Plastic Surgery

Rhinoplasty (Nose job)

What is the Rhinoplasty (Nose job)?

Rhinoplasty (nose job), is a plastic surgery procedure for correcting and reconstructing the form, restoring the functions, and aesthetically enhancing the nose, by resolving nasal trauma (blunt, penetrating, blast), congenital defect, respiratory impediment, and a failed primary rhinoplasty.

Rhinoplasty surgery can change:

- nose size, in relation to the other facial structures;

- nose width, at the bridge;

- nose profile, with visible humps or depressions on the bridge;

- nasal tip, that is large or bulbous, drooping, or too upturned;

- nostrils that are large, wide or upturned;

- nasal asymmetry and deviation.

Rhinoplasty can usually be categorized into different types:

• Reduction rhinoplasty. The most common complaint in people who wish to undergo nasal reshaping is that their nose is too ‘big’. More accurately, the size of their nose is disproportionately too large for their face. Specifically, one or more of the following may be too large: nasal length, nasal width or nasal projection (how far the nose sticks out from the face). In addition many people with big noses tend to have a ‘hump deformity’ of the nasal bridge. Reduction rhinoplasty aims to reshape the nose into a more harmonious size and form.

• Augmentation rhinoplasty. Augmentation rhinoplasty involves the insertion of an implant to increase the height of the nasal bridge. There are different kinds of implants the patients can choose from: he/she may opt to have a silicone, a gore-tex or a cartilage implant.

• Refinement rhinoplasty. Even if the length, width and projection of a nose are acceptable, other elements will influence nasal aesthetics. Important considerations include tip definition, contour irregularities, asymmetry and the brow-tip nasal aesthetic line. A well defined tip is adequately narrow with properly positioned tip-defining points and has appropriately shaped and sized lobules with smooth contours. A poorly defined tip is either too wide, boxy or bulbous. A poorly defined tip is usually the result of large, widely- spaced lower lateral cartilages. In addition the bone and cartilage framework of the nasal bridge should impart a smooth curvilinear brow-tip aesthetic line.

• Crooked or asymmetric rhinoplasty. Ideally, the nose should be aligned in the middle of the face. Several factors can contribute to a crooked or asymmetric nose. Indeed, in some individuals their inherent growth is such that the nose is located off the midline or has a curvature associated with it. This is much the same phenomenon that one sees with women who have one breast different than another. More commonly, however, a crooked nose or asymmetric nose is the result of trauma or previous nasal surgery. When analyzing a crooked nose several factors should be taken into account. It is important to consider the position and shape of the bone and cartilage segments separately. The bone segment corresponds to the upper third of the nose and the cartilage segment corresponds to the lower two-thirds of the nose. Asymmetry may also be seen in the nasal tip or nasal base.

• Cleft lip rhinoplasty. Cleft lip and palate deformities are the most common type of facial deformity found at birth (congenital). Although they primarily affect the lip and roof of the mouth, their effect extends beyond this to involve the nose and upper jaw. The nasal deformity is referred to as a cleft lip nasal deformity. The abnormalities seen in the nose vary depending on the type of underlying cleft lip and palate deformity.

• Revision rhinoplasty. Revision rhinoplasty refers to nasal reshaping surgery performed in an individual who has undergone one or more previous rhinoplasty procedures. Revision rhinoplasty can range from a simple procedure to remove some residual excess bone or cartilage in the nasal bridge to a very complicated complete overhaul of the nose. Revision rhinoplasty in an individual who has had the misfortune of having too much tissue removed and has severe residual deformity is generally considered the most difficult type of rhinoplasty.

• Reconstructive rhinoplasty. Following surgery to remove cancer or occasionally following facial trauma, the nose may be left severely disfigured due to the lack of tissue that has been removed or lost.

Septoplasty is a subtype of rhinoplasty: it is a corrective surgical procedure done to straighten the nasal septum, the partition between the two nasal cavities. Ideally, the septum should run down the center of the nose. When it deviates into one of the cavities, it narrows that cavity and impedes airflow. Often the inferior turbinate on the opposite side enlarges, which is termed compensatory hypertrophy. Deviations of the septum can lead to nasal obstruction.

You may be offered septoplasty to treat a blocked nose or if you get frequent sinus infections. Septoplasty is also sometimes done to help your surgeon reach your sinuses if you need sinus surgery.

Septoplasty won't usually change the way your nose looks. However, if your nose isn’t straight, it may be possible to have surgery to reshape it at the same time.

What is the procedure?

The operation is usually done as a day case under general anesthesia.

Surgery of the nose is performed either using a closed procedure, where incisions are hidden inside the nose, or an open procedure, where an incision is made across the columella, the narrow strip of tissue that separates the nostrils.

Through these incisions, the soft tissues that cover the nose are gently raised, allowing access to reshape the structure of the nose.

Surgery of the nose can reduce or augment nasal structures with the use of cartilage grafted from other areas of your body.

If the septum is deviated, it is now straightened and the projections inside the nose are reduced to improve breathing.

What kind of result can you expect?

Rhinoplasty surgery can change:

- nose size, in relation to the other facial structures;

- nose width, at the bridge;

- nose profile, with visible humps or depressions on the bridge;

- nasal tip, that is large or bulbous, drooping, or too upturned;

- nostrils that are large, wide or upturned;

- nasal asymmetry and deviation.

Recovery period and recommendations

Splints and internal tubes will likely support the nose as it begins to heal for approximately one week.

While initial swelling subsides within a few weeks, it may take up to a year for your new nasal contour to fully refine

You may have some minor nose bleeds for a few days. To reduce your risk of bleeding, keep your head up as much as possible and don't have a hot bath for a week or two.

You're likely to feel bunged up for up to two weeks after the operation - your surgeon may give you some drops or spray to help this. You may find the pressure lessens at night if you sleep in an upright position on several pillows.

You will need to breathe through your mouth for the first few days. This can lead to dry lips so use petroleum jelly or lip balm on your lips to stop them cracking.

You shouldn't blow your nose for at least the first week. Your nose may drip, but only wipe it gently. If you need to sneeze, cough it out.

Stay away from dusty or smoky places until your nose has recovered.

Possible side effects and complications

The possible risks of rhinoplasty include:

• rupture of small surface vessels of the nose;

• bleeding (hematoma);

• nose asymmetry;

• change in skin sensation (numbness);

• nasal airway alterations may occur after a rhinoplasty or septoplasty that may interfere with normal passage of air through the nose;

• nasal septal perforation (a hole in the nasal septum) may develop but is rare; additional surgical treatment may be necessary to repair the nasal septum but in some cases, it may be impossible to correct this complication;

• unfavorable rhinoplasty scarring;

• skin discoloration and post rhinoplasty swelling.

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