Rhinoplasty

Rhinoplasty or nasal reshaping is an operation designed to improve the shape and appearance of your nose. Sometimes this operation is done purely for cosmetic reasons, at other times it is done for reconstructive reasons and occasionally it is done because accidents have dramatically changed the appearance and function of your nose. Regardless of your reason for undertaking rhinoplasty it is helpful to know what you should expect from the surgery, what the recovery will entail, what limitations you will have subsequent to the surgery and the general course you will experience. It's also helpful to now the type of anesthesia which is recommended as well as the recovery time which you may require and limitations will be necessary after the surgery and for how long these limitations will continue.

The most common complaint that patients have regarding their nose is that it seems too large for their face. This can involve the nose being too long, the tip of the nose having too much projection, the nose being too wide either in the bony portion or the tip or cartilage portion or possibly both portions. Other patients will be concerned that their nose is twisted or pushed to one side. This can involve either the bony portions of the nose or the tip and cartilaginous areas of the nose or possibly both areas. Some people feel that the tip of their nose is too wide and that their nostrils seems too flared or prominent. A nose may also not have sufficient projection and be too small in certain aspects compared to other areas of the nose. In these situations an augmentation or placement of a graft material may be indicated. Generally I will try and use your own natural tissues before using synthetic materials if this is possible. These materials have been used extensively in nasal reconstruction and are well tolerated. It is possible that newer graft materials will become available and will be used instead of the above.

In order to reshape the nose access must be gained to those areas in need of reshaping. Once this is accomplished a variety of techniques will be used in order to change or improve the shape of the underlying support tissues. At all times I keep in mind that it is important to maintain the support of your nose so that as the years pass the shape of your nose will be maintained in its new configuration. At times this is accomplished by placement of internal permanent sutures as well as grafts.

In order to narrow the widened nose, osteotomies or bony cuts are made to allow the nasal bones to be brought closer together. When this is accomplished there will usually be some bruising or black, which may last for seven or ten days. Recently however by using a small osteotome the amount of bruising has been reduced. In a similar way, if the height of the nasal bone and cartilage is excessive these areas will be reduced.

In order to narrow a widened nasal tip, the cartilages of the nose, which form the lower part of the nose, must be addressed. This can be done in either a closed rhinoplasty or an open rhinoplasty. In any event, the cartilage which forms the support and shape of these areas, must be addressed and reshaped. If this approach is done through an open or external method, sutures will be used to maintain support upon closure. The final shape of the nasal tip will often take several months to even a year before all the swelling resolves in the tip area. Normally once the nasal splints are removed a week after surgery approximately 70 percent of the swelling will already be resolved. The remaining swelling will gradually reduce itself. Many times I will request that you perform nasal massages. These massages help to reduce the swelling in a more rapid fashion and help to reshape the nose.

In order to help you see some of the changes, which may occur after rhinoplasty I have provided you with the opportunity to review previous patients photos. I can send you computerized projections of your change.

The surgery itself generally takes from one to three hours depending upon the complexity of the problem. Some cases are relatively straightforward and merely require the adjustment of the cartilage height or possibly simply breaking the nasal bones and repositioning them. Other cases are far more complex; these types of cases may involve an open or external nasal incision, which will allow access to the cartilages of the lower part as well as the upper part of the nose and the nasal bones. Through this external access a very precise reshaping of the tip and supratip areas can be accomplished. In addition this approach is sometimes used to place spreader grafts for patients who have nasal valve problems, which cause a compromise in nasal respiration. In addition this approach is used when grafts or replacement tissue is necessary because the patient has either lost structural support, sometimes due to previous surgery, trauma, tumors or other causes. This approach can also be used in cases of septal perforations or holes inside the nose. This may be combined with different approaches if necessary. In any event you can understand that the surgery itself can be relatively simple or quite complex, it may involve simple removal of a cartilage fragment or it may be as complex as a significant reconstruction using implants of your body's own materials such as ear cartilage or synthetic implants.

When an external or open approach is used to correct the appearance of the nose the scar itself is usually almost imperceptible. This scar will fade in time and will usually only be seen if someone is extremely close. Rarely, this scar will benefit from a revision.

