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Nose & Sinus

Shaping the nose through rhinoplasty.

The term rhinoplasty means to mold or shape the nose. The operation itself is performed by removing any excess cartilage or bone while reshaping or contouring the remaining structure.

Most nasal surgeries are performed to improve nasal function, to improve air flow through the breathing passages. Or, a patient may simply desire a nose that is in better harmony with their other facial features. Fortunately, both improved nasal function and improved appearance are the natural outcomes of a rhinoplasty. The nose may be the least noticeable or the most noticeable structure on an individual’s face. A truly beautiful nose is in harmony with, and does not distract from, the surrounding structures such as the eyes and lips. Therefore, a pleasant-appearing nose on one face may appear quite unattractive on a very different face. Consequently, any changes proposed for the appearance of one nose may be inappropriate for another. Nasal surgery must be customized with numerous other techniques available to the facial plastic surgeon.

Frequently, the nose becomes more disfigured as a natural expectation of the aging process. A drooping, lengthened nose may be a revealing mark of aging, amenable to a nose lift for a more youthful look.

The goal of rhinoplasty is to improve function and improve the harmony between the nose and the patient’s distinctive facial features. Every nose, just like every face, is unique to that individual. Recommended nasal alterations are determined by many factors including one’s height, age, skin thickness, ethnic background, and configuration of features such as forehead, eyes, and chin.

The objective is to achieve a natural-looking nose rather than one which appears operated on. Rhinoplasty surgery is as artistic in nature as it is scientific. Each nose is reshaped to suit the patient’s face and other distinctive characteristics. Consequently, no two resulting noses are identical.

Before Surgery

Photographs are taken of the face for study and analysis and to plan the surgery. Video imaging may also be helpful to patients who wish to see how the improvements may look and to help communicate their interests.

Due to the limitations of surgery and healing, it is often difficult to exactly duplicate the presented idea. No ethical physician can guarantee the results of any treatment or surgery.

Surgery

The surgical procedure itself can take one to three hours depending on the amount of work necessary. Usually, the operation is nearly painless and the patient sleeps through the entire procedure under twilight or general anesthesia. Postoperatively, very little if any, pain medication is needed.

In most cases, the entire procedure is performed through the inside of the nose. This approach leaves no external scarring and minimizes swelling. Under certain circumstances, these internal incisions may be connected by a small incision under the tip of the nose crossing the thin central portion between the nostrils. When this is done, it will leave a small scar in this inconspicuous location. If the base of the nose requires narrowing, a small incision in the nostril crease is necessary and will be slightly red for a few weeks.

Ordinarily, the nose is not packed after surgery. A small drip dressing is placed below the nostrils which may obstruct the nostrils and prevent sniffing, but internal packing is usually not necessary. Internal suturing techniques eliminate the necessity for packing, thereby dramatically reducing pain, swelling and discoloration.

A tan, taped splint will be placed on your nose and you will be advised to stay upright and in bed. Cold compresses over the nose constantly for two to three days helps to reduce swelling and discoloration. Keeping the head of the bed elevated is also important to further reduce these postoperative conditions. A specific instruction sheet is reviewed with the patient after surgery.

One week following surgery, the splint dressing is removed and no further dressing need be applied. Most patients are able to return to school or work the same day.

Some swelling may still exist at this point in time and will diminish slowly. In general, 80% of swelling is gone at two weeks, 90% at two months. The remaining ten percent gradually resolves over the year. The final result is not present for about one year, significantly longer if the patient has thick skin.

Patients may experience a variable degree of nasal stuffiness, which will decrease with the resolution of swelling. These patients frequently find relief with decongestants.

Important Points about Rhinoplasty

• When the dressing is removed, the nose appears turned up due to the bandage and swelling. This will settle down into a more normal position.

•Nasal congestion continues to improve as swelling resolves.

•Experience has demonstrated that 80% of swelling is generally gone at two weeks; 90% at two months. The remainder resolves over the following year. Furthermore, swelling resolves more slowly in patients with thicker skin.

•Patients should realize that severely injured noses or previously operated-on noses are inherently more difficult to correct. Most of the time these problems are correctable with one operation. However, because of “memory,” the healing process tends to drift the tissues back to the pre-existing curvature, and a second procedure may be necessary after one year.

•Incisions within the nose do not leave visible scars. Occasionally, these may be connected with a small incision under the tip. When narrowing the nose is necessary, crease incisions are made. These external incisions will be slightly red for a few weeks.

•Patients must remember that there are limitations to the corrective procedures that can be safely completed. The surgical goal is to improve one’s looks and function rather that match the ideal in a person’s mind.

Limitations of Rhinoplasty

Qualities which limit rhinoplasty results include: the existing size, shape and structure of the nose; the shape and contour of the face; the slope and projection of the forehead, chin and lips; the texture and thickness of the skin; the depth of the angle between the forehead and nose; the patient’s height; the healing abilities of the tissues; and facial asymmetries.

Often, correcting a receding chin (at the time of nasal surgery) significantly enhances facial harmony.


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