If
you're considering rhinoplasty...
Rhinoplasty,
or surgery to reshape the nose, is one of the most common
of all plastic surgery procedures. Rhinoplasty can reduce
or increase the size of your nose, change the shape
of the tip or the bridge, narrow the span of the nostrils,
or change the angle between your nose and your upper
lip. It may also correct a birth defect or injury, or
help relieve some breathing problems.
If
you're considering rhinoplasty, the information presented
here will give you a basic understanding of the procedure,
when it can help, how it's performed, and what results
you can expect. It can't answer all of your questions,
since a lot depends on the individual patient and the
surgeon. Please ask your surgeon about anything you
don't understand.
The
best candidates for rhinoplasty
Rhinoplasty
can enhance your appearance and your self-confidence,
but it won't necessarily change your looks to match
your ideal, or cause other people to treat you differently.
Before you decide to have surgery, think carefully about
your expectations and discuss them with your surgeon.
The
best candidates for rhinoplasty are people who are looking
for improvement, not perfection, in the way they look.
If you're physically healthy, psychologically stable,
and realistic in your expectations, you may be a good
candidate.
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Age
may also be a consideration. Many surgeons prefer not
to operate on teenagers until after they've completed
their growth spurt—around 14 or 15 for girls,
a bit later for boys. It's important to consider a teenager's
social and emotional adjustment, too, and to make sure
it's what they, and not their parents, really want.
Rhinoplasty can be performed to meet aesthetic goals
or for reconstructive purposes—to correct birth
defects or breathing problems.
All
surgery carries some uncertainty and risk
When
rhinoplasty is performed by a qualified plastic surgeon,
complications are infrequent and usually minor. Nevertheless,
there is always a possibility of complications, including
infection, nosebleed, or a reaction to the anesthesia.
You can reduce your risks by closely following your
surgeon's instructions both before and after surgery.
After
surgery, small burst blood vessels may appear as tiny
red spots on the skin's surface; these are usually minor
but may be permanent. As for scarring, when rhinoplasty
is performed from inside the nose, there is no visible
scarring at all; when an "open" technique
is used, or when the procedure calls for the narrowing
of flared nostrils, the small scars on the base of the
nose are usually not visible.
In
about one case out of ten, a second procedure may be
required—for example, to correct a minor deformity.
Such cases are unpredictable and happen even to patients
of the most skilled surgeons. The corrective surgery
is usually minor.
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Planning
your surgery
Good communication between you and your physician
is essential. In your initial consultation, the surgeon
will ask what you'd like your nose to look like, evaluate
the structure of your nose and face, and discuss the
possibilities with you. He or she will also explain
the factors that can influence the procedure and the
results. These factors include the structure of your
nasal bones and cartilage, the shape of your face, the
thickness of your skin, your age, and your expectations.
Your
surgeon will also explain the techniques and anesthesia
he or she will use, the type of facility where the surgery
will be performed, the risks and costs involved, and
any options you may have. Most insurance policies don't
cover purely cosmetic surgery; however, if the procedure
is performed for reconstructive purposes, to correct
a breathing problem or a marked deformity following
injury, the procedure may be covered. Check with your
insurer, and obtain pre-authorization for your surgery.
Be
sure to tell your surgeon if you've had any previous
nose surgery or an injury to your nose, even if it was
many years ago. You should also inform your surgeon
if you have any allergies or breathing difficulties;
if you're taking any medications, vitamins, or recreational
drugs; and if you smoke.
Don't
hesitate to ask your doctor any questions you may have,
especially those regarding your expectations and concerns
about the results.
Preparing
for your surgery
Your surgeon will give you specific instructions
on how to prepare for surgery, including guidelines
on eating and drinking, smoking, taking or avoiding
certain vitamins and medications, and washing your face.
Carefully following these instructions will help your
surgery go more smoothly.
While
you're making preparations, be sure to arrange for someone
to drive you home after your surgery and to help you
out for a few days, if needed.
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Where
your surgery will be performed
Rhinoplasty may be performed in a surgeon's
office -based facility, an outpatient surgery center,
or a hospital. It's usually done on an outpatient basis,
for cost containment and convenience. Complex procedures
may require a short inpatient stay.
Types
of anesthesia
Rhinoplasty can be performed under local or
general anesthesia, depending on the extent of the procedure
and on what you and your surgeon prefer.
With
local anesthesia, you'll usually be lightly sedated,
and your nose and the surrounding area will be numbed;
you'll be awake during the surgery, but relaxed and
in-sensitive to pain. With general anesthesia, you'll
sleep through the operation.
