Rhinoplasty is the name of the operation designed to improve imperfections of the nose. The operation is performed to repair noses that are crooked from birth or due to injury, to repair asymmetries, to reduce or make more delicate certain nasal features, or to create a nose that is more harmonious with the face upon which it sits.
Rhinoplasty can be combined with the repair of the nasal septum, also known as Septoplasty. The septum is the structure which should sit in the middle of the nose, separating one side from the other. Often, twists and deflections may be present which obstruct breathing through the nose. A Septoplasty improves this problem.
Some noses are too long for a short face; some are too broad for a skinny face. Some have unattractive humps, and some droop with the passage of years and the effect of gravity pulling the nasal tip down. These things can, in most cases, be corrected. The surgery is also an artistic endeavor. Resculpting the nose requires a careful analysis of many features present in a particular face. The size of the forehead, strength of the chin, and the length of the lips all influence the appearance of the nose. The nose, in turn, influences the appearance of the whole face. It is sometimes advisable to create a stronger chin (mentoplasty) to correct what appears to be an excessively large nose or to shorten a lip. In short, the nose sits in the center of the face and is a focal spot for the beauty of the face. It cannot be viewed alone.
We strive to create a nose that is in harmony with the rest of the face and, when viewed separately, has a pleasing appearance. We perform a careful analysis of all of the above factors, and we temper our recommendations with the wishes and desires of the patient. Some patients know exactly what it is that they do not like about their nose, and some know only that they don't like their nose. In almost all instances, it is our experience that surgical changes, where appropriate, can enhance the beauty of the face and make the patient happy to have sought the change.
When Can Surgery Be Performed?
There are only two limitations upon the timing of nasal surgery. We generally avoid doing extensive surgery on children. There are major growth centers in the nose that affect the growth of the face. In cases of severe disfigurement due to accidents, we perform surgery in an attempt to restore the alignment of those centers. For lesser deformities, we defer surgery until after the child has stopped growing. If parents are concerned about a nasal imperfection, we prefer to consult with them early on so that we may reassure the parents and inform them of the possibilities and limitations. We also like to monitor pictorially the changes brought about due to the deformity during the growth process. The second limitation upon surgery is in adults sustaining a nasal fracture. We attempt to realign the nose within 10 days of the accident. If reconstructive surgery is necessary, we prefer to wait at least six weeks. Rhinoplasties performed on teenagers and young adults are often very beneficial to the social development and self-confidence of the individual. Similarly, many rhinoplasties that we perform are on individuals in their forties and fifties, occasionally older. The aging process is reflected in many ways in the nose, and its correction can add youthfulness and freshness to the appearance.
During the consultation, we make every effort to understand what changes the patient desires. We make a detailed analysis of the face and nose, allowing us to inform the patient of the possibilities and limitations. Following this consultation, the patient should have a good idea of our surgical goals. We attempt to create the desired changes surgically, using our skill and experience; however, we cannot guarantee the achievement of those exact changes. Sculpting a nose is far different than working in clay. It is also significant to note that the changes performed on the table are not the final result. We must consider the healing process and its effect upon the final result. This is always taken into account in the surgical planning; however, the actual healing is not within the surgeon's control. The final result of surgery will not, in fact, be known for about one year.
Rhinoplasty is performed under Light Sleep Anesthesia in the Surgery Center. The patient usually comes to the Surgery Center the morning of surgery, at which time sleeping medications are given through an IV. Once the patient is asleep, local anesthesia is then injected into the nose. Surgery generally lasts about one and a half hours. The patient experiences no pain during the surgery, and most patients remember nothing about the surgery. The patient is recovered after surgery in the Surgery Center before being driven home.
At the completion of surgery, if the airway has been improved (Septoplasty), nasal packing is often placed into the nose for 24 hours. Tape and a splint are applied to the outside of the nose to maintain the new positioning. A bulky pressure dressing is placed over the eyes and forehead for four hours after surgery. This reduces swelling and discoloration from the surgery. The tape and splint are left on for approximately seven days, and a gauze drip pad is taped below the nose to catch any blood or mucus. This will need to be changed four to eight times in the first 24 hours. A drip pad may be used for three or four days post-operatively, as needed.
There's More To It
Most patients generally tell us that the operation is completely painless and have total amnesia to the whole process. Most patients tell us that in the post-operative period they had very little pain and are usually surprised at how easy the whole experience has been. We take great pains to design it that way!
The final result takes a period of time to achieve. One can generally get a good idea of what the nose will look like by one month after the surgery. But be patient, because it keeps getting better and better.
Most rhinoplasties require no external incisions and, therefore, no external scars. All the work is done from the inside of the nose. It seems amazing to be able to work inside such a small space, but it can be done. In certain instances, some external incisions are performed, yet are placed in such a way as to be practically invisible. If this is necessary, it will be discussed at the time of the consultation.
This section has been intended to help the person interested in nasal surgery to have an idea of the types of problems that can be corrected and what is entailed. The specifics of a particular problem need to be discussed at the consultation. If you decide to have a rhinoplasty, use this section as a reference, particularly for the post-operative instructions!
The First Week After Surgery
The patient is discharged from the Surgery Center to home. Patients generally experience very little discomfort after rhinoplasty, although pain medicine is provided should the need arise. The patient must keep his/her head elevated to approximately 30 degrees for the next week by sleeping with two pillows under the head of the mattress and one or two pillows under the patient's head. The patient should never bend over during this time, and the activities should be no greater than walking. Exercise, straining, and lifting should be avoided. Bumping the nose should be carefully avoided. The patient is given an appointment to return to the Surgery Center the day after surgery for nasal packing removal if required. The tape and splint are removed on approximately day seven to ten. Be careful not to get the tape and splint wet. If they should become loose, let us know.
The First Month After Surgery
The level of activity maintained the first week should be the same level maintained until three weeks (21 days) after surgery. At that time, activity may be increased slowly until the end of the fourth week when all activities, except contact sports, are permitted. Contact sports may be engaged in six weeks after the completion of surgery.
The nose and eyes may be swollen and discolored after surgery. Approximately 80 percent of the swelling and 100 percent of the discoloration are usually gone by two weeks after surgery. Ninety percent of the swelling is gone by two months after surgery, and the rest slowly disappears over the first year. Although the nose is still swollen after the first month, most people would not recognize this fact. The patient will not notice the swelling. Instead, the patient will notice that the nose becomes more refined with better definition over the first year.
The inside of the nose may be swollen for approximately three weeks after surgery. Nasal breathing may be difficult during this time. An improvement in breathing due to straightening of the nasal septum may be appreciated at about three weeks..