NASAL SURGERY (RHINOPLASTY)

About Rhinoplasty (Nasal Surgery or Reshaping)

For hundreds and even thousands of years the nose has been a focal point of art and medicine.  Some of the earliest manuscripts in medicine describe methods of restoring nasal shape.  Today Nasal Reshaping or Rhinoplasty consistently ranks in the top 3 cosmetic surgical procedures performed annually with several hundred thousand cosmetic nasal procedures performed annually (statistics from The American Society of Plastic Surgery website, www.plasticsurgery.org ).  Because our noses are so individually unique, most people entertain the decision to alter or improve their nasal contours with great care and thought.  We understand the importance of making a decision that is right for you and we believe that education, information and a comfortable doctor/patient relationship are the cornerstone of a successful outcome. 

Our surgeons will assist you in understanding what modifications can be made to achieve the cosmetic appearance you desire.  Part of this process is helping each person to understand the limitations of Nasal Reshaping (Rhinoplasty), the recovery, the associated risks and any alternatives.

Is Nasal Reshaping Right For Me?

Nasal shape is the result of a combination of factors including genetics, age or history of injury.  Nasal Surgery can help restore harmony and proportion to the facial region which, in turn, increases self confidence and in some instances improves nasal function.

Nasal Reshaping Options

In general, Nasal Reconstruction can be performed through limited incisions in the nostril region or inside the nostrils.  Through these incisions, changes can be made to reshape underlying cartilage creating more nasal refinement, reduce humps, create greater symmetry and modify the angle between the nose and the upper lip.

This surgery can remove a hump, correct a drooping tip, narrow flaring nostrils, or straighten a crooked nose. These esthetic changes can also be incorporated with improvement in breathing. Your nose is a very personal part of your face. Its shape must not only be acceptable to you but must also function well. Not all Nasal Surgery is cosmetic: many patients elect to have Nasal Surgery because of breathing difficulty and associated sinus problems, nasal drainage, sleep problems, and difficulty exercising.

These airway problems can be due to a deviated septum (the dividing structure between the right and left air passages on the inside.) This deviation is usually from trauma but it can be congenital. The term Septoplasty applies only to the surgery to correct a deviation and will not change the shape of the nose.

The size of the nose must relate to the overall face. The dorsum (outside shape) should be smooth and straight without a hump. But a slight convexity (hump) is better than a scooped-out appearance, or the “ski slope” nose. The tip should be crisp and well-defined, not bulbous or asymmetric (uneven). There should be a slight depression just above the tip on the dorsum to give a defining point to the tip. As the tip flows onto the columella (the structure below the nose that separates the nostrils), it is esthetic to have an open angle, between the lip and the tip. This area is called the infra-tip lobule.

The junction of the columella to the face forms an angle called the naso-labial angle. This angle should be about 100-110° for a woman and 90 to 100° for a man. Your overall height helps determine the degree of this angle, because it relates to how “turned up” the nose appears. On a tall person it is best to keep the angle less obtuse (or less than 100°).

The nares (nostrils) should be symmetrical and somewhat almond-shaped. They should not flare or be wider than the distance between the inside of the eyes.

All these descriptions and dimensions are ideals, and it is impossible and undesirable to give everyone the same nose. Our goal is to make your nose fit your face attractively and function properly.

Before		After
Before		After

Preparing For Surgery

At least 1 month before surgery 
Stop smoking at least 1 month prior to your procedure. Smoking reduces circulation to the skin, impedes healing, and can result in major postoperative complications. 

2 weeks prior to surgery 
Stop all medications that can thin the blood 2 weeks prior to surgery. These include drugs such as Aspirin, Coumadin, Lovenox, Ibuprofen, Vitamin E, and multiple herbal preparations. These medications may cause bleeding during and after surgery.

1 week prior to surgery
Report any sign of a cold or infection that appear the week prior to your surgery. You may need to postpone your procedure to avoid unnecessary complications.

The day before surgery 
Do not eat or drink anything after midnight before your surgery. This includes water, ice, or hard candy. The only exception is that you may take your blood pressure or heart medication with a sip of water the morning of surgery. 

The day of surgery 
Plan to wear comfortable clothes to the procedure. Wear a button down top so it does not have to be put over your head.

Do not wear jewelry or bring valuables with you on the day of surgery. 

The day before the morning of surgery you may wash your surgical site with regular soap. 

Do not wear cream or makeup on your face the day of surgery.

You must arrange to have a responsible adult drive you home after your procedure.

What To Expect On The Day Of Surgery

When you arrive, you will be escorted to a preoperative evaluation area where you will be asked to change into a gown and will be given foot covers. Your surgeon and the anesthesiologist will meet with you before you enter the operating room suite. During this time, the surgical consent form will be reviewed with you in detail and special markings may be made on your skin at the surgical site. You will have the opportunity to ask any last minute questions.

Once in the operating room, you will be transferred to our padded operating room table. A nurse will start an intravenous drip in your arm and connect you to monitoring devices. The anesthesiologist will give you medication through your intravenous drip to make you feel drowsy.

When your surgery is completed and your dressings are in place, you will be moved to the recovery room. During this period a recovery room nurse will assure your comfort and continue to monitor you closely.

Your stay in the recovery room will last approximately 1 to 1 1/2 hours. Most patients are fully awake within 30 to 60 minutes after their surgery, but may not remember much about their time in the recovery room due to some of the anesthesia medication. Once you are ready for discharge, a postoperative appointment will be scheduled and your discharge instructions will be reviewed.

You must have a responsible adult drive you home from the surgery center. This individual should have your prescription filled at the hospital pharmacy prior to taking you home. A responsible adult must stay with you the first night after your surgery because have been sedated.

