk to you about the
risks and benefits of surgery in detail before the operation.
Is rhinoplasty painful?
Not for most people. At the one day post-operative visit, most
people rate their pain between 0-4 out of 10.
Will you pack my nose?
No. Packing can be very uncomfortable. You will likely have some
soft splints in your nose, however. These splints have a hole in them to make
it possible to breathe through them, at least for a few days. These splints are
easily removed at the one week visit.
How long will I be bruised?
Bruising is uncommon. If you do have some minor bruising, it
typically lasts a week or so