Nose reshaping, or rhinoplasty, is the surgical reshaping of the nose in order to make it proportional to the rest of the face, or to repair the nose after it has been injured. Rhinoplasty can address both the outer appearance of the nose and the inner air passages, so the procedure can be cosmetic, functional, or both.
This is a surgical procedure which is done to improve the appearance of the nose and/or the ability to breathe through the nose. The operation, therefore, may be considered cosmetic, functional, or for some patients both. Nasal irregularities may be present at birth or develop with aging and growth. Traumatic injuries (broken nose) or changes from previous surgeries may result in significant deformity.
Most often, patients request removal of a "hump" on the nose, refinement of a round nasal tip or elevation of a drooping tip. Noses which are crooked, too wide, long, pointy or flat may be improved.
Frequently, the nasal septum (the cartilage separating the right and left nasal passages) is deviated and needs to be corrected. This disorder can potentially be worsen by a crooked nose and may require correction. This operation is called a septorhinoplasty. Turbinates are parts of the nose which help to add moisture and filter inspired air. These structures can contribute to airway blockage, and when this happens doctors will recommend the removal as part of the nasal surgery. Additionally, narrowed passages and airway "collapse" can require placement of cartilage grafts for structural support. On rare occasions, scar tissue within the nose from previous injury or surgery may block air flow and require correction.
Cosmetic rhinoplasties are frequently done with local anesthesia and intravenous sedation, but often general anesthesia may be used upon patient request or physician recommendation. Functional surgeries with septal turbinate, scar correction or the need for grafts usually require general anesthesia. These operations most often are outpatient procedures.
Cosmetic rhinoplasties have incisions hidden within the nostrils inside the nose. A small "nick" in the skin is sometimes placed at the upper nose near the corner of the eye. More complex nasal operations often require a small incision in the skin at the base of the nose (columella). Allowing the surgeon to "lift" the nasal skin and directly view all of the cartilage and bone requiring correction, this scar is barely visible to the eye. This is called an "open rhinoplasty."
Wide noses may require narrowing of the base. Small incisions (Weir incisions) are placed in the groove where the nostril meets the cheek and the base is pulled together.
More complex nose corrections may require grafts. Cartilage and bone grafts are often taken from within the nose (septum). Ear cartilage, rib, hip, or outer portion of the skull are other possible grafts. Synthetic nasal implants may be used to build-up portions of the nose.
If you need to improve breathing, correction of a deviated septum (septoplasty) and enlarged turbinates may also be appropriate.
Chin augmentation with a small synthetic implant may help create better facial harmony and an improved profile when used.
The risks and suitability of this procedure will be determined only during a consultation. It is important to remember that all surgical procedures carry some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are unusual.
EXTERNAL SPLINT: The external splint put on your nose at the end of surgery is intended to provide protection, serving as a sort of small external skeleton." If the splint or cast falls off, you can replace it and hold it in position with tape. We usually remove the splint or cast 7 days after surgery.
INTERNAL SPLINTS: If you have had surgery on your septum as part of your rhinoplasty, plastic splints will be sutured inside your nose. Although these take up some room, your nasal passages should not be totally obstructed. The doctor will usually remove the splints from 7 to 14 days after surgery.
NASAL PACKING: We usually are able to avoid nasal packing after surgery. If you have bled slightly more than usual during your operation, or if there is some other reason, we may occasionally use packing. With packing in place, you will have to breathe through your mouth, and you will have somewhat more swelling than usual. We will usually remove such packing in 24-48 hours.
POSITION: Keeping your head (and nose) elevated tends to reduce swelling. If possible, sleep on two or three pillows.
DRIED BLOOD IN THE NOSTRILS: After surgery, some oozing and bleeding usually occurs for a day or two, and crusting dried blood will collect in the nostrils. Use Ocean Spray Saline Nasal Spray or arnica gel solution for a few days will help clean the area; debris can be removed with an infant aspiration bulb.
CONGESTION: Your nose will be partially or completely obstructed for a few days after surgery. If splints have been placed, some reduced airway will be present. Following removal of splints or packing, the nose will continue to be somewhat congested - usually for 2-4 weeks.
BLEEDING: Elevation, ice, and pressure (squeezing both sides of the nostrils together for 10-20 minutes) can help control bleeding.
VOMITING BLOOD: Many patients will swallow blood that drips down the throat; this can create nausea, and the vomit will be bloody.
BLOOD IN "TEARS AND EYES": We frequently use small nicks in the skin at the upper nose near the lower eyelids. Small amounts of bleeding will occur here during the first few days.
DISCOMFORT: Postoperative pain is usually minimal if septal splints have been placed. If nasal packing has been indicated, the discomfort will be somewhat greater. In either case, oral medication should control the symptoms.
NASAL DISCHARGE AND CRUSTING: As long as packing or splints are in place during the initial healing phase, discharge and crusting are normal.
NASAL DROPS AND SPRAYS: If septal splints are in place, the use of saline spray for a few days will not be harmful. Prolonged use of drops is not advised.
ANTIHISTAMINE/DECONGESTANTS: The use of over-the-counter or prescription decongestants may decrease your symptoms and drainage during the postoperative period.
POSTOPERATIVE CONGESTION: Even though septoplasty has been performed to help correct a nasal obstruction, the feeling of a nasal congestion will not disappear immediately. All surgery inside the nose will cause the mucous membranes to swell for some period of time. Some patience is required.
NUMBNESS AND SWELLING: You may experience some degree of numbness of the tip of your nose for up to one year. You may have some swelling for 12-36 months, and the incision site inside the nose may remain swollen or feel firm for many months after surgery.
INCREASING SWELLING: Intermittent increases in swelling will occur for the first few weeks after surgery.
DRIPPING: You may want to carry some tissues with you for a few weeks after surgery, as your nose may "drip."
ACTIVITIES: Nasal surgery usually hurts very little. Many people feel quite "normal" within a day or two. If your work keeps you sedentary, you may return when you are able. Heavy exercise or straining can cause bleeding or swelling during the first 2-3 weeks. Please be careful!
RETURN TO WORK: If work is strenuous, wait 7-10 days. If work is sedentary, you may return when you are able. If nasal packing has not been placed, this could be as early as 1-3 days after surgery.
EXERCISE: Avoid strenuous or aerobic exercise for at least 2 weeks.
If you would like more information about nose reshaping or if you would like to schedule a consultation, feel free to contact us.
Call Pacific Center Plastic Surgery at (949) 565-2121.