Rhinoplasty - Nose Reshaping
What is rhinoplasty?
Rhinoplasty is the reconstruction and shaping of the nasal bones and cartilages with the aim of reshaping the nose and/or improving breathing. Nose operations are one of the most common cosmetic surgical procedures. The reason for visiting a head and neck plastic surgeon is people's dissatisfaction with the nose they were born with or the change in its appearance that occurred during aging. Other cases are related to injuries that contributed to the distortion of the nose or have the goal of improving breathing. One thing is clear: nothing has a greater effect on appearance than the size and shape of the nose. Considering that the nose is almost the most defining feature of the face, even the slightest change can greatly improve one's appearance.
If you've ever wondered how a nose surgery or rhinoplasty can improve your appearance, confidence, and health, you need to know how rhinoplasty is performed and what to expect. This text will try to provide you with answers to most of the questions related to rhinoplasty.
Successful plastic surgery is primarily the result of a good relationship between the patient and the surgeon. Trust, based on realistic expectations and demanding medical expertise, is developed during the pre-operative consultation phase.
Is rhinoplasty right procedure for you?
As with all facial plastic surgery, the prerequisites for the success of the surgery are health and realistic expectations. Understanding the nose surgery itself is also an important factor. Since there is no ideal in rhinoplasty, the goal is to aesthetically improve the nose and harmonize it with the other elements and features of the face.
Important factors that are discussed with the surgeon before the surgery itself are skin type and age. Before deciding to have rhinoplasty, young patients must reach full maturity, which usually means 15 or 16 years of age. Exceptions are cases in which breathing is seriously impaired.
Before deciding to have rhinoplasty, you should ask your head and neck plastic surgeon if he recommends any additional surgery that could improve the appearance of your face. Many patients have chin augmentation combined with rhinoplasty to create a balance of facial features.
How to decide on surgery?
Regardless of whether the surgery is desired for functional or cosmetic and aesthetic reasons, your decision about the recommended plastic surgery is of the utmost importance. Most plastic surgeons perform almost all operations on the face: ears, nose, throat and cosmetic facial operations, which provide the patient with the highest level of practice and expertise. The surgeon will examine your nose both externally and internally to assess what you can expect from rhinoplasty. In order for you to be satisfied with the result of nose surgery, the surgeon must explain to you what the surgery can and cannot achieve, as well as possible potential risks.
Only after you and your surgeon have made a joint decision to proceed with the operation, the surgeon will photograph you and discuss all possible options with you. He will explain to you how the structure of the nose, including bone and cartilage, can be reshaped and show how, for example, by shaping the chin, it can enhance the final result.
After conducting a detailed medical history examination of the patient, the surgeon will provide you with information about anesthesia, necessary preoperative treatment, and the procedure date.
Understanding the surgery
The term rhinoplasty is derived from the German “rhinoplastik” which means “changing the shape of the nose”. The technique involves first accessing the bone and cartilage support of the nose. This is achieved through incisions made inside the nose, where they are invisible. In some cases, an incision is made in the area of skin separating the nostrils. Next, the underlying bone and cartilage is reduced, augmented or rearranged to create a newly shaped structure. For example, if the tip of the nose is too large, the surgeon can sculpt the cartilage in this area to reduce it in size. If the bridge of the nose has a prominence, this can be reduced to yield a more pleasing profile. If any portion of the nose appears disproportionately small, cartilage or soft tissue grafts can be placed to create better harmony. The angles of the nose in relation to the upper lip or the forehead can also be altered by further sculpting the nasal support structure.
The tissues are then redraped over the new frame and the incisions are closed. A small plastic splint is applied to the outside of the nose to minimize swelling and to help maintain the new shape while the nose heals. Soft, absorbent material may be used inside the nose to maintain stability along the dividing wall of the air passages called the septum. Alternatively, soft nasal supports that permit nasal breathing post-operatively can be placed.
What to expect after the surgery?
Upon completion of the surgery, you will be monitored in the post anesthesia recovery area until you feel well enough for discharge home. The majority of patients do not experience any significant pain, however, analgesic medications can be given as needed for post operative discomfort. Whether packing is placed in the nose or not, most patients will comment that their nasal breathing is limited in the first few days after surgery. This is a result of intranasal swelling and as the swelling subsides, the breathing improves. Your face will feel puffy,especially the first day after surgery. Some patients develop swelling and/or bruising around the eyes. This generally subsides in the first 2-5 days after surgery. Cold compresses will help minimize and reduce the bruising and any discomfort. Absorbable sutures are generally used inside the nose and do not need removal. Any external sutures, if required, are removed in 5-8 days. Nasal dressings and splints are also removed at 5-10 days after surgery.
It is imperative that you follow your surgeon’s post-operative instructions, especially those regarding keeping the head on a high headboard until the fixation is removed from the nose. It is important not to blow your nose and to avoid any impact to the nose while the structures inside and out are healing. Activities such as heavy lifting, excessive exertion, sun exposure or any activity that would increase the risk of injury should be avoided. If you wear glasses, you must be careful not to exert excess pressure on the bridge of the nose. Tape and other devices are sometimes used to permit wearing glasses without stressing the area during healing.
Follow-up care is crucial to success in rhinoplasty. Any concerns regarding your post-operative course such as excess bleeding, unexpected swelling, fever or significant pain should be reported to your surgeon immediately. It is essential that you keep your follow-up appointments with your surgeon. As your healing is being monitored, there may be techniques such as massage, use of nasal sprays or even small injections of cortisone like medications that can further enhance the desired result.
With proper analysis, realistic patient expectations and the skills of a qualified facial plastic surgeon, rhinoplasty is a very rewarding procedure for both patient and surgeon alike. Rememeber, even a minor correction can make a difference in overall facial harmony.
