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Rhinoplasty considered as one of the oldest cosmetic surgical procedure and one of the most popular one today. The art of rhinoplasty has evolved significantly in the past few decades. It used to be one size fit all approach to create a specific type of nose, whereas today the primary target is to create a nose that blends harmoniously with the rest of the face to achieve a balanced facial profile.

Along with the cosmetic reasons, rhinoplasty can also be performed for functional purposes to correct breathing problems to ensure individual’s having a proper airflow. It is a great procedure that customized to the needs of each individual whether for cosmetic or functional purposes and there are number of effective techniques that can be used to be able to realize those unique goals.

WHAT IS RHINOPLASTY?

Rhinoplasty is also known as ‘nose job’ or ‘nose reshaping’ or nose sculpting’, is a surgical procedure that changes the shape and/or size of nose. It often involves targeting any parts of the nose including tip, nostrils and bridge in order to improve the appearance of the nose and balance out facial features in relation to the rest of face.

WHO IS A GOOD CANDIDATE FOR RHINOPLASTY?

Rhinoplasty can be performed on both women and men once completing their facial growth and feel the need to improve their nose contour can be eligible for this surgery. Ideal candidates are the individuals who are in generally good health, non-smokers and have realistic expectations about the procedure.

Some of the common features for the patients require to get corrected through a rhinoplasty are given below and you are a good candidate if you have one or more of the following features:

  • Asymmetrical nose
  • Crooked nose
  • Droopy nose
  • Disproportionate nose in relation with the rest of the face
  • Shallow or flat bridge that may cause slipping of the glasses
  • Visible humps or depressions on the bridge
  • Excessively large, small, wide, narrow or collapsed nostrils
  • Thick, large, bulbous or upturned nasal tip
  • Bothered with the shape and dimensions of your nose
  • Difficulty breathing through your nose and snoring problems
  • Feel to improve the results of the previous rhinoplasty
  • Want to repair a nose that was impacted by trauma or injury

CONSULTATION WITH YOUR SURGEON BEFORE THE SURGERY

MediExpert surgeon will discuss the following issues during your rhinoplasty consultation:

  • Your surgical goals to be achieved
  • Your general health status will be evaluated, allergies and previous medical treatments will be checked
  • Current prescribed medications and the usage of supplements and vitamins will be checked
  • Smoking, alcohol and drug usage will be asked
  • Previous surgery history will be checked
  • Chin augmentation options will be discussed
  • Course of treatment will be recommended
  • The type of anesthesia that will be used will be discussed
  • Photos of the face will be taken
  • Potential complications and the risks of rhinoplasty surgery will be discussed

WHAT DO I NEED TO DO PRIOR TO THE SURGERY?

We will ask the patients to prepare for the nose job procedure in advance in order to ensure for the procedure to be as smoothly as possible before and after. Some of the instructions that may be required from the patients are as follows:

  • Blood testing will be required to evaluate general health status prior to the surgery and EKG may also be requested from your surgeon
  • Previous surgical history will be checked if any
  • Usage of medication including nasal spray and allergy medication will be checked
  • Avoid all sorts of blood thinners and certain anti-inflammatory drugs at least 10 days prior to the surgery as they might increase bleeding and bruising
  • Stop smoking both nicotine or marijuana at least one weeks prior to the surgery as it can delay the healing process. If you are a heavy smoker, we will try to encourage you to avoid smoking as much as possible prior to the surgery
  • Avoid alcohol at least 1 week prior to the surgery as it may prolong the swelling
  • Avoid taking any herbal supplements such as fish oil, garlic extract and Vitamin E 10 days before the surgery as these may prolong the bleeding
  • Drink plenty of water in the days approaching the surgery
  • Sleep well the night of the surgery
  • Ensure to have cold compresses ready to use after the surgery
  • Wear comfortable and loose clothes and not wear jewelry, body piercings, contact lenses and necklaces at the day of the surgery
  • Do not eat or drink anything 8 hours prior to the surgery except any prescribed medication
  • Ensure picking up the prescribed post operative medications including antibiotics, nausea and pain medications prior to the surgery
  • Ensure that the bed in pre-arranged with plenty of pillows as elevation of the head will reduce swelling after the surgery
  • Glasses should be avoided after the surgery as they can put a pressure on the nose
  • Ensure that a family member or a friend is arranged to take care is available to stay with you for assistance the night after the surgery
  • Shower the morning of the surgery and do not wear any lotion, perfume, makeup and sort cosmetic products at the day of the surgery

TYPES OF RHINOPLASTY

Rhinoplasty is often performed to reshape the nose, either to decrease or increase its size. There are three common kinds of nose job procedures.

CLOSED RHINOPLASTY

It is also known as the ‘Endonasal Procedure’, involves creating small incisions inside of the nostrils. Through the incisions, excess skin is removed and the cartridge is sculpted as required. The incisions are then closed with absorbable sutures. There is no visible scarring following closed rhinoplasty and is a less invasive procedure compared to the open rhinoplasty, but more complex corrections may not be appropriate for this technique.

