Rhinoplasty, more commonly known as a nose job, is a popular and common procedure. It can be reconstructive, as when the surgeon repairs a broken nose. Rhinoplasty, however, is often cosmetic, and the surgeon reshapes the patient’s nose to improve its proportions and appearance.
Are There Different Types of Rhinoplasty?
Yes. There are two main types of nose jobs: open and closed. The open rhinoplasty is the older type. During an open rhinoplasty, the surgeon will make an incision along the columella, which is the strip of cartilage between the nostrils at the bottom of the nose. They will then peel back the skin to access the surgery site. While the open rhinoplasty will leave a scar, it is in a place that is not immediately visible.
Most surgeons prefer to perform the closed rhinoplasty in which all of the incisions are made inside the nose. There are thus no visible scars. The closed rhinoplasty also provides the advantages of a quicker recovery and less swelling.
What Can a Patient Expect?
The surgeon never uses general anesthesia for any of their procedures. They prefer to use sedation anesthesia which is administered through an IV. The patient will not need to inhale any gases, and they won’t need a breathing tube.
The exact procedure will depend on what is being done. A patient may undergo a rhinoplasty to do the following:
- Remove humps or bumps from the bridge of the nose
- Correct nostrils that are upturned, wide, or large
- Correct a nasal tip that is large, bulbous, upturned, hooked, or drooping
- Change the size of the nose so it is proportionate with the face
- Change the shape of the nose so that it is symmetrical
In some cases, the surgeon will remove excess cartilage and done. In other cases, they may use cartilage grafts. The surgeon will then close the incisions.
A rhinoplasty can take one to four hours, depending on what needs to be done. For example, if the patient wants their nose augmented, the surgeon will have to harvest the needed cartilage from another part of the body.
After completing the procedure, the surgeon will use splints to hold the nose in place and protect it from injury. They won’t use any nasal packing, however. Nasal splints are often made of silicone or aluminum, and they can be internal or external. Internal splints are placed in the nasal cavities, while external splints are placed outside the nose. The latter are more common. The surgeon will use tape to hold the external splints in place.
Nasal splints help the recovering patient by preventing swelling and the development of hematomas. They also keep the nasal passages open and thus help the patient breathe more easily.
The surgeon will remove the nasal splint around the sixth day after the operation, and the patient will be able to resume their usual activities.
What Is Revision Rhinoplasty?
Revision rhinoplasty is a procedure done to correct the results of an earlier and unsuccessful rhinoplasty. Despite their popularity and ubiquity, nose jobs are actually challenging procedures. The surgeon has to make certain that they don’t impair the patient’s ability to breathe easily through their nose while trying to improve their appearance. In addition, no two rhinoplasties are identical, for different patients have different needs and wants, and noses vary widely in size, shape, proportion, and so forth. It is thus unfortunately easy for something to go wrong.
Revision rhinoplasties are even more difficult to perform than regular rhinoplasties, for the surgeon has less bone and cartilage to work with, and the earlier rhinoplasty may have left scar tissue that will hamper the surgeon’s efforts. In many cases, the surgeon will have to harvest cartilage from another part of the patient’s body to use in restructuring their nose.
Is There an Age Limit?
Patients undergoing cosmetic rhinoplasty need to be at least 15 years old. By that age, the nose will have reached its adult size.
Who Is a Good Candidate for Rhinoplasty?
In addition to being at least 15 years old, a good candidate for a rhinoplasty needs to be in good overall health and have realistic expectations. For example, they need to realize that the surgeon can’t make them look like their favorite movie star and that a nose job won’t make them more popular or otherwise change their life.
A patient who shows signs of body dysmorphic disorder is not a good candidate. Body dysmorphic disorder is a psychological condition in which the patient is obsessed with a perceived physical flaw. They believe themselves to be ugly and often spend hours out of every day brooding about their defect. A person with the disorder may turn to cosmetic surgery to correct their appearance. While the surgery may momentarily make them feel better, their anxiety and dissatisfaction will soon return. Consequently, a person with body dysmorphic disorder will try to undergo multiple procedures. The late Michael Jackson is sometimes said to have had body dysmorphic disorder, and he is believed to have undergone many cosmetic operations, including several nose surgeries.
