Also known as rhinoplasty, nose surgery improves the appearance and proportion of your nose, enhancing facial harmony and self confidence. Surgery of the nose may also correct impaired breathing caused by structural abnormalities in the nose.
Best Candidates for Nose Surgery
The best nose surgery candidates simply want to improve the nose appearance, but do not seek perfection. The ideal candidate should not expect rhinoplasty to transform them into someone else. The best candidates are well adjusted and otherwise happy with their lives.
Ideal candidates for nose surgery include those who may:
- Have a nose that he or she feels is too large or too small in comparison with other facial features
- Have a bump on the bridge of the nose
- Have a nasal tip that droops, protrudes, or is enlarged
- Have nostrils that are excessively flared or pinched
- Have been injured so that the nose is asymmetrical
- Have problems breathing due to irregularities with internal nose structure
- Have a deviated septum
Nose surgery is a highly individualized procedure and you should do it for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image.
Surgery of the nose is a good option for you if:
- Your facial growth is complete and you are 13 years of age or older
- You are physically healthy
- You do not smoking
- You have specific, but realistic goals in mind for the improvement of your appearance
What Nose Surgery Can Do
Nose surgery can improve the shape of your nose. Surgery of the nose may also correct impaired breathing caused by structural abnormalities in the nose, it can also correct a deviated septum.
Rhinoplasty can change:
- Nose size, in relation to the other facial structures.
- Nose width, at the bridge.
- Nose profile, with visible humps or depressions on the bridge.
- Nasal tip, that is large or bulbous, drooping, or too upturned.
- Nostrils that are large, wide or upt.
What Nose Surgery Won't Do
Rhinoplasty can reshape or correct the nose to enhance your appearance, but it won’t necessarily make you look younger, or change your overall looks
Preparing for Nose Surgery
The success and safety of your nose surgery depends very much on your complete candidness during your consultation. You’ll be asked a number of questions about your health, desires and lifestyle.
Prior to surgery, you may be asked to:
- Get lab testing or a medical evaluation
- Take certain medications or adjust your current medications
- Stop smoking well in advance of surgery
- Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding
Special instructions you receive will cover:
- What to do on the day of surgery
- The use of anesthesia during your nose surgery
- Post-operative care and follow-up
Your plastic surgeon will also discuss where your procedure will be performed. Surgery of the nose may be performed in an accredited office-based surgical center, outpatient or ambulatory surgical center, or a hospital.
Nose Surgery Overview
Plastic surgery of the nose begins when the rhinoplasty surgeon makes an incision either inside the nose or across the skin that separates the nostrils (this skin is called the columella). The cartilage and bone that make up the framework of the nose are then exposed and sculpted to create the desired shape and profile. The plastic surgeon then stitches the skin back into place to complete the nose surgery. Rhinoplasty surgery generally lasts one to two hours and is usually an outpatient procedure.
Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation or general anesthesia. Your doctor will recommend the best choice for you.
Surgery of the nose 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 soft tissues that cover the nose are gently raised, allowing access to reshape the structure of the nose.
Reshaping The Nose Structure
There are two main options for the incisions that your plastic surgeon can use: closed rhinoplasty and open rhinoplasty.
Closed rhinoplasty involves incision confined to the inside of your nose. Swelling improves soon and recovery is fast. However, your surgeon may have a limited ability to achieve some changes in your nose because of her or his inability to see parts of the inside of the nose.
Open rhinoplasty involves a small incision across the columella, between the nostrils, in addition to incisions on the inside of your nose. Open surgery is usually preferred in more complicated cases.
Surgery of the nose can reduce or augment nasal structures with the use of cartilage grafted from other areas of your body. Most commonly, pieces of cartilage from the septum, the partition in the middle of the nose, is used for this purpose.
Occasionally a piece of cartilage from the ear and rarely a section of rib cartilage can be used.
Nose surgery to improve an obstructed airway requires careful evaluation of the nasal structure as it relates to airflow and breathing. Correction of a deviated septum, one of the most common causes of breathing impairment, is achieved by adjusting the nasal structure to produce better alignment.
If the surgeon is to correct a deviated septum, it is now straightened and the projections inside the nose are reduced to improve breathing.
Closing The Incisions
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.
When mistakes are made during a rhinoplasty procedure, or when patients are simply so dissatisfied with the results of their procedure that they cannot accept them, revision rhinoplasty is the answer. Though following the initial nose surgery, the tissue usually must be allowed to heal for some time before a revision procedure may be undertaken, nevertheless significant improvements may be seen through revision rhinoplasty.
The Non surgical Nose Job
Several doctors have begun to offer non surgical nose jobs, or nose jobs which do not actually alter the structure of the nose itself. This is done through the injection of a facial filler. The type of filler that is used will be determined by you and your doctor after a discussion of your goals and medical history. Just as fillers are used to plump out wrinkles, they can fill out areas of the nose to correct minor deformities. While this procedure certainly has limitations, it can be much more affordable than full plastic surgery of the nose, and can be done much quicker with little or no downtime.
