‘Nose job’ or ‘Rhinoplasty’ is one of the most commonly performed cosmetic surgery procedure especially in the younger age group. Nose being the most prominent part of our body cannot go unnoticed. A pleasing nose in harmony with lips and chin is considered hallmark of one’s beauty. ‘Ideal nose’ is that which suits your face the best and is in harmony with other facial features.
Nose is divided into upper fixed root, middle dorsum or bridge and the lower moveable lobule or the tip region. All these regions of the nose are amiable to change. Thus a nose that is too big, very broad, with hump or prominent bridge, very long, drooping, broad, rounded or heavy tip, short, depressed or crooked, wide and flaring can be corrected and made more pleasing. Blocked nose with difficulty in breathing responds well to septum correction surgery or Septorhinoplasty.
Operative and post operative:
Nose job or rhinoplasty surgery is absolutely painless. It is done under local or general anaesthesia and takes about 1 to 2 hours. After the surgery there are tapes and light splints over the nose for about 7 days. Nostrils are sometimes packed with dressing for 1-2 days if septum is corrected. Slight swelling or bruise is expected after the surgery. After the surgery the person may have to stay for 1- 2 days. The patient can eat light meals.
All stitches, dressings and splints are off after 7 days and one can resume normal light activities. There are no visible scars or marks over the nose. Although the postoperative swelling may take several months to subside nose looks good after dressings are out and keeps improving thereafter.
Results & Complications
Rhinoplasty or nose job is one of the most rewarding surgeries in terms of altering the shape of a body part. However what is desirable may not be attainable at times, especially if a person has unrealistic expectations. Sometimes small touch up procedures may be required at a later date to improve the results. It is very important to remember that cosmetic surgery can improve/enhance your looks but it cannot change your face totally to look like some actress or actor whom you adore. It is important to know what can and cannot be changed and what rhinoplasty can and cannot do for you. Just remember to be sure to have proper communication with your surgeon.
Open v/s Closed Rhinoplasty
Most nasal surgery is 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). Surgeon usually makes a small 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.
Frequently Asked Questions about Rhinoplasty
What is rhinoplasty?
Rhinoplasty is cosmetic surgery of the nose. It is also known as nasal refinement and the layman’s term “nose job”.
When can rhinoplasty be performed?
Extensive nasal surgery is generally avoided in children. Rhinoplasty is performed on teenagers and young adults.
What does a typical Rhinoplasty consultation entail?
First, your doctor will discuss your goals with you and he will explain what can be achieved realistically. A good doctor will not just slim your nose or shorten it, rather he will take into account what your facial features and bone structure would benefit from. Be it a slimmer more defined or perhaps more “turned up”. Perhaps it is only a “hump” that is desired to be removed, making it unnecessary to even have a full Rhinoplasty. There is no “one size fits all” when it comes to this procedure. It is all individual. Just like you.
How is Rhinoplasty performed?
A Rhinoplasty can be performed under Local or General Anaesthesia. Surgery generally lasts about 1 – 2 hours. The patient experiences no pain during the surgery.
A splint or cast is applied when required and will be worn for approximately 7 days. Many patients remember very little about the surgery. After the procedure is completed, the patient then recovers in a relaxed environment and monitored for a couple of hours before being driven home by a companion.
What should I expect post-operatively?
After your surgery your surgeon will have placed a pressure dressing over your eyes and a gauze pad underneath your nose to catch blood and mucous. You will remove the pressure dressing after a few hours or as specified by your surgeon. You nose will be sensitive for approximately a month and a half although patients report no serious pain or discomfort. However, patients do report the discomfort of breathing with the packing and cast on the nose. Some patients feel claustrophobic feeling as if they cannot breathe. This feeling widely resembles a head cold or sinus infection. Only when the cast is removed do you feel slight discomfort, unless you bump it accidentally.
When will the cast be taken off and does this hurt?
The cast is removed approximately 7 days post-operatively. You may feel a slight stiffness in the upper lift as the swelling “moves downward”. This will subside in a matter of hours. You must be very careful not to bump it as it is vulnerable to breakage. The bones will completely mend within 2 months.
When will I be able to see the results?
The nose will be very sensitive for approximately a month and a half. The patient will start to see a difference immediately but it will still be swollen. The swelling starts to generally disappear about a week after the cast is removed. Approximately 80% of the swelling and 100% of the discoloration are usually gone by 2 weeks after surgery. 90% of the swelling is gone by two months after surgery and the rest slowly disappears over the next year. Although the nose is still swollen after the first month, most people would not recognize this fact. The patient will not notice this swelling. Instead the patient will notice that the nose becomes more refined with better definition over the first year. The inside of the nose may be swollen for approximately three weeks after the surgery. Nasal breathing may be difficult during this time. If surgery is performed to straighten the nasal septum, an improvement in breathing will be appreciated at about 3 weeks.
