Rhinoplasty is a reshaping of the nose. The reshaping can be done to improve the appearance of an otherwise normal nose, or to reconstruct a damaged nose. It can also be used to restore breathing through the nose. When the rhinoplasty is used to both improve breathing and the appearance of the nose it is called a septo-rhinoplasty.
The reshaping of the nose can be divided into procedures that change only the appearance of the tip of the nose (tip plasty) and those that reshape the bony part of the nose (rhinoplasty)
A good candidate is a patient with a nose which is out of proportion with the rest of the face, in good health, emotionally stable, and with realistic expectations.
• Do not take aspirin or anti-inflammatory medications
• If you smoke, quit smoking for at least 2 weeks pre-op and anticipate no smoking for the recovery
• Fill prescriptions before surgery
• Prepare icepacks to reduce post-op swelling
• Moisturizers, scar reducing creams and petroleum jelly for incisions
• Follow your physician’s directions carefully regarding medications, eating and drinking
Anesthesia: General or Sedation
Surgery time: 1-2 hours
Rhinoplasty is one of the common procedures plastic surgeons perform and also one of the most difficult as the surgeon performs it mainly by feel.
Rhinoplasty may be performed in order to increase the patient’s ability to breath, improve the nose by reducing or reshaping it and/or, straightening an injured nose.
There are two main options for the incisions: closed rhinoplasty and open rhinoplasty.
Closed rhinoplasty involves incision confined to the inside of your nose. Swelling improves soon and recovery is fast.
However, your surgeon may have a limited ability to achieve some changes in your nose because of her/his inability to see parts of the inside of the nose.
Open rhinoplasty involves a small incision across the columella, between the nostrils, in addition to incisions on the inside of your nose. Open surgery is usually preferred in more complicated cases.
Nasal surgery can change your nose by recontouring the underlying cartilage and bone. Your surgeon can make your nose larger, shorter, smaller, straighter, or thinner. Most of the incisions for the reshaping the nose are made internally and scars will not be visible.
Thick skin will not “drape out” as well over the new underlying structure as thin skin.
But thick skin will hide small irregularities of the cartilage and bone better than thin skin.
Common changes made:
• Tip of the nose: corrected by adding or excising cartilage at the tip and stitches the cartilage together. A low tip of the nose can be raised by adding cartilage to support the tip, removing excess cartilage in the septum, or repositioning the cartilage.
• Dorsal bone: the hump of the bridge can be corrected by removing excess cartilage and bone, then brings the nasal bones together.
• Wide bony portion of nose: corrected by breaking the bones of the nose and repositioning them inward.
• Wide base of the nose: corrected by removing tissue at the base of the nose and the nostrils moved closer together.
• Nostrils too wide: corrected by removing small wedges of skin from their base and bringing them closer together.
• Angle between nose and lip: corrected by trimming the septum.
Pain level: Moderate-severe discomfort. 2-10 days of pain medication
Swelling and bruising: 1-6 weeks for closed
1-6 months for open
Numbness: lasts several weeks (tip of nose)
Bandages: Changed in 5-10 days
Work: Return after 1-3 weeks
Exercise: Wait 6 weeks
Sunblock: very important for first few months
Final result: Seen 3 months-2 years. The majority see their final result within 6 months.
During recovery your nose may be:
For faster recovery:
• Apply cold, dry compresses often
• Aviod nasal medications for 3 months
• Use humidifier and saline spray for 2 weeks
• Keep head elevated to reduce swelling
• Avoid blowing or picking your nose for the first 4 weeks to reduce bleeding and abnormal healing
• Abnormal shape
• Burst Blood Vessels
• Loss of smell
• Slow healing
• Visible scar
The goal of rhinoplasty is a nose that looks natural and blends harmoniously with your other facial features.
In most rhinoplasties, you’ll be administered general anesthesia, which is the preferred method, as it allows the surgeon to protect the airway during surgery. However, some providers perform rhinoplasties under local anesthesia, which numbs only the treated area. During surgery, your doctor will make incisions to access the bones and cartilage. The doctor will then add or remove bone and cartilage to change your nose’s form and function if needed.
In a “closed” rhinoplasty, incisions are placed inside the nose. In an “open” rhinoplasty, the doctor cuts immediately underneath the nose in the columella, or the thin strip of tissue that separates the nostrils. A closed rhinoplasty is the more established and common technique. Some doctors say closed rhinoplasties heal faster than open rhinoplasties, while others say open rhinoplasties provide more control during the operation and more consistent results.
Immediately following your surgery, expect visible swelling and bruising, which may include black eyes. Many people say that they feel congested and have to breathe through their mouths. While pain may be a factor, also don’t expect to sleep well or look particularly presentable. About a week post-op, depending on your healing progress, your cast and/or nasal packing is removed. At this point, you can expect to breathe and sleep better, and blow your nose. After 10 to 14 days, swelling and bruising should subside enough for you to return to work and/or school, and other non-strenuous activities. Most doctors recommend waiting at least a month before returning to vigorous activity and exercise. Avoid wearing glasses or sunglasses as the nasal bridge heals.
Rhinoplasty results are likely to change over time. It takes several months and sometimes up to a year for swelling to subside.