Rhinoplasty: a guide to the nose job

Overview of Rhinoplasty surgery
Rhinoplasty is a procedure performed to make alterations to the appearance of the nose in order to enhance it. It is one of the most highly requested cosmetic surgery procedures, and is most often done to improve an individual’s appearance and boost his self-confidence. It may also be performed to correct any nasal structural abnormalities that may cause difficulty in breathing, and to correct any damage caused to the nose due to injuries. Rhinoplasty can involve narrowing the nostrils, increasing or decreasing the proportions of your nose, and reshaping the cartilage and bone to change the shape of the nose.

Eligibility for Rhinoplasty
When you consult with a plastic surgeon, he will ask you a number of questions related to your health and expectations from your surgery. He will want to know the reasons for the rhinoplasty. He will also enquire about any previous surgeries that you may have had, allergies to drugs, current physical conditions and other aspects of your health history. He will evaluate your current health condition, and look for risk factors. He will take measurements of your face and nose, and take photographs. He will discuss the kind of nose reshaping that you desire, and will inform you of any risks from the surgery.

Preparing for Rhinoplasty
Before the surgery, you have to be free from any respiratory infections, coughs and colds. Smokers will be asked to stop smoking, because it increases the risk of infection. The operation is conducted under general anesthesia, so you will be required to abstain from eating and drinking for about 6 hours before you are given anesthesia. Also, avoid taking anti-inflammatory medications or herbal supplements because they can increase the risk of bleeding. If you are currently taking medications, you may be advised to stop these or adjust the schedule.
Once you have arrived at the hospital, you will be asked to undergo a lab test. Your blood pressure and heart rate will also be checked. You may be given compression stockings to wear to prevent the formation of blood clots in your legs.

How the procedure is performed
Rhinoplasty generally takes between an hour and 90 minutes. The patient is first given sedative medication, either in the form of general anesthesia or intravenous sedation.

In the case of reduction rhinoplasty, incisions are made inside the nostrils to approach the lower half of the frame of the nose. The bone and cartilage may be rearranged or even removed to achieve the desired shape. Here, the skin that covers the nose is not touched in any way – it simply adjusts to the new shape of the nose. Occasionally, a procedure called open rhinoplasty may be performed, where incisions are made between the nostrils.

In the case of augmentation rhinoplasty, the surgeon will make incisions either in the skin between the nostrils, or inside the nostrils, to access the bone and cartilage. This bone and cartilage is then rearranged to give the desired shape to the nose. If you need a graft to bulk up the nose, the surgeon may take cartilage from your ears, while bone may be taken from a rib or the hip bone. Artificial implants may also be used. Incision sutures are dissolvable, which means that you don’t need to get them removed by the surgeon.

Post-surgery care
You may be given pain relief medication to remove any pain resulting from the surgery. You will be required to spend a night in the hospital, although in minor surgery cases you may be allowed to go home the same day. You will have a splint, dressing or internal tubes placed inside your nose, and bandages covering it from the outside. The splint will have to remain for at least for a week to 10 days to support your nose. Ask someone to drive you home from the hospital and arrange for someone to stay with you at least for a day. For at least 24 hours, your face will be swollen, especially around the eyes. Some amount of bleeding is also common. You will be asked to refrain from blowing your nose for a few days to allow healing to take place.

At the end of the first week of the surgery, the bandages and splints will be removed. The stitches will dissolve on their own in about 7 days. Avoid strenuous activity for the first couple of weeks, and refrain from contact sports for at least 6 months after surgery. Generally, it takes at least 3 months for all the swelling to settle down, so don’t worry if the shape you see soon after the surgery is different from what you had expected. Once the swelling is completely gone, the appearance enhances considerably. You can also expect numbness and stiffness for many months after the surgery.

Complications of Rhinoplasty
Rhinoplasty is a surgery, and hence there are always a few things that can go wrong.

  • People who smoke may find themselves contracting a chest infection.
  • There may be heavy bleeding from the nose soon after surgery, or after a few days.
  • Some amount of breathing difficulty is common at least for the first week after the surgery. However, in rare cases, these breathing difficulties can persist, and can even become permanent.
  • There may be rupture of the nasal surface vessels.
  • There may be risks from the general anesthesia.
  • There may be numbness in the skin.  Occasionally, a hole may develop in the nasal septum, requiring additional surgery.
  • There may be scarring, skin discoloration and other irregularities.
  • As with any surgery, there is always the risk of infection.
  • There may be asymmetry in the nose, leading to an undesirable shape. Generally, in such cases, the surgeon will have to perform a second surgery, but it can take a year. In rare cases, there may be cardiac and pulmonary complications.

If you notice some chest pains, an accelerated heart rate or severe pain in the site of the operation, seek emergency medical care immediately.

Generally, it takes up to a year for the results of the nose surgery to be fully visible. In a large majority of the cases, patients are completely satisfied with the results. It’s important however, to have realistic expectations of the surgery to avoid disappointment later.