Nose Surgery (Rhinoplasty)

  • What is a Rhinoplasty?
  • How is a Rhinoplasty done?
  • What kind of anesthesia is recommended during a Rhinoplasty?
  • What can I expect after Rhinoplasty?
  • How long will the effect of the Rhinoplasty last?
  • When is it the right time for a Rhinoplasty?
  • A rhinoplasty is the surgical correction of the nose. It addresses any or all of the structures within the nose including the bones, the cartilage and soft tissues such as skin and fatty layers.
  • The nose holds a very significant position in the face. Not only is it in the center but it also projects from the face. It is important that the nose be in proportion with the other features of the face so as to not detract from them.
  • A rhinoplasty may be performed exclusively for cosmetic purposes, functional purposes or both. It may be performed for the following reasons:
    • Restore the airway to allow improved breathing
    • Reduce asymmetries and improve alignment
    • Decrease excess height, width and length along the entire nose
    • Provide better definition along the nasal tip
    • Lift a drooping nasal tip
    • Decrease flaring of the nostrils
    • Create a nose that is more proportional and in better harmony with other facial features
  • In general, rhinoplasty procedures may be classified into two types: open rhinoplasty and closed rhinoplasty.
  • The primary difference between the two is that the open rhinoplasty requires a very small incision along the vertical segment of tissue separating the two nostrils.
  • Generally speaking, the more extensive the work that is required, the more likely the need for an open Rhinoplasty
  • In both types of surgeries, the skin and soft tissues are elevated from the underlying cartilage and bone so that these might be trimmed or in some cases augmented to the appropriate dimensions. Once the changes have been made to the cartilage and bone, the skin and soft tissues are allowed to re-drape over the new framework.
  • The thinner the skin, the more likely it will re-drape over the new framework and allow the changes of the new structure to manifest.
  • In general, thin skin is more favorable in rhinoplasty procedures than thick skin. However, in cases where the skin is excessively thin, any slight irregularities in the cartilage or bone may be visible externally.
  • Thick skin does not re-drape back as easily as the thin skin. This can pose limitations in the changes that may be achievable within the nose. This is especially true along the nasal tip where thick skin can significantly limit the extent of achieving tip definition.
  • Depending on the degree of surgical correction necessary, the procedure may be performed under local anesthesia with IV sedation (twilight anesthesia) or general anesthesia.
  • In extensive rhinoplasty cases or when patients are very apprehensive, general anesthesia is recommended.
  • There will be swelling and bruising. Both will become worse over the first 48 hours after surgery.
  • The swelling occurs along the nasal tip, both eyes and the forehead. The only part of the nose that is not noticeably swollen is the part covered by the nasal splint as this provides pressure and minimizes swelling.
  • The bruising accumulates along the eyes.
  • Most patients will have an aching sensation in the nose for the first few days following surgery. Some may even report a mild headache. The prescribed pain medication should be sufficient to alleviate the pain.
  • The nasal splint and tape will be removed approximately one week following surgery. When the splint is removed patients may see the new shape of the nose. There will be a fair amount of swelling through the nasal tip as well as across the bridge. This subsides over the subsequent two to three months.
  • It will take approximately one year to see the final appearance of the nose.
  • Although a Rhinoplasty accomplishes permanent changes in the nose, it is normal to expect the nose to change with age even in those who have never had nasal surgery. This is also true after nasal surgery.
  • As we age, we lose fat throughout our face, including the nose. Similarly, the natural thinning of our bones and decrease in the strength of supporting structures leads to drooping of the nasal tip.
  • The extent to which these changes become noticeable depends upon the starting point of the nose in terms of bony support, thickness of the skin, and prominence of the cartilage. The thinner the skin and the more prominent the cartilage, the more noticeable these changes will become.
  • Once the face has completed growing, it is safe to consider a rhinoplasty. Usually, after completion of puberty the facial features have reached their adult relative proportions. As such, it is safe to consider rhinoplasty in girls after 14 or 15 years of age and in boys after 15 or 16 years of age.
Illustrations of Procedure