Rhinoplasty – Plastic Surgery for the Nose
Rhinoplasty is the name given to the operation whose purpose is to correct deformities of the nose. The operation consists of removing any excess bone or cartilage and rearranging and reshaping the remainder.
Most rhinoplasties are performed because the patient desires an improvement in appearance; he or she may simply want a nose which is in harmony with the rest of the face rather than one which is distorted. On the other hand, one may be motivated by economic or career considerations as is the case with models, actresses, etc. Or, it may be as is often the case, that the nose is becoming progressively more disfigured the older the patient becomes until breathing difficulty occurs. At times, patients have deformities of the inside of the nose which impair breathing, cause headaches, or sinus trouble which cannot be satisfactorily corrected without simultaneously straightening the external nose.
The Rhinoplasty Consultation
During the consultation, photographs are taken and then using computer imaging you can actually “try on your new nose”. Dr. Silver will sketch on the screen what he envisions your outcome to look like. He and the patient discuss extensively different options. This is the time when the patient really needs to communicate well what their goals and desires are so as to achieve the best results.
Dr. Silver also uses these pictures to study the individuals nose and face and plan the operation in much the same way a builder plans a house; in this connection, the object is not only to improve the shape of the nose but also the appearance of the entire face. While trying to achieve the patient’s goal, he cannot guarantee to duplicate the ideal exactly because of the limitations inherent in surgery; as a matter of fact, no surgeon can “guarantee” the results of any treatment or procedure.
Fees in general are quoted at the consultation visit, and if special problems exist then fees are quoted after studying the photographs and sketches prepared. In some case insurance will pay for a procedure especially if breathing issues are involved. However, cosmetic surgery is not covered by insurance.
For a week before surgery, certain medications are given to speed healing and hold to a minimum the amount of swelling and dis-coloration which usually occurs around the eyes.
Nasal surgery is performed as an out-patient procedure at the main campus of Northside Medical Center. Comfort and care are the main concerns of everyone involved while patients undergo rhinoplasty surgery. Following surgery, the patient is allowed to remain in the recovery area until fully reactive and is then discharged home in the care of a friend or family member. Certain lab work is required to insure the maximum safety of all our patients.
For anesthesia the patient is given an intravenous injection in the arm to be put to asleep. When general anesthesia is indicated and administered, it is done so under the care of an anesthesiologist, whose charges are separate from the surgical or out-patient charges. The actual surgery takes about two and one-half hours; however, additional time is taken for certain preliminaries necessary to properly prepare the patient.
Post Rhinoplasty Surgery
At the completion of surgery, a small adhesive tape-compound splint is applied to the nose, and a small amount of soft packing is inserted into each nostril (not the entire nasal passages). The premedication taken during the week prior to surgery plays a tremendous part in the reduction of swelling and discoloration. The dressings and the packing are removed at the office about 5-6 days following surgery.
Following discharge, the patient is urged to remain out of bed at home because being in an upright position will decrease swelling and accelerate healing.
At the end of one week most of the swelling and discoloration about the eyes has disappeared in 90% of the patients. Some slight swelling of the nose (which the patient feels more that anyone else sees) is present in progressively diminishing amounts for several weeks; the patient is particularly conscious of this in the morning when first arising and notices that is is much reduced as the day progresses. If work has to be done on the nasal septum 9the partition in the middle of the nose), there may be varying amount of nasal blockage for several days after the packing is removed; antihistamine-decongestants may be given to relieve this. The average patient may return to work about a week after surgery. However, desk work can be resumed in two to three days after surgery.
After all dressings have been removed, the patient visits the office on several occasions for a six-month period in order to check progress. During this time, the patient must be very careful that the nose is not injured in any way. Protection must be taken from prolonged exposure to direct sunlight. Eye glasses must not be worn unless they are suspended from the forehead with adhesive tape for the first six weeks. The nose may be gently blown after two week. There is no contraindication to gently cleansing the outside of the nose, or to the use of cosmetics. It is not advisable to lift heavy weight for at least two wee after the operation.
Several Facts That Should Be Understood About Rhinoplasty
1. When the dressings are first removed, the nose appears turned up too much due to the effects of the bandage and swelling of the tissues. Therefore, the patient who expects to see a perfectly shaped nose as soon as the dressings are removed will suffer keen disappointment.
However, a great deal of swelling disappears within three or four days after removal of the bandage, and the nose begins to approximate its eventual shape; the average acquaintance met on the street would probably not notice any swelling. It generally take upwards of one year for the last one or two percent of the swelling disappear; this does not usually bother the patient nor detract from the appearance of the nose – rather, the elements of the nose seem to have improved “definition” as this last bit of swelling subsides.
2. In like manner, the tissues within the nose are somewhat swollen after surgery; therefore, progressively decreasing amount of nasal blockage should be expected for a time following the average uncomplicated rhinoplasty.
3. In about 99% of the cases the operation is absolutely painless and the patient sleeps naturally throughout the procedure. The same is true of the post-operative course with respect to pain; as a matter of fact, most people require a pain reduction medication on only one occasion. In comparison, patients have a greater amount of pain after tonsillectomies.
4. The thicker the skin, the longer it takes for the nose to return to its final shape.
5. All the work done is on the inside of the nose; there are no scars on the outside. There are two exception. If it is necessary to make the nostrils smaller, an incision is made where the side of the nostril adjoins the upper lip. Because this is located in a natural body fold, the scar is practically invisible within a few weeks. If the surgeon feels there is an indication to approach the cartilage and bone through the base of the nose, a small incision is made in the skin between the nostrils. This scar likewise, is practically invisible within a few weeks.
6. At the pre-operative visit the patient is given a comprehensive set of printed instructions concerning his activities and the care of the nose during the post-operative period.
7. Patient should remember that there is a limit to the corrective procedures possible or recommended. The surgical goal is improvement, not to match the ideal which might be present in one’s mind. Some of the limiting factors in rhinoplasty are the contour and shape of the face, the texture and thickness of the skin, the inclination of the chin, lip, and forehead, the depth of the angle between the forehead and the nose, the height of the individual,a nd the healing powers of their tissues.
8. Finally, noses that have been severely injured (as from boxing, football playing, or an accident, for example) or those which are markedly crooked or that have had previous surgical operations are technically difficult to correct. A physician tries to make the correction in one operation and succeeds in the vast majority of cases, but sometimes a short additional procedure is required.