Cosmetic Surgery of the Nose Rhinoplasty
Rhinoplasty
or cosmetic nose surgery, is performed to reduce excess cartilage and bone
in the nose, removing irregularities and bumps to give a straightened, smooth
and, usually, smaller appearance. Adding tissue to enhance certain features
of the nose can also occur. The overall trend in modern rhinoplasty is away
from over-reduction of tissue which can reduce the ability to breath through
the nose and towards individualized treatment of each segment of the nose
to give a balanced and refined look without compromising function.
Usually, Rhinoplasty takes from one to two hours depending on the complexity
of the condition of the nose. Most patients have sedation prior to and during
the procedure while some patients request a general anesthesia. Nearly all
rhinoplasty operations are done as outpatient surgeries. In general,
most patients experience five to seven days of purple discoloration and
swelling around the eyes and upper cheeks. The nose itself will be swollen
for around ten to fourteen days or longer, but subtle resolution of the
swelling at the tip of the nose can take many months after surgery to go
away.
Most of the incisions in rhinoplasty are hidden in the inside of the nostril.
While external incisions hidden in the creases where the nose meets the
cheek can be used to narrow the nose, incisions on the bridge or tip are
not usually used in cosmetic surgery of the nose.
Rhinoplasty, or surgery to reshape the nose, is one of the most common of
all plastic surgery procedures. Rhinoplasty can reduce or increase the size
of your nose, change the shape of the tip or the bridge, narrow the span
of the nostrils, or change the angle between your nose and your upper lip.
It may also correct a birth defect or injury, or help relieve some breathing
problems. Rhinoplasty can enhance your appearance and your self-confidence,
but it won't necessarily change your looks to match your ideal, or cause
other people to treat you differently. Before you decide to have surgery,
think carefully about your expectations and discuss them with your surgeon.
The best candidates for rhinoplasty are people who are looking for improvement,
not perfection, in the way they look. If you're physically healthy, psychologically
stable, and realistic in your expectations, you may be a good candidate.
Rhinoplasty can be performed to meet aesthetic goals or for reconstructive
purposes-to correct birth defects or breathing problems. Age may also be
a consideration. Many surgeons prefer not to operate on teenagers until
after they've completed their growth spurt-around 14 or 15 for girls, a
bit later for boys. It's important to consider teenagers' social and emotional
adjustment, too, and to make sure it's what they, and not their parents,
really want.
When rhinoplasty is performed by a qualified plastic surgeon, complications
are infrequent and usually minor. Nevertheless, there is always a possibility
of complications, including infection, nosebleed, or a reaction to the anesthesia.
You can reduce your risks by closely following your surgeon's instructions
both before and after surgery. After surgery, small burst blood vessels
may appear as tiny red spots on the skin's surface; these are usually minor
but may be permanent. As for scarring, when rhinoplasty is performed from
inside the nose, there is no visible scarring at all; when an "open" technique
is used, or when the procedure calls for the narrowing of flared nostrils,
the small scars on the base of the nose are usually not visible. In about
one case out of ten, a second procedure may be required-for example, to
correct a minor deformity. Such cases are unpredictable and happen even
to patients of the most skilled surgeons. The corrective surgery is usually
minor.
Your
surgeon will give you specific instructions on how to prepare for surgery,
including guidelines on eating and drinking, smoking, taking or avoiding
certain vitamins and medications, and washing your face. Carefully following
these instructions will help your surgery go more smoothly. While you're
making preparations, be sure to arrange for someone to drive you home after
your surgery and to help you out for a few days if needed.
Rhinoplasty can be performed under local or general anesthesia, depending
on the extent of the procedure and on what you and your surgeon prefer.
With local anesthesia, you'll usually be lightly sedated, and your nose
and the surrounding area will be numbed; you'll be awake during the surgery,
but relaxed and insensitive to pain. With general anesthesia, you'll sleep
through the operation.
Rhinoplasty usually takes an hour or two, though complicated procedures
may take longer. During surgery the skin of the nose is separated from its
supporting framework of bone and cartilage, which is then sculpted to the
desired shape. The nature of the sculpting will depend on your problem and
your surgeon's preferred technique. Finally, the skin is redraped over the
new framework. Many plastic surgeons perform rhinoplasty from within the
nose, making their incision inside the nostrils. Others prefer an "open"
procedure, especially in more complicated cases; they make a small incision
across the columella, the vertical strip of tissue separating the nostrils.
When the surgery is complete, a splint will be applied to help your nose
maintain its new shape. Nasal packs or soft plastic splints also may be
placed in your nostrils to stabilize the septum, the dividing wall between
the air passages.
After surgery-particularly during the first twenty-four hours-your face
will feel puffy, your nose may ache, and you may have a dull headache. You
can control any discomfort with the pain medication prescribed by your surgeon.
Plan on staying in bed with your head elevated (except for going to the
bathroom) for the first day. You'll notice that the swelling and bruising
around your eyes will increase at first, reaching a peak after two or three
days. Applying cold compresses will reduce this swelling and make you feel
a bit better. In any case, you'll feel a lot better than you look. Most
of the swelling and bruising should disappear within two weeks or so. (Some
subtle swelling-unnoticeable to anyone but you and your surgeon-will remain
for several months.) A little bleeding is common during the first few days
following surgery, and you may continue to feel some stuffiness for several
weeks. Your surgeon will probably ask you not to blow your nose for a week
or so, while the tissues heal. If you have nasal packing, it will be removed
after a few days and you'll feel much more comfortable. By the end of one
or, occasionally, two weeks, all dressings, splints, and stitches should
be removed.
Most rhinoplasty patients are up and about within two days, and able to
return to school or sedentary work a week or so following surgery. It will
be several weeks, however, before you're entirely up to speed. Your surgeon
will give you more specific guidelines for gradually resuming your normal
activities. They're likely to include these suggestions: Avoid strenuous
activity (jogging, swimming, bending, sexual relations-any activity that
increases your blood pressure) for two to three weeks. Avoid hitting or
rubbing your nose, or getting it sunburned, for eight weeks. Be gentle when
washing your face and hair or using cosmetics. You can wear contact lenses
as soon as you feel like it, but glasses are another story. Once the splint
is off, they'll have to be taped to your forehead or propped on your cheeks
for another six to seven weeks, until your nose is completely healed. Your
surgeon will schedule frequent follow-up visits in the months after surgery,
to check on the progress of your healing. If you have any unusual symptoms
between visits, or any questions about what you can and can't do, don't
hesitate to call your doctor.
In the days following surgery, when your face is bruised and swollen, it's
easy to forget that you will be looking better. In fact, many patients feel
depressed for a while after plastic surgery-it's quite normal and understandable.
Rest assured that this stage will pass. Day by day, your nose will begin
to look better and your spirits will improve. Within a week or two, you'll
no longer look as if you've just had surgery. Still, healing is a slow and
gradual process. Some subtle swelling may be present for months, especially
in the tip. The final results of rhinoplasty may not be apparent for a year
or more. In the meantime, you might experience some unexpected reactions
from family and friends. They may say they don't see a major difference
in your nose. Or they may act resentful, especially if you've changed something
they view as a family or ethnic trait. If that happens, try to keep in mind
why you decided to have this surgery in the first place. If you've met your
goals, then your surgery is a success.-
