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Nose Reshaping Surgery (Rhinoplasty)
With nearly 400,000 procedures performed yearly, nose surgery, or rhinoplasty, is one of the most common plastic surgery procedures performed today. Often, the structure or size of the nose is not proportionate with other features on the face. Rhinoplasty is used to change the appearance and proportion of the nose and enhance facial harmony. Nose reshaping procedures can help to correct problems such as the size or shape of the nose, the span of the nostrils, or the angle between the nose and the upper lip. Surgery of the nose may also correct impaired breathing caused by structural abnormalities in the nose.
There are two types of nose surgery: closed procedure and open procedure. In closed procedure, incisions are made inside the nose, while in open procedure, an incision is made across the columella, the narrow strip of tissue that separates the nostrils. Whether your doctor uses one approach or the other will depend on his training and preferences. While some physicians prefer the closed technique due to shorter procedure and recovery time, both types of procedures can produce excellent results. Rhinoplasty is typically performed while the patient is under general anesthesia.
A closed rhinoplasty procedure may last approximately one to two hours. To begin the procedure, the physician generally makes two small incisions inside each nostril to gain access to the cartilage and bone. After the incisions are made, the surgeon, using very small instruments, reshapes the nose by removing or adding bone, cartilage, and tissue to achieve the desired appearance. In patients whose nasal tip is wide or bulbous, the physician may choose to remove a portion of the alar cartilage from the tip of the nose. Depending on patient’s anatomy and the extent of treatment necessary, the physician may choose to use sutures to bend or pull the alar cartilages inward to create a narrower tip or adjust its position.
Reduction of the dorsal hump, bump on the nose, is one of the main reasons why patients choose to have rhinoplasty. The dorsal hump usually consists primarily of cartilage and some bone. In order to remove the dorsal hump, the physician may choose to use a chisel-like device called an osteotome. Using the osteotome, the physician carves away areas of cartilage and bone. Following the removal of the dorsal hump, your nose may have what is known as an open roof, which is an open space between the nasal bones.
To close the open roof, the surgeon will perform an osteotomy to reposition the nasal bones. Although it is not always necessary, an osteotomy can be performed to correct a high nasal dorsum with a dorsal hump, close an open roof after the removal of a dorsal hump, or create a narrower base of the nose. Using an osteotome, the physician carefully creates breaks in the nasal bones by tapping the device gently along a designated path. Once broken, the nasal bones are shifted upward to close the open roof.
Once the physician has finished reshaping the nose, the incisions inside the nose are closed with dissolvable stitches. The physician places nasal airway splints inside your nostrils that provide support and stabilize the nose as it heals. Steri-strips are applied to the outside of your nose. If the nasal bones were broken during the procedure, a nasal splint is applied as well. The bandages and splint are used to help the tissues heal and conform to the new cartilage and bone structure.
After the surgery, you will likely experience some pain, bruising, and swelling, particularly in the upper portion of your face and around your eyes. The pain can be effectively treated with oral medication. These symptoms will begin to dissipate within the first few days following surgery. Stitches, bandages, and the nasal splints may stay in place for approximately five to seven days. Although the majority of the swelling will subside within a few weeks, some minor swelling may persist for a few months. However, with this surgical procedure, the final results may continue to evolve for up to one year. During this time you may notice gradual changes in the appearance of your nose as it refines to a more permanent outcome. Swelling may come and go and worsen in the morning during the first year following your nose surgery.
Our plastic surgeons will explain in detail the risks associated with the surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure and any risks and potential complications associated with it. Some of the more common complications that may arise after the procedure are bleeding (hematoma), infection and fluid accumulation. These complications can be corrected. That’s one of the reasons why our safety-conscious surgeons ask our patients to stay in the hospital for several days.
Even though you are going to be staying at a tropical destination, after the surgery you will not be able to swim in the ocean or be in direct sunlight. You will feel well enough to return to work within seven to ten days following your procedure. While you are recovering, you should avoid strenuous activity (such as heavy lifting) or exercise to allow your body sufficient time to heal. Furthermore, patients must refrain from smoking for several weeks before and after the surgery. Any corrective glasses that are worn must be taped up and off the nose. The nose will need to be well-protected from the sun for the first year after the procedure.
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