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Rhinoplasty

Rhinoplasty

Rhinoplasty is the operation designed to improve the appearance of the nose. This procedure involves the meticulous removal and/or reshaping of the nasal bones and cartilage.

Most rhinoplasties are performed to improve appearance. Facial harmony may be disturbed when a nose is out of proportion with other facial features (because it is too wide, too long, too large, is crooked, is deformed secondary to traumatic injury, has a hump or drooping tip, etc.). Improvement of nasal deformities can often improve a person’s self-image which may improve that person’s self-confidence and self-esteem.

Deformities of the inside of the nose that may impair breathing can sometimes be improved by an internal nasal procedure called septoplasty. However, internal changes are sometimes achieved while simultaneously straightening the external nose.

The Changes

Reduction in nasal size, improvement of a hump, drooping tip or wide bridge, and changes in the tip or nostrils are some of the anatomical alterations (through rhinoplasty) that can bring pleasing improvements in facial harmony. We strive to tailor your nose to fit your face and achieve a natural-looking nose, rather than the “one-fits-all” or “assembly-line” nose.

There are limitations to what can be accomplished in each case. The existing nasal size and configuration, the position and angle between the forehead and the nose, the structure and angle of the top-lip upper jaw complex, the shape and symmetry of the face, the position of the chin and forehead, the patient’s height, the thickness of the skin, the strength, configuration, and thickness of the bones and cartilage, prior surgical or traumatic changes, and the individual’s healing characteristics are some of the limitations encountered in rhinoplasty. There are several nasal characteristics that cannot be changed or only partially altered. For example, there are some crooked noses that can only be partially straightened. Please understand that our practice is intensely sub specialized, and we do everything possible to obtain the best possible result in your particular condition. However, the surgeon is limited by the condition and anatomical realities of each individual patient.

At What Age Can We Operate?

Many people wonder if there is an ideal age to perform cosmetic surgery of the nose. In most cases, girls are mature enough at fifteen and boys at eighteen. Maturity is variable; therefore, the timing of rhinoplasty depends on each individual’s growth, maturation and specific problem. It is essential that a parent accompany a young adult for his/her consultation visit.

On the other hand, if you are in good health, it is never too late for nasal surgery. In fact, often the surgery is done around the time of a facelift. Sometimes a nose becomes progressively disfigured with age. A long nose with a drooping tip may be a sign of aging and a nose lift can give a more youthful appearance.

The Surgery

Usually the procedure is performed in the clinic’s outpatient surgical facility. Preoperatively medications are given to begin relaxation, promote healing, and help minimize swelling and bruising. Generally, twilight sedation is used and is supplemented by local anesthesia. Most patients report the procedure is painless and that they have amnesia of most of the experience.

Surgery takes about one to two hours in uncomplicated cases. Most incisions are made entirely inside the nose. The injured, twisted, or difficult nose may require a small incision below the tip of the nose between the nostrils. Wide, flaring nostrils may necessitate an incision in the crease where the side of the nostril joins the upper lip and cheek. These incisions usually become inconspicuous with time.

Many people ask if the nasal bones are broken during the surgery. Our surgical technique eliminates most of the side effects of older approaches that usually resulted in extreme swelling and bruising. With our technique, an incision is made into the nasal bones when repositioning is required. With this technique there is usually less postoperative discomfort, discoloration, and swelling when compared with older techniques.

After Surgery

After surgery, a small protective splint is usually placed on the nose that is worn for one week. We do not ordinarily pack the nose. We find less discomfort, swelling, and discoloration by avoiding packing, thus making your postoperative course much more comfortable and pleasant. We are usually able to eliminate packing by using a special absorbable suturing technique to reposition the internal nasal tissues. This technique is a great advance in nasal surgery because it reduces much of the undesirable postoperative discomfort and swelling. The initial swelling usually resolves in seven to ten days. Keep in mind that every patient is different.

There is usually little discomfort after surgery. Although the nose is naturally somewhat tender, patients rarely require anything more than plain Tylenol®. However, we provide a prescription for stronger medication.

When the nasal splint is first removed, the nose may appear turned up because of the effects of the splint and swelling of the tissues. Shortly after the splint is removed, the average person usually cannot tell that you have had nasal surgery. Most of the swelling subsides by one to two weeks, but it may take a year (occasionally longer) for the final 1 to 2 percent to dissipate. This usually does not bother the patient or distract from the appearance; the nose gains definition over time as the last bit of swelling subsides. Patients with thick skin or who have had previous nasal surgery or trauma, may take longer for the swelling to totally diminish. The tissues inside your nose may also be swollen after surgery. This causes some nasal stuffiness, but the stuffiness improves as the swelling decreases.

After one week, you may be able to return to light work or school and usually do not look as if you have just had surgery.

Postoperative instructions are provided to you at your preoperative appointment. If you are from out-of-town, you should plan to stay nearby for at least two days postoperatively.

The Profile

In some instances, a chin implant may be recommended in conjunction with nasal surgery. A weak chin can cause the nose to appear larger, and a chin implant may improve the profile. (See chapters on “Chin Augmentation” and “Preparing For Your Consultation” for more specific information.)

The Difficult Nose

The nose that has suffered a traumatic injury, is crooked, is asymmetric, or has undergone previous surgery is technically more difficult to correct. Some surgeons plan treatment with several operations spaced over months or years. We attempt correction with a single operation and are successful in the majority of cases. However, additional procedures may be necessary several months later. In certain cases, some deformity may persist.

Nasal Fractures

Injury to the nose can cause fractures and/or dislocations of the nasal bones and cartilage. If considerable swelling is present, this condition is often difficult to diagnose and x-rays are of limited value.

As the swelling subsides, the nose may appear crooked or deformed and airway obstruction may persist; these conditions are often a result of nasal fractures. Nasal fractures do not always require emergency surgery, but such an injury may be treated within a couple of weeks. We make recommendations based on each individual case.

Finally

We are committed to the pursuit of excellence and strive to provide the best quality facial plastic surgery available. However, there is a limit to what can be done with each individual patient. Remember, the goal of any surgical procedure is improvement in the existing conditions, not perfection.

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