Summary

Rhinoplasty is still one of the most performed aesthetic surgical procedures. Over the past 20 years, the trend has shifted from ablative techniques involving reducing or dividing the osseo-cartilaginous framework to conserving native anatomy with cartilage-sparing suture techniques and augmentation of deficient areas to correct contour deformities and restore structural support. The foundation for a successful experience for both patient and surgeon involves accurate preoperative analysis and clinical diagnosis, identification of both the patient’s expectations and the surgeon’s goals, and a thorough review of the plan of care and expected postoperative recovery. Rhinoplasty remains one of the most challenging procedures in cosmetic surgery. I can achieve excellent surgical outcomes only through a thorough understanding of the multiple nasal anatomical variants and a comprehensive knowledge of the ultimate long-term effects of various surgical techniques on the overall appearance and function of the nose. I should practice a philosophy of balance, preservation, and restoration of tissues (rather than a purely deductive approach, which can introduce tissue spaces and uncontrolled scarring of tissues).

Rhinoplasty, or nose reshaping surgery, improves the shape, size, and symmetry of a person’s nose, bringing it into better proportion with the rest of the face. When performed by a skilled, qualified cosmetic surgeon, rhinoplasty can be a rewarding and life-enhancing procedure—patients often notice that their overall appearance has improved, as the nose they see now looks natural, like the nose they have always thought they should have.

What Can Nose Surgery (Rhinoplasty) Treat?

• Nose size about facial balance
• Nose width at the bridge or in the size and position of the nostrils
• Nose profile with visible humps or depressions on the bridge
• Nasal tip that is enlarged or bulbous, drooping, upturned, or hooked
• Nostrils that are large, wide, or upturned
• Nasal asymmetry

If you desire a more symmetrical nose, keep in mind that everyone’s face is asymmetric to some degree. Results may not be completely symmetric, although the goal is to create facial balance and correct proportion.

What are the Goals of Nose Surgery (Rhinoplasty)?

The goals of nose reshaping are as individual as the patients who choose to have a rhinoplasty. By reshaping the nasal structures, including bone, cartilage, and skin, a cosmetic surgeon can help achieve one or more of the following:

• Straighten a crooked nose
• Smooth a prominent bump in the bridge of the nose
• Reduce the length of an over-protruding nasal tip
• Refine the size of a bulbous nasal tip
• Narrow a nose that is too wide for the face
• Reduce the size of a nose that is too large
• Restore symmetry to the nose following injury
• Correct breathing problems by opening up blocked nasal passages

What are the Patient Expectations and Suitability for Nose Surgery (Rhinoplasty)?

Evaluation of patient expectations is a vital component of the preoperative consultation. The patient should list specific concerns about their nasal appearance and/or function and attempt to rank these in order of importance. Most patients have realistic expectations for surgery and can understand the limitations of rhinoplasty with adequate discussion. Reviewing photographs with the patient allows the patient to appreciate different views of their face and nose to help identify specific areas of concern. A patient that focuses on minor or uncorrectable problems or has unrealistic expectations despite extensive discussion will likely be disappointed following surgery regardless of the aesthetic improvement; it is better to avoid operating on these patients.

Assessment of the emotional stability of the patient is critical when evaluating the patient seeking rhinoplasty. I should identify motivating factors, and the surgeon must differentiate between healthy and unhealthy reasons for seeking rhinoplasty. Feelings of inadequacy, immaturity, family conflicts, divorce, and other significant life changes may be unhealthy motivating factors behind the patient seeking aesthetic surgery.

Who is the Right Candidate for Nose Surgery (Rhinoplasty)?

Men and women of all ages benefit from rhinoplasty. Nose reshaping is one of the more popular cosmetic surgery procedures for teenage patients, too. However, cosmetic surgeons take special care when evaluating whether a younger patient is ready for rhinoplasty. The nose must be physically developed—typically by around age 14 for girls and 16 for boys. Younger patients also need to demonstrate emotional maturity and understanding of the cosmetic surgery process. For patients of any age, it is essential to have realistic expectations. Rhinoplasty can help you improve upon your existing nose, but it cannot deliver “perfection,” nor can it give you the nose of someone else. A skilled, qualified cosmetic surgeon will explain to you what is possible and help you achieve a nose that looks natural with your unique features.

You Maybe the Right Candidate for Rhinoplasty if:

• Your facial growth is complete
• You are physically healthy
• You don’t smoke
• You have a positive outlook and realistic goals in mind for the improvement of your appearance.

What should I Expect During a Consultation for Nose Surgery (Rhinoplasty)?

During your rhinoplasty consultation, be prepared to discuss:

• Your surgical goals, concerning both appearance and breathing
• Medical conditions, drug allergies, and previous medical treatments
• Current medications, vitamins, herbal supplements, alcohol, tobacco, and drug use
• Previous surgeries

Your Nose Surgery (Rhinoplasty) Surgeon may also:

• Evaluate your general health status and any pre-existing health conditions or risk factors
• The options available to you for nose reshaping
• Examine and measure your face
• Take photographs
• Discuss your nose surgery options
• Recommend a course of treatment
• Discuss likely outcomes of nose surgery and any risks or potential complications

It’s crucial to understand all aspects of your rhinoplasty procedure. It’s natural to feel some anxiety, whether excitement for your anticipated new look or a bit of preoperative stress. Don’t be shy about discussing these feelings with your plastic surgeon.

