What is rhinoplasty?
Rhinoplasty is cosmetic surgery of the nose. It is also known as nasal refinement and the layman's term "nose job". With rhinoplasty, 'defects' from either birth or trauma can be corrected by infracturing or "breaking" the bones of the nose and re-setting them in the desired shape, often narrow and straight.
A "hump" may be removed to give a more pleasing, symmetrical look. The cartilages of the nose can be molded and trimmed to create a more compact or pleasing shape. Rhinoplasty can soften an otherwise beautiful face by refining one's features.
When can rhinoplasty be performed?
Extensive nasal surgery is generally avoided in children. There are major growth centers in the nose that affect the growth of the face. In cases of severe disfigurement due to accidents, surgery is performed in an attempt to restore the alignment of those centers. For lesser deformities surgery is deferred until after the child stops growing. Rhinoplasties performed on teenagers and young adults, it seems, are often beneficial to the social development and self confidence of the individual. The aging process is reflected in many ways in the nose and its correction can add youthfulness and freshness to the appearance.
What does a typical Rhinoplasty consultation entail?
First, your doctor will discuss your goals with you and he will explain what can be achieved realistically. A good doctor will not just slim your nose or shorten it, rather he will take into account what your facial features and bone structure would benefit from. Be it a slimmer more defined or perhaps more "turned up". Perhaps it is only a "hump" that is desired to be removed, making it unnecessary to even have a Full Rhinoplasty. There is no "one size fits all" when it comes to this procedure. It is all individual. Just like you!
How is Rhinoplasty performed?
Usually, Light Sleep Anesthesia is utilized. A Rhinoplasty can also be performed under General Anesthesia. The patient usually arrives early and medications are administered and supplemented with intravenous medication. After you are "asleep" and your vital signs are determined as safe and stable, local anesthesia is then applied to the nose. Surgery generally lasts about one and a half hours. The patient experiences no pain during the surgery.
A splint or cast is applied when required and will be worn for approximately 7 days. Many patients remember very little about the surgery. After the procedure is completed, the patient then recovers in a relaxed environment and monitored for a couple of hours before being driven home by a companion. You absolutely can not drive yourself home after a ANY procedure.
What should I expect post-operatively?
After your surgery your surgeon will have placed a pressure dressing over your eyes and a gauze pad underneath your nose to catch blood and mucous. You will remove the pressure dressing after a few hours or as specified by your surgeon. You may become sick from ingested blood during the procedure and vomit, expelling a black mixture of stomach acid and blood. This will pass as soon as the blood is expelled. It really isn't that much so you shouldn't be sick for long unless you were under general anesthesia - you may become sick from this alone. Your doctor can give you special medications to remedy or prevent this. If you continue to vomit and/or run a high fever, contact your doctor immediately.
You nose will be sensitive for approximately a month and a half although patients report no serious pain or discomfort. However, patients do report the discomfort of breathing with the packing and cast on the nose. Some patients feel claustrophobic feeling as if they cannot breathe. This feeling widely resembles a head cold or sinus infection. Only when the cast is removed do you feel slight discomfort, unless you bump it accidentally.
When will the cast be taken off and does this hurt?
The cast is removed approximately 7 days post-operatively. You may feel a slight stiffness in the upper lift as the swelling "moves downward". This will subside in a matter of hours. you must be very careful not to bump it as it is vulnerable to breakage. It isn't a bone china figurine but it isn't as strong as your nose was before the rhinoplasty either. Don't worry, the bones will completely mend within 2 months.
If you had a rhinoplasty where the nostrils were narrowed (in the case of flared nostrils) your sutures will get absorbed
When will I be able to see the results?
The nose will be very sensitive for approximately a month and a half. The patient will start to see a difference immediately but it will still be swollen. The swelling starts to generally disappear about a week after the cast is removed. Approximately 80% of the swelling and 100% of the discoloration are usually gone by 2 weeks after surgery. 90% of the swelling is gone by two months after surgery and the rest slowly disappears over the next year. Although the nose is still swollen after the first month, most people would not recognize this fact. The patient will not notice this 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 the surgery. Nasal breathing may be difficult during this time. If surgery is performed to straighten the nasal septum, an improvement in breathing will be appreciated at about 3 weeks.
What are the risks of Rhinoplasty?