Ethnic rhinoplasty is a nose surgery designed to improve aesthetics while still maintaining ethnic characteristics. People with the same ethnic backgrounds tend to have similarities in their nasal features; some have particularly wide bases, while others might be more pronounced. Ethnic rhinoplasty can preserve or enhance these characteristics, depending on your taste.
Rhinoplasty for Men
Rhinoplasty surgery, as far as the procedure is concerned, is essentially the same for men as it is for women. But there are differences in the aesthetics of the male nose versus the female nose that must be taken into consideration. While every case must be addressed individually, based on your physical condition and goals, there are certain aesthetic commonalities in male noses.
Nose Surgery Results
The new contours of your nose may be apparent as soon as swelling subsides. But although the 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 nose surgery.
Nose Surgery Scars
Although scarring from rhinoplasty will be permanent, the incision lines will be hidden completely inside the nose, or tucked in the base of your nose between the nostrils.
Recovery After Nose Surgery
After your procedure is completed, a splint, internal tubes or packing will likely be placed inside your nose and a splint or bandages placed on the outside to support and protect the new structures during initial healing.
You will be given specific instructions that may include: How to care for the surgical site, medications to apply or take orally to aid healing and reduce the potential for infection, specific concerns to look for at the surgical site or in your general health, and when to follow up with your plastic surgeon.
Be sure to ask your plastic surgeon specific questions about what you can expect during your individual recovery period:
- Where will I be taken after my surgery is complete?
- What medication will I be given or prescribed after surgery?
- Will I have dressings/bandages after surgery?
- When will they be removed?
- Are stitches removed? When?
- When can I resume normal activity and exercise?
- When do I return for follow-up care?
When You Return Home
If you experience shortness of breath, chest pains, or unusual heart beats, seek medical attention immediately. Should any of these complications occur, you may require hospitalization and additional treatment.
The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure. Another minor surgery may be necessary to reach the intended aesthetic goal.
Following your physician’s instructions is key to the success of your surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Your doctor will give you specific instructions on how to care for yourself.
Nose Surgery Post Operative Care
Limit your activity sharply during the first week following surgery. You are encouraged to walk about the house, but avoid bending at the waist or picking up heavy objects. If you overexert yourself, bleeding may result. When you rest or sleep, keep your head elevated on 2-3 pillows and try to avoid turning on your side. Keep your emotions under control. It is not unusual to feel a bit depressed for a few days after surgery. This quickly passes as you begin to look and feel better.
Anger or crying will only add to the swelling or initiate bleeding. Restrict your diet to plenty of fluids and easily chewable foods. Hard to chew foods (like steak) should be avoided for one week. You may carefully clean around the nostrils with a Q-tip and hydrogen peroxide three times a day.
Immediately afterwards, place a bit of pure Vaseline or antibiotic ointment around the nostrils to keep them from drying out. Swelling for at least two weeks will obstruct your nasal passages. A humidifier may help you sleep by allowing you to breathe through your mouth more comfortably. Do not blow your nose or sniff excessively as this will only irritate the healing tissues. If you must sneeze, open your mouth. Also, avoid picking up babies, small children or pets; a flailing little arm may strike your nose.
You probably will hit your nose one or more times during the first week. This will hurt, but will cause no problem unless the force is excessive. With assistance, you may bathe in a tub, showering is allowed on the second post-operative day. Cover the nasal cast so that it remains dry. If the cast becomes wet, use a blow dryer to help dry it. It is all right to carefully wash your face with a mild soap and a clean washcloth or cotton balls. Avoid cigarette smoking or even being in an area of excessive smoke as this irritates the nasal tissue and impedes healing. Also, avoid alcoholic beverages the first two weeks following surgery as this may increase your chances of bleeding.
It takes six weeks for the nasal bones to fully heal. Slowly resume your activity. After the first week, let your body tell you how much to do. Strenuous exercise may be resumed in 5-6 weeks. Build up to this level slowly. Semi-contact sports are to be avoided for four to six months. Swimming is allowed after six weeks. Do not let your nose become sunburned for six months after surgery. This may result in prolonged swelling and erythema (redness). When outside, wear sunscreen with a SPF of at least 15.
Possible Nose Surgery Risks
The decision to have nose surgery is extremely personal and you’ll have to decide if the benefits will fulfill your goals and if the risks and potential complications are acceptable.
Your plastic surgeon and/or staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks or potential complications.
Possible risks of nose surgery include:
- Rupture of small surface vessels of the nose
- Poor wound healing
- Anesthesia risks
- Bleeding (hematoma)
- Nose asymmetry
- Cardiac and pulmonary complications can occur in longer surgical procedures and may be associated with the formation of, or increase in, blood clots in the venous system
- Change in skin sensation (numbness)
- Nasal airway alterations may occur after a rhinoplasty or septoplasty that may interfere with normal passage of air through the nose
- Nasal septal perforation (a hole in the nasal septum) may develop but is rare; additional surgical treatment may be necessary to repair the nasal septum but in some cases, it may be impossible to correct this complication
- Pain, which may persist
- Unfavorable scarring
- Skin contour irregularities
- Skin discoloration and swelling
- Sutures may spontaneously surface through the skin, become visible or produce irritation that require removal
- 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 directly with your plastic surgeon.