The goal of rhinoplasty is to improve the aesthetic appearance of the nose while optimizing its function of nasal airflow. Oftentimes, other nasal procedures such as septoplasty, inferior turbinate reductions, nasal valve corrections, and septal perforation repairs are performed in conjunction with rhinoplasty. Having a trained specialist with experience in primary and revision (or secondary) rhinoplasty provides the best opportunity to achieve both aesthetic and functional improvements.
Who is a candidate?
- Reasonable expectations. Patients ought to realize that the nose changes over a lifetime and that there is a small possibility that a minor “touch up” procedure might be required at some point after surgery.
- Even though patients who had no prior nasal surgeries or trauma are best candidates, patients who had prior surgeries or trauma may still be good candidates for secondary or revision rhinoplasty as long as the general health allows for general anesthesia
- Common reasons for rhinoplasty include: 1.) crooked nose 2.) dorsal hump 3.) bulbous tip 4.)amorphous shape
What are the details of surgery?
The vast majority of rhinoplasties are performed under general anesthesia in an operating room as an outpatient procedure (i.e. patients go home the day of surgery). The operation takes as long as necessary to accomplish the surgical goals, both aesthetically and functionally, but usually takes several hours. The duration varies from patient to patient depending on the complexity of the case and required changes. In general, primary rhinoplasty (first nasal surgery) takes less time than revision or secondary rhinoplasty (prior nasal surgeries). Nasal improvements are performed using a structural approach with supporting cartilage grafts harvested usually from the nasal septum on the inside of the nose. In rare cases, either ear or a small piece of rib cartilage might be needed. This will be discussed with you at your initial consultation. Different surgical approaches exist as well. The surgery may be performed with incisions completely hidden inside the nose (endonasal) or with a small incision on the bottom of the nose between the nostrils that is difficult to see even to close inspection (external). The approach utilized is customized to each patient depending on his or her needs.
What can a rhinoplasty accomplish?
- Remove a hump from the bridge of a nose
- Augment the nasal dorsum
- Straighten a nose
- Make a nose more symmetrical
- Change the angle and shape of the area between the nose and upper lip
- Refine and/or change the shape of the nasal tip
- Change the size or shape of the nostrils
- Project or deproject the nasal tip
- Improve nasal breathing
- Repair the nose after injury or trauma
- Reconstruct a nose after skin cancer resections
What is the recovery time?
Patients wear an external splint for 5-7 days. After 1 week, all sutures have been removed, the nasal cast is off, and most bruising underneath the eyes (if any is present) has subsided. In very rare cases, nasal packing is placed overnight and will be removed the first day after surgery. Some swelling and discomfort are expected following surgery for the first few weeks. This is variable between patients and depends on the extent of the required interventions. Elevating the head, avoiding trauma, and using a cool compress for the first 24 hours help minimize the swelling. Pain is well controlled and usually resolves after a few days.
Although direct trauma and nosebleeds may occur, normal activities may be restarted after 10-14 days. However, strenuous physical activities should be avoided for 6 weeks after surgery and the patient should adhere to a low-salt diet to keep the swelling minimal. The initial swelling from the surgery takes up to 6 weeks to subside, with the final contours steadily improving for the next 9-12 months as swelling resolves.
Downtime from school or work is usually 1 week (sometimes up to 2 weeks). In general, pressure cannot be placed on the nasal bridge for 6 weeks (until the nasal bones have healed). Patients from out-of-town should make arrangements to stay in-town for approximately 14 days.