The nose is one of the most noticeable facial features, defining and accentuating the rest of the face. Surgery to cosmetically alter its shape is one of the most popular procedures available today. Common problems include a hump, a nose that is too long or wide, deformity, and obstructions of the nasal cavity are all problems that can be corrected with rhinoplasty. The best candidates for the surgery are people with realistic expectations and good health. It is important to remember that in rhinoplasty, perfection can never be the goal. Since the nose is the most defining characteristic of the face, a slight alteration can greatly enhance one’s appearance. Patients older than their mid to late teens are normally preferred.
PRIOR TO SURGERY
A complete medical history and a careful examination with blood tests will be done in the initial preoperative visit to determine the general health of the patient. The surgeon will also evaluate the shape and structure of the patient’s nose, and determine the extent of surgery required given the description of ones desired nose. The surgeon will also discuss other options available to help achieve the desired facial look, such as a chin augmentation, in addition to the rhinoplasty to create a better balance of features. Photographs may also be taken before and after surgery to evaluate the extent of improvement. Moreover, the surgeon will discuss the procedure, realistic expected results, type of anesthesia to be used, and possible risks of surgery. Some insurance companies will pay for a rhinoplasty to correct a nasal obstruction. Preoperative instructions generally include taking certain vitamins and elimination of certain drugs to minimize the possibility of excess bleeding. Furthermore, antibiotics may be prescribed for the days prior to surgery in order to prevent infection.
Rhinoplasties are generally performed at an outpatient surgical facility or the physician’s office under general or local anesthetic, depending on the patient and doctors preference. The complete surgery can take anywhere from one to two hours. Two basic incision techniques are available. In the “closed” method the incisions are made inside the rim of the nostrils and scars are mostly hidden. In more complicated cases, the “open” technique must be used, in which the incisions are made at the base of the nose and nostrils. This procedure allows better visibility of the surgical area. After the cuts are made, the skin is lifted and certain amounts of cartilage and bone are removed or rearranged to give the nose a new shape. Any breathing obstructions can also be corrected at this time. The skin is then draped over the restructured nose and the incisions are closed. A splint is then applied to the outside of the nose and nasal pads may be used inside the nostrils to stabilize the dividing wall between the air passages.
Patients usually are free to go home after surgery but supervision will be required to help around the house for a day or two. The nasal pads are removed within two days and the splint and non-dissolvable stitches are removed within a week. Pain and discomfort from the surgery can be controlled with medication and normal swelling and bruising will occur around the eyes and treated areas. However, cold compresses and elevation of the head can reduce these side effects. It is also common to have a little bleeding and nasal stuffiness; the physician will explain when it is safe to lightly blow the nose. All bruises and facial discolorations will disappear within 2-3 weeks but it is important to still be careful not to hit the nose, let it sunburn, or wear glasses. In addition, any activity that raises blood pressure should be avoided for the first several weeks. One must remember that final results may not be seen until up to a year after surgery, although the bruises would have subsided before this time.
Each year thousands of rhinoplasties are performed successfully. Complications are rare but as with any surgery, inherent risks are present. Patients can minimize these risks by carefully following the physician’s pre- and post-operative directions.