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If you're considering
nose plastic surgery...
Rhinoplasty, or surgery to reshape the nose, is
one of the most common of all plastic surgery procedures.
Rhinoplasty can reduce or increase the size of your
nose, change the shape of the tip or the bridge,
narrow the span of the nostrils, or change the angle
between your nose and your upper lip. It may also
correct a birth defect or injury, or help relieve
some breathing problems.
If you're considering rhinoplasty, this information
will give you a basic understanding of the procedure-when
it can help, how it's performed, and what results
you can expect. It can't answer all of your
questions, since a lot depends on the individual
patient and the surgeon. Please ask your surgeon
about anything you don't understand.
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The best candidates
for nose plastic surgery
Rhinoplasty can enhance your appearance and your
self-confidence, but it won't necessarily change
your looks to match your ideal, or cause other people
to treat you differently. Before you decide to have
surgery, think carefully about your expectations
and discuss them with your surgeon.
The best candidates for rhinoplasty are people
who are looking for improvement, not perfection,
in the way they look. If you're physically healthy,
psychologically stable, and realistic in your expectations,
you may be a good candidate.
Before surgery, these rhinoplasty
patients have large, slightly hanging
noses, with a hump and an enlarged tip.
Rhinoplasty can be performed to meet aesthetic
goals or for reconstructive purposes-to correct
birth defects or breathing problems.
Age may also be a consideration. Many surgeons
prefer not to operate on teenagers until after they've
completed their growth spurt-around 14 or 15 for
girls, a bit later for boys. It's important to consider
teenagers' social and emotional adjustment, too,
and to make sure it's what they, and not their parents,
really want.
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All nose surgery
carries some uncertainty and risk
When rhinoplasty is performed by a qualified plastic
surgeon, complications are infrequent and usually
minor. Nevertheless, there is always a possibility
of complications, including infection, nosebleed,
or a reaction to the anesthesia. You can reduce
your risks by closely following your surgeon's instructions
both before and after surgery.
After surgery, small burst blood vessels may appear
as tiny red spots on the skin's surface; these are
usually minor but may be permanent. As for scarring,
when rhinoplasty is performed from inside the nose,
there is no visible scarring at all; when an "open"
technique is used, or when the procedure calls for
the narrowing of flared nostrils, the small scars
on the base of the nose are usually not visible.
In about one case out of ten, a second procedure
may be required-for example, to correct a minor
deformity. Such cases are unpredictable and happen
even to patients of the most skilled surgeons. The
corrective surgery is usually minor.
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Planning your
nose surgery
Good communication between you and your physician
is essential. In your initial consultation, the
surgeon will ask what you'd like your nose to look
like, evaluate the structure of your nose and face,
and discuss the possibilities with you. He or she
will also explain the factors that can influence
the procedure and the results. These factors include
the structure of your nasal bones and cartilage,
the shape of your face, the thickness of your skin,
your age, and your expectations.
Your surgeon will also explain the techniques and
anesthesia he or she will use, the type of facility
where the surgery will be performed, the risks and
costs involved, and any options you may have. Most
insurance policies don't cover purely cosmetic surgery;
however, if the procedure is performed for reconstructive
purposes, to correct a breathing problem or a marked
deformity, the procedure may be covered. Check with
your insurer, and obtain pre-authorization for your
surgery.
Be sure to tell your surgeon if you've had any
previous nose surgery or an injury to your nose,
even if it was many years ago. You should also inform
your surgeon if you have any allergies or breathing
difficulties; if you're taking any medications,
vitamins, or recreational drugs; and if you smoke.
Don't hesitate to ask your doctor any questions
you may have, especially those regarding your expectations
and concerns about the results.
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Preparing for
your nose surgery
Your surgeon will give you specific instructions
on how to prepare for surgery, including guidelines
on eating and drinking, smoking, taking or avoiding
certain vitamins and medications, and washing your
face. Carefully following these instructions will
help your surgery go more smoothly.
While you're making preparations, be sure to arrange
for someone to drive you home after your surgery
and to help you out for a few days if needed.