What are the risks of Rhinoplasty?
It is possible to develop tiny red marks and “spots”, this can be the result of blood vessels that may have burst under the skin’s surface during the surgery. Although this is extremely infrequent it can happen and the “spots” may not ever go away. Scarring is minimal if the incisions are made inside of the nose, however when an “open” technique is used, or if narrowing of the nostrils is desired the scars made on the outside of the nose may be visible forever. Even when a highly skilled surgeon performs your surgery, sometimes your body may not heal “correctly” or have adverse reactions causing undesired results. If so it is quite possible that additional surgeries may be needed. Some patients will lose their sense of smell, temporarily. Your nose may be slightly swollen and for over a year. Scar tissue may heal in a way that may cause a “whistling” sound to be heard when you breathe in and out.
This surgery has the highest rate of revisions. It seems that some people, especially mature people, may not readily accept the “new” look. Being accustomed to their “old” nose, they just can’t seem to comfortably make the transition. Although there are a few rhinoplasties that just don’t heal correctly, due to something as serious as human error (the surgeon’s) or as simple as not having your head elevated enough or sleeping on one side a lot without a proper cast. The nose can “pull” to one side if the cast does not support it properly in the first week. Or quite simply, your body may just heal that way.
Are there any new techniques to repair a deviated septum? Is cauterization used? Does the nose always have to be packed after surgery?
There are many ways to fix a septum. Generally cautery is used only on the turbinates or the initial incision on the columella in open techniques. The septum is like a wall frame in a house. The skin (mucosa) over it is like wall paper, and the cartilage on the inside is like drywall. You place an incision in the front part of the nose where it is hidden and raise the wallpaper off the wall. Then you can perform the necessary correction to the “drywall” (cartilage) and when you put the “wall paper” (mucosa/skin) back it looks like nothing was done.
Usually packing will be required however, some patients are eligible for tubes or straws placed in the centre of the packing on each side so that direct airflow through the nose is possible. Most patients find this a psychological discomfort rather than a physical.
I am 16 and have been thinking of rhinoplasty for a long time. At what age is it safe to have a rhinoplasty?
Usually rhinoplasty is performed at the earliest, 15 or 16 years of age in girls and 16 to 17 years of age in boys. In other words, this depends upon the stage of growth in the face as well as the gender of the patient. A qualified surgeon can better help you upon personal examination.
I’m getting a deviated septum and a hump fixed all in one and I wanted to know what kind of scarring I should expect. Also, how long is it after the operation that I’ll see good results?
Usually, there is no visible scarring unless it is an “open rhinoplasty”. Some surgeons perform all of their rhinoplasties, “open”, some, all closed. It solely depends upon the surgeon. You will find that most surgeons tend to disagree when it comes to technique. They either prefer open or they prefer closed. If it is an open rhinoplasty the scar would be on the columella (the skin that separates the nostrils) sometimes resembling a straight line or a flattened “z”.
You can expect swelling, especially in the tip if you are having tip “work” performed. The swelling usually begins to subside within the first month but the end result may not be seen until at least 9 months post-operatively. Although this time period tends to lean towards a year and over.
I have thick nasal skin and a surgeon I spoke with said that I may not be able to see much detail with my rhinoplasty? Is this true? Should I see another surgeon?
For many patients with thick skin, the skin is thinned out in the surgery as the tip is worked on. This really adds a lot to help with definition. Excess skin length just shrinks away as the swelling decreases. Also, many patients with thick skin actually do better with rhinoplasties because the flaps that are elevated are so firm that you can do a lot more with the cartilages and it is better hidden. Very thin skin shows every little imperfection.
Going on several consults and getting a second, third and even more opinions is a good idea in any case.
Can I see other operated patients before & after photographs?
Yes. Doctor can show you photographs of patient who had similar problem like yours.
During childhood I had undergone surgery for cleft lip but nose is still asymmetrical, can it be corrected?
Can my own tissues be used for augmentation of Nose Bridge? What are the nasal implants? Are there any side effects?
Implants are synthetic materials usually derived from silicon polymers e.g. Prolene mesh, porex, etc. There is always remote possibility of infection, displacement or extrusion of implant.