OPEN RHINOPLASTY

An open rhinoplasty involves creating small incision at the base of the nose (trans-columellar incision), between the nostrils. Excess skin is then excised, cartilage is reshaped or nasal implant is placed. The incisions are then closed with sutures after the corrections are made. This procedure allows the surgeon accuracy and enhances the precision of the procedure. Scarring can be visible, however these are well concealed within the natural curvature of the nose.

SEPTOPLASTY SURGERY

Septoplasty surgery involves an incision in the lining of the nose. Parts of the cartilage and the bone that are bent removed inside the upper part of the nose in order to correct the wall between nostrils to a straight position. The surgery does not result in any facial scars and sometimes effective to reduce snoring.

STEPS IN A RHINOPLASTY SURGERY

The following steps are taken in a common rhinoplasty surgery.

1. ADMINISTRATION OF ANESTHESIA

A typical rhinoplasty is performed under general anesthesia or local anesthesia with sedation. MediExpert surgeon will choose the best option based on the type of rhinoplasty to be performed consulting with the patient.

2. OPENING INCISIONS

Rhinoplasty is performed either with ‘Closed Rhinoplasty’ technique where incisions are concealed inside the nose, or with ‘Open Rhinoplasty’ technique, where an incision is created at the base of the nose (columella), between the nostrils. Through these incisions, the skin that covers the nasal bones and cartilages is raised which allows an access to reshape the structure of the nose.
Open rhinoplasty incision across the columella.

3. RESHAPING THE NOSE STRUCTURE

After the incisions are made, the surgeon can perform the process of reshaping the nose in compliance with what was agreed with the patient beforehand. An excessively large nose may be reduced by removing cartilage or bone.
In some cases, surgery of the nose may require the addition of cartilage grafts. Most frequently, cartilage from the septum which is the partition in the middle of the nose used for this purpose and sometimes cartilage from the ear and in rare cases cartilage from a section of rib can also be used.
In the condition of a septum deviation, septum be straightened and the protrusions inside the nose can be reduced in order to improve breathing.

4. CLOSING THE INCISION

After the structure of the nose is sculpted to the desired shape, the surgeon will then close the incisions with stitches. Additional incisions may also be placed in the natural creases of the nostrils to change their size.

BENEFITS OF RHINOPLASTY

Rhinoplasty can make a massive change on individuals appearance and potentially include improvement in:

  • Desirable nose shape
  • Desirable nose size
  • Symmetry to the face is gained
  • Ease of breathing
  • Facial harmony and aesthetic balance is improved
  • Rejuvenated facial appearance
  • Increase in self-confidence

WHAT IS EXPECTED IMMEDIATELY AFTER THE SURGERY?

Post operative period is extremely important for a quicker healing and recovery period. Following are most likely to be expected within the first few days after the surgery:

  • You will be kept under observation for few hours following the surgery
  • You may experience some amount of discomfort, swelling and bruising. Prescribed medication will be given to reduce discomfort.
  • You will wake up with cold compress gauze over your eyes and nose
  • Your vision might be slightly blurry due to lubricants placed over your eyes to prevent them drying during surgery
  • You might not be breathing properly through your nose due to nasal packing or swelling
  • You may have internal dressings up to a week
  • You will have bruising over your eyes which should subside after a week or two
  • You may feel dizzy and get nauseated for few days
  • You will be asked to limit facial expressions such as laughing and smiling for several weeks.

HOW LONG IS THE RHINOPLASTY SURGERY TAKE?

The length of the surgery take between1 ½ - 4 hours depending on the technique performed and complexity of the case.

HOW OLD DO I HAVE TO BE TO UNDERGO THE SURGERY?

If the reason for undergoing rhinoplasty is to improve your appearance rather than your health, it is recommended to wait until the nasal bone is grown and the facial structure is fully completed. That is about the age of 15 for girls and 16 for boys. On the other hand, if the reason is due to a breathing impairment, the procedure can be performed at a younger age.

WHAT KIND OF PAIN SHALL I EXPECT AFTER A RHINOPLASTY?

Although pain tolerance may vary from patient to patient, most of the patients experience mild discomfort. Pain medication is prescribed to reduce any possible discomfort and often used only for few days. It is very uncommon for the patients to report extreme pain following the surgery.

WILL THERE BE ANY SCARRING AFTER RHINOPLASTY?

Scars are not visible when the incisions are made inside the nose using Closed Rhinoplasty technique, whereas Open Rhinoplasty can cause mild scarring at the base of the nose, between the nostrils. (along the columella) However, it will be well hidden in the natural curvature of the nose in professional hands. Scar will fade over time and alternatively there are also treatments such as radiofrequency abrasion to assist dealing with scars following rhinoplasty.

HOW LONG IS THE RECOVERY TIME?

After the surgery, most of the patients experience mild discomfort. Some swelling and bruising is expected, where majority of bruising should be subsided after a week or two and the swelling should be gone after several months. Most of the patients can barely notice swelling after two months. Pain medication is prescribed to reduce discomfort. Recovery period averages 1-2 weeks from a rhinoplasty depending on the technique performed.

