Rhinoplasty

What is rhinoplasty?

Rhinoplasty enhances facial harmony and the proportions of your nose. It can also correct impaired breathing caused by structural defects in the nose.

Rhinoplasty surgery can change:

·         Nose size in relation to facial balance

·         Nose width at the bridge or in the size and position of the nostrils

·         Nose profile with visible humps or depressions on the bridge

·         Nasal tip that is enlarged or bulbous, drooping, upturned or hooked

·         Nostrils that are large, wide, or upturned

·         Nasal asymmetry

If you desire a more symmetrical nose, keep in mind that everyone’s face is asymmetric to some degree. Results may not be completely symmetric, although the goal is to create facial balance and correct proportion.

Rhinoplasty to correct a deviated septum

Nose surgery that’s done to improve an obstructed airway requires careful evaluation of the nasal structure as it relates to airflow and breathing.

Correction of a deviated septum, one of the most common causes of breathing impairment, is achieved by adjusting the nasal structure to produce better alignment.

Surgery Overview

Rhinoplasty is surgery to reshape the nose. It can make the nose larger or smaller; change the angle of the nose in relation to the upper lip; alter the tip of the nose; or correct bumps, indentations, or other defects in the nose.

During rhinoplasty, the surgeon makes incisions to access the bones and cartilage that support the nose. The incisions are usually made inside the nose so that they are invisible after the surgery. Depending on the desired result, some bone and cartilage may be removed, or tissue may be added (either from another part of the body or using a synthetic filler). After the surgeon has rearranged and reshaped the bone and cartilage, theskin and tissue is redraped over the structure of the nose. A splint is placed outside the nose to support the new shape of the nose as it heals.

Rhinoplasty may be done using general or local anesthesia. It is usually done as an outpatient procedure but sometimes requires a 1-night stay in the hospital or surgery center.

Surgeons who do rhinoplasties typically have training in either plastic surgery, otolaryngology (ear, nose, and throat specialty), or both.

 

What To Expect After Surgery

The splint and bandaging around your nose will be removed in about a week.

Your face will feel puffy and the area around your eyes and nose will be bruised and swollen for several days. Cold compresses can help minimize the swelling and reduce pain. Your doctor may also recommend pain medicine. It takes about 10 to 14 days before most of the swelling and bruising improves.

You may need to keep your head elevated and relatively still for the first few days after surgery. It may be several weeks before you can return to strenuous activities.

 I a candidate for cosmetic nose surgery (rhinoplasty)?

Cosmetic nose surgery is a highly individualized procedure, with the best results achieved through a thorough consultation with your cosmetic surgeon. While almost any physical change is possible through nose surgery, a cosmetic surgeon from a Cleveland Clinic Cosmetic & Plastic Surgery Center will be able to recommend the best approach to achieve a balanced result based on your nose’s unique characteristics as they relate to the context of the entire face.

The best candidates for nose surgery include:

·         Individuals whose facial growth is complete; generally, surgery is performed on individuals age 18 or older

·         Individuals who are physically healthy

·         Individuals with a positive outlook and specific, but realistic goals in mind for the improvement of their appearance

How do I prepare for cosmetic nose surgery (rhinoplasty)?

Preparing for your nose surgery at a Cleveland Clinic Cosmetic & Plastic Surgery Center  may include:

·         Lab testing or a medical evaluation

·         Taking photos of your nose to allow for computer images to demonstrate potential post-operative results

·         Taking certain medications or adjusting your current medications

·         Stopping smoking well in advance of surgery

·         Avoiding taking aspirin, anti-inflammatory drugs and herbal supplements due to increased risk of bleeding

What are the different types of cosmetic nose surgery (rhinoplasty)?

The two primary types of rhinoplasty include "open" and "closed," though there are other types of cosmetic nose surgery:

·         Open Rhinoplasty is used for major nose reshaping. Incisions are made in the vertical strip of skin separating the nostrils, called the columella. The skin and soft tissue are then lifted off the underlying structures of the nose so the surgeon can see the nasal anatomy.

·         Closed Rhinoplasty is used for minor nose reshaping. Incisions can be made within the nose. The skin of the nose is then separated from the bone and cartilage, which form its supporting framework. Once exposed, bone and cartilage can be removed, reshaped, augmented or rearranged to achieve the desired new shape.

·         Secondary Rhinoplasty. Also called revision rhinoplasty, this is performed to correct problems that persist or develop after a previous nose surgery. Although the problems may be minor and easily corrected, the problems may be more complex, which makes the secondary rhinoplasty more difficult. Secondary rhinoplasty can also be done as an open or closed procedure.

·         Filler Rhinoplasty. This involves the use of injectable fillers to “fill” depressions, smooth out sharp angles or change the angle of the tip of the nose to restore symmetry. For instance, instead of removing a bump, your surgeon would use an injectable filler to make the nose more even. While effective, injectable fillers do not offer permanent results. Learn more about Injectable Fillers.

Types of Anesthesia

General anesthetic is used so that you will sleep and remain comfortable throughout the procedure. Local anesthesia with intravenous sedation is also an option for some patients.

How Well It Works

The results of rhinoplasty may be minor or significant, depending on what kind of correction you want. It is important that you and your plastic surgeon agree on the goals of the surgery. If your expectations are realistic and your plastic surgeon shares them, he or she will probably be able to give you the results you want.

The results of rhinoplasty are permanent, although subsequent injury or other factors can alter the nose's appearance. Cosmetic surgery should only be done on a fully developed nose. Complete development has usually occurred by age 15 or 16 in females and by age 17 or 18 in males. If surgery is done before this time, continued development of the nose can alter the surgical results and possibly cause complications.

