Rhinoplasty

Rhinoplasty, also referred to as nose surgery, is a surgical procedure that can shorten or lengthen your nose, change its shape or contour, narrow the nostrils, or lift and define the tip.
When planning rhinoplasty, your surgeon considers your features, the skin on your nose and what you would like changed. The upper portion of the nose is bone, and the lower portion is cartilage. Rhinoplasty can modify bone, cartilage or both.

Why Rhimoplasty is done?

Rhinoplasty surgery can change:

  • Nose size, in relation to the other facial structures

  • Nose width, at the bridge

  • Nose profile, with visible humps or depressions on the bridge

  • Nasal tip, that is large or bulbous, drooping, or too upturned

  • Nostrils that are large, wide or upturned

  • Nasal asymmetry and deviation

  • The angle between nose and upper lip

Rhinoplasty can also repair defects following an injury, correct a birth defect or improve some breathing difficulties.

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Risks of Rhinoplasty

As with any major surgery, rhinoplasty carries risks such as bleeding, infection, pain or swelling.

Before Rhinoplasty

Before scheduling rhinoplasty, you must meet with your surgeon to discuss important factors that determine whether the procedure is likely to work well for you. This meeting generally includes:

Your medical history
Your doctor asks questions about conditions you have or have had, as well as any medications you take. If you have a bleeding disorder, such as hemophilia, you may not be a candidate for rhinoplasty.
A physical examination
Your doctor conducts a complete physical examination, including any laboratory tests, such as blood tests. He or she also inspects your skin and the inside and outside of your nose. The physical exam helps your doctor determine what changes need to be made and how your physical features — for example, the thickness of your skin or the strength of the cartilage at the end of your nose — may affect your results.

Before rhinoplasty, you may also need to:

Avoid certain medications
Avoid medications containing aspirin or ibuprofen for two weeks before and after surgery. These medications may increase bleeding. Take only those medications approved or prescribed by your surgeon.
If you smoke, stop smoking
Smoking slows the healing process after surgery.

During Rhinoplasty

Rhinoplasty requires local or general anesthesia, depending on the complexity of the surgery and your surgeon’s preferences.

Local anesthesia
This type of anesthesia is usually used in an outpatient setting and is limited to a specific area of your body. Your doctor injects a pain-numbing medication into your nasal tissues and sedates you with medication injected through an intravenous (IV) line.
General anesthesia
You receive the drug (anesthetic) by inhaling it or through an IV line. General anesthesia affects your entire body and induces a temporary state of unconsciousness.
During rhinoplasty, the surgeon makes incisions to access the bones and cartilage that support the nose. The incisions are usually made inside the nose so that they are invisible after the surgery. Sometimes he or she makes cuts in the septum between the nostrils. Then the surgeon separates the skin from the underlying bone or cartilage and mucous membranes, and follows a series of steps to cut, trim or build up (augment) the nasal bone or cartilage.
The surgeon can augment your nasal bone or cartilage in several ways, depending on how much needs to be added, the structure of your nose and available materials. Depending on the desired result, some bone and cartilage may be removed, or tissue may be added (either from another part of the body or using a synthetic filler).

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For small changes, the surgeon may use cartilage harvested from deeper inside your nose or from your ear. For larger requirements, the surgeon can use implants or bone grafting. Bone grafting is a procedure in which bone material (the graft) is inserted into another bone (the host bone) to enhance the host bone.
After the surgeon has rearranged and reshaped the bone and cartilage, the skin and tissue is redropped over the structure of the nose. A splint is placed outside the nose to support the new shape of the nose as it heals. Nasal packing may be used inside the nose to provide additional support.

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After Rhinoplasty

After the surgery you need to rest in bed with your head raised higher than your chest, to reduce bleeding and swelling. Slight bleeding and drainage of mucus and old blood are common for a few days after the procedure or after removing the dressing.
Your nose may be congested because of swelling or from the cotton packed inside your nose during surgery. In most cases, the dressings remain in place for one to seven days after surgery. Your doctor also tapes a splint or plaster cast to your nose for protection and support. It’s usually in place for about one week.
To further decrease the chances of bleeding and swelling, your doctor may ask that you follow these precautions for several weeks after surgery:

  • Avoid strenuous activities such as aerobics and jogging.

  • Don’t swim.

  • Don’t blow your nose.

  • Avoid foods that require heavy chewing.

  • Avoid large facial expressions, such as smiling or laughing.

  • Brush your teeth gently to limit movement of your upper lip.

  • Wear clothes that fasten in the front; don’t pull clothing, such as shirts or sweaters, over your head.

In addition, don’t rest eyeglasses or sunglasses on your nose for at least eight weeks after the surgery, to prevent pressure on your nose. Also, avoid exposing your skin to the sun for some time after surgery. Too much sun may cause permanent irregular discoloration in the skin of your nose.
Some temporary swelling, black-and-blue discoloration of your eyelids and numbness can occur for two to three weeks after nasal surgery. Ice packs or cold compresses can help reduce swelling and discoloration around your eyes.
Because of the slow healing process, you might not see the final results of your surgery for up to a year.

Results

Very slight changes to the structure of the nose, often measured in millimeters, can make a large difference in how your nose looks. Most of the time, an experienced surgeon can get results both of you are satisfied with. But in some cases, the slight changes aren’t enough, and you and your surgeon might opt for a second surgery for further refinements. If this is the case, you must wait at least a year for the follow-up surgery, because your nose can undergo changes during this time.