How Should the Patient Prepare?
Before accepting someone as a candidate for nose surgery, the doctor will want to take a medical history and order lab tests like X-rays and blood tests to ensure the patient is healthy enough to withstand surgery.
Anybody who smokes needs to quit at least two weeks before undergoing rhinoplasty since nicotine can increase bleeding. Similarly, the patient should stop taking herbal supplements and non-steroidal anti-inflammatory drugs (NSAIDs) a few weeks before the procedure.
Since the patient will be groggy from the IV sedation, they should have somebody take them home. They should also arrange to have someone stay with them for at least the first day after the procedure.
What Is the Recovery Like?
The patient should rest in bed with their head elevated above their chest to reduce swelling and bleeding. They will generally have to wear splints and dressings for about a week. The surgeon may also place a “drip pad” under their nose to absorb any blood or mucus draining out of the nose. They will advise the patient on how and when to change it.
The doctor may recommend a variety of precautions to help the nose heal. For example, they may recommend that the patient take baths instead of showers while their nose is bandaged. The patient should not blow their nose, and they should avoid expressions like smiling that require extensive movement of the upper lip.
The patient should avoid clothing like pullover sweaters that have to be pulled over the head. They should limit themselves to button-down shirts and the like. They should let their sunglasses or spectacles rest on their nose for at least four weeks after the surgery to avoid putting pressure on their nose. If they need to wear glasses, they should tape them to their forehead or use cheek rests.
The patient should use a sunscreen with an SPF of at least 30 when outside. Otherwise, the sun could permanently discolor the skin of the nose.
While most of the swelling will go down within the first few weeks after the procedure, it may take as long as a year for the results of the rhinoplasty to become apparent. Consequently, the surgeon recommends waiting at least that long before undergoing a revision rhinoplasty.
What Are Turbinates?
Turbinates are bony structures in the nose that are covered by vascular tissue and a mucous membrane. They humidify and cleanse the air that passes through the nose to the lungs. Allergies and infections can make them become inflamed and swollen and thus cause nasal congestion. Doctors can use radiofrequency energy to reduce the size of the turbinates; if that doesn’t have the desired results, the patient may need surgery.
What Are Nasal Polyps?
Nasal polyps are soft and non-cancerous growths that develop on the lining of the sinuses or nasal passages. They are caused by chronic inflammation that is in turn caused by allergies, asthma, recurrent infections, some immune disorders, or reactions to certain drugs.
Nasal polyps are painless, and small ones might not cause any problems. Larger nasal polyps, however, can cause breathing difficulties, frequent infections, and a diminished sense of smell. Various medications can be prescribed to shrink nasal polyps, but if they don’t work, the patient may need surgery. The operation for removing nasal polyps is usually an outpatient procedure.
What Is a Saddle Nose?
A saddle nose, which is also called a boxer’s nose, is a nose with a concave or flattened bridge. It can be caused by injury, cocaine use, or certain diseases. It can be accompanied by problems like sinusitis and an impaired sense of smell. The patient will need nose augmentation surgery to give them a higher bridge.
What Is a Cleft Lip?
A cleft lip is a very common birth defect in which there is not enough tissue to properly form the lip. It can range in severity from a barely noticeable notch in the lip to a cleft that extends all the way up to the nose. A cleft lip can also affect just one side of the lip (unilateral) or it can affect both sides (bilateral). A patient with cleft lip may also have problems affecting their nose like a deviated septum, oversized turbinates, or blocked nasal passages.
To learn more about rhinoplasty and the other services we offer, feel free to visit Palmer Cosmetic Surgery. We are conveniently located in Fort Lauderdale, FL, and our educated staff would be more than happy to answer any questions you may have. Contact us today to schedule your consultation!