Rhinoplasty: nose surgery

Dr Mark Kohout
Thursday, October 13, 2005

What is rhinoplasty?
Rhinoplasty, more commonly known by the unflattering moniker "nose job", is an operation designed to change the appearance of your nose.

There are several components to your nasal shape that you may wish altered in some way, such as the profile from the side view, the length or width, or the shape of the tip. Rhinoplasty, can improve the shape, size and general appearance of your nose. The goal is a nose that looks natural and achieves a harmonious balance with your other facial features The changes you wish to achieve may require altering the bones, the lining of the nasal passageways or even the skin covering. It is important to be clear about the changes you want and to agree with your surgeon on realistic goals before surgery. Digital imaging can improve the communication between you and the surgeon. It is important that you can tell the surgeon what you would like to see and also that the surgeon is able to demonstrate visually what surgery can achieve.

Is rhinoplasty for me?
Assuming you are in good health, there is no upper age limit for having your nose reshaped. Rhinoplasty can alter the nasal profile, change the angle between the nose and upper lip and reshape the nasal tip. Alterations can be made to decrease the nasal bridge and reduce the size of the nose. The results of rhinoplasty enhance the balance between the nose and other facial features.

Sometimes certain breathing problems related to the internal nasal structures can be corrected at the same time as nose reshaping is performed. Your plastic surgeon will be able to help you determine whether these structures should be modified along with reshaping your nose.

Any of the following conditions may make you a candidate for rhinoplasty:

  • You have a hump on the nasal bridge seen from profile.
  • Your nasal bridge is too low.
  • Your nose looks too wide seen from the front
  • Your nose looks too small or too large for your face
  • The nasal tip droops
  • The nasal tip is thickened or enlarged
  • Your nostrils are excessively flared
  • Your nose is off-center or crooked
  • Previous injury has made your nose asymmetrical
  • You have breathing difficulty because of previous injury

The initial consultation
It is important that you have a clear idea of how you would like your nose to look and, at the same time, realise that there are limitations to the procedure. During the initial consultation, you may be asked to point out exactly what you would like to see improved. This will help your plastic surgeon to understand your expectations and determine whether they can be realistically achieved.

Your plastic surgeon may also ask whether you have difficulty breathing through your nose, suffer from allergies that may cause nasal stuffiness, or are a chronic user of nasal sprays. Your plastic surgeon will examine your internal nasal structures. Your skin quality as well as the size and shape of your nose and its relationship to your other facial features will be carefully studied.

Preoperative photographs may be taken during your initial consultation or a subsequent visit. Your surgeon will discuss with you the details of the operation and the possible risks and complications associated with the procedure. Digital photos will also be taken and altered to demonstrate the possible result of the reshaping.

Does Medicare and private insurance cover rhinoplasty?
While most insurance plans will not pay for aesthetic nose reshaping, they frequently will cover surgery performed on the internal structures of the nose to improve breathing problems. Nasal deformities from trauma or birth defects are also covered by Medicare and private funds. Your plastic surgeon can discuss this with you at the time of your consultation.

Your operation
The operation is usually performed in a hospital under general anaesthetic. Usually rhinoplasty involves an overnight stay in hospital. It is possible for the surgery to be done on a day surgery basis if you wish. You may experience some discomfort over the next two to three days. Pain relief will be prescribed for this time.

In most instances, all of the incisions will be placed inside your nose, so they will not be visible from the outside. However, it may be necessary to place a small external incision across the vertical strip of tissue that separates the nostrils, called the colurnella if your surgeon feels this offers the best way of correcting your problem. This technique is called an "open rhinoplasty". Whatever incisions are used to reshape your nose, they will ultimately be very inconspicuous.

Alterations may be made to increase or decrease the height of the nasal bridge, reduce the width of the nose, narrow the nostrils, change the angle between the nose and upper lip, or reshape the tip. If the base of the nose is narrowed or the nostrils reduced, small wedges of skin at the base of the nostrils may be removed. Through the small incisions described previously, work is done on the cartilage and bone that form the framework of your nose. Sometimes, the position of nasal bones may need to be changed to make your nose look narrower and straighter. If your nose needs to be built up in some areas. this can be done using nasal cartilage, or perhaps bone or cartilage from another site. The skin and soft tissues then redrape themselves over this new scaffolding.

The exact procedures will be worked out by your surgeon prior to the operation.

How long does the operation take?
The operation takes one and a half to three hours, depending on the complexity of the procedure.

The subject of risks and potential complications of surgery is best discussed on a personal basis between you and your plastic surgeon. You can help to minimise certain risks by following the advice and instructions of your plastic surgeon, both before and after your surgery.

After surgery
After the operation, there will be packs in both your nostrils and a splint or plaster on your nose. Your nose will feel stuffy and there will be swelling and bruising around your eyes. Minor oozing is not uncommon and the nasal packs used overnight following the procedure are intended to control this. Generally, bruising around the eyes and cheeks is most apparent during the first three days following surgery.

In the first week after surgery, you should restrict your activities and sleep with your head elevated. Also, make certain you do not bend, strain or lift anything heavy. This will help to minimise swelling and reduce the possibility of minor bleeding, which is not uncommon. Remember, you must not take aspirin or certain anti-inflammatory medications as these increase the likelihood of bleeding.

Most bruising will disappear within two weeks. A few days after surgery, you can begin to use make-up as a concealer, if desired. Although most of the swelling subsides in four to six weeks, there continues to be some swelling that may take six months or longer to subside. Swelling inside the nose can persist for several weeks and cause nasal stuffiness. It is important to keep in mind that improvement in appearance rather than perfection is the goal of surgery.

After surgery, you will return to your plastic surgeon's office for follow-up care at prescribed intervals, at which time your progress can be evaluated. Post-operative photographs will form a part of the evaluation of your result. Once the immediate postoperative follow-up is complete, many surgeons encourage their patients to come back for periodic check-ups to observe and discuss the long-term results of surgery.

Please remember that the relationship with your plastic surgeon does not end when you leave the operating room. If you have questions or concerns during your recovery, or need additional information at a later time, you should contact your surgeon.

When can I resume my normal activities?
Generally speaking you will be able to engage in social contact by the second week following surgery. It is important for you not to over-exert during the healing period to prevent bleeding which may require repacking of the nose.

In many instances, you may be able to return to work within a week or ten days after surgery, depending on the extent of surgery and your occupation. Walking can be resumed immediately after surgery and most other normal activities including exercise can usually be resumed within three weeks.

Dr Mark Kohout FRACS
Plastic Surgeon
Ph: 1300 551 151
Leichhardt — Bondi Junction — Orange NSW

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