It is possible to develop tiny red marks and "spots", this can be the result of blood vessels that may have burst under the skin's surface during the surgery. Although this is extremely infrequent it can happen and the "spots" may not ever go away. Scarring is minimal if the incisions are made inside of the nose, however when an "open" technique is used, or if narrowing of the nostrils is desired the scars made on the outside of the nose may be visible for am undetermined amount of time (usually until maturation). Even when a highly skilled surgeon performs your surgery, sometimes your body may not heal "correctly" or have adverse reactions causing undesired results. If so it is quite possible that additional surgeries may be needed. Some patients will lose their sense of smell, temporarily. Your nose may be slightly swollen and for over a year. Scar tissue may heal in a way that may cause a "whistling" sound to be heard when you breathe in and out.
This surgery has the highest rate of revisions. It seems that some people, especially mature people, may not readily accept the "new" look. Being accustomed to their "old" nose, they just can't seem to comfortably make the transition. Although there are a few rhinoplasties that just don't heal correctly, due to something as serious as human error (the surgeon's) or as simple as not having your head elevated enough or sleeping on one side a lot without a proper cast. The nose can "pull" to one side if the cast does not support it properly in the first week. Or quite simply, your body may just heal that way.
Are there any new techniques to repair a deviated septum. Is cauterization used? Does the nose always have to be packed after surgery?
There are many ways to fix a septum. Generally cautery is used only on the turbinates or the initial incision on the columella in open techniques. The septum is like a wall frame in a house. The skin (mucosa) over it is like wall paper, and the cartilage on the inside is like drywall. You place an incision in the front part of the nose where it is hidden and raise the wallpaper off the wall. Then you can perform the necessary correction to the "drywall" (cartilage) and when you put the "wall paper" (mucosa/skin) back it looks like nothing was done.
Usually packing will be required however, some patients are eligible for tubes or straws placed in the center of the packing on each side so that direct airflow through the nose is possible. Most patients find this a psychological discomfort rather than a physical.
I am 16 and have been thinking of rhinoplasty for a long time. At what age is it safe to have a rhinoplasty?
Usually rhinoplasty is performed at the earliest, 13 or 14 years of age in girls and 15 to 16 years of age in boys. Reason being, and it is a known fact, girls physically mature faster than boys and the collective goal is to perform surgery when at least 90% of the growth is complete. There are major growth centers in the nose that affect the growth of the face.
In cases of severe disfigurement due to accidents, surgery is performed in an attempt to restore the alignment of those centers. For lesser deformities surgery is deferred until after the teen stops growing. Rhinoplasties performed on teenagers and young adults, it seems, are often beneficial to the social development and self confidence of the individual.
In other words, this depends upon the stage of growth in the face as well as the gender of the patient. A qualified surgeon can better help you upon personal examination.
I'm getting a deviated septum and a hump fixed all in one and I wanted to know what kind of scarring I should expect. Also, how long is it after the operation that I'll see good results?
Usually, there is no visible scarring unless it is an "open rhinoplasty". Some surgeons perform all of their rhinoplasties, "open" -- some, all closed. It solely depends upon the surgeon. You will find that most surgeons tend to disagree when it comes to technique. They either prefer open or they prefer closed, OR if they are highly skilled, know that it is case-dependent and different patients have different needs. If it is an open rhinoplasty the scar would be on the columella (the skin that separates the nostrils) sometimes resembling a straight line or a flattened "z".
You can expect swelling, especially in the tip if you are having tip "work" performed. The swelling usually begins to subside within the first month but the end result may not be seen until at least 9 months [post-operatively. Although this time period tends to lean towards a year and over.
It's been five months since my surgery and now since I started to get back in shape and returned to my gym. I have notice that when I run and workout my nose drips. It is very runny, here I am walking away and every few min. I have to use a tissue. Is this just part of the healing stage or need I bring this up to my doctor? Its really annoying! Has anyone experienced this at all?
Many patients complain of "runny noses" after rhinoplasty/septoplasty surgery. Some over 2 years. Most of the excess mucous production ceases at 9 months but can continue well after that. For now I can only advise to carry more Kleenex around as it may persist for several more months.
My surgeon mentioned a shot of cortisone to help some of the scar tissue. Why is this and what will this do?