Post-operative Instructions

Diet: Start with clear liquids and toast or crackers. If those are well tolerated, progress to a regular diet. 

Driving: No driving for 48 hours after your procedure or while taking narcotics.

Activity: Light activity only for the first 48 hours to avoid excessive swelling, bruising, or bleeding. After 2 weeks you may resume moderate activity such as brisk walking. Do not lift anything heavier than a gallon of milk for the first 6 weeks after surgery. After 6 weeks you may resume most normal activity including strenuous aerobic work and lifting activities.  Do not wear sun glasses or any type of glasses until instructed to do so by your surgeon as this can significantly affect your cosmetic outcome.

Work: Depending on your career and your rate of healing you should be able to return to work within 1-2 weeks of surgery. Your surgeon will be able to give you a better estimate depending on you physical and professional profile. 

Wound Care:  A splint will be applied covering the nose and every effort should be made to keep the splint dry and in place.  The splint will be removed by your surgeon approximately 7 days after surgery.  Some of the sutures will be dissolvable and will disappear on their own, any sutures needing to be removed will be taken out in the first 5-7 days.  Often a small pad of gauze is placed just beneath the nose to absorb any bleeding that is present during the first few days after surgery.  This gauze can usually be removed 1-2 days after surgery depending on the amount of drainage experienced.  After the dressings have been removed, clean your incision twice a day with hydrogen peroxide on a cotton swab. If crusting occurs along the incision line, apply bacitracin ointment twice daily.  In some instances, soft packing is placed inside the nose.  Your surgeon will advise you as to the removal of the packing as this usually takes place in the first few days after surgery.

Swelling: Moderate swelling and bruising should be expected during the first 10 days after surgery. To minimize swelling, sleep on 2 to 3 pillows so that your head and shoulders are elevated at a 45-degree angle. Cold packs help to reduce pain and swelling, but should be wrapped in a towel before they are applied to the face. Apply cold packs 20 minutes every hour while awake for the first 48 to72 hours. Do not apply the cold pack directly to your face. It must be wrapped in a towel. Application of cold packs directly to the facial skin may result in serious burns. 

Bathing: You may carefully shower, but keep the nasal splint dry.  Do not submerge the incision in a bath or swimming pool for 4 to 6 weeks. 

Medications: Ask your surgeon when you may resume your blood thinning medication. All other prescription medications may be resumed immediately, as usual. While you are taking pain medicine, you are encouraged to follow a high fiber diet and take a stool softener such as Colace (available over the counter), as pain medications tend to cause constipation. Take the full course of antibiotics given by your surgeon, to help prevent infection. 

Smoking and Alcohol: Do not smoke for the first several weeks after surgery as it impedes wound healing and can lead to serious wound complications. Alcohol consumption is dangerous while taking pain medicine. It has a tendency to worsen bleeding. 

Post-operative Appointment: Your first appointment will be within the first 7 days after surgery and this appointment will be scheduled either prior to your surgery or before you leave the recovery room at our surgery center (Park Meadows Outpatient Surgery Center)  Your second appointment will be scheduled 1-2 weeks after surgery. At the second appointment your sutures will be removed.

Special Considerations: Call your surgeon immediately if you experience any of the following: excessive pain, bleeding, swelling of the face, redness at the incision site, or fever over 101°F.

Sun Exposure: If new scars are exposed to the sun, they tend to become darker and take longer to fade. Make sure you wear a strong sunscreen with UVA and UVB protection, and or a brimmed hat for the first 6 months after surgery. 

Itching: It is common to experience itching or small shooting electrical sensations within the skin as the nerve endings heal.  It is not unusual for the tip of the nose to have some numbness for the first several months after surgery.  In some instances a very small area below the tip of the nose may remain numb.   Cool compresses and massage are frequently helpful. These symptoms typically resolve within 3 to 6 months. 

Swelling: It will take several months for all swelling to resolve.  The fine detail of a Rhinoplasty will become more evident as the trace amounts of swelling resolve.

Surgical Risks: 

All surgical procedures involve some risk, such as the effects of anesthesia, bleeding, pain, and swelling. There are also possible complications specific to facelifts that occur in a very small percent of people. After reading the discussion below, please contact your surgeon if you have any remaining questions. 

Bleeding: Bleeding is usually minimal and well controlled during this procedure.

Hematomas: A hematoma is a collection of blood under the skin. Small hematomas can be observed and allowed to absorb spontaneously. Larger hematomas may require aspiration or drainage for optimal results. 

Infections: Antibiotics will be given to you prophylactically before and after surgery for several days to help prevent infection. If a superficial infection does develop, it typically can be treated with stronger antibiotics by mouth. Deep infections require intravenous antibiotics and or incision and drainage of the wound. This may initially result in a larger scar, which can be revised at a later date.

Scarring: All new scars are red, dark pink, or purple. Scars of the face usually fade as they mature within the first 3 to 6 months. Abnormally thick, wide, or depressed scars may occur despite meticulous surgical closure. In this situation the scar may be injected with steroids, placement of silicone sheeting onto the scar, or surgical revision may be necessary to achieve optimal aesthetic results. 

Numbness: Initially, expect some numbness on your face in particular along the suture lines. The sensation in this area typically returns within 2 to 3 months as nerve endings heal spontaneously. Some numbness and nerve damage may be permanent. 

Delayed Wound Healing or Wound Dehiscence: In some instances wounds take longer to heal than normal. Cigarette smoking, poor nutrition, and a compromised immune system can all cause delayed wound healing or wound separation. 

Skin Discoloration: Skin discoloration may occur after surgery. This may be revised after the healing process is complete. 

Facial Asymmetry: Motor nerve injury is rare. If it does occur it is usually temporary, but may persist.