RHINOPLASTY (NOSE RESHAPING)

Surgery to reshape the nose is one of the most popular procedures, and was one of the first ever performed in the early days of plastic surgery. Rhinoplasty is an extremely satisfying procedure due to the psychological improvements that come with physical reshaping. Due to the intricate underlying structures, rhinoplasty is one of the most complex procedures performed in cosmetic surgery. It is extremely important to find a doctor who has the specific combined medical and artistic skill that will produce a pleasing result.

Interesting facts about rhinoplasty:

• Teenagers requesting this procedure should be assessed to determine if most of their growth spurts have occurred.
• Revisions are not uncommon-swelling during the procedure can sometimes mask imperfections. Also, there's no way to gauge exactly how the body will heal.
• A hump/bump can be removed or the nose made smaller, narrower or shorter, but not always wider or larger without extensive surgery.
• Cartilage implants are sometimes necessary-cartilage may be removed from one part of the nose (the septum) and grafted to another (usually the tip); cartilage or bone from ear, skull or rib may also be used. If adequate cartilage isn't available, a synthetic material like Gore-Tex may be used.
• It's not unusual to have a chin augmentation or reduction in conjunction with a rhinoplasty to bring the profile into balance.
• If breathing is obstructed, the septum can be repaired at the same time.

ALTERNATIVES TO SURGERY
There is no non-surgical method of reshaping the nose.

PREPARING FOR SURGERY
Bring magazine pictures of noses that you like to your initial consultation with your doctor-but remember your new nose has to fit the shape and size of your face. This procedure requires an in-depth evaluation of your nose, facial structure, and skin type. As a result of this assessment, the doctor may make a computer image (or sketch) of the nose that you have agreed upon.

To bring your profile into balance, it's not unusual to have a chin augmentation or reduction in conjunction with a rhinoplasty. Also, if your breathing is obstructed due to a deviated septum, your surgeon may recommend that it be straightened at the same time.

You will also be given pre-and postoperative instructions which will include information on eating drinking and what prescription medications to take and those to avoid. Be sure you and your physician agree on the surgical approach and understand the potential risks and complications involved with the procedure.

THE PROCEDURE
Rhinoplasty can reduce or increase the size of your nose, change the shape of the tip or the bridge, narrow the span of the nostrils or change the angle between your nose and upper lip. It may also correct a birth defect or injury, or help relieve some breathing problems.

Two techniques are currently being practiced; the one your surgeon uses may depend on his or her training and experience. With the traditional "closed" technique, all incisions are made inside the nostrils. Incisions made using the newer "open" technique are made on the central portion below the tip of the nose between the nostrils. If a reduction in nostril size is desired, incisions are made in the crease where the side of the nostril meets the upper lip and cheek. The incision(s) usually heals to a very fine, inconspicuous scar.

Anesthesia
Rhinoplasty can be performed under intravenous sedation with local anesthesia or under general anesthesia. The type of anesthesia depends on the extent of the procedure to be performed, the patient's medical history, and what you and your doctor prefer.

Length of Surgical Procedure
Rhinoplasty can take from one and one-half to four hours, depending on the extent of the surgery to be done. The time can be increased if the surgery is a revision or a reconstructive procedure.

Level of Pain/Discomfort
Pain tolerance is different for everyone. Generally, there can be minimal to moderate discomfort. Some people experience absolutely no discomfort at all. Most discomfort can be controlled with prescribed or over-the-counter pain medications. You may find you only need pain medication for the first day or two.

PRE- AND POSTOPERATIVE INSTRUCTIONS
Although your doctor may have different or additional instructions, these suggestions are intended to make you more comfortable and help you heal.

• Stop smoking, discontinue the use of alcohol, and stop taking vitamin E and any medications containing aspirin or ibuprofen (two weeks pre- and preoperative is usually recommended). Check with your doctor regarding any other medications (including homeopathic/herbal products) you're currently taking.
• Eliminate milk products from your diet a few days before surgery and during the initial healing period (milk products produce mucous).
• Have someone stay with you the first night after surgery (the first twenty-four hours, optimally).
• Dressings - if the procedure requires a splint, this may be applied by the doctor or nurse immediately after the procedure. This must be kept dry.
• Sunbathing and tanning beds must be avoided for a minimum of two weeks prior to surgery (for optimal skin care and health, these should be avoided completely). After surgery, you must protect your nose from the sun for at least six weeks. The longer, the better.
• Do not wear glasses for the first two months unless okayed by your doctor (and then they must be taped to your forehead). Or wear contact lenses. Some glasses are heavy and could cause a groove at the bridge or place unnecessary pressure on the new structure.
• Do not blow your nose until instructed. Then, blow using alternating nostrils so that pressure is not built up.
• Sneeze with your mouth open to minimize pressure.
• Cold compresses-most doctors instruct that cold compresses be applied for twenty minutes every hour for a minimum of forty-eight hours.
• Consider sleeping alone for the first week or so to protect against accidental blows to the nose while sleeping.

RECOVERY
While everyone heals differently, you should plan on approximately seven days for the initial healing period. Stay in bed the first day after surgery. Your nose will be stuffy, your mouth dry, and you could be swollen and bruised around the central portion of your face, including the eyes. A little bleeding is common. Your nose will remain stuffy for about two to three weeks. Swelling in the center of your face should lessen in the first few days, with some minor swelling remaining the first weeks. However, it can take up to a year or longer for all the swelling (which may only be noticeable to you) to disappear, especially for the tip.

Packing is very rarely used these days. If packing is used, it's usually removed by the doctor or nurse in one to three days. Sutures (if external) are removed in about a week, along with the splint. Your scars, if external, may remain red for four to six weeks then gradually fade. Most scars become barely noticeable over time.

RISKS/COMPLICATIONS
Although problems are unlikely, you need to be aware of what can happen and what action you should take. Most risks/complications will be avoided if you make an informed decision, choose a qualified physician, and follow your physician's instructions. After rhinoplasty there is the potential for infections, nosebleed, or numbness. Sometimes a secondary procedure or a revision may be required to correct a hump, asymmetry, or a collapse in nasal passages.

STILL YOU…ONLY BETTER
Most rhinoplasty patients eagerly await the removal of the splint to unveil the new nose they have probably been dreaming about for years. Although the swelling is still marked after the first week, the new shape of the nose is easily identifiable. Rhinoplasty is such a satisfying procedure and the new shape will last a lifetime, unless otherwise corrected.