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Rhinoplasty

A Comprehensive Guide to Your Nose-Shaping Surgery

So, you’re not happy with your nose. Rest assured that you are not alone. Nearly 350,000 new noses debut each year as a result of rhinoplasty, the second most popular cosmetic surgery in the United States.

Here you’ll find a comprehensive guide including all you need to know before you decide to reshape not only your nose, but your life:

  • What is rhinoplasty?
  • What does the surgery entail?
  • What are the risks and benefits?
  • Who makes a good candidate for rhinoplasty?
  • What goes into choosing a surgeon?
  • How much recovery time is needed?
  • What costs are involved?

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Perhaps your dissatisfaction with your nose is that it doesn’t match your face in balance and proportion. Perhaps you simply don’t breathe as well as you know you should. In the first case, you may lack self-confidence and feel less attractive than you’d like. In the second, naturally, you want to breathe more easily. For whatever reason, be it self-consciousness or a case of medical necessity, you can find relief in rhinoplasty, also known as septoplasty or septorhinoplasty when dictated by a deviated nasal septum. With a shapely and finely contoured new nose, you’ll be looking good and breathing easily.

Rhinoplasty Defined

Rhinoplasty, also called nose-reshaping surgery, nasal surgery or a “nose job,” is a cosmetic plastic surgery to correct and reconstruct the form and functions of the nose. Septal reconstructions to improve the function of the nose are often called septoplasty or septorhinoplasty as the procedure is intimately connected with traditional rhinoplasty.

Originating from the Greek words “rhis,” meaning nose, and “plassein,” meaning to mold, rhinoplasty is a procedure during which the bones and cartilage of the nose are shaped, rearranged, repositioned or removed to create a more attractive form, one that matches the rest of the face in proportion and balance. Rhinoplasty surgeons literally sculpt the nose, enhancing the symmetry of the face and correcting impaired breathing caused by structural defects.

Recently, with advances in nose-shaping techniques, surgeons can perform what is called “reorientation,” which keeps the existing structure of the nose. Rather than removal of cartilage, which tends to weaken the skeletal support, reorientation demands more sculpting and reshaping.

Additionally, this reorientation helps to maintain a strong, well-proportioned nasal skeleton, which is key to the nose’s improved and lasting function and appeal. Those undergoing nasal surgery today experience less pain and bruising than they did just a few years ago.

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Nasal packing is also becoming less frequent and, when used, less invasive. New techniques are allowing aesthetically appropriate nose-shaping surgery for patients of different ethnicities, permitting patients and their noses to stay true to their ethnic heritage.

Additionally, advancements in technology now allow surgeons to create a video image of what the patient’s new nose will look like.

When performed to restore damaged functions, rhinoplasty corrects problems created by nasal trauma, defects present since birth, impeded breathing or a previous, unsuccessful rhinoplasty surgery. During the procedure, the plastic surgeon reforms and builds a newly functioning and aesthetically pleasing nose proportionate to the patient’s face, doing so by separating the skin and soft tissues from the osseocartilaginous (bone and cartilage) framework of the nose. A more temporary fix can be found in a non-surgical rhinoplasty procedure which involves a series of subcutaneous (administered under the skin) injections of dermal fillers to correct slight imperfections such as bumps and/or depressions in the bridge of the nose, creating an overall smoother and more refined shape. Results of non-surgical procedures tend to be temporary rather than a more permanent fix provided by surgical rhinoplasty.

Rhinoplasty for Nasal Trauma

Perhaps you’ve struggled with your nose since childhood when you experienced a blunt facial injury or broken nose that resulted in, at best, a misshapen nose and, at worst, impaired breathing. Often a result of blunt force trauma, this type of injury to the nose can cause a separation in the septum, the wall dividing the nostrils. A serious injury that requires immediate medical attention, blunt injuries usually result in a fracture causing damage to the cartilage of the nose, which can cause excessive blood to collect. Left undrained, a collection of blood can result in an abscess or permanent deformity that can cause the tissue of the nose to die and/or the nose to collapse. Equally serious are penetrating nasal traumas, during which the nasal cavity is penetrated with a foreign object, and blast injuries, in which the force of a blast causes injury to the nose’s massive soft tissue, the maxillary sinuses and/or the nasal bones. Rhinoplasty surgery can remediate the trauma, leaving you with an aesthetically pleasing and functional new nose.