A Injections of steriods can help break up excess tissue. It is a common remedy to inject steroids such as these and also is used primarily to reduce swelling and inflamed tissue. Although care must be taken regarding excess use of these injections as it can break down the tissue too much.
I'm going to get my nose done soon and my doctor also recommended me getting a chin implant because he says my nose will still appear 'big' since my chin goes a little further in then it should...Do people get both these procedures at the same time? And do you recommend I should do this?
This is very common. A weak chin can and does make even an "ideal" sized nose look larger than it actually is. The chin augmentation is a relatively minor procedure when implants are used although it entails some risks all on its own. Such as lower lip numbness which can be remedied (usually) by removing the implant and trimming the implant so that it is not pressing up against the nerve as much.
I have to get my cast off soon and wanted to know if it is going to hurt? Is there anything I can do beforehand?
Most patients report a little tenderness when the cast is removed but if your surgeon uses a cotton swab saturated with alcohol to help remove the adhesive from the tape and glue you should be okay. Although it really shouldn't cause you great discomfort.
The sutures that may be removed may hurt when someone else removes it due to them not actually being able to tell when they are hurting you. They also may snip your flesh slightly when the scissors are used to cut the actual suture. This isn't as rare as it as it should be and solely depends upon the surgeon's meticulous nature.
I have thick nasal skin and a surgeon I spoke with said that I may not be able to see much detail with my rhinoplasty? Is this true? Should I see another surgeon?
For many patients with thick skin, the skin is thinned out in the surgery as the tip is worked on. This really adds a lot to help with definition. Excess skin length just shrinks away as the swelling decreases. Also, many patients with thick skin actually do better with rhinoplasties because the flaps that are elevated are so firm that you can do a lot more with the cartilages and it is better hidden. Very thin skin, shows every little imperfection.
Going on several consults and getting a second, third and even more opinions is a good idea in any case. "Shopping" for surgeons is a serious matter and you should be as comfortable as you can be with a surgeon, his skill, and his bedside manner.
Can I see other operated patients before & after photographs?
Yes. Doctor can show you photographs of patient who had similar problem like yours.
What is a "hanging columella"?
A nasal columella is the external, and sometimes partial internal, fleshy section of the nose which separates the nostrils. When it is referred to being a "hanging columella" this section is often prominent or hangs down.
Is it possible for someone to be allergic to dissolvable stitches? And if so, what would the reaction be?
This isn't as uncommon as you may think. There are usually two types that promote a response in those who are sensitive to these sutures. These two are usually Absorbable Poly (glycolide/L-lactide) Surgical Suture material and Absorbable Gut Suture material.
If you experience redness and itchiness and sometimes pus formation - you very well may be allergic to the dissolvable type sutures. Sometimes the symptoms may not show up until about 3-4 weeks after surgery, if this happens, antibiotics can be given but it usually reoccurs. The best thing to do in some cases is to remove any of the left over material and replace it with nylon sutures. These sutures are usually removed in 10 days. Another option can be tissue glue although this isn't very mainstream for rhinoplasty.
Also be advised that when the skin gets red and itchy around a suture, be it absorbable or non-dissolving - usually it is time for them to be removed. Your body knows and will tell you when your healing. Besides healing skin always turns itchy. Know the difference between typical irritation and an allergic reaction.
I recently had a rhinoplasty & septoplasty, its almost 6 months & on one of my nostrils I still can hardly breath. Is this normal?
Usually by the 6th month the breathing is most definitely restored. In fact, most patients notice improved breathing within a month to two months of surgery if they had difficulty breathing beforehand. I would suggest that you have a follow up with your surgeon and ask his advice or determine if the lack of airway is indeed from a deviated septum, redundant mucosa or enlarged or redundant turbinates. I do not know from your question if this is a constant occurrence or if this is at certain times of the day, while the body is horizontal or after exercise. These factors can also hinder breathing due to engorged tissue due to increased blood flow.
I am 55 years old. Can I undergo rhinoplasty?
Yes. Provided you don’t have diabetes, blood pressure ,etc .you should be medically fit.
During childhood I had undergone surgery for cleft lip but nose is still asymmetrical, can it be corrected?
Can my own tissues be used for augumentation of nose bridge? What are the nasal implants? Are there any side effects?
Implants are synthetic materials usually derived from silicon polymers.e.g.prolen mesh,porex, etc. There is always remote possibility of infection, displacement Or extrusion of implant.