Procedure Description: One of the most common of all cosmetic procedures, rhinoplasty (nose surgery) is used to improve the appearance and possibly the function of the nose. Rhinoplasty can be performed under a general anesthetic or with local anesthetic, depending on what you and your surgeon prefer. Incisions are made inside the rim of the nostrils. Sometimes, tiny, inconspicuous incisions are also made on the rim of the nose. Soft tissues of the nose are then separated from the underlying structures, and the cartilage and bone causing the deformity are reshaped. There are two major ways to perform a rhinoplasty: the closed rhinoplasty and the open rhinoplasty technique. The open technique includes an incision across the columella, the small skin between the two nostrils. One major advantage of this technique is the ability to completely visualize the internal structures of the nose, and place sutures precisely where they may be required. With this type of rhinoplasty, the swelling takes significantly longer to subside and some of the tissues may be unnecessarily disrupted. The scar is most often quite small and fades rapidly. The closed technique does not require an external incision, heals more quickly and does not disturb the tissues as much as the open technique.
Rhinoplasty should generally be delayed until age 15 or after for girls and 16 to 18 years for boys, due to psychological and physical maturity.
Length of Procedure: A rhinoplasty usually takes one to two hours, but on rare occasions it may take longer.
Recovery: If the nose is being reduced in size, a splint will be applied and the nose will be packed lightly with medicated gauze. Sometimes, only tape supports the nose while it is healing. The stitches are self-absorbing and do not require removal. Occasionally, a certain type of incision may require stitches that will need to be removed. Your doctor will be able to discuss this with you pre-procedure. There will be some swelling and stuffiness for several weeks, but patients usually resume normal light activity after a few days. It will take several weeks before the nose is completely healed to allow full physical activity.
You should be able to return to sedentary work after a couple of days. Although there is some pain in the first 24 hours, after this there is usually just a feeling of pressure and stuffiness. You will still look puffy and swollen. You should keep your head elevated above the level of your heart for the first few days to reduce swelling. Bruising around the eyes is to be expected, usually peaking around 72 hours and subsiding in seven to 10 days.
You will still need to be careful to not blow your nose for about two weeks, and avoid bumps to the nose for about six weeks. You should use extra sunscreen, be gentle when washing your face and avoid strenuous activity for about 4 weeks.
Risks: Rhinoplasty will provide significant improvements in the appearance of the nose for the vast majority of patients although, in occasional cases, a secondary correction may be required. There are risks with all surgical procedures. You should discuss all benefits and risks with your cosmetic surgeon. The national average of revision rhinoplasty is approximately 20% and this is usually due to unrealistic patient expectations.
Results: It is common to feel dissatisfied with the appearance of the nose in the immediate post-operative period. At this point, the nose is still quite swollen, and much of the detail is still not visible enough to appreciate. It is important to be patient during this period of time. Rushing to perform a second operation during the first nine to twelve months is almost always a mistake. A new sense of confidence is the most frequently observed change.
Estimated Cost: Rhinoplasty costs range from $3,000 to $8,000.