Rhinoplasty (Nose Job)

Overview

A rhinoplasty is a procedure to reshape the nose and/or to improve breathing. The most common reasons patients undergo a rhinoplasty include:

• To change or improve appearance
• To open blocked nasal passages that are caused by a deviated septum
• To correct an injury or birth deformity

The surgery is done by making incisions inside the nostrils or outside the nostrils across the columella. The underlying cartilage and bone structures are then exposed and altered to produce the desired result.

Who Is a Candidate?

A rhinoplasty can be done at any age, but the procedure is recommended for those who have finished puberty and nose growth. Any person who wants to improve the appearance of their nose is a good candidate. Patients with a history of nasal trauma and increased difficulty breathing are candidates for evaluation.

Before the Procedure

Some of the specific instructions you’ll receive about preparing for surgery include:

• Smoking cessation
• Medications to avoid
• When to take your prescribed medications
• Proper washing techniques
• Restrictions regarding eating and drinking the night before surgery

Procedure Details

A rhinoplasty can be done in a variety of ways with different types of incisions. Your plastic surgeon will perform a careful evaluation of your entire face including your chin and mid-face, and suggest which procedure is best for you. The surgeon will show you where the incisions will be made.

A rhinoplasty has three main components:

• Lifting the skin of the nose from the bone and cartilage. The nose is injected with xylocaine (a numbing medication), and epinephrine (to minimize bleeding). After the incisions are made, the skin is then lifted off the cartilage of the nose to expose the cartliage and the bone structures that will be altered.
• Remodeling bone and cartilage. Depending on the desired outcome, some nasal bone may be removed, precisely cut, and reset to a new shape. Cartilage may be trimmed. Other techniques involve using a tissue graft (most often cartilage or bone) to help remodel the shape of the nose. Occasionally, a synthetic graft may be used.
• Redraping the skin over the new base. Once the procedure is finished, the incisions are closed and the skin is redraped over the new bone structure. The skin is taped to keep it in place and a protective splint is applied on the outside of the nose so that it maintains the proper position when healing. Nasal packs generally are not necessary.

Where Will the Surgery Be Performed?

A rhinoplasty is usually done in a hospital as outpatient surgery, or you may be required to stay overnight. You must be driven to and from the hospital by a friend or family member.

Type of Anesthesia

Your doctor will recommend the best type of anesthesia for you but local anesthesia along with intravenous sedation or general anesthesia can be used.

Immediate Postoperative Recovery

In most cases, patients may experience some nasal discomfort and swelling immediately after surgery. You should keep your head elevated for the first few days after surgery. Take prescription or over-the-counter pain medications as directed by your doctor.

You will have to breathe and sneeze through your mouth, and you will be instructed to avoid totally blowing your nose during the first week, and not blowing it forcefully for one month. You may notice signs of bruising (black and blue discoloration) below your eyes. Both the swelling and bruising will begin to disappear in a week, and the external nasal splint and all external sutures will be removed within a week’s time.

Short-term Recovery

Most patients will be able to return to work in approximately 10-14 days.

Showering is permitted within the first several days. Vigorous physical activity is limited for several weeks following surgery. Protect your nose from any injury for six weeks, do not wear glasses, and be careful when washing your face.

Risks

A rhinoplasty will routinely enhance the appearance and function of your nose but is considered major surgery so you should think carefully about your specific expectations and communicate your goals to your plastic surgeon.

Risks from a rhinoplasty are uncommon but possible complications include slight nasal asymmetry, poor healing of the skin, anesthesia-related risks, development of permanent excess scar tissue, perforation of the septum, or collapse of the nasal bridge (relatively rare). Repeat surgery because of infection and dissatisfaction with the result can occur.

Not every person is a candidate for this procedure, and your risks may be greater or different than those of other patients. Your plastic surgeon will review all potential risks and complications with your prior to the surgery.