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Where your
nose surgery will be performed
Rhinoplasty may be performed in a surgeon's office-based
facility, an outpatient surgery center, or a hospital.
It's usually done on an outpatient basis, for cost
containment and convenience. Complex procedures
may require a short inpatient stay.
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Types of anesthesia
for nose plastic surgery
Rhinoplasty can be performed under local or general
anesthesia, depending on the extent of the procedure
and on what you and your surgeon prefer.
With local anesthesia, you'll usually be lightly
sedated, and your nose and the surrounding area
will be numbed; you'll be awake during the surgery,
but relaxed and insensitive to pain. With general
anesthesia, you'll sleep through the operation.
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The surgery
Rhinoplasty usually takes an hour or two, though
complicated procedures may take longer. During surgery
the skin of the nose is separated from its supporting
framework of bone and cartilage, which is then sculpted
to the desired shape. The nature of the sculpting
will depend on your problem and your surgeon's preferred
technique. Finally, the skin is redraped over the
new framework.
If your nostrils are too wide, the surgeon
can remove small wedges of skin form
their base, bringing them closer together.
Many plastic surgeons perform rhinoplasty from
within the nose, making their incision inside the
nostrils. Others prefer an "open" procedure, especially
in more complicated cases; they make a small incision
across the columella, the vertical strip of tissue
separating the nostrils.
Incisions are made inside the nostrils
or at the base of the nose, providing
access to the cartilage and bone, which
can then be sculpted into shape.
When the surgery is complete, a splint will be
applied to help your nose maintain its new shape.
Nasal packs or soft plastic splints also may be
placed in your nostrils to stabilize the septum,
the dividing wall between the air passages.
The surgeon removes the hump using a
chisel or a rasp, then brings the nasal
bones together to form a narrower
bridge. Cartilage is trimmed to reshape
the tip of the nose.
Trimming the septum improves the
angle between the nose and upper lip.
After your
nose surgery
After surgery-particularly during the first twenty-four
hours-your face will feel puffy, your nose may ache,
and you may have a dull headache. You can control
any discomfort with the pain medication prescribed
by your surgeon. Plan on staying in bed with your
head elevated (except for going to the bathroom)
for the first day.
You'll notice that the swelling and bruising around
your eyes will increase at first, reaching a peak
after two or three days. Applying cold compresses
will reduce this swelling and make you feel a bit
better. In any case, you'll feel a lot better than
you look. Most of the swelling and bruising should
disappear within two weeks or so. (Some subtle swelling-unnoticeable
to anyone but you and your surgeon-will remain for
several months.)
A little bleeding is common during the first few
days following surgery, and you may continue to
feel some stuffiness for several weeks. Your surgeon
will probably ask you not to blow your nose for
a week or so, while the tissues heal.
If you have nasal packing, it will be removed after
a few days and you'll feel much more comfortable.
By the end of one or, occasionally, two weeks, all
dressings, splints, and stitches should be removed.
A splint made of tape and an overlay
of plastic, metal, or plaster is applied
to help the bone and cartilage of the
nose maintain their new shape.
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Getting back
to normal after nose surgery
Most rhinoplasty patients are up and about within
two days, and able to return to school or sedentary
work a week or so following surgery. It will be
several weeks, however, before you're entirely up
to speed.
Your surgeon will give you more specific guidelines
for gradually resuming your normal activities. They're
likely to include these suggestions: Avoid strenuous
activity (jogging, swimming, bending, sexual relations-any
activity that increases your blood pressure) for
two to three weeks. Avoid hitting or rubbing your
nose, or getting it sunburned, for eight weeks.
Be gentle when washing your face and hair or using
cosmetics.
You can wear contact lenses as soon as you feel
like it, but glasses are another story. Once the
splint is off, they'll have to be taped to your
forehead or propped on your cheeks for another six
to seven weeks, until your nose is completely healed.
Your surgeon will schedule frequent follow-up
visits in the months after surgery, to check on
the progress of your healing. If you have any unusual
symptoms between visits, or any questions about
what you can and can't do, don't hesitate to call
your doctor.
