Rhinoplasty

Rhinoplasty, also known as a nose job, refers to a surgical procedure that can alter the appearance of the nose. Rhinoplasty can be performed as an open or closed procedure. An open procedure is performed by making incisions along the creases of the outer nose in order to treat a wide array of nasal despondencies. A closed procedure consists of internal incisions and is limited in what it can accomplish. Rhinoplasty can be performed for aesthetic reasons, functional issues or both. This type of procedure can improve the contour of the nose and provide better overall balance between the nose and the rest of the facial features. Many patients with a deviated septum or breathing problems chose to have rhinoplasty to correct symptoms such as snoring, sleep apnea, headaches and chronic sinus conditions.

Am I a Good Candidate for Rhinoplasty?

A GOOD CANDIDATE for rhinoplasty includes:

• Any male or female patient who is unhappy with the appearance of the nose
• Patients with a droopy or twisted nasal tip
• Any patient with a hump on the bridge of the nose, narrow or wide nasal passages or depressions in the nose
• Patients who have chronic sinus problems or breathing issues
• Patients who had trauma to the nose
• Those with a deviated septum
• A patient whose nose has stopped growing
• Patients who have inadequate airflow through the nose and suffer dry mouth symptoms

The following patients are NOT GOOD CANDIDATES for rhinoplasty:

• Patients with high blood pressure or bleeding disorders
• A patient with diabetes, heart or lung disease
• Patients who have skin or nasal cartilage which is deficient in structure
• A patient in their teens (or younger) whose nose has not stopped growing

How is Rhinoplasty Performed?

During open rhinoplasty, the surgeon makes an incision along the columella AKA the soft tissue located between the nostrils. When the skin is lifted, this gives the surgeon an unobstructed view of the lower nasal skeleton. The surgeon can use this access to alter various structures of the nose including the cartilage and/or bone that supports the nose. Implants can be placed within the tip of the nose for a more prominent or masculine look. Surgeons can also treat more complex nasal deformities such as a cleft lip or misshapen nose with the open technique. Once the alterations have been made, the skin will be re-draped over the nasal structure and small sutures will be used to close the incision.

Closed rhinoplasty involves the surgeon creating the incisions from inside the nostrils. The surgeon can then alter or remove the bone and cartilage. In addition, tissue can be added from the patient’s own body or by using synthetic filler.

Alternative Techniques

An alternative technique for closed rhinoplasty is endoscopic sinus surgery. The doctor will insert an endoscope, AKA a flexible tube with a light and camera, through the nostril to gain visualization. Thin surgical instruments are used to alter or remove small amounts of bone which may be blocking the sinus opening.

Patients who want subtle changes to their nasal structure, but do not want to undergo surgical rhinoplasty, may wish to consider non-surgical rhinoplasty. Non-surgical rhinoplasty utilizes dermal fillers to immediately alter the shape of the nose with little to no downtime. Dermal fillers can treat issues such as a bump on the bridge of the nose, fill-in depressions, lift a drooping tip and increase the size of the nose. However, they cannot decrease the size of the nose or make drastic changes. Furthermore, dermal fillers are temporary and require continued treatments to maintain the effects. Only a surgical rhinoplasty can provide permanent results via one procedure.

What Is the Cost of Rhinoplasty?

The cost of rhinoplasty can range anywhere from $6000 to $15,000 depending on the technique used by the surgeon, the extent of the procedure, the surgeon’s level of expertise and the geographic location of the surgery. If a nose job is being performed for purely aesthetic purposes, it will not be covered by health insurance. Rhinoplasty that is being performed to improve the breathing ability of the patient may be covered by insurance.

Recovery and Downtime

Rhinoplasty RECOVERY varies from patient to patient according to the technique used and its complexity. Patients can expect some discomfort during the first few days but pain medication can easily manage the discomfort. Swelling and bruising is common and can be quite extensive during the first 2 weeks. Therefore, most patients require at least 2 weeks of DOWNTIME from work. Patients will be very limited during the first week and should not do anything to raise their blood pressure since this can result in further bleeding, swelling and bruising. Patients are advised to keep the head elevated and use ice packs on the mid-face region to help with pain and swelling. Puffiness and bruising around the eyes is normal after rhinoplasty. The doctor may place a splint on the outside of the nose to maintain the new shape. Nasal swelling post procedure can lead to reduced airflow and dry mouth. Mouth breathing can also cause dry mouth, bad breath and a sore throat. A humidifier can be placed in the room to keep the air moist and help with these symptoms. The packing and splint will be removed at a follow-up visit in about 5 to 7 days. As soon as the packing is removed, patients can breathe more freely and feel immediate relief. However, patients should not attempt to blow the nose, sniff hard or rub the nose. Patients should also avoid bending over, running or participating in any strenuous activities until the doctor states otherwise.

Results

Rhinoplasty results depend on the technique used and the goals of the patient. Patients who had a nose job for functional issues should notice results after the packing is removed and the passageways are cleared of dried blood. There should be overall improvement with airflow that allows the patient to breathe effortlessly. The complete results may not be apparent for 12 months since it can take that long for the swelling to completely dissipate and for the nasal contours to become fully refined. The surgical effects of rhinoplasty are permanent. However, any trauma to the nose after surgery can alter or void the results. Furthermore, gradual changes to the face and nose will occur over time. The skin will become lax and gravity may cause the tip of the nose to slightly droop. To maintain the results, patient should adopt a good skincare routine and use sunscreen whenever going outside.

Limitations of Rhinoplasty

The limitations of rhinoplasty include:

• It cannot create the “perfect nose” but it can make improvements
• The length of downtime needed after surgery might be longer than some patients desire
• The total amount of changes that can be made
• The degree of nasal tip adjustments in patients with thick skin
• The inability to completely fix a twisted or misshapen nose

Risks of Rhinoplasty

The risks associated with rhinoplasty include:

• An adverse reaction to anesthesia
• Significant bruising
• Persistent swelling that can last a year
• Infection
• Serious nasal blockage caused by swelling inside the nose
• Changes in sensation
• Injury to the septum
• Skin necrosis/death
• Asymmetry
• Frequent nose bleeds
• Continued sinus issues
• Over, or under, correction

Considering Rhinoplasty

Rhinoplasty can reshape the nose and provide better overall proportion to the nose and the rest of the facial features. It can also improve chronic symptoms associated with sinus pressure and breathing issues. Rhinoplasty can make subtle or drastic changes and can be customized to meet each patient’s individual goals. Since the nose is the center of the face, and a 3-dimensional feature, rhinoplasty should be performed by a board-certified surgeon who specializes in rhinoplasty and performs it regularly. Although a skilled surgeon can produce the most optimal results, a patient must have realistic expectations about what rhinoplasty can do for them. Otherwise, they may not be satisfied with even the most ideal outcome.

Written by Cosmetic Town Editorial Team

Based on exclusive interview provided by Dr. Anil Shah of Shah Facial Plastics in Chicago, IL.