Rhinoplasty Revisited


According to the American Society of Aesthetic Plastic Surgery (ASAPS), 143,801 rhinoplasty surgeries were performed in 2012.  Rhinoplasty allows the nose to be reshaped, by decreasing or increasing the size of the nose, changing the width, altering the profile and bridge, refining the shape of the tip, narrowing the span of the nostrils, or changing the angle between the nose and the upper lip. In some cases, rhinoplasty can correct a breathing problem. In every case, the goal is to sculpt a nose which is in harmony with the rest of the face.

When I evaluate a patient for possible nasal surgery, I begin by handing the patient a mirror and asking him or her what he or she likes, and dislikes, about his or her nose.  This helps me to determine the patient’s expectations, and whether or not they can be realistically achieved with surgery.  Your medical history is very important, as prior surgeries, current medications, and allergies can affect your surgical course and recovery.   I recommend that teenagers wait until at least age 16 in girls and age 18 in boys in order to ensure that their facial growth is complete.

During my examination, I look at the size and shape of the nose, and its relationship to your other facial features.  In particular, the relation of the chin to the nose is key to achieving facial balance.  In some cases, I recommend simultaneous placement of a small chin implant for harmony.  A painless examination of the internal nasal structures helps me to assess the need for surgery on the nasal septum or turbinates.  The quality of the overlying skin of the nose is also incredibly important, as thicker skin tends to remain swollen longer, and to mask finer changes on the nose.  In most cases, I use computer imaging when planning the specific modifications to be made to the nose.  This is very helpful when reviewing the plan with the patient to ensure that we have a similar vision for the outcome.  This also helps many patients in realizing that there are limitations to any cosmetic procedure.  However, patients who are emotionally and physically mature who undergo rhinoplasty because they want to enhance their self-image are usually very satisfied with their decision.

The surgical techniques I use depend primarily on the goals that have been established during our consultation.  I generally prefer to use an “open” approach, in which an incision is made across the columella (the vertical strip of tissue separating the nostrils), in addition to small incisions inside the nose.  In cases in which only a bump on the nasal bridge needs to be addressed, I use a “closed” approach, placing my incisions on the inside of the nose only.  The nasal skin is then separated from the underlying framework of bone and cartilage, which is sculpted to the desired shape. In some cases I may harvest a graft of bone or cartilage to provide additional support to the framework.  After the framework has been established, I redrape the patient’s skin, and place all of the sutures.  Dissolvable sutures are used inside the nose, and very small removable sutures are placed on the outside if needed.  If the base of the nose needs to be narrowed or the nostrils reduced, small wedges of skin at the base of the nostrils are removed, with incisions concealed in the natural crease between the nostril and the cheek.  At the conclusion of the procedure, I almost always place a splint, both to protect the nose and to help it to maintain its new shape.  Packing is rarely used.

The total time for surgery ranges from 1-2 hours, and is performed on an out-patient basis in the hospital under general anesthesia.  Most patients are able to return home the same day with a responsible adult, and I recommend having someone stay with you the first night.  I bring patients back to my office in 5 days to remove the splint, and any sutures.

After surgery, most patients have bruising around the eyes and cheeks for 3-5 days.  I advise patients to use cold compresses for 48 hours after surgery to speed resolution, and to sleep with their heads elevated for several days.  Most discoloration will disappear within a week.  A few days after surgery, you can begin to use makeup as a concealer. Noticeable swelling may last for several weeks. Minor residual swelling, especially on the tip, may continue for many months.  The remainder of the swelling will gradually resolve over the course of the next 6-12 months.  Straining, bending and lifting should be avoided for the first week.  Most patients may return to work one week after surgery, but strenuous activity should be avoided for three weeks. Contact sports should be avoided for three months after surgery to prevent trauma to the nose.

There are potential complications after any surgery.  Specific risks after rhinoplasty include hematoma (an accumulation of blood under the skin that may require removal), infection, reactions to anesthesia, temporary numbness of the nasal skin, and the need for additional surgery.  Smokers should stop smoking 3 weeks prior to surgery, and any anti-inflammatory medications should be avoided for 2 weeks prior to surgery.

The goal of rhinoplasty is ultimately a nose that looks natural and blends harmoniously with the rest of your face.