RECOVERY INSTRCUTIONS

Some of the recovery instructions to be followed are summarized below.

  • Cold packs need to be applied over eyes and nose during the first 48-72 hours
  • Keep the head elevated for the first two days to minimize swelling and the best sleeping position is semi-reclined
  • Stay away from hot places including in front the heater and oven as it may increase the chances of nose bleeding
  • Take your prescribed medications routinely as not doing so can prolong the healing period
  • Drink considerable amount of water to stay hydrated
  • Do not blow your nose heavily for at least 3 weeks and keep your mouth open if you sneeze
  • Take baths instead of showers until the bandages are removed
  • Brush your teeth gently as the upper lip movement should be limited
  • Eat high-fiber foods
  • Avoid salty and spicy food
  • Avoid excessive chewing
  • Do not pull clothing over your head such as sweaters and jumpers, choose clothing that fasten in the front.
  • Avoid sun exposure and use sunscreen when outside, especially on your nose as sun can cause skin discoloration.
  • Avoid sunglasses and eyeglasses for at least a month.
  • Avoid all sorts of blood thinners, herbal supplements and certain anti-inflammatory drugs for at least 10 days as they might increase bleeding and prolong the healing period.
  • Stop smoking both nicotine or marijuana at least two weeks as it can delay the healing process.
  • Avoid alcohol for at least a week as it may prolong swelling.
  • Little walks are encouraged to minimize the chances of blood clots in the legs.

SHOULD I NEED TO STAY IN THE HOSPITAL AFTER RHINOPLASTY?

It is typically an outpatient procedure meaning that it is not required to stay at the hospital overnight, however it may be required to stay at the hospital for a night or two if it is a complicated procedure.

WHEN WILL THE STITCHES REMOVED?

The stitches will be typically removed within 5-7 days after surgery if they are not dissolvable type.

WHEN CAN I GO BACK TO WORK?

Most of the patients can return for a desk job within 1 week.

CAN I DRIVE AFTER THE SURGERY?

It is recommended not to drive before 48 hours following the surgery and ideally not before stopping the medication.

WHEN CAN I HAVE A SHOWER AFTER THE SURGERY?

It is typically allowed to take a cool shower the next day following a rhinoplasty procedure, however bath would be a better option compared to shower to avoid water directly to the face.

WHEN CAN I START EXERCISING?

Light exercises can be resumed generally within 3-5 days after the surgery, whereas swimming should be avoided for 3 weeks and strenuous exercises can be resumed after 4-5 weeks following the surgery.

WHEN CAN I HAVE SEX?

Sex should be avoided for the first week following the surgery and is ok afterwards as long as not overly exerting yourself.

IS THERE AN ALTERNATIVE OPTION TO RHINOPLASTY?

Fillers may be a temporary solution to reshape and improve the appearance of nose, however neither it can assist on reducing the size of the nose nor the results are likely to be as effective as a rhinoplasty procedure. Fillers can help in minor changes and the results will likely to be between 6-9 months, with the most lasting more than 18 months.

CAN RHINOPLASTY COMBINED WITH OTHER PROCEDURES?

There are number of different cosmetic surgical procedures that can be safely performed in combination with rhinoplasty. It is in fact very common to address other parts of the face in order to achieve a comprehensive facial rejuvenation.

The most common, but not limited procedures combined with rhinoplasty is septoplasty (type of rhinoplasty), chin augmentation mentoplasty , neck lift platysmaplasty , facelift , eyelid lift blepharoplasty and lip augmentation .

There are benefits of having these surgeries at once as initially it avoids the risks of two surgeries, anesthesia applied one at a time and advantageous in terms of minimizing recovery process, saving time and money accordingly.

WHEN CAN I SEE THE FINAL RESULTS?

The majority of the swelling following a rhinoplasty will be gone after a few months, however it may take up to a year for the final results to be appreciated until the new nasal contour to fully refined. During this time, there will be gradual improvements in the appearance of the nose.

POTENTIAL COMPLICATIONS AND RISKS OF RHINOPLASTY SURGERY

All the surgeries carry uncertainty and risk in to some extent. Individuals have to weigh the potential benefits in terms of achieving the aesthetic goals with the risks and potential complications of a rhinoplasty surgery. Some of the complications and risks include:

  • Anesthesia risks
  • Swelling and bruising
  • Nosebleeds
  • Infection
  • Seroma and hematoma
  • Difficulty breathing
  • Possible need for revision surgery
  • Unfavorable scarring
  • Skin discoloration
  • Altered sense of smell
  • Changes in skin sensation
  • Poor wound healing

HOW LONG WILL THE RESULTS LAST?

The results of rhinoplasty is long-lasting and sometimes for a lifetime as long as the procedure is done on a fully developed face and the procedure is undertaken in right hands. However, it is inevitable to have some gradual changes as the body ages while most of the improvement should remain permanent. A healthy lifestyle combined with life-long sun protection will have a positive impact on extending the results and achieve a permanent outcome.

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