Rhinoplasty 101

blog image Overview

Rhinoplasty is a surgical procedure that modifies the shape of the nose, which can be done for aesthetic reasons, to enhance breathing, or both. The nose's structure consists of bone in the upper portion and cartilage in the lower. Rhinoplasty can alter the bone, cartilage, skin, or a combination of these elements. Discuss with your surgeon if rhinoplasty is suitable for you and what the expected outcomes are.

When planning the surgery, your surgeon will consider your other facial features, the skin on your nose, and your desired changes. If you qualify for rhinoplasty, the surgeon will create a tailored plan specifically for you.

Why Is it done

Rhinoplasty can alter the size, shape, or overall proportions of the nose. It is often performed to repair deformities from an injury, correct congenital defects, or enhance breathing difficulties.

How do you prepare

Before you schedule a rhinoplasty, you will have a consultation with a surgeon to determine if the procedure is right for you. This preliminary meeting generally includes several components:

  1. Medical History: The key focus here is on your motivations for seeking surgery and what you hope to achieve. You'll discuss any past medical issues, previous surgeries, medications you're taking, and if you have conditions like hemophilia, which might disqualify you from undergoing rhinoplasty.
  2. Physical Examination: The surgeon will conduct a thorough examination of both the internal and external structures of your nose and other facial features. This exam helps the surgeon understand necessary modifications and how your unique physical attributes, such as skin thickness or cartilage strength, might influence the outcome. This step is crucial for assessing how the surgery could impact your breathing.
  3. Photographs: Your surgeon will take photos of your nose from various angles. These might be altered using computer software to show potential results. These images serve as a reference during surgery and for before-and-after assessments, facilitating a focused discussion on your surgical goals.
  4. Expectations Discussion: It's vital to discuss your reasons for the surgery and your expectations. This conversation will help the surgeon explain what rhinoplasty can and cannot achieve and give you a realistic idea of the potential outcomes. Open communication is essential, even if discussing your appearance makes you feel self-conscious.
  5. Consideration of Facial Proportions: The surgeon might also discuss how other aspects of your face, like a small chin, could affect perceptions of your nose size. Sometimes, enhancing the chin can be recommended to achieve better facial balance, although it's not mandatory.

After the surgery is scheduled, make sure to arrange transportation home if it’s an outpatient procedure. Also, as anesthesia can affect your memory, reaction times, and judgment temporarily, it’s advisable to have someone stay with you for a couple of days post-surgery to assist with personal care as you recover.

Food and medications

Avoid taking medications containing aspirin or ibuprofen (such as Advil or Motrin IB) for two weeks before and after your surgery, as these can increase bleeding. Only use medications that your surgeon has approved or prescribed. Also, steer clear of herbal remedies and over-the-counter supplements.

If you smoke or use vaping products, it’s important to quit. Smoking and vaping can hinder the healing process following surgery and increase the risk of tissue death and infections.

During the Procedure

During the surgery, you'll be administered anesthesia to induce a sleep-like state. The type of anesthesia used depends on the complexity of the surgery and your surgeon's preference. Discuss with your surgeon the most suitable anesthesia for your procedure.

  • Local anesthesia with sedation: Commonly used in outpatient settings, this anesthesia is applied to a specific area. Pain-relieving medication is injected into the nasal tissues, and sedative medication is delivered through an intravenous (IV) line, usually inserted in the hand, neck, or chest, making you drowsy but not fully unconscious.
  • General anesthesia: Administered either through inhalation or an IV line, this type of anesthesia affects the entire body and puts you completely to sleep during the operation. It requires the use of a breathing tube.

Rhinoplasty can be performed internally within the nose or externally through a small incision at the base of the nose. During the procedure, the surgeon adjusts the underlying bone and cartilage to reshape the nose.

The modifications to the bone or cartilage depend on how much material needs to be removed or added, the structure of your nose, and the materials available. For minor adjustments, cartilage might be sourced from deeper within your nose or your ear. For more significant changes, cartilage from a rib, implants, or bone from other parts of your body may be utilized. Once the adjustments are made, the nasal skin and tissues are repositioned, and the incisions are stitched closed.

If the septum, the wall dividing the two sides of the nose, is misaligned (known as a deviated septum), it can be corrected during the procedure to improve breathing.

Post-surgery, you'll be monitored in a recovery room as you awaken. Depending on your health status, you may leave the same day or stay overnight for further observation.

After the procedure

After your surgery, it's important to rest in bed with your head elevated above your chest to help minimize swelling and bleeding. You might experience a stuffy nose due to swelling or from the splints inserted during the surgery.

Typically, the internal bandages are left in place for anywhere from one to seven days post-surgery. A splint may also be secured to your nose for about a week to offer protection and support.

In the days following the surgery, you might notice some minor bleeding along with mucus and old blood drainage. To manage this, a drip pad — a small piece of gauze taped below your nose — is used to absorb the drainage. Remember to change the gauze as recommended by your healthcare provider and avoid pressing it tightly against your nose.

For several weeks post-surgery, follow these additional guidelines to reduce the risk of bleeding and swelling:

  • Refrain from vigorous activities like aerobics and jogging.
  • Opt for baths instead of showers while you have bandages on your nose.
  • Avoid blowing your nose.
  • When you need to sneeze or cough, do so with your mouth open.
  • Limit facial expressions, such as smiling or laughing.
  • Eat a diet rich in high-fiber foods like fruits and vegetables to prevent constipation, which can strain the surgical site.
  • Brush your teeth gently to minimize movement of your upper lip.
  • Wear front-fastening clothes to avoid pulling garments over your head.

Furthermore, avoid resting eyeglasses or sunglasses on your nose for at least four weeks after surgery to prevent pressure on the area. Alternatively, you can use cheek rests or tape the glasses to your forehead until your nose has fully healed.

When outside, apply SPF 30 sunscreen to protect your nose, especially since excessive sun exposure can lead to permanent discoloration of the nasal skin.

You might experience temporary swelling or bruising around your eyelids for 2 to 3 weeks following the surgery. The swelling on the nose may persist longer, potentially lasting up to a year. Reducing your sodium intake can help decrease the swelling more quickly. Avoid placing anything cold, like ice packs, on your nose after the surgery.

Results

Even minor adjustments to the structure of your nose, sometimes only a few millimeters, can significantly alter its appearance. Generally, a skilled surgeon can achieve outcomes that both you and they are happy with. However, there are instances where these subtle modifications may not suffice. In such cases, you and your surgeon might consider a second procedure to further refine the changes. If a second surgery is deemed necessary, it's important to wait at least a year before undergoing it, as your nose may undergo natural changes during this period.

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