Rhinoplasty

Overview

Rhinoplasty, often referred to as a nose job, is a type of cosmetic surgery designed to change the shape and size of the nose. It can serve both aesthetic and functional purposes. Some people seek cosmetic rhinoplasty to improve the appearance of their nose and overall facial look, while others undergo functional rhinoplasty to address breathing difficulties and enhance nasal function. This procedure is typically performed by surgeons specialized in plastic surgery or facial plastic surgery.

Rhinoplasty effectively reshapes the nose, offering the following benefits:

• Adjust a nose that seems drooping, hooked, bulbous, or upturned.
• Adjust a septum that is deviated. Adjust nostrilsthat turn upward, are too big, too tiny, or too wide.
• Eliminate any obvious lumps or dips on your nose’s bridge.
• Clear obstructed nasal passageways.
• To achieve facial balance, enlarge or reduce the size of the nose.

Types of rhinoplasty techniques

There are two primary types of rhinoplasty procedures:

• Open rhinoplasty: This method is employed for substantial alterations to the nose’s shape. In open rhinoplasty, the surgeon creates incisions to fully detach the skin of the nose from the underlying bone and cartilage, providing a clear view of the underlying anatomy of the nose.
• Closed rhinoplasty: Closed rhinoplasty is a minor procedure for reshaping the nose. In closed rhinoplasty, the surgeon creates incisions inside the nose to separate the skin from the bone and cartilage, facilitating reshaping without external scarring.

Other types of rhinoplasty include:

• Cosmetic rhinoplasty: This procedure focuses on enhancing the aesthetics of the nose and overall facial appearance.
• Nonsurgical rhinoplasty (filler rhinoplasty): A cosmetic rhinoplasty technique that involves using dermal fillers to temporarily address dips, irregularities, lift a droopy nasal tip, or correct a small bump.
• Functional rhinoplasty: Aimed at restoring both the form and function of the nose, particularly after diseases, cancer treatments, traumatic injuries, or to address congenital defects and deviated septum issues.
• Secondary rhinoplasty: Also known as revision rhinoplasty, this procedure aims to correct any complications or issues that arise after the initial rhinoplasty surgery. These issues may range from minor to more complex, requiring the expertise of the surgeon for correction.

Reasons for undergoing the procedure

One of the following reasons to consider rhinoplasty surgery is:

• Make a more polished appearance overall.
• Restore breathing function after illness, cancer treatments, burns, or traumas.
• Open nasal passages obstructed by a deviated septum.
• To correct a congenital abnormality (birth defect).
• Fix a facial fracture, such as a fractured nose.

A candidate for a rhinoplasty should:

• Be in good physical health and have done growing.
• Abstain from smoking.
• Have the surgery because they want to, not because someone else thinks it will make them look better.
• Recognize the limitations of nose surgery and set realistic expectations for the treatment.

Risks

Every surgical procedure, including rhinoplasty, entails certain risks. Possible complications following rhinoplasty include:

• Pain.
• Infection
• Scarring
• Blood from the nose.
• Poor scarring or healing of wounds.
• A nasal septal perforation, or hole in your nasal septum.
• A change in skin color.
• An Unsatisfactory look.
• A change in your sense of smell.
• Still more surgeries.

Before the procedure

Prior to your rhinoplasty procedure, you’ll have an initial consultation with your surgeon. This meeting serves as an opportunity for you to ask questions and communicate your desired outcomes. Your doctor will assess your facial features, take measurements, and capture photographs. Together, you’ll discuss various surgery options, potential outcomes, and associated risks.

During this consultation, it’s important to bring:

• A list of all prescribed drugs and dietary supplements, together with their dosages.
• Pictures, if you have any, showing the desired appearance of your nose following surgery.

During the procedure

Rhinoplasty is commonly performed as an outpatient procedure, allowing patients to return home on the same day following the surgery. It’s essential to arrange for someone to drive you home and stay with you overnight. Depending on the case, you may undergo general anesthesia (rendering you unconscious) or local anesthesia (numbing the nose) with intravenous sedation (inducing relaxation without full unconsciousness). The procedure can be conducted in either a hospital setting or an outpatient medical facility.

Throughout the rhinoplasty procedure, your surgeon:

• Creates a closed rhinoplasty incision on the interior of your nose. Additionally, an open rhinoplasty (cut across the base of the nose) may be performed.
• Lifts the skin that covers the cartilage and bones in your nose.
• Modifies the underlying bone and cartilage by adding, removing, or rearranging them to correct a deviated septum or to give them a new form.
• Replaces the skin that covers the cartilage and bones in your nose.
• Secures your skin in place with tiny sutures.

The duration of your rhinoplasty procedure can range from one to three hours.

After the procedure

Following rhinoplasty surgery, you can have:

• A little plastic splint to reduce swelling and hold your nose in its new position as it heals. The splint will be worn by you for a week or two.
• You might put packing, or cotton gauze, inside your nose. As long as you follow your surgeon’s instructions, you should be able to remove the packing 24 to 48 hours after surgery.
• You can get swelling and bruises around your eyes and nose; these go away after a few weeks. Up to a year following surgery, you can have modest face edema, especially in the morning.

Stages of swelling after rhinoplasty

Following rhinoplasty surgery, swelling is a common occurrence. This swelling arises due to fluid accumulation within and beneath the skin, resulting in the nose appearing larger than its usual size. The stages of swelling post-rhinoplasty surgery typically unfold as follows:

• Initial 4 to 6 weeks: During this period, swelling is prominent, and your nose may appear and feel significantly larger than usual. Bruising and changes in skin color around the nose may also occur as part of the healing process.
• 3 months post-surgery: Swelling gradually diminishes over the course of one to three months, with approximately 90% of the swelling subsiding by the end of this period.
• 1 year post-surgery: Some residual swelling may persist in the nose for up to a year following the procedure. The complete results of the surgery become apparent only after all swelling has completely resolved.

It’s important to note that healing varies from person to person, and the extent of swelling and the timeline for observing results can vary accordingly. Adhering to your doctor’s post-operative care instructions and attending follow-up appointments is crucial to ensure proper healing of the nose.

Outcome

Full recovery from rhinoplasty surgery may extend up to a year. Initially, swelling is common for about four to six weeks after the procedure, gradually decreasing over the following three months. Even between three months and a year post-surgery, the nose continues to heal, and some residual swelling may persist. It usually takes around a year for complete healing and the full results to be apparent. However, the recovery process varies for each person.

After rhinoplasty, it’s important to follow your healthcare provider’s instructions regarding returning to work or resuming regular activities. Typically, individuals can expect to return to work or school within one to two weeks. Light exercises can often be resumed within four to six weeks, but it’s advisable to avoid lifting heavy objects during this period.

You may notice initial changes in the appearance of your nose approximately one week after the splint is removed post-surgery. However, it may take up to a year for your nose to fully settle into its new shape. Facial swelling during this time is normal. For those undergoing functional rhinoplasty to correct a deviated septum, improvements are often observed within six weeks. Around 15% of individuals may require a follow-up (revision) surgery for minor adjustments after the initial procedure.

It’s essential to understand that rhinoplasty is a permanent procedure, with results lasting a lifetime. However, if desired, a second rhinoplasty surgery can be considered after complete healing to address any cosmetic concerns and align with your expectations.