Rhinoplasty
The nose is the most prominent feature of the face and a change in its shape often significantly improves overall facial appearance. Rhinoplasty is a common operation. Most patients complain of a large or wide nose, a twisted nose or obstructed nasal breathing. Depending on the problem, tissue is removed to make the nose smaller. Often, parts of the nose are reshaped or other areas enlarged (augmented) to elevate a low bridge or improve tip position or definition. Most patients are happy and pleased with their new appearance after rhinoplasty.
A nose is considered most attractive when it has a straight dorsum without a hump. The tip should be the highest point of the nose on profile. In a man, the nose should lie approximately at right angle to the lip, while in a woman it should be slightly upturned. People are often unhappy with a nose that looks too long relative to other parts of the face.
In the past, rhinoplasty was an “all take and no give operation.” It was assumed that every nose was too large and that cartilage and bone should be removed. The goal was to make all noses look smaller.
It is now apparent that this may not be the correct choice for every nose. Cartilage gives shape and, in many instances, cartilage should be added (especially at the tip) to give the nose an attractive shape, rather than removed. Such cartilage is usually taken from the septum, the ear, or occasionally the rib, if other sources have been removed during past rhinoplasties, and added to the nose to improve its appearance. Taking cartilage from the ear does not deform it. As an analogy, it is impossible to give more shape to a seat cover by deceasing the size of the underlying furniture. It is the underlying supportive framework of a chair which gives shape to its cloth covering. In the same way, the shape of nasal bone and cartilage support the covering nasal skin to create an attractive contour. In many cases, a good result requires more that just removing cartilage. Cartilage should be often be reshaped in different parts of the nose to improve the overall appearance. Sometimes cartilage pieces should be added, not taken away.
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About Rhinoplasty Surgery
Dr. Frederick J. Menick offers a comprehensive overview of Nasal Reconstruction and Rhinoplasty on eMedicine, a web-based clinical reference guide.
Rhinoplasty is usually performed as an outpatient under general anesthesia. Most patients find that discomfort after a rhinoplasty is modest. The nose may feel achy or stuffy for several days, but, often after the first night, only a small amount of pain medication is required. Swelling and black and blue discoloration is present for approximately five to seven days. Due to internal nasal swelling, the nose may feel “stuffed,” like a cold. An external splint is worn for seven days on the outside of the nose and then removed. “Nasal packing” is rarely used. Patients are usually presentable after a week. Usually an acquaintance or passersbys will not notice the swelling. Further swelling decreases over the next two to three weeks. However, it may be six to twelve months before the final shape of the nose is visible because the nasal skin slowly shrinks to conform to the underlying shape of the new nose.
Incisions for a rhinoplasty are made within the nose where they are hidden. Often, an incision is also made across the columella (the “post” between the nose and the nostrils) because this allows the surgeon create a much more attractive nose than would otherwise be possible(open rhinoplasty). The scar is usually hard to see. Occasionally incisions are made in the alar groove (junction between nostril and cheek) or along the nostril margin. As mentioned, there is swelling for approximately a week to ten days. By that time, the nose looks normal and attractive. However, the final shape of the nose may not be evident for six months. It takes that long for the nasal skin to reshape to the new nasal skeleton. It is always better to “underdo rather than overdo” a nose. In approximately 2 – 5% of rhinoplasties, it may be worthwhile to perform additional surgery to create more improvement. However, this is not done for at least six to twelve months so that the final result of the original surgery is visible and areas which need improvement are identified. Most often, a revision is not required.
Many patients have nasal obstruction and difficulty breathing. This has two causes. The nasal passages may be physically narrowed by a deviated septum or weak airway support, or obstructed by swelling due to nasal allergies and hay fever. Septal surgery may improve breathing significantly by removing deviated or thick cartilage in areas of blockage. Internal or external valve obstruction may be improved by adding support to weak areas. Nasal surgery, however, will not improve nasal allergies or obstruction due to swelling or allergy. Most noses “run” for several weeks after rhinoplasty. This is normal and is part of the healing process.
Nasal surgery for relief of nasal obstruction or to correct damage due to accidents may be covered by insurance. Surgery to improve nasal appearance, in an otherwise normal nose, is considered cosmetic surgery and is not normally covered by insurance.
Complications may follow any surgery. After rhinoplasty, patients may experience excessive bleeding. Aspirin, ibuprofen, and herb and vitimin supplements should be avoided for two weeks before and after surgery to decrease this risk. The nose should not be “blown” for two weeks. Any inner crusts are allowed to spontaneously clear. If you need to sneeze, sneeze through your mouth. Infection is rare. All scars are within the nose or, if an incision was made on the external skin, are usually minimally visible. When the septum is removed to relieve obstruction or to supply grafts to shape the nose, occasionally a septula fistula forms (a small opening between both sides of the inner nose). This is invisible but can cause bothersome crusting or noisy breathing. If it is a problem, it is sometimes correctable. Click here for rhinoplasty post surgery care instructions
Most people find that areas of the nasal skin are numb and have less feeling for months after surgery. Although patients usually look normal and are pleased with their appearance within several weeks after surgery, occasionally a revision or “touch-up” operation is worthwhile to improve appearance or function. A revision is not performed until the swelling disappears and skin shrinkage is complete, after approximately six to twelve months. You are responsible for surgical fees, operating room charges, and anesthesia costs if a revision surgery is planned by the patient and surgeon.