Rhinoplasty - Recontouring or reshaping of the External Nose

Rhino (Latin for nose) and plasty(Greek for molding or forming) is a medical procedure that reshapes the nose for cosmetic or reconstructive purposes. It's more commonly referred to as a "nose job."

The rhinoplasty procedure helps reshape the nose by altering its size, angle curves and proportions in order to achieve a better aesthetic looking nose. The rhinoplasty procedure also reshapes the nasal tip and nostrils. With rhinoplasty a person may shape or correct the way their nose looks in order to achieve a more pleasing look or that is in more harmony with the overall appearance of their face than their current nose.

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
  • Reducing the nostril side.
  • Lifting the tip higher.

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 is performed using one of two techniques: the open technique or the closed technique. Both techniques involve incisions made inside the nostrils, but the open technique makes a second incision in the fleshy skin between the nostrils. The skin is separated and adjustments are made to the bone and cartilage. Bones may be broken or chiseled depending on the patient's desired result. Cartilage may be trimmed. The nasal passages are then packed and an external splint is applied. The packs are removed in 24 hours but the splint is worn for about a week. The operation normally takes 1-3 hours and can be done under general or local anesthesia.

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.

Rhinoplasty surgery costs can vary widely.

A surgeon’s fee will be based on his or her experience and geographic office location.

Rhinoplasty cost may include:

  • Anesthesia fees
  • Hospital or surgical facility costs
  • Medical tests
  • Post-surgery garments
  • Prescriptions for medication
  • Surgeon’s fee

When choosing a board-certified plastic surgeon in your area for a rhinoplasty procedure, remember that the surgeon’s experience and your comfort with him or her are just as important as the final cost of the surgery.

When rhinoplasty is performed to improve breathing function, the cause is most commonly an obstructed airway.

This procedure, whether performed alone or in conjunction with cosmetic rhinoplasty, is considered reconstructive and may be covered by insurance.

This requires a detailed examination to verify the cause of your breathing impairment and prior authorization from your insurer.

Both men and women are candidates for rhinoplasty, but most surgeons will caution against the procedure for girls under 15 or boys under 17, pending full maturity.

You may be a good candidate for rhinoplasty if:

  • Your facial growth is complete
  • You are physically healthy
  • You don’t smoke
  • You have a positive outlook and realistic goals in mind for the improvement of your appearance

During your rhinoplasty recovery, a splint and/or packing will likely be placed inside your nose and a splint or bandages placed on the outside to support and protect the new structures during initial healing.

While initial swelling subsides within a few weeks, it may take up to a year for your new nasal contour to fully refine. During this time you may notice gradual changes in the appearance of your nose as it refines to a more permanent outcome.

Swelling may come and go and worsen in the morning during the first year following your rhinoplasty 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.

You will be given specific instructions that may include:

  • How to care for the surgical site
  • Medications to apply or take orally to aid healing and reduce the potential for infection
  • Specific concerns to look for at the surgical site or in your general health
  • When to follow up with your plastic surgeon.

Be sure to ask your rhinoplasty surgeon specific questions about what you can expect during your individual recovery period:

  • Where will I be taken after my surgery is complete?
  • What medication will I be given or prescribed after surgery?
  • Will I have dressings/bandages after surgery?
  • When will they be removed?
  • Are stitches removed? When?
  • When can I resume normal activity and exercise?
  • When do I return for follow-up care?

The results of rhinoplasty surgery will be long-lasting.

You can view rhinoplasty before and after photos in our gallery.

While initial swelling subsides within a few weeks, it may take up to a year for your new nasal contour to fully refine. During this time you may notice gradual changes in the appearance of your nose as it refines to a more permanent outcome.

As your body ages, it is natural to have some gradual changes to your face including your nose. But most of your improvement should be relatively permanent.

A healthy lifestyle and life-long sun protection will help extend the results of your new appearance.

Rhinoplasty surgery includes the following steps:

Step 1 – Anesthesia

Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation or general anesthesia. Your doctor will recommend the best choice for you.

Step 2 – The incision

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.

Open rhinoplasty incision across the columella

Step 3 – Reshaping the nose structure

An overly large nose may be reduced by removing bone or cartilage. Sometimes surgery of the nose may require the addition of cartilage grafs.

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.

Step 4 – Correcting a deviated septum

If the septum is deviated, it can be straightened and the projections inside the nose reduced to improve breathing.

Step 5 – Closing the incision

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.

Step 6 – See the results

For a few days splints and gauze packing will likely support the nose as it begins to heal. Get more information about rhinoplasty results.

The decision to have plastic surgery is extremely personal. You will have to decide if the benefits will achieve your goals and if the risks and potential complications of rhinoplasty are acceptable.

Your plastic surgeon and/or staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure and any risks or potential complications.

Rhinoplasty surgery risks include:

  • Anesthesia risks
  • Bleeding (hematoma)
  • Infection
  • Poor wound healing or scarring
  • Change in skin sensation (numbness or pain)
  • Nasal septal perforation (a hole in the nasal septum) is rare. Additional surgical treatment may be necessary to repair the septum but it may be impossible to correct this complication
  • Difficulty breathing
  • Unsatisfactory nasal appearance
  • Skin discoloration and swelling
  • Possibility of revisional surgery

These risks and others will be fully discussed prior to your consent. It is important that you address all your questions directly with your plastic surgeon.

During your rhinoplasty consultation be prepared to discuss:

  • Your surgical goals, with regard to both appearance and breathing
  • Medical conditions, drug allergies, and previous medical treatments
  • Current medications, vitamins, herbal supplements, alcohol, tobacco, and drug use
  • Previous surgeries

Your rhinoplasty surgeon may also:

  • Evaluate your general health status and any pre-existing health conditions or risk factors
  • The options available to you for nose reshaping
  • Examine and measure your face
  • Take photographs
  • Discuss your nose surgery options
  • Recommend a course of treatment
  • Discuss likely outcomes of a nose surgery and any risks or potential complications

It’s very important to understand all aspects of your rhinoplasty procedure. It’s natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of preoperative stress. Don’t be shy about discussing these feelings with your plastic surgeon.

In preparing for rhinoplasty surgery, you may be asked to:

  • Get a lab test
  • Take certain medications or adjust your current medications
  • Stop smoking
  • Avoid taking aspirin, anti-inflammatory drugs, and herbal supplements as they can increase bleeding

Rhinoplasty may be performed in an accredited office-based surgical facility, a licensed ambulatory surgical center or a hospital. Be sure to arrange for someone to drive you to and from surgery and to stay with you for at least the first night following surgery.

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