Rhinoplasty - Nose Reshaping
Am I a good candidate for rhinoplasty?
Some of the indications that you may be a good candidate for rhinoplasty are:
- your nose appears too large for your face
- there is a bump on the nasal bridge when viewed in profile
- your nose seems too wide when viewed from the front
- the nasal tip droops or plunges
- the tip is thickened or enlarged
- your nostrils are excessively flared
- your nose is off-center or crooked
- previous injury has made your nose asymmetrical
Plastic surgeons usually recommend that patients wait until they are at least 14 or 15, and possibly older for boys, before undergoing rhinoplasty. This is because the nose may not be fully developed at a younger age. If you are a teen, your plastic surgeon will want to be certain that you have thought carefully about surgery and that the desire to change your appearance is based on your own feelings rather than those of your parents or friends.
Assuming you are in good health, there is no upper age limit for having your nose reshaped. Rhinoplasty is sometimes performed in conjunction with a facelift or other rejuvenate surgery to correct aging changes of the nose such as a drooping tip.
Sometimes certain breathing problems related to the internal nasal structures can be corrected at the same time as nose reshaping is performed. Your plastic surgeon will be able to help you determine whether these structures should be modified along with reshaping your nose.
Your Personal Consultation
During the initial consultation, you may be asked to look in a mirror and point out exactly what you would like to see improved. This will help your plastic surgeon to understand your expectations and determine whether they can realistically be achieved.
How will my plastic surgeon evaluate me for rhinoplasty?
You should come to the consultation prepared to discuss your medical history. This will include information about any medical conditions you may have, medical treatments you have received, previous surgeries including repair of nasal injuries, and medications that you currently take. Your plastic surgeon may also ask whether you have difficulty breathing through your nose, suffer from allergies that may cause nasal stuffiness, or are a chronic user of nasal spray. It is important for you to provide complete information.
In evaluating you for rhinoplasty, your plastic surgeon will conduct a routine and painless examination of your internal nasal structures. Your skin quality as well as the size and shape of your nose and its relationship to your other facial features will be carefully studied. In some instances, your plastic surgeon may recommend surgery of your chin, making it either more or less prominent, to improve facial balance. This procedure can be done at the same time as your rhinoplasty.
How should I prepare for surgery?
If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions.
If your rhinoplasty will be performed on an outpatient basis, be sure to arrange for someone to drive you home after surgery and to stay with you at least the first night following surgery.
What will the day of surgery be like?
Your rhinoplasty may be performed in a hospital, free-standing ambulatory facility or office-based surgical suite. Medications are administered for your comfort during the surgical procedure. Frequently, local anesthesia and intravenous sedation are used for patients undergoing nose reshaping, although general anesthesia may be desirable in some instances. For your safety during the operation, various monitors are used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.
When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. There may be some discomfort, but this can be controlled by medication which you may continue taking at home. Depending on the surgical technique used, a splint may have been placed on the bridge of your nose for the purpose of holding the tissues in place until they have stabilized. The splint will protect your nose while you sleep and shield it from accidental bumps. Frequently, you may also have a small triangular bandage beneath the tip of your nose. Packing or soft internal splints are sometimes used inside the nostrils, especially if work has been done to improve your breathing.
You probably will be permitted to go home after a few hours, although some patients may stay overnight in the hospital or surgical facility.
How Rhinoplasty is Performed
Because of individual factors, not everyone will achieve the same results from rhinoplasty. Your surgeon's goal is to obtain the best possible results for you.
Where are the rhinoplasty incisions placed?
Alterations may be made to increase or decrease the nasal bridge, reduce the size or width of the nose, narrow the nostrils, change the angle between the nose and upper lip, or reshape the tip. The surgical techniques employed will depend primarily on the goals established by you and your plastic surgeon. In many instances, all of the incisions will be placed inside your nose, where they will not be visible. If the base of the nose is narrowed or the nostrils reduced, small wedges of skin at the base of the nostrils will be removed. Incisions are hidden in the natural crease where the nostril joins the cheek.
