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Rhinoplasty
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Rhinoplasty

(Plastic Surgery of the Nose)

En Español (Spanish Version)

Definition

Rhinoplasty is a plastic surgery procedure to reshape the nose or remove an obstruction to breathing.

Parts of the Body Involved

The nose including nasal cartilage, bone, and mucus membrane of the septum are involved in the procedure.

Reasons for Procedure

  • To change or improve appearance
  • To open blocked nasal passages (eg, due to a deviated septum)
  • To correct an injury or birth deformity

Deviated Septum

Deviated Septum

© 2008 Nucleus Medical Art, Inc.

Risk Factors for Complications During the Procedure

  • Smoking—no smoking allowed 2 to 4 weeks before surgery
  • Age—recommended age is after teen growth spurts and before middle age
  • Prior nose surgery
  • Medical problems such as cardiac conditions or hypertension that increase the risks of anesthesia

What to Expect

Prior to Procedure

You may be asked to provide the surgeon with a picture of the nose shape you desire, or you may be given a book to look through to choose a nose shape.

Your doctor will likely do the following:

  • Blood tests
  • Urine tests
  • X-rays of the facial bones
  • Take before pictures of your nose

During Procedure

Anesthesia and IV sedation will be administered.

Anesthesia

Depending on the individual procedure the surgeon may choose local or general anesthesia . IV sedation medication may also be given.

Description of the Procedure

There are three main components of the procedure:

Lifting the Skin of the Nose from the Bone and Cartilage

The nose is injected with xylocaine (a numbing medication) and epinephrine (to discourage excessive bleeding). An incision is made either inside the nostril, or outside the nostril, across the ridge between the nostrils called the columella. The skin is then lifted off the cartilage of the nose.

Remodeling Bone and Cartilage

Depending on the desired outcome, some nasal bone may be removed, fractured, and reset to a new shape. Cartilage may also be trimmed. Other techniques involve using a tissue graft (bone, cartilage, or skin) from the patient or a donor, or a synthetic graft to help remodel the shape of the nose.

Redraping Skin Over the New Base

Once the procedure is finished, the incisions are closed, and the skin is redraped over the new bone structure. The skin is tightly taped to keep it in place. Then a protective metal splint is applied on the outside of the nose to maintain the positioning during healing. Nasal packs, which may be either soft plastic splints or gauze packing coated with petroleum jelly, may also be inserted into the nostrils to support the cartilage during healing.

After Procedure

Stitches will be removed after the first week. Nasal packing is removed after 1 to 2 days, and the splint is worn for 1 to 2 weeks. Numbness, swelling, or bruising of the surgical area and around the eyes should be expected.

How Long Will It Take?

The procedure typically takes 2 to 4 hours.

Will It Hurt?

Anesthesia prevents pain during the procedure, but there will be some pain for approximately 1 to 4 weeks after the surgery. You will be given pain medication to relieve this discomfort.

Possible Complications

  • Poor healing of the skin
  • Discomfort and pain caused by gauze packing
  • Tiny red spots from torn blood vessels, which should recede, but may be permanent
  • Allergic reaction to anesthetic
  • Development of permanent excess scar tissue
  • Puncture of septum or collapse of nose bridge (relatively rare)
  • Increased risk of nosebleeds
  • Need for repeat operation to achieve desired result
  • Infection
  • Unsatisfactory cosmetic result

Average Hospital Stay

Rhinoplasty is generally an outpatient procedure.

Postoperative Care

  • For the first few days after surgery, rest in bed with your head elevated to reduce swelling.
  • Apply ice packs to your nose to relieve discomfort during the first two days, then use a warm compress to relieve pain.
  • Take prescription or over-the-counter pain medications as directed by your doctor.
  • Do not blow your nose at all during the first week, and do not blow your nose forcefully for one month.
  • Protect your nose from any injury for 8 weeks, do not wear glasses, and be careful when washing your face.
  • Avoid vigorous exercise for at least 3 weeks and contact sports for 6 months.

Outcome

Expect swelling and bruising to worsen over the first several days after the surgery. You can also expect some bleeding from the nose, headache, and a feeling of nasal congestion. Once the swelling and bruising have diminished, expect full healing in about 3 to 4 weeks. Your facial appearance will be changed, and if surgery was done to correct a breathing obstruction, your symptoms should be alleviated.

Call Your Doctor If Any of the Following Occurs

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting

RESOURCES:

American Academy of Facial Plastic and Reconstructive Surgery
http://www.aafprs.org

American Society of Plastic Surgeons
http://www.plasticsurgery.org

CANADIAN RESOURCES:

Canadian Society of Plastic Surgeons
http://www.plasticsurgery.ca/

Health Canada
http://www.hc-sc.gc.ca/index_e.html

References:

American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) website. Available at: http://www.plasticsurgery.org . Accessed October 14, 2005.

Medical encyclopedia: cosmetic nose surgery. Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/002983.htm . Accessed October 14, 2005.



Last reviewed December 2007 by Elie Edmond Rebeiz, MD, FACS

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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