When the nose is reshaped an integral and important part of the procedure is to improve the patient's nasal respiration. This generally involves correction of the position of the nasal septum, which is the partition that separates the left and right sides of your nose. In addition reduction in the size of the turbinate or humidifier tissue located along the sidewalls of the nose is typically indicated. Generally the amount of tissue removal of the turbinates is carefully assessed in order to not cause problems with long-term dryness within the nose. It is important though to realize that those patients who travel to a northern city and cold environments will probably benefit from using saline spray is to keep the nose moist subsequent to rhinoplasty or septoplasty.

Generally after this type of surgery is completed you'll have a splint placed over the nose under which a special tape is applied to help reduce the swelling of the tissues after this procedure. The use of ice for 15 or 20 minutes every hour or two will help to reduce the swelling and discomfort you will experience for the first few days after surgery. You should sleep with your head elevated on three or four pillows to feel more comfortable and also reduce swelling. Normally packing which is placed inside the nose is coated with ointment to allow it to slide out more easily the day after surgery. By grasping the black silk sutures, which is over the center portion of the nose, and pulling outward, you'll be able to remove this packing. This packing also helps to absorb any blood which is generally noted the first day or two after surgery.

You may begin wearing glasses with plastic lenses as long as they do not cause pinching of the nose or excessive pressure on the nasal bones, if you feel the glasses are too heavy and causing too much pressure on the nose you may tape them to the forehead to reduce the pressure. Sometimes you may need to see your eye doctor and have the eyeglasses adjusted to avoid excess pressure on the nose. Once you have reached approximately four weeks post surgery you can wear your glasses, in general without concern. As far as wearing contact lenses after the surgery once the swelling of the eye area has reduced or as soon is you are comfortable using the contact lenses you may begin their use.

The final shape of the nose after cosmetic or reshaping nasal surgery will gradually occur. Generally once the splint is removed from your nose approximately 70 percent of the swelling of the nose will be gone. The remaining percentage of swelling will require many weeks and oftentimes six to nine months before the final swelling resolves. This is because the drainage from the nose via the lymphatic system has to re-establish itself and during this time there will be some swelling which generally is more noticeable in the tip or lower part of the nose. This is often the period time during which the nasal massages will be helpful in reducing the swelling and helping the final shape of your nose become more evident. The internal swelling of the nose associated with either correction of the nasal septum's position or reduction of the turbinates will usually be resolved within four to six weeks from the time of surgery. This occurs more quickly because there's less interruption of the drainage system with the surgery on the inside the nose than there is on the outside of the nose.

Any bruising will typically last for approximately 7 to 10 days post surgery. The good news is this will usually resolve within this time.

There are few risks associated with the reshaping of your nose. Occasionally a patient will request a minor revision of their surgery. In these instances if the benefit of additional surgery outweighs the risks of additional surgery I will gladly undertake this to facilitate the patients satisfaction. In general these revisions will not be undertaken for at least nine months after the surgery. This will allow time for swelling to resolve and for the more definitive appearance of the nose to be demonstrated. Minor expenses will be involved in this touchup procedure. Any anesthesia, supply and facility expenses will need to be covered. Many times the revision can be done in the office under local anesthesia with oral sedation.

Rarely a patient will develop bleeding after the surgery. Most of the times this can be controlled in office setting. Normally infection is not an issue but occasionally will need to be treated. Rarely a small perforation or hole in the nasal septum occurs during this type of surgery.

I generally advise patients to not plan travels outside of the local area for approximately 10 to 14 days after the surgery, subsequent to this time there are no restrictions on travel. In general after 10 to 14 days you can resume normal exercise and activity routines. Strenuous activity such as weightlifting or vigorous exercise may require two to four weeks before they can be completely resumed. If you are a scuba diver I would recommend waiting three to four weeks before resuming this activity. Should you have any questions regarding a particular activity please contact our office.

In general it is best to perform this surgery under a deep intravenous sedation or general anesthesia. Occasionally for a revision rhinoplasty or a straightforward rhinoplasty intravenous sedation, which is oftentimes near general anesthesia, can be utilized and in special occasions only local injection anesthesia will be utilized. Utilization of anesthesia for the above service may not be included in the surgical fee. There may also be a fee for the facility, which is utilized during the surgical procedure. An estimate of the facility fee will be provided if this is applicable.