Nose Surgery (Rhinoplasty)
Rhinoplasty, also known as nose surgery or a nose job, is a surgical procedure which can reshape the nose by reducing or increasing the overall size, changing the angle between the nose and upper lip, removing a hump, narrowing the span of the nostrils, or changing the shape of the tip or bridge.
The best candidates for rhinoplasty are physically healthy men and women who have realistic expectations and are looking to improve the appearance of their nose. Rhinoplasty should not be performed on children until they have finished growing.
It’s generally recommended that rhinoplasty not be performed on children who have not yet finished growing. Children tend to finish growing around the age of fifteen for girls and around eighteen for boys. Future growth of the nose can negatively impact any changes achieved through rhinoplasty.
Rhinoplasty can be performed in an outpatient surgical center or a hospital.
Rhinoplasty is most often performed with either local anesthesia combined with sedation or with general anesthesia.
The actual time it takes to perform rhinoplasty will vary according to the particular case and the technique used. Simpler procedures can take as little as 45 minutes while more complex procedures can take over three hours.
There are two types of rhinoplasty procedures, open rhinoplasty and closed rhinoplasty. For closed rhinoplasty, the incisions are confined to the inside of the nose. For open rhinoplasty, incisions are made on the inside of the nose and an additional small incision is made on the underside of the nose between the nostrils.
The incisions made for rhinoplasty will result in scars. For closed rhinoplasty, the incisions are confined to the inside of the nose and thus no visible scarring will result. Open rhinoplasty involves an additional small incision made on the underside of the nose between the nostrils which results in a well-concealed, fine-line scar.
Patients describe mild discomfort, but rarely pain. You may feel like you have a stuffy nose.
No, it’s best to make preparations for someone to drive you home.
It’s best to have someone stay with you for at least the first night after your procedure.
After rhinoplasty, some swelling and bruising can occur. Patients should plan to stay in bed for the first 24 hours, but should feel much better after a day or two.
Nasal packing is material placed in the nose to either prevent bleeding or to support the nasal bones up or both. It is sometimes used in the repair of broken noses. Many times, Dr. uses absorbable packing in the repair of a broken nose.
Patients typically are able to return to work within about a week after surgery.
Light exercise can be resumed after about a week, though more strenuous activities and contact sports will need to be avoided for three weeks.
If stitches are used, they are usually removed within a week.
Revision rhinoplasty can be performed if you are unhappy with the results of your rhinoplasty. However, it’s important that you give the nose sufficient time to heal as post-operative swelling and bruising can disguise the final result for six months to a year.
Revision rhinoplasty refers to procedures performed to fix or revise a previous rhinoplasty procedure.
Rhinoplasty performed for purely cosmetic purposes is typically not covered by insurance. However, insurance may be available to some degree for procedures used to treat breathing problems or deformities.
Many plastic surgery procedures can be financed and your plastic surgeon should be able to give you more information.
In general, rhinoplasty, cosmetic nose surgery, is designed to reduce excess cartilage and bone in the nose, removing irregularities and bumps to give a straightened, smooth and, usually, smaller appearance. Adding tissue to enhance certain features of the nose can also occur. The overall trend in modern rhinoplasty is away from over-reduction of tissue which can reduce the ability to breath through the nose and towards individualized treatment of each segment of the nose to give a balanced and refined look without compromising function.
Usually, Rhinoplasty takes from one to three hours depending on the complexity of the condition of the nose. Most patients have sedation prior to and during the procedure while some patients request a general anesthesia. Nearly all rhinoplasty operations are done as outpatient surgeries.
This depends again on how complex the procedure is, but in general most patients experience five to seven days of purple discoloration and swelling around the eyes and upper cheeks. The nose itself will be swollen for around ten to fourteen days or longer, but subtle resolution of the swelling at the tip of the nose can take many months after surgery to go away.
The condition described is usually associated with a deviated septum or a bent internal framework of the nose. Most of the time this results from trauma such as a broken nose but many patients with this condition cannot recall an episode where this might have occurred. The condition described in this question however, could also result from allergies or the two conditions can exist simultaneously. Careful examination is needed before surgery to separate the two conditions. While individual insurance policies can vary, in general, functional surgery to improve breathing is considered a covered benefit in many group policies. If additional correction of a cosmetic deformity of the nose is done at the same time the cost of this part of the procedure is usually not covered by insurance.
In general, most or all of the incisions in rhinoplasty are hidden in the inside of the nostril. While external incisions hidden in the creases where the nose meets the cheek can be used to narrow the nose, incisions on the bridge or tip are not usually used in cosmetic surgery of the nose.
In general, our noses tend to elongate as we enter the middle years of our life and drooping of the tip of the nose can occur in the later years as elasticity disappears from the body. While undergoing a cosmetic rhinoplasty as a teenager or young adult will not prevent the effects of aging on the nose, the final shape that results from this surgery is expected to last a lifetime and regrowth of bumps and deformities corrected by the operation is a rare occurrence.
Within three weeks, 75% of the swelling is typically gone, and in three months 90% of the swelling is usually gone after rhinoplasty. Yet, the final result really does not appear until at least one year after surgery. That is because even a small amount of swelling in the nose is important. At national and international meetings, when we present before and after results to explain techniques to other doctors, it is not acceptable to present results prior to one year postoperatively because of this fact. Additionally, the nose tends to slightly swell up and down related to water retention, dietary changes, hormonal changes and the like for up to one year after surgery. That is because the drainage system of the nose is disrupted during a rhinoplasty and takes up to one full year to regenerate. In revision rhinoplasty, swelling can be present even longer because of scar tissue slowing the healing process.
Flat noses generally require that cartilage be added to them to build them up and to increase projection. Narrowing the nose also gives the illusion of it not looking so flat. I almost always use the patient’s own tissue (ear cartilage, rib cartilage, septal cartilage) but occasionally I will use a synthetic implant.
Though it will be swollen, your nose will look more aesthetically pleasing and natural immediately after surgery. You will first see this as soon as your plastic splint is removed (after one week). And, once all bruising is resolved, there will be no adverse signs of surgery – only a better nasal structure that continues to improve as healing progresses.
If your procedure is done with the “closed” technique, then all incisions are inside the nose and no scars are created in your skin. If you have the “open” technique, then there will be a very small, unnoticeable scar in the skin between your nostrils.
At least one week is recommended. The plastic splint on your nose will be removed after seven days, leaving you free of this obvious stigmata of surgery. You may still be mildly bruised under your eyes, so if this will interfere with your work or school, then it may be safer to take two weeks off.
You should avoid contact to your nose for about two months after surgery. Also, any strenuous activities or exercise during the two or three weeks after surgery will increase your swelling, so should be avoided. We understand it is often difficult to abstain from exercising during this time, but you should consider this an important investment in your outcome. Wearing heavy glasses should be avoided for several weeks. Lastly, avoid excessive heat or sun exposure for the month after surgery.
These are answers to the most common asked questions. We feel the more informed our patients are the better we feel. This information was not meant to be exhaustive or complete. Dr. Fustok will give you additional information during the consultation and will answer to the best of his knowledge any inquiry. Surgery is an art not an exact science.