The
surgery
Rhinoplasty usually takes an hour or two, though
complicated procedures may take longer. During surgery
the skin of the nose is separated from its supporting
frame-work of bone and cartilage, which is then sculpted
to the desired shape. The nature of the sculpting will
depend on your problem and your surgeon's preferred
technique. Finally, the skin is redraped over the new
framework.
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| Incisions
are made inside the nostrils or at the base of the
nose, providing access to the cartilage and bone,
which can then be sculpted into shape. |
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The
surgeon removes a hump using a chisel or a rasp,
then brings the nasal bones together to form a narrower
bridge. Cartilage is trimmed to reshape the tip
of the nose. |
Trimming
the septum improves the angle between the nose and
upper lip. |
Many
plastic surgeons perform rhinoplasty from within the
nose, making their incision inside the nostrils. Others
prefer an "open" procedure, especially in
more complicated cases; they make a small incision across
the columella, the vertical strip of tissue separating
the nostrils.
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| If
the nostrils are too wide, the surgeon can remove
small wedges of skin from their base, bringing them
closer together. |
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To
improve the nasal airway, the shape or position
of the septum may be altered. Or, the deviated portion
of the septum may be partially removed.
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A
splint make of tape and an overlay of plastic, metal,
or plaster is applied to help the bone and cartilage
of the nose maintain their new shape. |
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A
splint make of tape and an overlay of plastic, metal,
or plaster is applied to help the bone and cartilage
of the nose maintain their new shape.
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When
the surgery is complete, a splint will be applied to
help your nose maintain its new shape. Nasal packs or
soft plastic splints also may be placed in your nostrils
to stabilize the septum. the dividing wall between the
air passages.
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After
your surgery
After surgery—particularly during the
first twenty-four hours—your face will feel puffy,
your nose may ache, and you may have a dull headache.
You can control any discomfort with the pain medication
prescribed by your surgeon. Plan on staying in bed with
your head elevated (except for going to the bathroom)
for the first day.
You'll
notice that the swelling and bruising around your eyes
will increase at first, reaching a peak after two or
three days. Applying cold compresses will
reduce
this swelling and make you feel a bit better. In any
case, you'll feel a lot better than you look. Most of
the swelling and bruising should disappear within two
weeks or so. Some subtle swelling—unnoticeable
to anyone but you and your surgeon—will remain
for several months.
A
little bleeding is common during the first few days
following surgery, and you may continue to feel some
stuffiness for several weeks. Your surgeon will probably
ask you not to blow your nose for a week or so, while
the tissues heal.
If
you have nasal packing, it will be removed after a few
days and you'll feel much more comfortable. By the end
of one or, occasionally, two weeks, all dressings, splints,
and stitches should be removed.
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After
surgery, the patient has a straighter bridge, a
well defined nasal tip, and an improved angle between
the nose and upper lip.
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Getting
back to normal
Most rhinoplasty patients are up and about
within two days, and able to return to school or sedentary
work a week or so following surgery. It will be several
weeks, however, before you're entirely up to speed.
Your
surgeon will give you more specific guidelines for gradually
resuming your normal activities. They're likely to include
these suggestions: Avoid strenuous activity (jogging,
swimming, bending, sexual relations—any activity
that increases your blood pressure) for two to three
weeks; avoid hitting or rubbing your nose, or getting
it sunburned, for eight weeks; and be gentle when washing
your face and hair or using cosmetics.
You
can wear contact lenses as soon as you feel like it,
but glasses are another story. Once the splint is off,
they'll have to be taped to your forehead or propped
on your cheeks for another six to seven weeks. until
your nose is completely healed.
Your
surgeon will schedule frequent follow-up visits in the
months after surgery to check on the progress of your
healing. If you have any unusual symptoms between visits,
or any questions about what you can and can't do, don't
hesitate to call your doctor.
Your new look
In the days following surgery, when your face
is bruised and swollen, it's easy to forget that you
will be looking better. In fact, many patients feel
depressed for a while after plastic surgery—it's
quite normal and understandable.
Rest
assured that this stage will pass. Day by day, your
nose will begin to look better and your spirits will
improve. Within a week or two, you'll no longer look
as if you've just had surgery.
Still, healing is a slow and gradual process. Some subtle
swelling may be present for months, especially in the
tip. The final results of rhinoplasty may not be apparent
for a year or more.
In
the meantime, you might experience some unexpected reactions
from family and friends. They may say they don't see
a major difference in your nose. Or they may act resentful,
especially if you've changed something they view as
a family or ethnic trait. If that happens, try to keep
in mind why you decided to have this surgery in the
first place. If you've met your goals, then your surgery
is a success.
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For
more information on facial rejuvenation procedures,
please click on a procedure below.
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