Revision Rhinoplasty

There are times when a revision rhinoplasty, also called a secondary rhinoplasty, may be required. An estimated ten to fifteen percent of nasal surgeries require small revisions, which are performed a year or so after the initial surgery, after healing and refinement of the nose is complete.

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Occasionally, however, a substandard surgery due to lack of expertise on the part of the surgeon results in what is called a failed rhinoplasty. When a rhinoplasty, for whatever reason, goes completely wrong, the result is often an awkward and unnatural looking nose. There may also be a destabilization of the nasal tissue, which can result in a progressive distortion of the nasal skeleton.

This destabilization usually results in additional deterioration of nasal function. When this occurs, patients can be disappointed to the point of devastation. Instead of the better functioning and shapely new nose they anticipated, they are left feeling angry and betrayed with a poorly functioning nose and an unattractive, unfamiliar face.

Rather than losing all hope, know that a revision rhinoplasty can help. The primary goal of a secondary rhinoplasty is to fix these problems, creating a nose that looks natural and functions as it should. If yours is a second rhinoplasty, choosing a highly skilled surgeon is absolutely essential to achieving the improvement you seek. Understand that revision rhinoplasty is a complicated procedure that creates substantially more medical and artistic challenges. A secondary rhinoplasty, widely considered to be among the most challenging of all cosmetic surgeries, can take up to three times as long as the first surgery. The surgeon must overcome obstacles created by remaining scar tissue to reconstruct the delicate skeletal framework of the nose, the underlying cartilage and bone, to either replace or strengthen what was left damaged by the initial surgery. He does so by grafting cartilage from either the rib or the ear. Healing from a secondary rhinoplasty also requires more time, in some cases up to two years.

Because revision rhinoplasty tends to be more difficult, the procedure requires exceptional expertise, both in analysis of the problem and in surgical skills. Finding a highly qualified plastic surgeon, preferably one who is certified by the American Board of Facial Plastic and Reconstructive Surgery and who regularly performs revision rhinoplasty, will give you comfort in knowing he or she can correct any problems that resulted from the previous surgery, including impaired breathing and/or deformities. Also note that you need to wait at least a year after your first surgery as your nose is subtly refining and reshaping during the first year of healing.

Surgical Overview

As with any surgery, you will need to prepare for your operation. You should try to relax as stress is a deterrent to post-operative healing. You should also eat healthy foods and get some exercise. Drinking alcohol and smoking should be limited as much as possible. Your surgeon will discuss with you what should and should not be done during the days leading up to your procedure. You will also consult with your anesthesiologist, who will ask you to avoid eating or drinking for a minimum of six to eight hours prior to your surgery.

Rhinoplasty is typically performed on an out-patient basis and takes two to three hours. Having an understanding of what to expect during surgery can help you relax, knowing that each step is part of the process of creating a more refined and functional nose.

Surgical steps of rhinoplasty:

  • Anesthesia
  • Incision
  • Reshaping
  • Correction
  • Closure

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Anesthesia: You will most likely have a choice of an intravenous sedation or a general anesthesia. Your surgeon will help you make the best decision based on your needs and level of comfort.

Incision: Your incision may be a closed procedure, also called an endonasal approach, in which the incision is hidden up inside the nasal cavity or an open procedure in which the incision is made across the narrow strip of tissue separating the nostrils – the “columella.” If a smaller nostril size is a desired outcome, other incisions are sometimes hidden in the nostrils’ natural creases.

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The endonasal approach allows for certain advantages. This closed procedure decreases the need for dissecting the nose and reduces the potential for losses in nasal tip support. It also reduces the risk of postoperative edema, which is the abnormal buildup of fluid that can cause swelling and pain, and of visible scarring.

Finally, the endonasal, or closed approach, tends to allow patients to heal more quickly, tactilely “feel” the changes made to their nose and return to their normal appearance more quickly.

Reshaping: Once the incision is made, the skin covering the nasal cartilage and bones is raised gently, allowing the surgeon to access and reshape the nose’s structure. Sometimes bone and/or cartilage is removed to reduce the size of a large nose. Other times, for a disproportionately small nose, cartilage grafts are added. In this instance, cartilage can be taken from the septum, which is the middle of the nose. Less frequently, cartilage is taken from an ear or a section of rib.

Correction: Deviated septums are straightened during the reshaping stage of surgery. Projections inside the nasal cavity are reduced, which improves air intake.

Closure: With the structure of your nose molded into its ideal shape, nasal tissue and surrounding skin is draped back over your nose and the incision is closed. Stiches are removed five to seven days after the surgery.

Risks and Rewards ……