Rhinoplasty - Nose Surgery

Rhinoplasty can correct a variety of conditions including an over-sized nose, a hump on the bridge, an undesirable shape of the nasal tip, or a narrow or wide span of the nostrils. Both frontal and profile views of the nose are corrected to complement other facial features, and to provide a balance of proportions. Rhinoplasty can also be used to correct breathing problems caused by narrow or partially obstructed nostrils.

If you are self-conscious about your nose, this surgery could open up new possibilities for changing your appearance and your self-image.

During the consultation, your cosmetic surgeon will discuss the changes that you would like to make in your appearance. Because the appearance of your nose is a matter of personal perception and preferences, you will need to discuss your concerns in detail so your surgeon can determine the appropriate alternatives.

Your surgeon may also point out other problems areas. For example, some patients who want rhinoplasty also have weak chins or flat cheekbones. In these cases, chin or cheekbone implants might be considered as a part of the operative plan.

A thorough medical history discussion, as well as a physical examination of your nose and other facial features, will be done during your visit. This will involve identifying functional and cosmetic issues. It is important for you to provide any history of trauma or surgery that you have had to your nose. You should also inform the doctor of any seasonal allergy problems.

Special considerations should be reviewed with your surgeon. For example, what influence will rhinoplasty have on your voice if you are a singer?

Computer imaging is a very useful adjunct to visualizing what you may look like after the procedure. While not a guarantee of results, it is a great benefit in preoperative planning. Not only will it help you and your surgeon determine what might be reasonable, but also what is not feasible in rhinoplasty surgery.

Rhinoplasty can be performed under a general anesthetic or with a local anesthetic, depending on what you and your surgeon prefer. Incisions are made inside the rim of the nostrils. Sometimes, tiny, inconspicuous incisions are also made on the rim of the nose. Soft tissues of the nose are then separated from the underlying structures, and the cartilage and bone causing the deformity are reshaped.

The exact nature of that sculpting depends on your particular problem, and should be discussed at the consultation. If the nose is being reduced in size, the nasal bones are carefully fractured toward the conclusion of the rhinoplasty. Breathing problems may be improved by a procedure called septoplasty, in which the obstructions are removed. Another type of soft-tissue surgery, alar narrowing, is used to adjust the width of the nostrils.

There are two major ways to perform a rhinoplasty: the closed rhinoplasty and the open rhinoplasty technique. The open technique includes an incision across the colummella, the small skin between the two nostrils. One major advantage of this technique is the ability to completely visualize the internal structures of the nose, and place sutures precisely where they may be required. With this technique, rhinoplasty swelling takes significantly longer to subside and some of the tissues may be unnecessarily disrupted. The scar is most often quite small and fades rapidly. The closed technique does not require an external incision, heals more quickly, and does not disturb the tissues as much as the open technique.

Rhinoplasty should generally be delayed until after age 13 for girls, and 15 for boys (since boys have their growth spurt later than girls). By this time, the nose is 90% of its adult size. However, not every teenager who dislikes his or her appearance is a good candidate for rhinoplasty many of them will outgrow their dissatisfaction their nose. About 10% of all rhinoplasties are performed in people younger than nineteen. In adults, the aging process frequently results in your nose becoming longer and droopier as the skin loses its elasticity. Elevation of the nasal tip may give the patient a younger look.

A rhinoplasty usually takes one to two hours, but on rare occasions, it may take longer.

Not necessarily. This procedure can be performed in the hospital or in an outpatient surgical suite. You will most likely be able to go home a few hours after your rhinoplasty surgery.

Surprisingly, there is very little pain after rhinoplasty and most patients require only mild analgesics.

If the nose is being reduced in size, a splint will have been applied and the nose will be packed lightly with medicated gauze. Sometimes, only tape supports the nose while it is healing. The stitches are self-absorbing and do not require removal.

If an incision is made across the columnella, or vertical strip of tissue separating the nostrils, skin stitches are placed which require removal in 3-5 days. The need to do this is usually identified and discussed fully prior to the procedure, and is usually necessary in only about 5-10% of people.

After a rhinoplasty, swelling and stuffiness will remain for several weeks, but patients usually resume normal light activity after a few days. It will take several weeks before the nose is completely healed to allow full physical activity.

You should be able to return to sedentary work a couple of days after a rhinoplasty. Although there is some pain in the first 24 hours, after this there is usually just a feeling of pressure and stuffiness. You will still look puffy and swollen. You should keep your head elevated above the level of your heart for the first few days to reduce swelling. Bruising around the eyes is to be expected, usually peaking around 72 hours and subsiding in 7 - 10 days.

Cold compresses will help to reduce the swelling around the eyes. You may have a little bleeding too, so you will probably want to change your gauze bandages a few times a day for the first several days.