Risks

You can always expect temporary swelling and bruising around the eyes and nose after rhinoplasty. Other problems that may occur include:

·         Bleeding.

·         Injury or holes to your septum (the wall that separates your nostrils).

·         Skin problems, including breakdown of skin tissue (skin necrosis) and irritation from the tape and bandaging.

·         Infection. Preventive antibiotics may be given after surgery to reduce the risk of infection.

·         Serious nasal blockage caused by swelling inside the nose.

·         Complications of anesthesia.

It is also possible that the cosmetic results of the surgery will not be what you wanted.

What To Think About

If you choose to have local anesthesia, be prepared for the sounds of your doctor working on the bones and cartilage of your nose.

One of the prominent features of the face, the nose can have a big impact on your self-image and appearance. If you're unhappy with your nose and have been so for a long time, rhinoplasty is a reasonable option to consider. As with other cosmetic procedures, you are more likely to be happy with the results of rhinoplasty if you have clear, realistic expectations about what the surgery can achieve and if you share these with your plastic surgeon.

Most insurance companies will not cover the costs of rhinoplasty unless it is being done to correct a functional problem or a defect caused by disease or injury. Even in these cases, be sure to check with your insurancecompany to find out what portion of the costs it will cover. Costs of surgery include not only the surgeon's fee but fees for the operating facility, the anesthesiologist, medicines, splints, and other services and materials.

BEFORE AND AFTER YOUR NASAL SURGERY PRIOR TO SURGERY:

In order to minimize the risks to surgery, it is mandatory that you follow these instructions: Do Not Ingest ANY of the Following for a Minimum of 10-14 Days Prior to Surgery Aspirin or Aspirin containing products Ibuprofen or similar medications (Motrin, Advil, Alleve, etc.) Ginko Biloba, Ginseng, Vitamin E supplements You Cannot Have Anything to Eat or Drink- Not Even In Small Amounts After Midnight the Night Before Your Operation An exception can be made for some prescription medications - please consult with your primary care physician and surgeon about this. You Must Have A Friend Or Family Member Drive You to the Surgical Center, as well as Drive You Home Afterward You are expected to have made these arrangements in advance. This is mandatory. You are not allowed to travel alone, nor in a cab, after your operation. You Must Make Arrangements to Have Someone with You the First 48 Hours After the Operation We will provide you with the option of contacting private duty nursing for this if you are interested. We find that many of our patients value this greatly. However, it is fine to simply have a family member with you. You are likely to require assistance with simple activities, incision care, eye care, and the like. In addition it is important to have someone available should a complication of some sort develop.

THE DAY OF SURGERY: You should wear loose and comfortable clothing that is easy to get in and out of. You will meet the anesthesiologist and nursing staff, as well as your physician and any additional team members (such as the fellow) in the morning.

AFTER THE OPERATION Keep your head elevated (the height of 2 pillows is appropriate) for 3 days to minimize swelling. Apply cold compresses to the eye and facial area after the operation until you go to sleep in the evening. You may use crushed ice, unopened bags of frozen peas, or commercial cold compress packs. Use them for 20 minutes each hour the first day and evening while you are awake. Then resume the cold compresses the next day until the evening. Following this regimen the first 48hours after surgery will help to reduce the swelling. If there are incisions on the nose begin cleaning those twice daily and additionally as needed with peroxide and antibiotic ointment. o The most favorable wound healing occurs when wounds are kept clean of crusts and moist with ointment. It is helpful to use a cotton swab to apply the ointment. Do not rub, but gently dab the incisions to clean them with peroxide and apply the ointment. It is okay to shower the day after surgery. The incision can be cleaned in the shower with warm water and soap. Reapply ointment after the shower. Keep the cast dry. If there is an incision, avoid direct sun exposure to avoid a dark scar. If there is a cast on the outside of the nose or a sutured in place ear dressing leave this in place until your follow up visit in clinic. If there are nasal packs in place, you will remove these at home 48 hours after the operation. Remove them by pulling on the black strings beneath your nose. Once the nasal packs are removed begin nasal saline spray to keep the mucous membranes moist during healing. We recommend 4 sprays to each side of the nose 4 times daily. Do not blow your nose for two weeks after surgery. Take the antibiotics and the pain medicine prescribed for you. Do not take aspirin or antiinflammatory medications for 7 days after the surgery. Resume vitamins, herbal supplements and minerals the first day after surgery. You may resume normal activities such as walking after the procedure when you feel able. Avoid strenuous exercise for three weeks. During the second week it is okay to perform nonimpact exercise like walking or stationary bike. It is okay to resume low-straining abdominals during the third week, and return to your pre-surgical exercise levels during the fourth week. You will return to your surgeon’s office 5 to 7 days after surgery. If there are sutures that do not dissolve on their own those will be removed at this time by our nurses or resident/fellow. If there is a dressing on the outside of the nose or ear it will be removed at this time. When we remove your nasal cast, your nose will be swollen and will remain so for several weeks. Initially, the nose will commonly appear larger and wider than you would prefer. This is normal. In fact, it takes at least one year for all swelling to subside. This is very important to keep in mind. While most patients have a very good appearance even 2-3 weeks after the operation, you will likely have some swelling persist for a year. Additional follow up appointments will be made for one, six, and twelve months after surgery so that we can follow your healing process. Please keep in mind that although much of the swelling resolves over the first several weeks after surgery, it takes a full year for all of the swelling in the nose to resolve.