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Nose Reshaping (Rhinoplasty)

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 you own feelings rather than those of your parents or friends.

Assuming you are in good health, there is no upper age limit for giving your nose reshaped. Rhinoplasty is sometimes performed in conjunction with a facelift or other rejuvenating 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.

EVALUATION

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.

Some of the indications that you may be a good candidate for rhinoplasty are:

-your nose appears too large for you 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 froops 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

It is important that you have a clear idea of how you would like your nose to look and, at the same time, realize that there are limitations to the procedure. Patients with sufficient physical and emotional maturity who undergo rhinoplasty because they want to enhance their self-image are usually very satisfied with their decision.

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, improve facial balance. This procedure can be done at the same as your rhinoplasty.

SURGICAL TECHNIQUE

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.

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 some instances, all of the incisions will be placed inside your nose, where they will not be visible.

External incisions are employed when the base of the nose is narrowed or the nostrils are reduced. Small wedges of skin at the base of the nostrils are removed, hiding the incisions in the crease where the nostril joins the cheek.

More complex procedures require greater exposure of the tip and bridge, which is accomplished by connecting the internal incisions across the vertical strip of skin that separates the nostril, called the collumela. This technique is called an ‘open rhinoplasty.’  Whatever incisions are used to reshape your nose, they will ultimately be very inconspicuous.

Through the small incisions described, work is done on the cartilage and bone that form the framework of you 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.”

RISKS AND COMPLICATIONS

Fortunately, significant complications from rhinoplasty surgery are infrequent. Every year, many thousands of women undergo successful liposuction surgery, experience no major problems and are pleased with the results.

Complications include surface irregularities or asymmetries, deviation of the bridge or tip to one side, difficulty breathing through one or both nostrils, or general dissatisfaction with the appearance of the nose. Many apparent problems with appearance improve with time and healing, resulting in a satisfactory result. If you and your surgeon decide that improvement can be made to your nose with a second surgery, it is usually not planned for at least six months to one year after the first surgery, allowing adequate time for the nose to heal completely.

PREPARATION 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.

Rhinoplasty will be performed on an outpatient basis.  You will need someone to drive you home and stay with you overnight and the next day to drive you to your surgeon’s office. Alternatively, there are aftercare facilities available that specialize in the care of plastic surgery patients for one or more days after their surgery. These facilities are operated inside hotels located nearby the surgery center, and staffed by registered nurses.

SURGERY

The goal of your plastic surgeon and the entire staff is to make your surgical experience as easy and comfortable for you as possible.

Your surgery will be performed in a fully accredited outpatient surgery center in the same building as your surgeon’s office. A general anesthetic is administered, so that you will be asleep throughout the procedure. Afterward, 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. A splint will be placed over the bridge of your nose, and tampon-like packing will be placed inside each nostril. These dressings will help protect your nose from being accidentally bumped.

You probably will be permitted to go home after a few hours, although some patients may stay overnight in a surgical aftercare facility.

RECOVERY

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-inflammatory 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.

Packing is removed the following day after surgery and your surgeon will evaluate you and clean around the sutures and inside of the nostrils. You will again return to five to seven days after surgery for removal of your splint and possibly sutures, if there are any. At this time, your swelling will have improved, however there will probably be a fair amount of swelling in the tip of your nose and between your eyes. It is not uncommon for the cheeks of your face to be slightly swollen too.

Straining, bending or 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 to four 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.

RESULTS

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 touch up may be desired to further improve the results. If this is the case, the additional procedure is usually less extensive than the original operation.

In most instances, the results of rhinoplasty are permanent, except for possible changes associated with the normal aging process.

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.