Rhinoplasty - information, surgeons, prices

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Rhinoplasty is a procedure to improve nasal function and enhance appearance. The word “rhinoplasty” comes from the Greek word “rhino,” meaning nose, and “plastikos,” meaning to mold or shape. Rhinoplasty may be performed for cosmetic reasons or to correct some kind of deformity due to injury or birth defect. Fortunately, almost all rhinoplasty procedures are performed through the nostrils so there are no visible cuts or scars to the nose or surrounding areas of the face.

Rhinoplasty may be used to reduce, or increase the size of the nose, change the shape of the tip or the bridge, narrow the size of the nostrils, or to change the angle between the nose and upper lip. Rhinoplasty may also be used to relieve breathing problems caused by narrow or partially obstructed nostrils, as improving the internal nasal structure can enable a person to breathe easier. As people age, their noses become longer, making breathing more difficult. An already unattractive nose may actually become dysfunctional as aging progresses. Rhinoplasty is the world’s most commonly performed cosmetic surgical procedure!

In rhinoplasty procedures, both frontal and profile views of the nose are corrected to complement other facial features, and to provide a balance of proportions. For those who are self-conscious about their nose, this surgery can open up new possibilities for positively changing appearance and self-image! The motivations for a rhinoplasty can range, but often, rhinoplasty candidates complain of their nose appearing too large on their face in height or in width, a prominent bump on their nose, nostrils being too large, the nasal tip sticking up or pointing down, or of their nose being off center or crooked. Rhinoplasty gives people the ability to alter the shape of their nose if they are unhappy with its appearance.

The best candidates for rhinoplasty are people who are looking for improvement in the way they look. Those who are physically healthy, psychologically stable, and realistic in their expectations, are good candidates for rhinoplasty. Rhinoplasty can be performed to meet aesthetic goals or for reconstructive purposes-to correct birth defects or breathing problems.

Rhinoplasty candidates must first visit a surgeon for a consultation to see if rhinoplasty will achieve their goals and in order that the surgeon can make sure the patient is in proper physical health to undergo the procedure. When candidates visit the rhinoplasty surgeon, they should have a good idea of what shape they would like their nose to be so that the rhinoplasty surgeon can properly evaluate the candidate's nose to determine whether their goals are realistic or not. A complete review of the candidate's medical history is necessary in order to determine whether the patient has any increased risk for adverse reactions.

Good communication between the patient and surgeon is essential. In the initial consultation, the surgeon will ask what the patient would like their nose to look like, will evaluate the structure of the nose and face, and discuss all possibilities. The surgeon will also explain factors that may influence the procedure and the results, including the structure of the nasal bones and cartilage, the shape of the face, the thickness of the skin, age, and expectations. Some candidates for rhinoplasty may be afraid to be forthcoming about any medical complications they have because they are afraid they will not be able to have the surgery, but if the surgeon is aware of any health conditions they will be able to monitor and take extra precaution.

The surgeon will also explain the techniques and anesthesia that will be used, the type of facility where the surgery will be performed, the risks and costs involved, and any other options available to the patient. Candidates should be sure to tell the surgeon whether they’ve had any previous nose surgery or any injury to the nose, even if it was many years ago. Candidates should also inform the surgeon if they have any allergies or breathing difficulties, if they’re taking any medications, vitamins, or recreational drugs, and whether they smoke. Candidates should feel comfortable asking the surgeon any questions they might have, especially those regarding expectations and concerns about the results of the procedure.

Surgeons will provide candidates with specific instructions on how to prepare for a rhinoplasty procedure, including guidelines on eating, drinking, smoking, taking vitamins or medications, and washing the face. By following these instructions, patients are sure to have a smooth and comfortable procedure! Preoperative rhinoplasty instructions may include discontinuing smoking until the surgery is completed and the surgeon says it is okay to start smoking again. Smoking can increase chances for cardiovascular complications to arise during the rhinoplasty and may decrease the optimal results of the procedure. Also, no anti-inflammatory medications should be taken due to the increased risk of bleeding they cause. When preparing for a rhinoplasty procedure, patients should arrange for someone to drive them home from the surgery and help them out for a few days after the procedure if required.

Rhinoplasty can be performed under a general anesthetic or with local anesthetic, depending on the extent of the procedure, the patient's preference, and what the patient and surgeon agree upon. Rhinoplasty may be performed in a surgeon's office, a hospital, or an outpatient surgery center. Rhinoplasty usually takes an hour or two, but may take longer. Complex procedures may require a short inpatient stay.

With local anesthesia, the nose and the surrounding area are numbed. The patient is usually lightly sedated, but awake, relaxed, and insensitive to pain during the surgery. General anesthesia allows the patient to sleep through the operation, and is typically used in children.

Incisions are typically made inside the rim of the nostrils, however, it is sometimes necessary for tiny, inconspicuous incisions to be made on the rim of the nose. The soft tissues of the nose are then separated from the underlying structures, and the cartilage and bone causing the deformity are reshaped. In the event that a rhinoplasty is being performed in order to straighten a nose, the surgeon may incorporate nasal cartilage to reshape the nose.

