Rhinoplasty

Also known as rhinoplasty, nose reshaping or nose job

Rhinoplasty is a term which covers several procedures to reshape the nose. Surgery can be used to alter the height, length and width of the nose; to straighten a bent nose; to change the shape of the bridge-line, tip or nostrils and/or alter the angle between the upper lip and nose. Sometimes, breathing difficulties can be corrected at the same time.

WHEN TO CONSIDER NOSE SURGERY?

  • If you are unhappy with the shape, size or angle of your nose

  • If your nose is too large, too small or not in proportion to the rest of your face

  • If you have breathing problems resulting from irregularities inside your nose

  • If you have a nasal hump or a nasal tip that is drooping, too elevated or wide

CONSIDERATIONS

PROS

  • The shape, angle and size of your nose will be improved

  • Structural problems that restrict breathing and cause congestion can be corrected

  • Rhinoplasty can have a significant impact on your self-image and self-confidence

CONS

  • Depending on the type of surgery, you may develop scars at the base of your nose 

  • You may have skin problems or breakdown of skin tissue associated with the use of grafting materials 

  • It will take time to adjust to your new look

These are the top three pros and cons to weigh when considering nose surgery. If you want to focus on what is unique to you, please consult with your aesthetic plastic surgeon.

Are you a good candidate for nose surgery?

The following are some common reasons why you may want to consider rhinoplasty:

  • Your nose is too large or too small

  • Your nose does not seem to fit with the rest of your face

  • Your nose is crooked, badly shaped, or out of alignment

  • You have nasal blockage inside your nose and have trouble breathing

  • You have a birth defect that you would like improved

  • You would like improvement, not perfection, in the appearance of your nose

If you are in good general health, have a positive attitude and realistic expectations, you are most likely a good candidate for this procedure.

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A.

A. Rhinoplasty can reshape your nose, remove bumps, improve angles and reduce an enlarged tip.

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B.

B. After swelling has subsided after rhinoplasty, your nose will better complement your other facial features.

HOW IS A NOSE SURGERY PERFORMED?

After numbing the area, your rhinoplasty surgeon will make incisions to access the bones and cartilage that support the nose. There are two general techniques for making the incisions: open and endonasal (see What will my nose surgery incisions and scars be like?).

By adding or removing bone and cartilage and adjusting the supporting structures inside the nose, the size of your nose can be reduced or increased and the nose may be shortened or lengthened.

  • Tip grafts made of cartilage can be used to remodel the tip of your nose, making it more uplifted, longer, shorter, or thinner.

  • Your skin and other soft tissues will remodel to assume the shape of the underlying structure.

  • In some patients, tissue fillers or fat grafts can be added to increase volume in desired areas.

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Areas where cartilage and bone can be adjusted to improve the shape of the nose are shown.

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The nasal bridge can be narrowed by moving the bone inward, as shown by the arrow.

WHAT ARE MY OPTIONS?

There are two main incision approaches: the open approach and the internal (endonasal) approach. 

In addition to incision options, there are various methods for augmenting your nose or smoothing surface deformities. 

  • Autologous cartilage grafts taken from your nasal septum (the wall inside the nose that divides one air passage from the other) offers the best chance for a natural result. If cartilage and bone have already been removed from the nasal septum, then ear or rib cartilage and sometimes bone from the skull are other options. 

  • Although solid silicone implants are available for nasal surgery, these are foreign materials that may become infected or react poorly with your nasal tissues and have to be removed. That is why natural cartilage, if a supply is available, is the most trouble-free option. 

  • Fillers or fat grafts may also be injected to smooth the nose, to camouflage deformities or indentations, or to add volume in desired areas.

WHAT WILL MY NOSE SURGERY INCISIONS AND SCARS BE LIKE?

As previously mentioned, there are two general techniques for making the incisions. 

Open rhinoplasty

For an open rhinoplasty, the incisions are made outside the nose with a small access incision on the underside of the nose between the nostrils that then connects with other incisions hidden inside the nose.

Advocates for the open rhinoplasty approach say that it fully opens the nose, providing better visualization of the nasal structures and a more direct route for surgical manipulation; the small scar at the base of the nose is barely visible once it heals.

