Rhinoplasty

Alternative names
Cosmetic nose surgery

Definition
Rhinoplasty is surgery to repair or reshape the nose. See also septoplasty (nasal septum repair).

Description

Rhinoplasty is one of the most common of all plastic surgery procedures. It can be used to:

     
  • Reduce or increase the size of the nose  
  • Change the shape of the tip or the nasal bridge  
  • Narrow the opening of the nostrils  
  • Change the angle between the nose and the upper lip  
  • Correct a birth defect or injury  
  • Help relieve some breathing problems

Rhinoplasty can be performed under local or general anesthesia, depending on the extent of the procedure and the patient’s preference. It may be performed in a surgeon’s office-based facility, a hospital, or an outpatient surgery center. Complex procedures may require a short inpatient stay. The procedure usually takes an hour or two, but may take longer.

With local anesthesia, the nose and the surrounding area is numbed. The patient will usually be lightly sedated, but awake during the surgery - relaxed and insensitive to pain. General anesthesia allows the patient to sleep through the operation, and is typically used in children.

The surgery is usually done through the incision inside the nostrils.

Indications

Nose surgery is considered “elective” when it is done for purely cosmetic purposes. In these cases, the purpose is to change the shape of the nose to one that the patient finds more desirable. Age may be a consideration. Many surgeons prefer not to perform cosmetic nose surgery until the growth of the nasal bone is completed (around 14 or 15 for girls, a bit later for boys).

In other cases, nose surgery may be needed for medical purposes. For example, surgery may be needed to treat a serious breathing problem or an injury. Age may be less of a factor.

Risks
The risks for any anesthesia are:

     
  • reactions to medications  
  • problems breathing

The risks for any surgery are:

     
  • bleeding  
  • infection  
  • bruising

After surgery, small burst blood vessels may occasionally appear as tiny red spots on the skin’s surface and are usually minor, but permanent. There is no visible scarring if the rhinoplasty is performed from inside the nose. There may be small scars at the base of the nose that are not usually visible when the procedure calls for the narrowing of flared nostrils.

Rarely, a second procedure may be necessary to correct a minor deformity.

Expectations after surgery

A splint (metal or plastic) will be applied externally to maintain the newly shaped bony structure when the surgery is complete. Soft plastic splints or nasal packs may also be placed within the nostrils to stabilize the septum (the dividing wall between the air passages).

Immediately following surgery, the nose and face will be swollen and painful. Headaches are common. Pain medications will control these discomforts.

Swelling and bruising around the eyes will increase and reach a peak after 2 or 3 days. Keeping the head raised (elevated) and placing cold compresses to the eyes can help reduce the swelling. Within 2 weeks, most of the swelling and bruising disappears. Some subtle swelling remains for several months, but this is generally unnoticeable to anyone but the patient.

During the first few days, minor bleeding from the nose is common. Do not blow the nose, pick the nose, or insert items into the nose for the first week while tissues heal.

The nasal packing is usually removed after 3 to 5 days and the patient will feel much more comfortable. All dressings, splints, and stitches should be removed within 1 or 2 weeks.

Convalescence
Within 2 days, most patients are up and about, and able to return to school or non-strenuous work within about a week following surgery. Full recovery takes several weeks.

Avoid strenuous activity (jogging, swimming, bending - any activity that increases blood pressure) for 2 to 3 weeks. Avoid rubbing or bumping the nose. Avoid unprotected sun exposure, especially for the first 8 weeks. Be gentle when washing the face and hair or using cosmetics.

Glasses will have to be taped to the forehead or propped on the cheeks for 4 to 6 weeks after the splint is removed and the nose is completely healed.

The patient may feel depressed following surgery, but day by day the nose will look better. Within a week or two, cosmetics will camouflage signs of the operation. Healing is a slow and gradual process. The tip of the nose may have subtle swelling and numbness for months. The final results may not be apparent for up to a year.

The patient might experience some unexpected reactions from family and friends. They may act resentful, especially if something they view as a family or ethnic trait is altered. The patient should keep in mind the reasons for the nasal correction, and if these have been reached, then the surgery is a success.

Johns Hopkins patient information

Last revised: December 4, 2012
by Harutyun Medina, M.D.

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