The two major ways to perform a rhinoplasty are the closed and the open techniques. The open technique involves making an incision across the colummella, the small skin between the two nostrils. One major advantage of this technique is being able to completely visualize the internal structures of the nose, and place sutures precisely where they may be required. With the open technique, the swelling takes significantly longer to subside and some of the tissues may be unnecessarily disrupted, though the scar is generally quite small and fades rapidly. The closed technique does not require an external incision, heals more quickly and does not disturb the tissues as much as the open technique.

The exact nature of the sculpting depends on the particular problem, and will be discussed at the consultation. When the nose is being reduced in size, the nasal bones are carefully fractured toward the end of the procedure. Breathing problems may be improved by a procedure called septoplasty, in which the obstructions are removed. Another type of soft-tissue surgery, alar narrowing, is used to adjust the width of the nostrils.

The operation procedure depends on factors such as the reasons for the surgery, but can include:

• Anesthesia – Patient is given a general or local anesthetic.
  
• Post trauma – Used to repair a broken nose, slender instruments are inserted into each nostril to gently push the bones back into their proper alignment. Bad breaks may require a small incision, so that the surgeon can see properly in order to arrange the bone fragments correctly.
  
• Cosmetic surgery - Rhinoplasty for cosmetic reasons can include 'open' or 'closed' techniques.
  
• 'Open' technique - Involves accessing the nasal bones via incisions inside the nostrils and through the columella (the skin that separates the nostrils).
  
• 'Closed' technique - Involves accessing the nasal bones via incisions inside the nostrils. The skin is then lifted away from the underlying bones and cartilages.
  
• Surgical procedures - Depends on the reshaping required. Nasal bones may be chiseled, broken and realigned, or cartilage may be trimmed back.
  
• Stitches - Incisions are closed with dissolving stitches
  

Following surgery, a splint is usually applied to help the nose maintain its new shape. This type of dressing is usually kept on the nose for 5-7 days to stabilize the nose and control swelling. Nasal packs or soft plastic splints may also be placed inside the nose to stabilize the septum, however, these are always small and removed within a few days after surgery. All dressings, splints, and stitches will be removed by one, or at most two, weeks after surgery.

After a rhinoplasty procedure, particularly during the first twenty-four hours, the face will feel puffy, the nose may ache, and patients may experience a dull headache. But rest assured, any discomfort can easily be controlled with pain medication prescribed by the surgeon! Patients should plan to stay in bed with their head elevated for the first day of recovery.

Swelling and bruising around the eyes will increase at first, reaching a peak after two or three days. Applying cold compresses will reduce the swelling and provide relief from discomfort. Most of the swelling and bruising should disappear within two weeks or so, though subtle swelling-unnoticeable to anyone but the patient and surgeon may remain up to several months.

A little bleeding is common during the first few days following surgery, and feelings of stuffiness are common during the first few weeks. Patients are typically asked not to blow their nose for a week or so while the tissues heal.

Most rhinoplasty patients are up and about within two days, and able to return to work (provided it’s not too physical) or school a week or so after the procedure. Rhinoplasty patients are usually able to resume normal activities within a few weeks. The surgeon will provide more specific guidelines for gradually resuming your normal activities.

After the procedure, patients can expect the following:

• The inside of the nose will be packed with special gauze.
  
• The bridge of the nose will be covered with a splint, commonly made of plaster of Paris, in order to minimize swelling and keep the nose in its new position while it heals.
  
• Tape may be placed over the nose to keep the dressings in place.
  
• Nurses will record vital signs, including temperature, pulse, breathing pattern and blood pressure, will inspect dressings for signs of bleeding, and will replace the outside dressing if necessary.
  
• Breathing through the mouth is necessary until the packing gauze is removed.
  
• Swelling and bruising will occur, mainly around the eyes. The swelling should go down in a few days, and the bruising should go away in the first week or two.
  
• It will be necessary to wait four or five hours before eating and drinking, however, once these few hours are over, there are no restrictions on what the patient may eat.
  
• Getting up out of bed and moving around is possible a few hours after the operation.

• Avoiding strenuous activity (jogging, swimming, bending, sexual relations or any activity that increases blood pressure) is necessary for two to three weeks after the procedure.
  
• Avoiding hitting or rubbing the nose, or getting it sunburned, is required for eight weeks.
  
• It is necessary to be gentle when washing the face and hair or using cosmetics.

Patients may wear contact lenses when they feel like it, but glasses are another story. When the splint is off, glasses will have to be taped to the forehead or propped on the cheeks for another six to seven weeks, until the nose is completely healed.

The surgeon will schedule frequent follow-up visits in the months after surgery, in order to check on the healing progress. Any unusual symptoms between visits should be reported to the surgeon, and patients should feel free to contact the surgeon with any questions relating to what they can or cannot do.

