Rhinoplasty, also known as nose reshaping or nose job, is a surgical procedure performed to improve the appearance and proportion of the nose to the rest of the face. Rhinoplasty is not exclusively a cosmetic procedure. The surgery also aims to maintain or improve nasal function if the patient has reduced airflow due to an obstructive process. It adds to the complexity of the procedure as internal nasal structures have to be modified to correct functional concerns. Combining these factors can explain why rhinoplasty is such a rewarding surgery, which can provide highly favorable outcomes.
What is Rhinoplasty?
As a central landmark of the face, nasal proportions and symmetry are directly linked to facial beauty. Rhinoplasty enhances facial harmony and the proportions of your nose. Besides addressing cosmetic concerns, it can also help treat functional issues due to obstruction in the airflow. Therefore, rhinoplasty is the most widely performed procedure worldwide.
Despite its popularity, rhinoplasty is one of the most challenging and complex procedures because the technical difficulties, the wide range of techniques used, and the struggle to achieve consistent results make it challenging even for experienced surgeons. Meticulous planning and excellent surgical skills are prerequisites for good outcomes. However, there is no such thing as an 'ideal nose' or 'ideal results' because a nasal configuration that may suit one patient's face might be very different or another.
How to Prepare for Rhinoplasty?
You can start preparing for rhinoplasty by scheduling a consultation with a qualified and experienced surgeon who can assess your candidacy, discuss your goals and expectations, and create a personalized treatment plan. You may need a medical evaluation to ensure you are healthy for the procedure. Your surgeon may also ask you to stop taking certain medications or supplements that can increase the risk of bleeding during or after surgery.
Moreover, you must avoid smoking and drinking alcohol for at least two weeks before and after surgery, as these can increase the risk of complications and delayed healing.
Plan your recovery by arranging for a responsible adult to drive you home and stay with you after surgery to assist you with daily activities for the first few days following surgery.
It's better to wear loose and comfortable clothing on the day of surgery that can be easily removed and put on.
Before the procedure, the patient should confirm that they accept the risk of:
a significant dissimilarity between the planned and actual outcome
operative impaired nasal breathing due to scarring
temporary or long-lasting numbness of the nasal tip
alteration of skin texture and color
reduced mechanical stability of the nasal framework
the eventual necessity of a revision.
A well-informed patient will find it easier to cope with post-operative swelling and bruising of the eyelids, nasal obstruction due to swelling, and the inconvenience of nasal packs.
A nose reshaping surgery typically involves the following steps:
General anesthesia or intravenous sedation is administered for your comfort during the procedure. The choice of anesthesia depends on the extent of the surgery, your personal preference, or your surgeon's recommendation.
Whatever the anesthesia choice is, it is done meticulously to produce numbness in the nasal region and a bloodless operative field.
Rhinoplasty is performed using a closed procedure, where incisions are well-hidden inside the nose, or an open procedure, where the nose is incised across the narrow strip of tissue separating the nostrils, called the columella.
The skin covering the nasal bones and cartilage is approached through these incisions and gently raised to reshape the structure of the nose.
Reshaping the Nose
An oversized nose may be reduced by removing bone or cartilage. Sometimes nose surgery may require adding cartilage grafts. Most commonly, cartilage from the septum is used for this purpose (the septum is the partition in the middle of the nose). Sometimes cartilage from the ear or a section of rib cartilage can be used, however infrequently.
If the septum has deviated, it can be straightened, and the protrusions inside the nose are reduced to improve breathing.
Closing the Incisions
Once the underlying structures of the nose are reshaped, nasal skin and tissue are redraped, and incisions are closed.
Additional incisions may be made in the natural folds of the nostrils to change their size.
Splints and Dressings
Splints (packing) and dressings are placed outside and inside the nose. Splints provide immobilization and protection of reshaped nasal tissues and preserve the new shape. Plaster of Paris, thermoplastic splints, and aluminum splints (Denver splints) are commonly used. The advantages of plaster of Paris splints are low cost and unparalleled versatility.
Initial swelling usually subsides within a week. However, your nose may take as long as a year to show a fully refined contour. During this time, you may observe gradual changes in your nose until it's permanently reshaped.
Swelling may come and go and get worse in the morning during the first year of your rhinoplasty. During this time, you will be given specific aftercare instructions and oral and topical medicines to promote healing and reduce the risk of infection.