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Your new look
after nose surgery
In the days following surgery, when your face
is bruised and swollen, it's easy to forget that
you will be looking better. In fact, many patients
feel depressed for a while after plastic surgery-it's
quite normal and understandable.
Rest assured that this stage will pass. Day by
day, your nose will begin to look better and your
spirits will improve. Within a week or two, you'll
no longer look as if you've just had surgery.
Still, healing is a slow and gradual process. Some
subtle swelling may be present for months, especially
in the tip. The final results of rhinoplasty may
not be apparent for a year or more.
After surgery, the patient has a smaller
nose, a straighter bridge, a well defined
nasal tip, and an improved angle
between the nose and upper lip.
In the meantime, you might experience some unexpected
reactions from family and friends. They may say
they don't see a major difference in your nose.
Or they may act resentful, especially if you've
changed something they view as a family or ethnic
trait. If that happens, try to keep in mind why
you decided to have this surgery in the first place.
If you've met your goals, then your surgery is a
success.
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© Copyright American Society of Plastic Surgeons
Nose Faqs
Below are links to the answers to some of the
most frequently asked questions about nose plastic
surgery, or rhinoplasty.
What will
my nose look like after surgery?
In general, rhinoplasty, or cosmetic surgery of
the nose, is designed to reduce excess cartilage
and bone in the nose, removing irregularities and
bumps to give a straightened, smooth and, usually,
smaller appearance. Adding tissue to enhance certain
features of the nose can also occur.
The overall trend in modern rhinoplasty is away
from over-reduction of tissue which can reduce the
ability to breath through the nose and towards individualized
treatment of each segment of the nose to give a
balanced and refined look without compromising function.
How long does
nose plastic surgery last and what kind of anesthesia
is used?
Usually, rhinoplasty takes from one to three hours
depending on the complexity of the condition of
the nose.
Most patients have sedation prior to and during
the procedure while some patients request a general
anesthesia.
Nearly all rhinoplasty operations are done as outpatient
surgeries.
Is there a
lot of bruising after nose plastic surgery and how
long will it last?
How much bruising occurs after nose surgery depends
again on how complex the procedure is, but in general
most patients experience five to seven days of purple
discoloration and swelling around the eyes and upper
cheeks.
The nose itself will be swollen for around ten
to fourteen days or longer, but subtle resolution
of the swelling at the tip of the nose can take
many months after surgery to go away.
I have trouble
breathing through my nose and have terrible sinus
problems. Will my insurance policy pay for nose
plastic surgery (rhinoplasty)?
The condition described is usually associated with
a deviated septum or a bent internal framework of
the nose. Most of the time this results from trauma
such as a broken nose, but many patients with this
condition cannot recall an episode where this might
have occurred. The condition described in this question,
however, could also result from allergies or the
two conditions can exist simultaneously. Careful
examination is needed before surgery to separate
the two conditions.
While individual insurance policies can vary, in
general, functional surgery to improve breathing
is considered a covered benefit in many group policies.
If additional correction of a cosmetic deformity
of the nose is done at the same time, the cost of
this part of the procedure is usually not covered
by insurance.
Where are
the incisions placed during nose plastic surgery?
In general, most or all of the incisions in rhinoplasty
are hidden in the inside of the nostril.
While external incisions hidden in the creases
where the nose meets the cheek can be used to narrow
the nose, incisions on the bridge or tip are not
usually used in cosmetic surgery of the nose.
Will my nose
grow after surgery?
In general, our noses tend to elongate as we enter
the middle years of our life and drooping of the
tip of the nose can occur in the later years as
elasticity disappears from the body.
While undergoing a cosmetic rhinoplasty as a teenager
or young adult will not prevent the effects of aging
on the nose, the final shape that results from this
surgery is expected to last a lifetime and regrowth
of bumps and deformities corrected by the operation
is a rare occurrence.
If you would like to contact New York plastic surgeon
Darrick Antell, or if have any further questions
about nose surgery (rhinoplasty) or any of our plastic
surgery procedures, please use our contact
form.
Phone: (212) 988-4040