What are the Risks of Nose Surgery (Rhinoplasty)?

The decision to have plastic surgery is highly personal. You will have to decide if the benefits will achieve your goals and if rhinoplasty’s risks and potential complications are acceptable. Your plastic surgeon and/or staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure and any risks or potential complications. Rhinoplasty surgery risks include:

• Anesthesia risks
• Infection
• Poor wound healing or scarring
• Change in skin sensation (numbness or pain)
• Nasal septal perforation (a hole in the nasal septum) is rare. Additional surgical treatment may be necessary to repair the septum, but it may be impossible to correct this complication.
• Difficulty breathing
• Unsatisfactory nasal appearance
• Skin discoloration and swelling
• Possibility of revisional surgery

Rhinoplasty has a variety of complications or side effects; increased knowledge of their anatomical correlates can assist in anticipating them intraoperatively. “Pollybeak” formation describes a postoperative fullness of the supratip region, inverted-V deformity, and nasal valve collapse. I will thoroughly discuss these risks and others before your consent. You must address all your questions directly with your plastic surgeon.

How Should I prepare for Nose Surgery (Rhinoplasty)?

In preparing for rhinoplasty surgery, you may be asked to:

• Get a lab test
• Take certain medications or adjust your current medications
• Stop smoking
• Avoid taking aspirin, anti-inflammatory drugs, and herbal supplements as they can increase bleeding.

Your plastic surgeon will also discuss where your procedure will be performed. Rhinoplasty is performed in MSI  accredited office-based surgical facility.  Be sure to arrange for someone to drive you to and from surgery and stay with you for at least the first night following surgery.

What are the Types of Nose Surgery (Rhinoplasty)?

Nose surgery is highly individualized, and the specific techniques a cosmetic surgeon will use during a procedure will look a little different each time, depending on a patient’s anatomy and desired changes. In general, however, a cosmetic surgeon’s techniques will fall under one of the following procedural approaches.

Open Rhinoplasty

For an “open” rhinoplasty, a small incision is made under the nasal tip, between the nostrils. This approach allows the cosmetic surgeon to complete access to the nasal structures, where they can then sculpt the nose into the desired shape. Because of this increased access, cosmetic surgeons will typically use the open rhinoplasty approach for patients requiring more extensive reshaping. The resulting scars are well-hidden in the natural contours of the nose, so they are as inconspicuous as possible.

Closed Rhinoplasty

For a “closed” rhinoplasty, incisions are made inside the nostril. This approach is most commonly used for patients who need more minor adjustments to the nasal structures to achieve their desired improvements. The advantage of closed rhinoplasty is that there is no visible scarring after surgery; however, this approach may not suit more extensive rhinoplasty procedures.

Tiplasty

A “tiplasty” refers to the area of reshaping rather than the incision techniques. As you might have guessed, tiplasty involves reshaping the nasal tip only without affecting the other nasal structures. Cosmetic surgeons may use the open or closed approach for tiplasty.

Rhinoplasty to Correct a Deviated Septum

Nose surgery that’s done to improve an obstructed airway requires careful evaluation of the nasal structure related to airflow and breathing. Correction of a deviated septum, one of the most common causes of breathing impairment, is achieved by adjusting the nasal structure to improve alignment.

Revision rhinoplasty

Revision rhinoplasty poses a significant challenge because of the complex nature of anatomical or functional abnormalities, alteration of native nasal anatomy, presence of scarring, and depletion of autogenous cartilage needed for grafting.

What are the advantages and disadvantages of open and closed treatment options?

The open plan continues to gain in popularity for both primary and revision rhinoplasty. Both the open approach and the endonasal (closed) approach are commonly used. Both methods have advantages and disadvantages, with the correct approach determined by the patient’s anatomical deformity and the surgeon’s experience. Some of the significant advantages of the open approach include complete visualization of the nasal framework to more accurately diagnose the cause of the nasal airway obstruction or the aesthetic deformity.

Manipulation of the various structures, from the dorsum to the septum to the tip, can be performed with precision and yield reproducible results. The open approach is instrumental when addressing posttraumatic deformity or in revision rhinoplasty. Patient dissatisfaction related to the trans-columellar scar does not appear to be substantiated when an inverted- V or stairstep incision is used. In addition, the safety of the trans-columellar incision has been validated, provided that the lateral nasal arteries are preserved. The primary source of patient dissatisfaction following the open approach tends to arise from prolonged nasal tip edema, and I should discuss this preoperatively. The endonasal approach is advantageous in patients with an isolated dorsal hump deformity or minimal modification of the tip required and intraoperative diagnosis.

