The Best Candidate for Nasal Surgery
Nasal surgery can be performed as soon as the nose has achieved its full growth. The best candidates are those who are emotionally stable, desire a specific change that can be achieved, are otherwise happy with their lives, and do not expect to look like somebody else. Nasal surgery is typically performed to reduce the overall size of the nose, reshape the tip, remove a nasal hump, or improve a poor angle between the nose and upper lip. In some patients it is necessary to add tissue from the inside of the nose or ear, or to use an implant in order to improve contour. One or all of these changes can be made during a single operation. The extent of the procedure depends on what changes are desired and what Dr. Smith deems appropriate.
Nasal surgery usually lasts an hour and a half to two hours or longer, depending on the extent of the surgery. Nasal surgery may be performed under a local anesthetic with sedation but Dr. Smith usually uses a general anesthetic with the patient completely asleep.
Some rhinoplasties may be done entirely through incisions inside the nose. But in most cases today, an external approach is used using a small incision in the skin between the nostrils (the columella). The incision provides the surgeon with excellent exposure of the cartilage, which can then be trimmed, reshaped, and even sutured to modify the shape of the nose to alter its external appearance. Occasionally, additional incisions are made in the fleshy outer part of the nostrils (the alae) to reduce their size. Dr. Smith feels that rhinoplasty is probably the most individualized plastic surgical procedure performed. A hump on the nasal bridge can be reduced in size by removal of some of the bone and narrowing the bridge of the nose at its base. Some noses require enlargement, or augmentation, of its parts, such as when an Asian patient who wishes to have the bridge of the nose made higher or when a tip has been made too small from a prior surgery or accident.
After tthe Surgery
Rhinoplasty is not an extremely painful operation but the patient is given sufficient pain medication to control what pain there is. For purely cosmetic rhinoplasties, nasal packing is not required but when work is done on the septum or other parts of the inside of the nose to improve the airway, packing is regularly required and is removed in about one week. Keeping the upper part of the body elevated in a recliner position will help reduce swelling and the small amount of the expected bleeding. There may be a considerable amount of bruising and swelling around the eyes producing "shiners" depending on how much work is required on the bony part of the nose. Cold compresses to your eyes helps to reduce postoperative bruising or swelling.
A splint is applied to the outside of the nose and is removed within a week. Although rare, it may be reapplied for another week but is usually worn at night for another week or so. Bruising around the eyes will generally disappear within the next two to three weeks. Some swelling may last another few weeks and there are very subtle changes that may continue to occur for as long as a year.