Treatments

It can be used to:

• Reduce or increase the size of the nose
• Change the shape of the tip or the nasal bridge
• Narrow the opening of the nostrils
• Change the angle between the nose and the upper lip
• Correct a birth defect or injury
• Help relieve some breathing problems
• 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

Nose surgery is considered elective when it is done for cosmetic reasons. In these cases, the purpose is to change the shape of the nose to one that the patient finds more desirable. Many surgeons prefer to perform cosmetic nose surgery after the nasal bone has finished growing. This is around age 14 or 15 for girls and a bit later for boys.

Risks of any surgery are:

• Bleeding
• Infection
• Bruising

After surgery, tiny blood vessels that have burst may appear as tiny red spots on the skin surface. These are usually minor, but are permanent. There are no visible scars if the rhinoplasty is performed from inside the nose. If the procedure narrows flared nostrils, there may be small scars at the base of the nose that are not usually visible.

Before scheduling rhinoplasty, you must meet with your surgeon to discuss important factors that determine whether the surgery is likely to work well for you. This meeting generally includes:

• Your medical history. The most important question your doctor will ask you is about your motivation for surgery and your goals. Your doctor will also ask questions about your medical history — including a history of nasal obstruction, surgeries and any medications you take. If you have a bleeding disorder, such as hemophilia, you may not be a candidate for rhinoplasty.
• A physical examination. Your doctor conducts a complete physical examination, including any laboratory tests, such as blood tests. He or she also inspects your skin and the inside and outside of your nose. The physical exam helps your doctor determine what changes need to be made and how your physical features — for example, the thickness of your skin or the strength of the cartilage at the end of your nose — may affect your results. The physical exam is also critical for determining the impact of rhinoplasty on your breathing.
  Sometimes your surgeon may speak with you about performing a surgery to augment your chin. This is because a small chin will create the illusion of a larger nose. It’s not required to have chin surgery in those circumstances, but it may better balance the facial profile.
• Photographs. Someone from your doctor’s office may take photographs of your nose from different angles. Your surgeon may use computer software to manipulate the photos to show you what kind of result is possible. Your doctor uses these photos for before-and-after assessments, reference during surgery and long-term reviews. Most importantly, the photos permit a specific discussion about the goals of surgery.
• A discussion of your expectations. You and your doctor should talk about your motivations and expectations. He or she explains what rhinoplasty can and can’t do for you and what your results might be. It’s normal for people to feel a little self-conscious discussing their appearance, but it’s very important that you’re open with your surgeon about your desires and goals for surgery.

Before rhinoplasty, you may also need to:

• Avoid certain medications. Avoid medications containing aspirin or ibuprofen (Advil, Motrin IB, others) for two weeks before and after surgery. These medications may increase bleeding. Take only those medications approved or prescribed by your surgeon.
• If you smoke, stop smoking. Smoking slows the healing process after surgery and may make you more likely to get an infection.
• Make arrangements for the day of the surgery. For the first few days after anesthesia, you may have lapses of memory, slowed reaction time and impaired judgment. Therefore, please arrange for someone to drive you home if you’re having an outpatient procedure. Also, arrange for a family member or friend to stay with you a night or two to help with personal care tasks as your recover from surgery.

Rhinoplasty requires local anesthesia with sedation or general anesthesia, depending on the complexity of the surgery and your surgeon’s preferences.

Rhinoplasty may be done inside the nose or through a small external incision at the base of the nose, between the nostrils. Your surgeon will likely readjust the bone and cartilage underneath your skin.

Your surgeon can augment your nasal bone or cartilage in several ways, depending on how much needs to be added, the structure of your nose and available materials. For small changes, the surgeon may use cartilage harvested from deeper inside your nose or from your ear. For larger requirements, the surgeon can use cartilage from the rib, implants or bone from other parts of the body.

After the surgery, you’ll be in a recovery room, where the staff monitors your return to wakefulness. You might leave later that day or, if you have other health issues, you might stay overnight.

After the surgery

After the surgery you need to rest in bed with your head raised higher than your chest, to reduce bleeding and swelling. Your nose may be congested because of swelling or from the splints placed inside your nose during surgery. In most cases, the internal dressings remain in place for one to seven days after surgery. Your doctor also tapes a splint to your nose for protection and support. It’s usually in place for about one week.

Slight bleeding and drainage of mucus and old blood are common for a few days after the surgery or after removing the dressing. Your doctor may place a “drip pad” — a small piece of gauze held in place with tape — under your nose to absorb drainage. Change the gauze as directed by your doctor. Don’t place the drip pad tight against your nose.

To further decrease the chances of bleeding and swelling, your doctor may ask that you follow these precautions for several weeks after surgery:

• Avoid strenuous activities such as aerobics and jogging.
• Take baths instead of showers while you have bandages on your nose.
• Don’t blow your nose.
• Eat high-fiber foods, such as fruits and vegetables, to avoid constipation. Constipation can cause you to strain, putting pressure on the surgery site.
• Avoid extreme facial expressions, such as smiling or laughing.
• Brush your teeth gently to limit movement of your upper lip.
• Wear clothes that fasten in the front; don’t pull clothing, such as shirts or sweaters, over your head.

In addition, don’t rest eyeglasses or sunglasses on your nose for at least four weeks after the surgery, to prevent pressure on your nose. You can use cheek rests, or tape the glasses to your forehead until your nose has healed.

Some temporary swelling or black-and-blue discoloration of your eyelids can occur for two to three weeks after nasal surgery. Swelling of the nose takes longer to resolve. Limiting your dietary sodium will help the swelling go away faster. Don’t put anything such as ice or cold packs on your nose after surgery.

Your nose changes throughout your life whether you have surgery or not. For this reason, it’s difficult to say when you have obtained your “final result.” However, most of the swelling is gone at a year.