Sometimes a very short incision is made across the vertical strip of tissue that separates the nostrils, called the columella. This technique is called an "open rhinoplasty." Whatever incisions are used to reshape your nose, they will ultimately be very inconspicuous.
Fortunately, significant complications from rhinoplasty are infrequent. Every year, many thousands of people have their noses reshaped, experience no major problems and are pleased with the results. Anyone considering surgery, however, should be aware of both the benefits and risks.
How is my plastic surgeon able to reshape my nose?
Incisions are placed inside the nose to provide access to the cartilage (blue shaded area) and brown (light brown shaded area) that form the nasal framework. Through the small incisions described previously, work is done on the cartilage and bone that form the framework of your nose.
Sometimes, the position of certain bones may need to be altered slightly in order to make your nose look narrower and straighter. If your nose needs to be built up in some areas, this can be done using nasal cartilage, or perhaps bone or cartilage from another site. The skin and soft tissues then redrape themselves over this new "scaffolding."
I understand that every surgical procedure has risks, but how will I learn more so that I can make an informed decision?
Depending on the surgical technique used, a splint may be placed on the bridge of the nose for the purpose of holding the tissues in place until they have stabilized. The subject of risks and potential complications of surgery is best discussed on a personal basis between you and your surgeon, or with a staff member in your surgeon's office.
Some of the potential complications that may be discussed with you include hematoma (an accumulation of blood under the skin that may require removal), infection and reactions to anesthesia. Numbness of the skin following rhinoplasty may occur but is usually temporary. Occasionally, if the surgical outcome needs further improvement, additional surgery may be necessary. You can help minimize certain risks by following the advice and instructions of your plastic surgeon, both before and after your surgery.
How will I look initially?
It is important to realize that the amount of time it takes for recovery varies greatly among individuals. The first couple of days after surgery, you should restrict your activities and sleep with your head elevated. This will help to minimize swelling and reduce the possibility of minor bleeding, which is not uncommon. Remember, you must not take aspirin or certain anti-flammatory medications.
Generally, bruising around the eyes and cheeks is most apparent during the first three days following surgery. Most discoloration will disappear within a week. A few days after surgery, you can begin to use makeup as a concealer, if desired. Noticeable swelling may last for several weeks. Minor residual swelling, most frequently affecting the nasal tip, may continue for many months, but generally this should not be apparent to others. If packing was used, it will either dissolve by itself or be removed three to seven days after surgery. Stitches may also be removed at that time. You may need to continue wearing the nasal splint for up to a week, during which time you should avoid getting it wet.
Results of Your Rhinoplasty
The goal of rhinoplasty is a nose that looks natural and blends harmoniously with your other facial features. Since the healing process is gradual, you should expect to wait up to one year to see the final results of your rhinoplasty. You are likely, however, to begin enjoying your new look within weeks of your surgery. Occasionally, a touchup may be desired to further improve the results. If this is the case, the additional procedure is usually less extensive than the original operation.
When can I resume my normal activities?
Straining, bending and lifting should be avoided during the early postoperative period. In many instances, you may be able to return to work within a week or ten days after surgery. Most normal activities including exercise can usually be resumed within three weeks.
It will be a few months before you can expose your reshaped nose to direct sunlight. Your nose will be sensitive during this time, and you must be conscientious about using a sunblock to protect your skin. If the bones of your nose were altered, it may be a number of weeks before you can wear glasses without special support such as tape.
Maintaining a Relationship with Your Plastic Surgeon
You will return to your plastic surgeon's office for follow-up care at prescribed intervals, at which time your progress will be evaluated. Please remember that the relationship with your plastic surgeon does not end when you leave the operating room. If you have questions or concerns during your recovery, or need additional information at a later time, you should contact your surgeon.