Rhinoplasty surgery includes the following steps:

Step 1 – Anesthesia

Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation or general anesthesia. Your doctor will recommend the best option for you.

Step 2 – The incision

Rhinoplasty is performed either using a closed procedure, where incisions are hidden inside the nose, or an open method, where an incision is made across the columella, the narrow strip of tissue that separates the nostrils. Through these incisions, the skin that covers the nasal bones and cartilages is gently raised, allowing access to reshape the structure of the nose.

Step 3 – Reshaping the nose structure.

I may reduce an overly large nose by removing bone or cartilage. Sometimes surgery of the nose may require the addition of cartilage grafts. Most commonly, cartilage from the septum, the partition in the middle of the nose, is used for this purpose. Occasionally cartilage from the ear or rarely a section of rib cartilage can be used.

Step 4 – Correcting a deviated septum.

If the septum deviates, it can be straightened, and the projections inside the nose reduced to improve breathing.

Step 5 – Closing the incision.

Once the underlying structure of the nose is sculpted to the desired shape, nasal skin and tissue are re-draped, and incisions are closed. Additional incisions may be placed in the natural creases of the nostrils to alter their size.

What should I Expect During my Nose Surgery (Rhinoplasty)recovery?

During your rhinoplasty recovery, a splint and/or packing may be placed inside your nose and a splint or bandages placed on the outside to support and protect the new structures during initial healing. While initial swelling subsides within a few weeks, it may take up to a year for your new nasal contour to fully refine. During this time, you may notice gradual changes in the appearance of your nose as it refines to a more permanent outcome. Swelling may come and go and worsen in the morning during the first year following your rhinoplasty surgery. You will be given specific instructions that may include:

• How to care for the surgical site
• Medications to apply or take orally to aid healing and reduce the potential for infection
• Specific concerns to look for at the surgical site or in your general health
• When to follow up with your plastic surgeon.

Be sure to ask your rhinoplasty surgeon specific questions about what you can expect during your recovery period:

• Where will I be taken after my surgery is complete?
• What medication will I be given or prescribed after surgery?
• Will I have dressings/bandages after surgery?
• When will they be removed?
• Are stitches removed? When?
• When can I resume regular activity and exercise?
• When do I return for follow-up care?

Take it easy After Nose Surgery (Rhinoplasty)

For the first 1 to 2 weeks, many patients experience bruising and swelling. At first, you may not be able to see the improvements made during surgery. But don’t worry—most of the bruising and swelling should subside after the first 10 to 14 days. Most patients feel ready to return to work or school after 1 or 2 weeks, depending on the level of activity required. Typically, after three weeks, You can resume most normal non-contact activities. However, limit activity according to your surgeon’s instructions and do not engage in any strenuous activities until you are cleared to do so.

Your New Nose will Continue to Improve!

While you will be able to see the improvements your cosmetic surgeon made during rhinoplasty after the initial bruising and swelling dissipates, it is reasonable to have some slight residual swelling present for up to a year. This is usually not noticeable to others, though. The results of rhinoplasty surgery are permanent. While this means your new nose will be with you for a lifetime, it also makes it that much more important to choose a qualified cosmetic surgeon whom you can trust to deliver the results you desire.

What results should I expect after Nose Surgery (Rhinoplasty)?

The results of rhinoplasty surgery will be long-lasting. While initial swelling subsides within a few weeks, it may take up to a year for your new nasal contour to fully refine. During this time, you may notice gradual changes in the appearance of your nose as it refines to a more permanent outcome. As your body ages, it is natural to change your face, including your nose, gradually. But most of your improvement should be relatively permanent. A healthy lifestyle and life-long sun protection will help extend the results of your new appearance.

Rhinoplasty is still one of the most commonly performed aesthetic surgical procedures in cosmetic surgery. Over the past 20 years, the trend has shifted from ablative techniques involving reduction or division of the osseo-cartilaginous framework to conserving native anatomy with cartilage-sparing suture techniques and augmentation of deficient areas to correct contour deformities and restore structural support. The foundation for a successful experience for both patient and surgeon involves accurate preoperative analysis and clinical diagnosis, identification of both the patient’s expectations and the surgeon’s goals, and a thorough review of the plan of care and expected postoperative recovery. Intra-operatively, adequate anatomical exposure of the nasal deformity; preservation and restoration of the normal anatomy; correction of the deformity using total control, maintenance, and repair of the nasal airway; and recognition of should ask the expectations of the patient and evaluate their suitability for rhinoplasty. Poor postoperative patient satisfaction is often based on emotional dissatisfaction instead of technical failure, which can be avoided by preoperative identification of these unhealthy motivating factors. Rhinoplasty remains one of the most challenging procedures in cosmetic surgery. I can achieve excellent surgical outcomes only through a thorough understanding of the multiple nasal anatomical variants and a comprehensive knowledge of the ultimate long-term effects of various surgical techniques on the overall appearance and function of the nose. I should practice a philosophy of balance, preservation, and restoration of tissues (rather than a purely deductive approach, which can introduce tissue spaces and uncontrolled scarring of tissues).