After 3-5 days, the splint and any packing will be removed. By the end of the first or second week, all splints, bandaging, and stitches will have been removed. You will still need to be careful to not blow your nose for about two weeks, and avoid bumps to the nose for about six weeks. Eyeglasses should be taped to the forehead, off the bridge of the nose, for the first month.

You may not be completely back to normal for several weeks. Your nose might be numb, especially if there have been considerable changes made to the tip. You should use extra sunscreen, be gentle when washing your face, and avoid strenuous activity for about 4 weeks.

It is common to feel dissatisfied with the appearance of the nose in the immediate post-operative period. At this point, the nose is still quite swollen, and much of the detail is still not visible enough to appreciate. It is wise to take a wait-and-see approach since the elasticity of the tissues, the blood flow, the thickness of the skin, and the appearance of the nose will change significantly during the first three months - even up to the first year or two. It is important to be patient during this period of time. Rushing to perform a second rhinoplasty during the first nine to twelve months is almost always a mistake.

Many people seem to blossom with positive personality changes after this procedure. A new sense of confidence is the most frequently observed change. Temporary blues after the procedure have also been reported and is generally attributable to two causes: (1) it takes up to six months after the operation to see the complete results of the procedure, and (2) rhinoplasty changes the appearance that you've grown accustomed to.

• A female: 16 or older
• A male: 17 or older.
• No previous rhinoplasty.*
• Lifestyle that will accommodate the restriction of activities required during the recovery period (i.e., no contact sports or other activity that could cause injury to the newly reshaped nose).

The above is only a partial list of the criteria that your surgeon will consider in determining whether or not this procedure is appropriate for you. Be sure to ask your surgeon if he/she considers you an ideal candidate for rhinoplasty.

*A previous rhinoplasty does not necessarily preclude you from having this surgery.

Rhinoplasty will provide significant improvements in the appearance of the nose for the vast majority of patients although, in occasional cases, a secondary correction may be required. There are risks with all surgical procedures. You should discuss all benefits and risks with your cosmetic surgeon.

Rhinoplasty cost varies, depending on the doctor, the location, technique used, and the difficulty of the specific case. In 2007, the national average of surgeon costs for rhinoplasty was $3,833 (Source: American Society of Plastic Surgeons). Regional averages: New England states: $4,047 Middle Atlantic states: $3,332 North Central states: $3,751 South Central states: $3,152 and Mountain/Pacific states: $4,180. These fees do not include anesthesia, operating room facility, hospital stay, and other related expenses. The procedure is not usually covered by health insurance policies except for cases of injury and a deviated septum.

We strongly recommend that you consider choosing a surgeon who is highly qualified in rhinoplasty surgery. See our Physician Locator feature to find a surgeon in your area, including detailed profile information for many of the listed doctors. Also read How to Select a Plastic Surgeon for a more detailed discussion on choosing the right doctor.

1. Are the desired results I described realistic?
2. Where is the surgery performed? How long will the procedure take?
3. What kind of anesthesia is used?
4. How much does rhinoplasty cost?
5. What is your experience in performing a rhinoplasty? (How long has he/she performed this procedure, and how many he/she has performed in the past year?)
6. What percentage of patients have had significant complications? (The physician should disclose this information to you.)
7. Will you repeat or correct procedures if it does not meet agreed upon goals? And if the procedure must be repeated/corrected, will I be charged again? (The physician should provide you with his/her policy on this issue.)
8. May I see rhinoplasty before and after pictures of recent patients? The physician should provide many rhinoplasty photos of recent patients.
9. May I have the names and contact information for several recent rhinoplasty patients? (Follow up to get first-hand information on the procedure and the surgeon.)
10. Could I observe the exact procedure I am considering before I decide to have the surgery? (Either on videotape or live.)
11. What should I expect post-operatively in terms of soreness, what to watch for, medication, bathing, and level of activity?
12. Who will be assisting during the surgery? What are their qualifications? (Does the plastic surgeon perform the entire surgery?)
13. Have you ever had your malpractice insurance coverage denied, revoked, suspended?
14. Do you offer patient financing?

• Tell your doctor about any allergies you have (to foods, drugs, environmental elements)
• Tell your doctor about all medications you are taking, including over-the-counter medicine, and herbal supplements such as St. John's Wort.
• Carefully follow any instructions your surgeon gives you regarding eating and drinking, smoking, and vitamins.
• Avoid aspirin and aspirin-containing medicines for two weeks prior to surgery.
• Arrange for someone to drive you home after surgery.

The information on this Web site is only intended as an introduction to rhinoplasty and should not be used to determine whether you will have the procedure performed nor as a guarantee of the result. The best method of determining your options is to consult qualified surgeons who are able to answer specific questions related to your situation.

Did you know that 29% of all Americans have considered having an elective procedure? Of those, 60% would schedule a procedure immediately if financing was available. With iEnchance's patient financing options, money no longer has to be the barrier between you and your new image. By filling out our on-line application you can qualify for a loan in as little as 30 seconds.

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