Men and women who come to our Honolulu, Hawaii practice for rhinoplasty each have their own reasons for wanting to enhance their nose.Rhinoplasty surgery is a procedure to reshape the nose. In most plastic surgery procedures, function follows form and reshaping the nose may affect breathing as well as the tone of speech. The nose consists of several subunits and rhinoplasty surgery may include shaping the bones, cartilage and overlying soft tissues.
Rhinoplasty surgery can be performed by a variety of methods and there is no one method which is best for all patients. In most practices, the patient will make the decisions regarding rhinoplasty based upon their goals and expectations as well as their anatomy. Like everything in life, there are advantages and disadvantages for each option and every patient has different opinions and desires so you are encouraged to discuss the various options with your plastic surgeon at length to find out which option is best for them. Your plastic surgeon will review a few common aspects of rhinoplasty and some of the advantages and disadvantages of each option.
The nasal tip is made up of cartilage subunits and relies upon the nasal septum for support and projection. Rhinoplasty surgery on the nasal tip is probably the most common type of rhinoplasty performed. The tip defining point is one of the most important aspects of the appearance of the nose and the underlying cartilages can be manipulated and shaped to alter the tip defining point. Nasal tip rhinoplasty oftentimes involves fine sutures to reposition the nasal tip cartilages and sometimes may involve a cartilage graft to enhance the nasal tip. A tip rhinoplasty can be performed as a separate procedure or in conjunction with surgery on the nasal dorsum and nasal root.
The nasal dorsum is the ridge that extends from the junction of the forehead to the nasal tip the dorsum consists of the nasal bones at the root and the upper lateral cartilages as well. In this regard, it is part bone and part cartilage. The nasal dorsum may be reduced, augmented or straightened depending upon the anatomy and patient’s desires. Manipulation of the nasal dorsum may involve cutting or breaking the nasal bones to reposition them. Following manipulation of the bones and cartilage, splinting may be required to support the tissues until they have healed in the appropriate position. Occasionally, surgery on the nasal dorsum involves adding tissue and this can be the patient’s own tissue or some type of artificial material. Another aspect of rhinoplasty surgery involves whether the nasal bones, fractured or manipulated. Moving the nasal bones usually requires an osteotomy or cut in the nasal bones using a special osteotome or bone cutting device. When osteotomy is performed, patients usually will experience black and blue discoloration around their eyes and this may last for several weeks. Because of the extensive undermining of tissues with all types of rhinoplasty procedures, the blood supply of the skin can be compromised. For this reason these procedures are usually not performed in smokers.
Oftentimes, rhinoplasty procedures are categorized as either open or closed. An open rhinoplasty procedure involves an incision across the columella which is the thin strip of skin that extends from the tip of your nose to your upper lip. This small incision allows complete exposure of the nasal tip cartilages for suturing and shaping the nasal tip. The tip cartilages can be manipulated to some degree without an open approach and this is called a closed rhinoplasty because the incisions are all hidden within the nostrils. It is important for you to discuss what options may be most beneficial to you with your plastic surgeon based upon your anatomy as well as your goals and expectations.
The plastic surgeon will perform specific measurements and may utilize photographs to determine what aspects of rhinoplasty surgery may be most beneficial for you. The ideal candidate for rhinoplasty surgery is a patient who has realistic expectations and the actual nasal defect is proportional to the patient’s perception of the defect. Oftentimes, patients may come into the office requesting rhinoplasty surgery when in reality a major component of their nasal appearance is related to a disproportion of some adjacent facial structures. These patients may benefit from additional facial cosmetic surgery and it is not uncommon for the plastic surgeon to discuss how the adjacent facial structures may or may not be affected by rhinoplasty surgery. Occasionally, a plastic surgeon may discuss the pros and cons of a chin implant or other facial contouring procedures as these procedures do have an affect on the appearance of the nose in relation to the entire face.
The immediate recovery will depend upon what type of anesthesia is employed for the surgery. A total intravenous anesthesia (TIVA) technique which wears off relatively quickly has minimal side effects such as nausea. Various anesthetic agents affect patients differently and will dictate the patient’s recovery. The other main determinant of recovery from rhinoplasty surgery is whether the nasal bones will be cut and moved or not. When nasal bones are cut and moved, this usually results in “black eyes” and black eyes almost always take 2-3 weeks to resolve. Another issue is whether a nasal splint will be placed at the time of surgery. Most patients will have one and this will stay on for about a week. Most plastic surgeons will incorporate extensive local anesthesia into the tissues which can allow patients to wake up pain free. The local anesthesia will begin to wear off in 3-4 hours and most patients will experience mild to moderate discomfort at this stage. Surprisingly, most patients state that the pain from rhinoplasty surgery is not as much is the anticipated. Most patients state the most discomfort is associated with nasal packing and is avoided if possible; however, nasal packing is sometimes necessary. If extensive work is performed on the septum, a special splint or packing may be used to hold the septum in position and this should be discussed with your plastic surgeon. Most plastic surgeons want to see certain patients back in the office 1-2 days after their surgery to remove packing or septal splints which are placed at the time of surgery. For other patients, there are no splints or packing to remove. It is most common to use absorbable sutures which melt on their own and your plastic surgeon may see you in about a week. One of the potential risks of surgery is infection and this usually manifests itself around 5-7 days after surgery and is usually effectively treated with oral antibiotics. Other risks of rhinoplasty surgery include anesthesia problems or adverse reactions, scars, bleeding, hematoma (blood collection), delayed wound healing, contour irregularities and nasal obstruction. Your plastic surgeon will go over all of the potential risks and complications with you prior to surgery so that you can make an informed decision regarding the risk to benefit ratio for their proposed surgery.
The actual “full” recovery period from rhinoplasty is at least a year and this involves a gradual softening and resolution of edema. A significant amount of the recovery occurs within 2-3 months but it will take the external scar a year to soften/mature and the internal tissues undergo similar softening. Immediately following rhinoplasty, the nose will have a very swollen. Other long term potential complications are related to each patient’s own tissues and these tissues are dependent on that particular patient’s genetic makeup.