Nose Surgery - Rhinoplasty
THE NOSE IS THE CENTRAL, MOST PROMINENT FEATURE OF THE FACE and a major factor in defining balance and harmony among facial features. When the nose is out of proportion with other facial features or the nose does not complement the lace, it can affect self-image and confidence. In most cases, the specific characteristics of the nose are a result of heredity; however the appearance of the nose may sometimes be the result of injury or prior surgery.
If you are bothered by the size or shape of your nose, then cosmetic surgery of the nose, or rhinoplasty, may be right for you. In general, rhinoplasty improves the appearance and proportion of the nose, enhancing facial harmony and self confidence. Surgery of the nose may also correct impaired breathing caused by structural defects in the nose.
Cosmetic surgery of the nose, or rhinoplasry is a procedure to improve the appearance of the nose. Specific features addressed in cosmetic surgery of the nose, and strictly for appearance enhancement, include:
- Nose size, in relation to facial balance
- Nose width, at the bridge or in the size and position of the nostrils
- Nose profile, with visible humps or depressions on the bridge
- Nasal tip, that is enlarged or bulbous, drooping, upturned or hooked
- Nostrils that are large, wide or upturned
- Nasal asymmetry
These features are generally caused by heredity however they can be caused by injury. In some cosmetic cases, the characteristics of the nose are not the only factors contributing to facial imbalance. The facial structure - especially a small chin, weak cheeks and/or lower jaw - may also contribute to imbalanced facial proportions. In these cases, surgery of the nose may be performed in conjunction with placement of facial implants or other procedures to achieve overall facial harmony.
When nose surgery is performed to improve breathing function, the cause is most commonly an obstructed airway. This procedure, whether performed alone or in conjunction with cosmetic surgery of the nose, is considered reconstructive and may be covered by insurance. This requires a detailed examination to verify the cause of your breathing impairment and prior authorization from your insurer.
Whether you have a personal desire to improve your appearance or you seek to improve breathing function, surgery of the nose is best performed when facial growth is complete, beginning around age 15. Good candidates are:
- Healthy individuals who do not have a life-threatening illness or medical conditions that can impair healing
- Individuals with a positive outlook and specific goals in mind for improvement
A consultation with your plastic surgeon is the first step to learn how surgery of the nose can improve the appearance of your nose and facial harmony, or how surgery of the nose can improve your breathing function. A consultation is designed to fully educate you in a non-pressured environment, and will include:
- A discussion of your primary concerns and an evaluation of your individual case
- The options available for surgery of the nose
- The likely outcomes of surgery and any risks or potential complications
- The course of treatment recommended by your plastic surgeon
Your plastic surgeon will also answer your questions.
- Honestly share your concerns, whether cosmetic or to improve nasal airway problems
- Fully disclose health history, current medications, the use of vitamins, herbal supplements, alcohol, tobacco, and drugs
- Commit to following all of your plastic surgeon's instructions precisely
About the Procedure
Cosmetic surgery of the nose is an individualized procedure that takes into account all the specific characteristics that contribute to the overall appearance of the nose and its relation to other facial features. Your plastic surgeon will carefully evaluate your individual case and goals for improvement to determine specific features to address through surgery of the nose. Appropriate techniques will then be defined and may include:
- Alteration of the nasal bridge
- Reshaping the nasal bridge
- Reducing the shape or width of the nose
- Reshaping the nasal tip
- Reducing the width or size of the nostrils
- Adjusting the angle between the nose and upper lip
If you desire a more symmetrical nose, keep in mind that everyone's face is asymmetric to some degree. Results may not be completely symmetric, although the goal is to create facial balance and correct proportion. Facial augmentation with implants of the chin, cheeks and jaw may further enhance your outcomes.
Nose surgery to improve an obstructed airway is also a very individualized procedure. It requires careful evaluation of the nasal structure as it relates to airflow and breathing. Correction of a deviated septum, one of the most common causes of breathing impairment, is achieved by adjusting the nasal structure to produce better alignment.
