SURGERY OF THE NOSE - RHINOPLASTY

f you are self-conscious about your nose, this surgery can open up new possibilities for changing your appearance and your self-image.

For many people, a prominent, asymetric bumpy or undesirable nose leads to extreme self-consciousness. Rhinoplasty can correct a variety of conditions including an over-sized nose, a hump on the bridge, an undesirable shape of the nasal tip or a narrow or wide span of the nostrils. Both frontal and profile views of the nose are corrected to complement other facial features, and to provide a balance of proportions. Rhinoplasty can also be used to correct for breathing problems caused by narrow or partially obstructed nostrils.

One of the most common of all cosmetic procedures, (nose surgery) is used to improve the appearance and possibly the function of the nose.

If you're considering nose surgery, the following information will provide you with a good introduction to the procedure.

As with all facial plastic surgery, good health and realistic expectations are prerequisites. Understanding nose surgery is also critical. Since there is no ideal in rhinoplasty, the goal is to improve the nose aesthetically, making it harmonize better with other facial features.

Skin type, ethnic background, and age are important factors to be considered in discussions with your surgeon prior to surgery.

Before the nose is altered, a young patient must reach full growth, usually around age fifteen or sixteen. Exceptions are cases in which breathing is severely impaired. Before deciding on rhinoplasty, ask your facial plastic surgeon if any additional surgery might be recommended to enhance the appearance of your face. Many patients have chin augmentation in conjunction with rhinoplasty to create a better balance of features.

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Nose surgery should generally be delayed until after age 13 for girls, and 15 for boys (since boys have their growth spurt later than girls). By this time, the nose is 90% of its adult size. However, not every teenager who dislikes his or her appearance is a good candidate for rhinoplasty; many of them will outgrow their dissatisfaction their nose. About 10% of all rhinoplasties are performed in people younger than nineteen. In adults, the aging process frequently results in your nose becoming longer and droops more as the skin loses its elasticity. Elevation of the nasal tip may give the patient a younger look.

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Whether the surgery is desired for functional or cosmetic reasons, your choice of a qualified facial plastic surgeon is of paramount importance. Many facial plastic surgeons are trained in both ear, nose, throat, and facial cosmetic surgery, which provides you, the patient, with the highest level of training and expertise. Your surgeon will examine the structure of your nose, both externally and internally, to evaluate what you can expect from rhinoplasty. Your surgeon will also discuss factors that may influence the outcome of the surgery, such as skin type, ethnic background, age, degree of deformity, and degree of function of nasal structures.

You can expect a thorough explanation of the surgeon's expectations and the risks involved in surgery. Following a joint decision by you and your surgeon to proceed with rhinoplasty, the surgeon will take photographs of you and discuss the options available. Your surgeon will explain how the nasal structures, including bone and cartilage, can be sculpted to reshape the nose and indicate how reshaping the chin, for example, could enhance the desired results.

After conducting a thorough medical history, your surgeon will offer information regarding anesthesia, the surgical facility to be used, and the costs for the procedure.

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The definition of rhinoplasty is, literally, shaping the nose. First, incisions are made and the skin of the nose is lifted from its underlying bone and cartilage support system. The majority of incisions are made inside the nose, where they are invisible. In some cases, an incision is made in the area of skin separating the nostrils. Next, certain amounts of underlying bone and cartilage are removed or rearranged to provide a newly shaped structure. For example, when the tip of the nose is too large, the surgeon can sculpt the cartilage in this area to reduce it in size. The angle of the nose in relation to the upper lip can be altered for a more youthful look or to correct a distortion.

The skin is then redraped over the new frame and the incisions are closed. A splint is applied to the outside of the nose to help retain the new shape while the nose heals. Soft, absorbent material may be used inside the nose to maintain stability along the dividing wall of the air passages called the septum. Risk factors in rhinoplasty are generally minor, and your facial plastic surgeon will discuss these prior to surgery.

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If the nose is being reduced in size, a splint will have been applied and the nose will be packed lightly with a medicated gauze. Sometimes, only tape supports the nose while it is healing. The stitches are self-absorbing and do not require removal.

If an incision is made across the columnella, or vertical strip of tissue separating the nostrils, skin stitches are placed which require removal in 3-5 days. The need to do this is usually identified and discussed fully prior to the procedure, and is usually necessary in only about 5-10% of people.

There will be some swelling and stuffiness for several weeks, but patients usually resume normal light activity after a few days. It will take several weeks before the nose is completely healed to allow full physical activity.

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You should be able to return to sedentary work after a couple of days. Although there is some pain in the first 24 hours, after this there is usually just a feeling of pressure and stuffiness. You will still look puffy and swollen. You should keep your head elevated above the level of your heart for the first few days to reduce swelling. Bruising around the eyes is to be expected, usually peaking around 72 hours and subsiding in 7 - 10 days.

Cold compresses will help to reduce the swelling around the eyes. You may have a little bleeding too, so you will probably want to change your gauze bandages a few times a day for the first several days.

After 3-5 days, the splint and any packing will be removed. By the end of the first or second week, all splints, bandaging and stitches will have been removed. You will still need to be careful to not blow your nose for about two weeks, and avoid bumps to the nose for about six weeks.

Eyeglasses should be taped to the forehead, off the bridge of the nose, for the first month. You may not be completely back to normal for several weeks. Your nose might be numb, especially if there have been considerable changes made to the tip. You should use extra sunscreen, be gentle when washing your face, and avoid strenuous activity for about 4 weeks.

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It is common to feel dissatisfied with the appearance of the nose in the immediate post-operative period. At this point, the nose is still quite swollen, and much of the detail is still not visible enough to appreciate. It is wise to take a wait-and-see approach since the elasticity of the tissues, the blood flow, the thickness of the skin and the appearance of the nose will change significantly during the first three months - even up to the first year or two. It is important to be patient during this period of time. Rushing to perform a second operation during the first nine to twelve months is almost always a mistake.

Many people seem to blossom with positive personality changes after this procedure. A new sense of confidence is the most frequently observed change. Temporary blues after the procedure have also been reported and is generally attributable to two causes: (1) it takes up to six months after the operation to see the complete results of the procedure and (2) rhinoplasty changes the appearance that you've grown accustomed to.