Rhinoplasty (Cosmetic Nose Surgery)

Rhinoplasty, or cosmetic nasal surgery, is one of the most common cosmetic procedures performed today. The operation is usually carried out because a patient desires to improve his or her appearance. It is also frequently requested for repair of injuries or correction of the increasing disfigurement of the nose that occurs as the patient grows older. In addition to the purely aesthetic reasons for seeking rhinoplasty, patients may also be influenced in their desire for surgery because of related functional problems such as breathing obstruction, which can also be corrected by the operation. In these cases, medical insurance may cover a part or all of the cost of surgery.

Because of the frequency with which this operation is carried out, technical refinements have allowed consistently good results which are considerably better than were possible twenty-five or fifty years ago. Nevertheless, patients must recognize that the goal of this operation is improvement, and that perfection is a goal that remains elusive. Patients who expect too much may be disappointed. During your consultation I will review many typical before and after pictures. The purpose of seeing other patients is not to allow you to pick out the nose that you want, but rather to give you some idea of the types of results that are generally achieved in this type of surgery.

Computer imaging has proven especially useful for this operation since it allows the patient to preview the anticipated results of surgery. Imaging is also helpful in evaluating the possibilities of concomitant procedures such as chin or cheekbone augmentation, which often enhance the results of rhinoplasty.

PATIENT SELECTION - AGE AND SEX

The timing of the nasal reconstruction will depend on many factors. In general, cosmetic rhinoplasty should be delayed until a patient's facial development is approaching maturity. This is usually around the age of 17 -18.When surgery is carried out to correct breathing problems or to correct deformity produced by injury, it may be advisable to proceed with the operation at an earlier age. There is no upper age limit for nasal reconstruction. Patients in their sixties and seventies choose to have this operation with good results. Many patients combine nasal reconstruction with other types of surgery for aging such as face lift or corrective eyelid surgery.

ABOUT THE OPERATION

The operation is carried out on an outpatient basis, usually local anesthesia. Most of the incisions are inside the nose and so visible scarring is limited. Each operation is different, but basically the procedure involves shifting or removal of bone and cartilage and is therefore primarily a modification of the framework of the nose. Following surgery the skin redrapes itself over the new nasal framework and it is almost never necessary to remove excess skin. All of the incisions are made within the nose. Incisions are closed with absorbable suture avoiding the need for removal. Often patients will combine chin or cheekbone augmentation with rhinoplasty.

NON FRACTURE RHINOPLASTY

Rhinoplasty is commonly thought of as a painful operation requiring fracture of the nasal bones and associated with considerable swelling and bruising. This is generally a misconception. It is important to realize that each operation is individualized according to the wants and needs of the patient. In many cases, the surgery requires only changes of cartilage, in which case, recovery is quicker and bruising, swelling and discomfort are much less likely.

While often the operation will require removal of bone or cartilage, there are often occasions where the nose needs augmentation, or filling in. If this is the case, synthetic fillers or the patients own cartilage may be used. This will be discussed on an individual basis.

POSTOPERATIVE CARE

After completion of the operation, a small dressing[sometimes plastic splint] is placed over the nose which remains in place for 2-3 days. Our technique avoids this need. After removal of the cast, there may be some swelling and bruising and stuffiness, but by the end 1-2 weeks most patients find that a large part of the swelling has resolved.
In general, the appearance of the nose continues to improve for as long as a year after the operation. Do not be overly concerned if the nose looks unsatisfactory when the splint is first removed. Swelling is quite variable, and while it usually begins to subside quickly, some patients take much longer than others.

Patients can wash or bathe normally after surgery. After removal of the splint, the patient must be very careful that the nose is not injured until complete healing has taken place.

The first three weeks after surgery are generally the most important. Although many patients can return to work within a few days after surgery, physical activity must be considerably limited for this three-week period. Patients must also be careful to prevent eyeglasses from pressing heavily on the nose until swelling resolves. During the second three weeks after surgery, patients are gradually allowed to increase their activity, but still must avoid any activity which endangers the risk of direct trauma to the nose.

RISKS AND LIMITATIONS

Any operation involves certain risks that are usually understood by all patients: for example, the risk of bleeding, infection, or anesthetic complications. Serious complications such as unfavorable appearance, significant scarring, nasal septal perforation or breathing obstruction are possible in unusual cases. These may require additional surgery for correction. Fortunately, these complications are uncommon after rhinoplasty. When they occur and are corrected, they usually do not interfere with the final result of the surgery.

In nearly all cases, there is significant improvement in the appearance and often the function of the nose after rhinoplasty. Unfortunately, as with all cosmetic surgery, the result may not always meet the expectations of the patient. A realistic approach toward the operation warrants that the patient understand that there is a limit to the ability the surgeon has to change the appearance of the nose. The vagaries of healing preclude an absolute prediction of the final appearance. Some problems, such as thick or oily skin, may make it difficult, if not impossible, to achieve more than a moderate improvement. Occasionally, a second procedure may be required to achieve the desired result although, when necessary, this is generally of a minor nature.

During your consultation we will have an opportunity to discuss individual goals, risks and limitations in detail. Cost of operation-Rhinoplasty.