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What You Need to Know About Rhinoplasty

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Updated June 19, 2008

What Is Rhinoplasty:

There are certain facial features that most of us would like to be “stand-outs,” such as big beautiful eyes and full, smooth lips. The nose, however, is one feature that most would prefer not to be the focus. Rhinoplasty, aka, a “nose job” is the surgical re-shaping of the nose. Sometimes, inner structures of the nose are affected, and the results go beyond the cosmetic, helping to improve the patient’s breathing (as in the case of a patient with a deviated septum). The goal of rhinoplasty is to bring the nose into more pleasing aesthetic harmony with the other facial features.

Who Is a Good Candidate:

The best candidates for a rhinoplasty are non-smokers who are in generally good health and who have a positive outlook and realistic expectations about outcome. Those who can benefit from a rhinoplasty procedure include patients with noses they feel are too large, too bulbous, too asymmetrical, too flat, too wide, or simply not in harmony with the proportions of their other features. Rhinoplasty may also be sought out by those who have had their noses broken (resulting in a crooked nose) or by those with breathing problems caused by anatomical problems within the nasal passage.

Pre-Operative Considerations:

Your surgeon will almost certainly order some type of lab tests to confirm your health status before operating. He or she may also require that you adjust, cease, or begin taking certain medications in the week or two before your surgery. It is also very important that you avoid aspirin, many anti-inflammatory drugs, and herbal supplements, in the 2 weeks prior to surgery, as all of these can increase bleeding. Talk to your surgeon about everything you may be taking.

Post-Operative Care:

Rhinoplasty is usually performed on an out-patient basis. After surgery, your nose will be packed with sterile gauze, and in most cases, your nose will be fitted with a splint to hold the bones and new cartilage in their new position until healing is complete. This splint will be removed after approximately one week. Swelling is often significant with rhinoplasty, and you may experience bruising of the cheeks or around the eyes. If you do not have dissolvable sutures, your surgeon will remove your sutures in a follow-up visit, usually 3-7 days after your procedure.

Recovery & Downtime :

Most patients can return to non-strenuous work after 7-10 days. However, for the first several weeks after surgery, you should avoid bending over, lifting heavy objects, or engaging in any strenuous exercise. You will also have to sleep with your head elevated for one or two weeks, and should avoid exposing your nose to direct sunlight for the first few months, due to increased sensitivity. If you need to wear glasses, you may need special support modifications in order to wear them safely during the healing period. These guidelines can vary widely, so always follow your surgeon’s recommendations.

Risks & Complications:

Risks and possible complications include: unfavorable scarring, excessive bleeding or hematoma, skin loss (tissue death), blood clots, numbness or other changes in sensation or intense itching, anesthesia risks, skin discoloration, persistent edema (swelling), skin contour irregularities, skin discoloration and swelling, breathing problems, unsatisfactory aesthetic results, and the need for additional surgery.

After surgery, call your surgeon immediately if any of the following occur: chest pain, shortness of breath, unusual heartbeats, excessive bleeding.

Costs:

The average total cost for a rhinoplasty is between $4,500-$7,500, although fees can range from $3,000 to $12,000, depending in large part on the geographical area. Costs tend to be higher based on the complexity of the surgery, and they are also usually higher if the surgery is a secondary rhinoplasty (i.e., the patient has had had previous nasal surgery). Total costs include your surgeon’s fee, anesthesia fees, facility fees, lab fees and medications.

Complementary Procedures:

Rhinoplasty surgery is often done in conjunction with other surgeries to enhance the patient’s results. The most common procedure performed together with a nose job is the augmentation of the chin via the use of a solid silicone implant. This is done to improve the overall proportions and profile of the patient’s face.

How It’s Done:

  1. Anesthesia is administered. Rhinoplasty surgery can be performed either under IV sedation or general anesthesia, according to the recommendations of your surgeon.

  2. Incisions are made. The majority of rhinoplasty procedures are “closed” procedures, which means that the only incisions are made on the inside of the nose, leaving the patient with no visible scars. However, there may be exterior incisions underneath the nose and/or at the side of the nostrils when there is extensive work to be done on the nasal tip, or when the size or shape of the nostrils is to be altered.

  3. Cartilage and Bone are remodeled. In some cases where the bridge of the nose needs to be narrowed, the nasal bones will need to be broken. This is done using a small hammer and chisel-type instrument. In other cases, the bone may be simply planed down by special instruments in order to remove an objectionable “hump." In still other cases, the bone is not altered at all, but pieces of cartilage are removed and/or rearranged. It is at this point that any inner structures may be repaired or straightened if needed. For those patients who wish to build up a too-flat nose, the use of bone or cartilage grafts may be required.

  4. Excess skin is removed. If the nostrils are being narrowed, or if an excessively long nasal tip is to be shortened, there may be an excision of the excess skin at this point.

  5. Incisions are closed and bandaged. The surgeon closes the incisions with sutures and places gauze packing, exterior dressings, and possibly a splint on the new nose in order to protect it, to promote proper healing, and to control swelling.

Sources:

Nose Reshaping (Rhinoplasty), Consumer Information Sheet, American Society for Aesthetic Plastic Surgery; http://www.surgery.org/public/procedures/nose_reshaping

Nose Surgery, Consumer Information Sheet, American Society of Plastic Surgeons, http://www.plasticsurgery.org/patients_consumers/procedures/Rhinoplasty.cfm

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