Cosmetic Surgery for the Nose
Rhinoplasty attempts to correct deformities and breathing difficulties of the nose. The surgeon reshapes and arranges bone and cartilage, removing any excess and occasionally augmenting the nasal structure with additional cartilage as necessary. There are many cases in which breathing difficulty occurs as the nose becomes progressively more disfigured because of aging or previous trauma. Some patients also have deformities inside the nose that impair breathing, cause headaches, or create sinus trouble that cannot be satisfactorily corrected without simultaneously straightening the external nose.
The surgical work is performed on the inside of the nose, and frequently a small incision is made on the outside of the nostril divider, which essentially leaves no scar. However, in the infrequent case when the nostril must be reduced, an incision is made where the nostrils join the upper lip area. This incision is placed in a natural fold so the scar becomes practically invisible in a few weeks.
Rhinoplasties are usually performed because people want to look better. They would like the shape and size of their nose to be in harmony with the rest of their features. People in business or fashion, for example, are motivated by economic or career considerations. Breathing difficulties that accompany cosmetic deformities are corrected during the same surgery. Such surgery is therefore functional as well as cosmetic.
Surgery for the nose is performed in our office surgical suite, or hospital outpatient surgery and patients go home the same day. Actual surgery takes from two to three hours, and additional time is needed for preparation. General anesthesia is utilized and the patient is monitored at all times during and after the procedure. Following surgery, a small Teflon “cast” is applied with underlying tape to the nose. Rarely is packing inside the nose used. Ice compresses are applied to the eyes for a short time after surgery in order to reduce any swelling and discoloration. Upon discharge, patients receive easy-to-follow instructions for home care. Patients are advised to be up and out of bed the day after surgery, resting no more than three hours in bed.
The dressing on the nose is removed in our office about five to seven days after surgery. When the cast is removed, the nose may appear at first to have a slightly exaggerated “turn-up,” the result of bandages and swelling. Three to five days after cast removal, the nose begins to approximate its eventual shape, and any swelling becomes barely discernible.
At the end of one week, most swelling and discoloration around the eyes have disappeared in ninety percent of our patients. Some slight swelling of the nose, which the patient feels more than can be seen, is present, but it steadily diminishes over a few weeks. This swelling may be more noticeable in the morning and becomes less so as the day progresses. The thicker the skin, the longer it takes for the nose to attain its final shape. It may be about a year before the last one or two percent of swelling is gone. This does not usually bother the patient or detract from the improved appearance.
Since surgery is frequently performed on the septum (the partition in the middle of the nose), there may be minimal nasal blockage for a few days after surgery owing to crusts and swelling. However, no intranasal packing is used after surgery.
After the nasal dressing is removed, patients visit the office a few times during a two-month period so that our staff can monitor progress. During this time, patients must be careful to avoid injury to the nose, to protect it from prolonged exposure to direct sunlight, and to refrain from wearing eyeglasses, which may cause pressure on the sides of the nose. Eyeglasses can be suspended from the forehead with a piece of clear adhesive tape. Patients may gently clean the outside of the nose and use cosmetics.
To avoid strain, patients are advised not to lift heavy objects for at least two weeks after the operation. There is usually minimal postoperative discomfort, and most patients require a minimal pain medication.
Limiting factors in rhinoplasty include the facial contour and shape; skin texture and thickness; inclination of the chin, lips, and forehead; and the depth of the angle between the forehead and the nose; the patient’s height; and the skin’s healing potential.
It is technically difficult to correct some noses that have been severely injured in contact sports or accidents. We try to make the correction in one operation and succeed in the vast majority of cases, but sometimes a short additional procedure is required.