Nose Reshaping

Rhinoplasty

Cosmetic or functional problems can occur in people of any age. In most cases, adolescents should wait until they have finished their growth spurts before undergoing rhinoplasty, usually at age 15 for girls, a bit later for boys.

During rhinoplasty surgery, the skin of the nose is separated from the supporting framework of bone and cartilage. The framework is reshaped and then the skin is redraped. Rhinoplasty surgery can be either open or closed, with the choice depending upon the nature of the problem.

In a closed procedure, we make the incision inside the nostrils and the nose is reshaped from the internal incisions. In an open procedure, we make a small incision across the columella (base of the center of the nose) and resculpt the structures under direct vision. In some cases, cartilage or bone grafts may be required. Open procedures are preferred for more complicated cases. We will discuss which option is best for you at your consultation.

Simple procedures take from one to two hours; more complicated surgeries will take longer. Many patients undergo rhinoplasty under local anesthesia with sedation, while others require general anesthesia. Surgery is usually performed in an outpatient setting.

You should expect temporary swelling and bruising around the nose and eyes. Headaches and nosebleeds may also occur, and temporary nasal stuffiness is to be expected.

After rhinoplasty, most patients can return to work or school within one to two weeks and resume strenuous activities within two to six weeks. The nose takes some time to settle into its new shape, and the final appearance may not be achieved for a year or more.

Rhinoplasties performed to correct congenital deformities, relieve breathing problems or repair defects caused by trauma may be covered by insurance. Cases are judged on an individual basis and may require preapproval.

Procedural Steps

First, Anesthesia is induced

Medications are administered for your comfort during the surgical procedure. This procedure is usually done under local with IV sedation or general anesthesia.

The Incision

Rhinoplasty is performed either using a closed procedure, where incisions are hidden inside the nose, or an open procedure, where an incision is made across the columella, the narrow strip of tissue that separates the nostrils.

Through these incisions, the skin that covers the nasal bones and cartilages is gently raised, allowing access to reshape the structure of the nose.

Reshaping the nose structure

Overly large nose may be reduced by removing bone or cartilage. Sometimes surgery of the nose may require the addition of cartilage grafts.

Most commonly, cartilage from the septum, the partition in the middle of the nose, is used for this purpose. Occasionally cartilage from the ear or rarely a section of rib cartilage can be used.

Correcting a deviated septum

If the septum is deviated, it can be straightened and the projections inside the nose reduced to improve breathing.

Closing the incision

Once the underlying structure of the nose is sculpted to the desired shape, nasal skin and tissue is redraped and incisions are closed.

Additional incisions may be placed in the natural creases of the nostrils to alter their size.

Rhinoplasty Recovery

During your rhinoplasty recovery, a splint and/or packing may be placed inside your nose and a splint or bandages placed on the outside to support and protect the new structures during initial healing.

While initial swelling subsides within a few weeks, it may take up to a year for your new nasal contour to fully refine. During this time you may notice gradual changes in the appearance of your nose as it refines to a more permanent outcome.

Swelling may come and go and worsen in the morning during the first year following your rhinoplasty surgery.

You will be given specific instructions that may include how to care for your incisions, specific concerns to look for at the surgical site and when to follow-up in the office.

Rhinoplasty risks and safety information

The decision to have plastic surgery is extremely personal. You will have to decide if the benefits will achieve your goals and if the risks and potential complications of rhinoplasty are acceptable.

Rhinoplasty surgery risks include:

• Anesthesia risks
• Bleeding (hematoma)
• Infection
• Poor wound healing or scarring
• Change in skin sensation (numbness or pain)
• Nasal septal perforation (a hole in the nasal septum) is rare. Additional surgical treatment may be necessary to repair the septum but it may be impossible to correct this complication
• Difficulty breathing
• Unsatisfactory nasal appearance
• Skin discoloration and swelling
• Possibility of revisional surgery

These risks and others will be fully discussed prior to your consent. It is important that you address all your questions prior to surgery.