Rhinoplasty (Plastic Surgery of the Nose)

Introduction Rhinoplasty surgery is the name for a group of operations. Each component is chosen and modified for the specific nose. Many different three–dimensional problems can be addressed by such sculpting. Some inherit their nasal shape, while others get theirs from trauma and injury. Many patients also need breathing obstruction issues addressed. Not all patients are aware of their nasal obstruction. During the consultation with the surgeon, he will try to learn what the concerns are and help learn what surgery realistically has to offer.

Rhinoplasty – Plastic Surgery of the Nose Rhinoplasty is the most common cosmetic procedure performed today. Nasal surgery can be done any time after physical growth of a nose is completed. This corresponds with puberty. The only exception is a younger patient with severe nasal obstruction or sinus disease. The surgeons perform rhinoplastic surgery to modify the nose by changing its size and sculpting the nasal structures so that the nose is in harmony with other facial features.

When the surgery is done to improve appearance, they re–shape the nose on an individual basis to achieve a more desirable, natural, non–surgical shape. This is in contrast to the unfortunately common and obvious surgical appearance of the scooped–out, turned–up nose with a pinched tip. Surgery may also improve nasal breathing when the septum is deviated or the patient suffers from allergies or sinus problems. Regardless of what is needed, removal of a hump, decreasing the length or width, correcting a deviation, or in some cases building up nasal depressions, surgeons tailor the procedure to meet the individual needs of each patient’s nose and face.

Preparing for the surgery The doctor will give the patient specific instructions on how to prepare for surgery, including guidelines on eating, drinking, smoking, taking or avoiding certain vitamins and medications, and washing your face. Carefully following these instructions will help the surgery go more smoothly. While making preparations, be sure to arrange for someone to drive the patient home after the surgery and to help the patient for a few days if needed.

Anesthesia for Rhinoplasty Rhinoplasty can be performed under local or general anesthesia, depending on the extent of the procedure and on what the patient and the doctor prefer. With local anesthesia, the patient will be lightly sedated, and nose and the surrounding area will be numbed; he will be awake during the surgery, but relaxed and insensitive to pain. With general anesthesia, he will sleep through the operation. General anesthesia is usually better for more extensive rhinoplasty or septal surgery. Local anesthesia is usually better for small adjustments or hump removal.

Open vs. Closed Rhinoplasty Most nasal surgeries are done from inside the nose. Several cuts are made in the nostrils depending on what needs to be done. In open rhinoplasty, the cuts start just inside the nostril and extend over the columella (the post between the nostrils). Most doctors usually make a stair step incision over the columella. This external scar visible from below is usually not significant. When the two nostril incisions are connected, the nasal skin can be elevated exposing the anatomy of the nose. Particularly effective for nasal tip and complex septal problems, the deformity can be addressed with the structures in their natural anatomic position. The cartilage and bone are sculpted under the skin. Closed rhinoplasty depends on incisions inside the nose only. There is no incision made across the skin of the columella. When the tip needs to be modified, it must be delivered through the nostrils and worked on in the delivered deformed position. When the surgery is complete, a splint will be applied to help the nose maintain its new shape. Occasionally soft rubber internal splints are placed inside the nose to stabilize the septum, the dividing wall between the air passages.

The Surgery Rhinoplasty usually takes an hour or two, though complicated procedures may take longer. During surgery the skin of the nose is separated from its supporting framework of bone and cartilage, which is then sculpted to the desired shape. The nature of the sculpting will depend on the problem. Finally, the skin is re–draped over the new framework.

Procedure The operation generally takes one to two hours. Most incisions are made inside the nose. However, a small incision between the nostrils may be required in difficult noses where there has been previous surgery, in noses with abnormalities of the tip, or noses with severe deviations. This “Open” approach, which was pioneered in this country over twenty years ago by Drs. Fleming and Mayer, provides the opportunity to see what the problem is, to suture parts directly to minimize later shift, to produce better symmetry and, therefore, to achieve results far better than the older closed technique. Though somewhat more time consuming, the results consistently justify the effort. The inconspicuous external incision is easily hidden. In noses with wide nostrils, small external incisions are sometimes made at the base of the nostrils in order to achieve narrowing of this portion of the nose.