Endonasal rhinoplasty

For an endonasal rhinoplasty, the incisions are made inside the nasal passages. Because these incisions are hidden, they are invisible after surgery.

Advocates for the endonasal approach say that it permits more limited dissection of nasal tissues, offers excellent visualization of nasal structures, and eliminates the visible scar at the base of the nose.

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An open rhinoplasty requires an incision on the underside of the nostril as shown.

AFTERCARE AND RECOVERY

Your surgeon will discuss how long it will be before you can return to your normal level of activity and work. After surgery, you and your caregiver will receive detailed instructions about your post-operative care, including information about:

  • Drains, if they have been placed

  • Normal symptoms you will experience

  • Potential signs of complication.

 

Immediately after rhinoplasty
After surgery you may be asked to wear a nasal splint over your nose for support. The splint will protect your nose while you sleep and shield it from accidental bumps. You may also have a small triangular bandage beneath the tip of your nose. Nasal packing will be placed inside your nose for additional support; it acts as an internal splint to hold everything in place and to keep the airway clean and free of crusts. Many patients dislike the idea of anything being put in their noses, so adjusting to the nasal packing may be difficult. Some surgeons insert a small tube in each airway to allow the patient to breathe more freely when the packing is in place. Expect some swelling and bruising and possibly some discomfort. Your face will be puffy, and the areas around your nose and eyes will be bruised and swollen after surgery. Your surgeon may recommend cold compresses to help minimize the swelling and reduce pain. You may need to keep your head elevated and relatively still for the first few days after surgery. Your doctor may prescribe a pain medication to deal with any pain you may experience. You will have to limit your activities for a few days to weeks.

Recovery time frame after rhinoplasty
It is vitally important that you follow all patient care instructions provided by your surgeon. Your surgeon will also provide detailed instructions about the normal symptoms you will experience and any potential signs of complications. It is important to realize that the amount of time it takes for recovery varies greatly among individuals. You will need to wait for several weeks before you can engage in exercise or athletics.

The first two weeks
All surgical packing within your nose will be removed within four to seven days after surgery. The splint and bandages on your nose will be removed in a week to ten days. It takes about ten to fourteen days before most of the swelling and bruising improves. Your return to work or school depends on how much exertion your job or your school activities require. Most normal activities including exercise can usually be resumed within three weeks. You should avoid strenuous exercise, straining, bending, and lifting until cleared to do so by your plastic surgeon.

After the first two weeks
Minor swelling of your nose may persist for up to a year but most likely will not be noticeable to others. It will be a few months before you can expose your reshaped nose to direct sunlight, and it may be a number of weeks before you can wear glasses without special support, such as tape, if your nasal bones were altered.

HOW LONG WILL THE RESULTS LASTS?

The results of rhinoplasty are permanent, so it is important that you have clear aesthetic goals when this procedure is planned. Rhinoplasty should only be performed on a nose that has finished growing; complete development has usually occurred by age sixteen or seventeen. If rhinoplasty is performed before development is complete, continued growth can change the outcome of your surgery and cause potential problems and complications.

Maintain a relationship with your aesthetic plastic surgeon


For safety, as well as the most beautiful and healthy outcome, it’s important to return to your plastic surgeon's office for follow-up evaluation at prescribed times and whenever you notice any changes in your rhinoplasty. Do not hesitate to contact your surgeon when you have any questions or concerns.

LIMITATIONS AND RISKS

Fortunately, significant complications from rhinoplasty are infrequent. Your specific risks for rhinoplasty will be discussed during your consultation. 

All surgical procedures have some degree of risk. Some of the potential complications of all surgeries are:

  • Adverse reaction to anesthesia

  • Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal) 

  • Infection and bleeding

  • Changes in sensation 

  • Scarring 

  • Allergic reactions 

  • Damage to underlying structures 

  • Unsatisfactory results that may necessitate additional procedures

Other risks specific to rhinoplasty are outlined below:

  • Skin problems or skin breakdown from bandaging or from grafting materials being exposed through thin skin, particularly if foreign materials have been inserted

  • Nasal blockage caused by swelling inside the nose

  • Injury to your septum, the structure that separates your nostrils

  • A raised scar at the base of the nose with the open approach

You can help minimize certain risks by following the advice and instructions of your board-certified plastic surgeon, both before and after your rhinoplasty.

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