Surgery of the nose is performed either using a closed procedure, where incisions are hidden inside the nose, or an open procedure, where an incision is made across the columella, the narrow strip of tissue that separates the nostrils.
Through these incisions, the soft tissues that cover the nose are gently raised, allowing access to reshape the structure of the nose.
Surgery of the nose can reduce or augment nasal structures with the use of cartilage grafted from other areas of your body. Once the underlying structure of the nose is sculpted to the desired shape, nasal skin and tissue is redraped and incisions are closed.
Additional incisions may be placed in the natural creases of the nostrils to alter their size.
Splints and packing will likely support the nose as it begins to heal. While initial swelling subsides within a few weeks, it may take up to a year for your new nasal contour to fully refine.
During this time you may notice gradual changes in the appearance of your nose as it refines to a more permanent outcome
Prepare for Surgery
Your plastic surgeon will carefully explain the surgical procedure recommended for your specific case. Prior to surgery you will be given specific instructions that may include:
- Pre-surgical considerations, diagnostic testing and medications
- Day of surgery instructions and medications
- Specific information related to the use of anesthesia
- Postoperative care and follow-up
In addition, you will be asked to sign consent forms to assure your plastic surgeon that you fully understand the procedure you will undergo and any risks or potential complications.
The risks associated with surgery of the nose include infection, nosebleed or rupture of small surface vessels of the nose. Surgery of the nose is a procedure in which aesthetic outcomes can be unpredictable, and in some cases a second procedure may be-necessary to fully achieve your goals. These risks and others as well as those associated with anesthesia will be discussed prior to your
It is important that you address all your questions directly with your plastic surgeon. It is natural to feel some anxiety whether excitement for the anticipated outcomes or preoperative stress. Discuss these feelings with your plastic surgeon.
Following Surgery and What to Expect
Surgery of the nose may be performed in your plastic surgeon's office-based surgical facility, an ambulatory surgical facility or a hospital. The decision for anesthesia will be based on the requirements of your specific procedure and considerations of patient and surgeon preference. Your plastic surgeon and the assisting staff will fully attend to your comfort and safety.
Once your procedure is completed, a splint and/or packing will likely be placed inside your nose and a splint or bandages placed on the outside to support and protect the new structures during initial healing. Before you are released following surgery, you and an accompanying family member, friend or caregiver will be given specific instructions that may include:
- How to care for the surgical site
- Medications to apply or take orally to aid healing and reduce the potential for infection
- Specific concerns to look for at the surgical site or in your general health
- When to follow up with your plastic surgeon
Progress and Healing
Initial healing may include some swelling, bruising, headache and discomfort that can be controlled with medication and cold compresses. These are all common conditions.
Your plastic surgeon will instruct you to keep your head elevated at all times until initial swelling has subsided, and to keep any nasal packing in place at all times. Following all postoperative instructions carefully is essential to the success of your outcome. A return to light, normal activity is possible as soon as you feel ready, usually within a few days of surgery.
Any packing or splints will likely be removed after the first week, although you may need to wear the splint for an additional week or two. You will be ready to return to work and normal activity at this time. Cosmetics can camouflage any bruising or redness that remains. Healing will continue for several weeks as swelling continues to dissipate and the improved appearance of your nose begins to become apparent. Diligent sun protection is recommended as you continue to heal. You must also protect your nose from injury during any physical activity for the next 4 to 6 months.
Result and Outlook
The outcome of your nose surgery will appear gradually over time. At a minimum, a year is considered normal for the outcome of surgery of the nose to fully refine. In general, the results of nose surgery are permanent; however, cartilage, the main supporting structure of the nose, is continually growing and moving tissue that may change the outcome over time.
You should be pleased with the improved balance amoung your facial featuress resulting from surgery of the nose. Achieving your personal goals for an enhanced appearance will likrly increase your self-confidence