The Rhinoplasty

The nose is located in the middle of the face and affects significantly the other structures on the face. For this reason, Rhinoplasty has become one of the most commonly used cosmetic surgery. If a person is upset by one or more of the following problems about the shape of his/her nose, he/she may consider surgery:

• Arched nose
• Curved nosed
• Drooping nose tip
• Long nose tip
• Wide and large nose tip
• Narrow nose
• Flattened nose tip

The goal of Rhinoplasty is to provide the patient with a symmetric, natural-looking nose in proportion with his/her face which performs its function a healthy way. A beautiful nose will also reveal other contours of the face.

How is Rhinoplasty performed?

First medications are administrated for the comfort of the patient during the surgical procedure, most of the time, general anesthesia is chosen by the surgeon. Secondly, Rhinoplasty is performed either using a closed procedure, where incisions are hidden inside the nose, or an open procedure, where an incision is made across the columella, the narrow strip of tissue that separates  the nostrils. Through these incisions, the skin that covers the nasal bones and cartilages is gently raised, allowing access to reshape the structure of the nose. And then, the surgeon starts to reshape the nose structure. An overly large nose may be reduced by removing bone and cartilage. Sometimes surgery of the nose may require the addition of cartilage grafts. Most commonly, cartilage from the septum, the partition in the middle of the nose, is used for this purpose. Occasionally cartilage from the ear or rarely a section of rib cartilage can be used. If the septum is deviated, it can be straightened and the projections inside the nose reduced to improve breathing. Finally, and once the underlying structure of the nose is sculpted to the desired shape, nasal skin and tissue is redraped and incisions are closed. Additional incisions may be placed in the natural creases of the nostrils to alter their size.

Immediately after Rhinoplasty: what should the patient expect?

• Mild to moderate pain.
• Swelling and bruising, mainly around the eyes- the swelling should go down in a few days and the bruising may go away within the first or two first weeks.
• The sensation of a stuffy or blocked nose.
• Numbness
• Dressings and splints being used to support healing. The inside of the nose will be packed with special gauze. The nose bridge will be covered with a splint, commonly made of plaster of Paris. The splint helps to minimize swelling and keep the nose in its new profile while healing takes place. Sometimes, a small piece of tape may be placed over the nose to keep the dressings in place.

After the first few hours:

• The patient can get up out of the bed and move around.
• The patient should be able to eat anything she/he likes. Of course, in case of general anesthesia should wait four or five hours before she/he will be able to eat and drink.

Self-care after Rhinoplasty

The surgeon will provide the patient with post-operative care instructions, such as:

• Reporting any bleeding, severe pain or unusual symptoms to the medical practitioner, including sudden nosebleeds.
• Pain management
• Wound care.
• Medications to take home from hospital (patient should be sure what they are for, how frequently they should be taken and for how long she/he has to take them. If the patient is prescribed antibiotics, she/he makes sure to take the whole course.

General self-care suggestions may include:

• Not blowing or rubbing your nose for a minimum of eight weeks, patient should sneeze and cough with the mouth open.
• It is advised to take baths instead of showers while the patient has bandages on his/her nose.
• Patient should avoid certain facial expressions, such as smiling or laughing.
• Patient should eat high-fiber foods, such as fruits and vegetables, to keep from getting constipated. Constipation can cause the patient to push hard, putting pressure on the surgery site.
• Patient should brush his/her teeth gently to keep the upper lip from moving.
• Patient should wear clothes that fasten in the front. Clothes should not be pulled such as shirts or sweaters over the head.
• Avoiding heavy lifting, strenuous exercise, swimming and sports until advised by the medical practitioner.
• Patient should hold his/her nose upright as much as possible.
• In addition, eyeglasses or sunglasses should not rest on the nose for at least four weeks after the surgery. They can put pressure on the nose.
• Patient should use SPF 30 sunscreen when he/she is outside, especially on the nose. Too much sun may cause permanent discoloration on the skin of the nose.

Short-term outlook following Rhinoplasty

The bandages and packing gauze may be left in place for up to a week or so. The surgeon will then remove the dressing and take out the nasal packs. The patient need to be off work for around two weeks.

Long-term outlook following Rhinoplasty

Swelling may come and go and may be worse in the mornings in the first year following the nose surgery. The results of Rhinoplasty are usually permanent. The patient will be able to see the difference in his/her nose shape as soon as the surgeon removes the dressing and nasal packs, approximately seven days after the surgery. However, it is important to realize that the new nose may take time to fully refine.

Even though initial swelling subsides within a few weeks, it may take up to one year to adjust to its final profile. During this time, the patient may notice gradual changes in its appearance of his/her nose as it refines to a more permanent outcome.