Following surgery, the face will be bruised and swollen and it is easy for patient’s to forget that soon they will be looking much better! It is natural for patients to feel slightly depressed in the days following the procedure, however this is understandable, and soon will pass, with a new sense of confidence and self-esteem! Day by day, the nose will begin to look better, patient’s spirits will improve, and within a week or two, they will no longer look as if they’ve just had surgery.

Healing can be a slow and gradual process, and some subtle swelling (usually only apparent to the patient and surgeon) may be present for months, especially in the tip.

It is common for family and friends to say they don’t see a major difference in the nose, however, patients should keep in mind why they had the surgery and whether they met their goals. Full results aren’t always visible until months after the surgery, and rhinoplasty is the most common and successful cosmetic procedure! It is also important to take note that full benefits of rhinoplasty aren’t always seen until a year after the procedure as the last 1 or 2 percent of swelling of the nose generally disappears very slowly.

Some guidelines for recovering from rhinoplasty at home include:

• Make an appointment for a check-up with the surgeon after about one week.

• Be sure to ask what medications are for (if they are dispensed at the hospital) and how often, and for how long they must be taken.
  
• When antibiotics are prescribed, be sure to take the whole course.
  
• Hold the head upright as much as possible.
  
• Bandages and packing gauze may be left in place for up to a week or so, then the surgeon will remove the dressing and take out the nasal packs.
  
• Follow all instructions on how to best keep the nose clean.
  
• Avoid blowing the nose.
  
• Contact the surgeon immediately if there are any sudden nosebleeds.
  
• Plan to be off work for around two weeks.
  
• Avoid contact sports (or any activities that may knock the nose) for about six weeks.
  
• Broken nasal bones may hurt or ache for up to eight weeks. Discuss appropriate pain relief with the surgeon and remember that aspirin can increase the risk of nosebleeds.

When undergoing a rhinoplasty for cosmetic reasons, candidates should be sure to know exactly what shaped nose they would like, and that the surgeon fully understands the reasons for wanting the operation so they can decide the best method of reconstructing your nose to your satisfaction. When surgery is required to repair a broken nose, it is best to seek medical attention immediately, otherwise the swelling of the tissues can delay surgery for around five days. When this is the case, the surgeon may prescribe a course of antibiotics to take in the meantime, to reduce the risk of infection.

For those considering rhinoplasty, it is important to know that complications are infrequent and minor, however, possible complications may include infection, nosebleeds, or a reaction to the type of anesthetic chosen. Any possible risks can be greatly reduced by following the surgeon’s instructions before and after surgery.

After surgery, patients may see tiny red spots on the skin’s surface – these are small burst blood vessels and are usually minor. When rhinoplasty is performed inside the nose, there is no visible scarring at all, and even when an open technique is used or when the procedure is performed to narrow flared nostrils, the small scars on the base of the nose are usually not visible and fade quickly.

Rarely, second procedures may be required in order to correct minor deformities, though this is very uncommon and the corrective surgery is usually minor.

Side effects and possible complications of rhinoplasty include:

• Pain
• Swelling
• Bruising
• The sensation of a 'stuffy' nose for a few weeks
• Numbness of the nose for a few months
• Delays in healing
• Sudden nose bleeds
• Infection.

Rhinoplasty patients must remember that a broken nose, once healed, isn't as strong as a nose that's never been broken, which means it is at increased risk of fracturing again if a blow to the face is received. Patients should take all possible precautions, including wearing protective headgear while playing sports and using a seat belt when traveling in a car. Those who had rhinoplasty for cosmetic reasons, must realize that their new nose may take up to six months to adjust to its final profile. However, a noticeable difference in the shape of the nose will be visible once the surgeon removes the dressing and nasal packs, seven days or so after the operation.

Rhinoplasty candidates should be aware that insurance coverage is frequently available when allergies, sinus problems, trauma, or accidental damage has occurred and is the reason for the procedure. Insurance policies generally don’t cover purely cosmetic surgery, however, if the procedure is for reconstructive purposes, or to correct a deformity, it may be covered. Rhinoplasty is considered elective when it is performed purely for cosmetic purposes, in order to change the shape of the nose to one the patient finds more desirable. Patients may wish to combine rhinoplasty with another cosmetic procedure to better fit their new nose.

Age may also be a consideration, as most surgeons prefer not to perform cosmetic rhinoplasty until the growth of the nasal bone is complete after 14 or 15 years of age. When performing rhinoplasty on teenagers, it's important to consider their social and emotional adjustment prior to the procedure. However, in some cases rhinoplasty may be required for medical purposes such as treating a serious breathing problem or an injury, and in these cases age is less of a factor.

Remember, rhinoplasty can enhance appearance and self-confidence! Rhinoplasty is the most common plastic surgery procedure and can be used to:

• Reduce or increase the size of the nose
• Change the shape of the tip or the nasal bridge
• Narrow the opening of the nostrils
• Change the angle between the nose and the upper lip
• Correct a birth defect or injury
• Help relieve breathing problems

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