Plastic and Reconstructive Surgery of the Nose
Plastic surgery can improve the appearance as well as the function of the nose. The surgeon precisely removes excess bone and cartilage, reshaping or “sculpturing” the nose. This operation is performed for many reasons: to make a more attractive nose; to repair defects from an injury; or to correct an internal deformity which blocks normal breathing or causes headaches and repeated sinus infections. Just as people differ, so every nose is different; a nose may be too long, too wide, or even crooked. Every nasal operation is different as well. The alterations we recommend will be dependent upon your sex, age, skin thickness, and complexion. The goal of surgery is to carefully tailor your nose, creating a natural look that doesn’t have an “operated” appearance. Before your surgery, we will perform a complete facial analysis, including the examination of photographs. The operation is planned in much the same way an architect plans a house; careful analysis and a thorough discussion with the patient is the key. The desired result of cosmetic nasal surgery is to “create” a nose which is in harmony with the other facial features. Occasionally, it is necessary to recommend additional procedures, such as chin augmentation, to adequately improve your profile. At what age can rhinoplasty be performed? We always prefer to wait until the nose has reached full “mature” growth. In a female, this is approximately age 15 to 16, in a male 17 to 18. However, if a severe deformity secondary to an injury were present, corrections would be performed at an earlier age.
Depending upon your nasal deformity and general health, the surgery can be performed in our office surgery suite or a hospital. We will use either a general anesthetic in which you sleep through the operation or a local anesthetic with intravenous sedation. We will discuss the benefits and risks of each with you to aid in your decision. We do ask you to come to the office/hospital several hours before your surgery is scheduled. Medications are given before the operation to help prevent infection, promote healing, and reduce swelling after the surgery. You can expect the operation to last 1½ to 2½ hours. In general, you should expect to have no scars on the outside of your nose. Sometimes, when performing a major correction or in a case of significant deviation secondary to injury, a small incision is placed under the tip of the nose to provide better visualization. Also, when narrowing of the nostrils is desired, we place incisions in the crease between the nostrils and the cheek, resulting in small scars that heal rapidly and become inconspicuous within a short time.
Following your surgery, we will place an adhesive splint over your nose and a small amount of soft gauze into each nostril to support the new nasal contour. Because the use of standard “packing” is avoided, much of the swelling, discoloration, and pain is reduced, making the recovery period much more pleasant for the patient. For the first day, you will need to apply cold compresses to your nose and keep your head elevated in an upright position. You will be discharged from the office/hospital several hours following your surgery. Occasionally we may suggest an overnight stay if you need additional observation or care. Upon your discharge, we will give you a complete list of instructions to aid your healing, and we will schedule your return office appointment. Typically, you should not expect a lot of pain during the healing period. We can, of course, prescribe pain medications if they are needed. You will experience the most swelling and bruising 48-72 hours following surgery. The bruising typically resolves ten days to two weeks after your operation. Most of the swelling will be gone in three weeks, although a minimal amount of swelling can last for up to one year. Your nose will feel stuffy at first, but this should clear up in two to four weeks. The use of an antihistamine/decongestant is OK following one week. We will remove the external splint from your nose a week after your surgery. Your nose may appear swollen or turned up too much at first. This is caused by fluid collecting in the soft tissues of your lip and the tip of your nose. This will gradually improve. Thicker and oilier skin will require more time for the swelling to subside. You may be able to return to work or school after one week, but you should no exert yourself for two weeks following surgery. This includes any exercise that results in an elevation of the heart rate or blood pressure-aerobics, jogging, bicycle riding, weightlifting, and the like. You should not play any contact sports for two months. Try to avoid hitting or bumping your nose. We do ask you to return for periodic check-ups during the first year following your surgery. This will give us a chance to assess your healing and provide you the opportunity to ask questions.
Several factors may limit the amount of improvement you experience following plastic surgery on your nose. These limitations include the thickness of your skin, the initial amount of deformity, previous nasal surgery, and the extent of internal obstruction. There is obviously a limit as to how much a very large nose can be reduced in size or a wide nose can be narrowed. Slight contour irregularities that are apparent only to the patient and physician may be present after an operation and often disappear during healing.
Our goal is improvement in appearance and function. A nose that has been severely injured or is markedly deformed may require more than one operation. This may be delayed six months to one year following the initial procedure.