Otolaryngology (ENT)

Rhinoplasty Plastic Nose Surgery

Rhinoplasty refers to plastic surgery of the nose. It is often performed to help people breathe better, but also to make the nose more cosmetically appealing if someone has a deviated septum, or a nose deformity. Rhinoplasty is among the top plastic surgical procedures performed each year in the United States.

Rhinoplasty Surgical Approaches

During the closed approach, the entire surgery is performed through incisions made inside the nose. This has several advantages including no external incisions, shorter surgeries, and generally less swelling after surgery.
During the open or external approach, a small incision is made across the narrow bridge of skin between the nostrils called the columella. Connecting this incision to others within the nose allows the surgeon to easily visualize the nose’s internal structure. Better exposure allows more precise correction of deformities such that many revision surgeries are performed in this manner. The external incision may be considered a disadvantage, but is often imperceptible when closed carefully.

What is Affected During a Rhinoplasty?

Nose Bridge – Many patients wish to straighten or narrow the bridge or have a bump removed. Some patients with low bridges, particularly Asian or African-American patients, wish to have their bridge raised.

Nasal Tip – Patients are often unhappy with the size, shape, or position of their nasal tip and it is commonly narrowed and made less round while droopy tips are lifted.

Who Can Get a Rhinoplasty?

It is preferable to wait until the nose has stopped growing before having any type of nasal surgery. Growth stops in females at approximately ages 15-16 and in males at ages 16-17. If a child’s shoe size has stopped increasing, this is generally a sign that nasal growth has also ceased. But if those conditions are met, here is a list of common Rhinoplasty patients:

People with Breathing Problems

Patients with difficulty breathing will often have related procedures performed at the same time. A septoplasty is a procedure to correct a deviated septum. The septum is the structure within the nose that separates the two nasal cavities. A crooked septum (often the result of prior trauma) constricts the airway, causes increased congestion and postnasal drip, and increases snoring. A turbinate reduction is another common procedure. The turbinates are pillows of tissue that protrude into the airway and help humidify the air. Slightly shrinking them helps improve breathing.

People with a Nose Deformity

Some people are just unhappy with the shape, position or size of their nasal bridge or nasal tip, or have a deviated septum that doesn’t affect breathing, but is visually unappealing. . That is a valid reason for getting a Rhinoplasty, but it is a serious procedure and should be considered carefully.

All races and genders

It was common in years past for the same operation to be performed on everyone regardless of individual facial features. Female patients particularly were often left with low, scooped bridges and narrow, pinched tips. Too much cartilage was often removed from the nose resulting in unnatural appearing noses and impaired airways that became more pinched as time passed.

Each Rhinoplasty Procedure is Unique

Modern rhinoplasty techniques emphasize more natural results individualized to each patient’s unique facial features. The internal nasal structures are reshaped and strengthened to maintain both the cosmetic and functional result over time. Computer imaging of the patient’s nose is often performed prior to surgery. This is invaluable in making sure the patient and the surgeon have the same surgical goals.

Rhinoplasty Procedure Timeframe

Rhinoplasty is an outpatient procedure most commonly performed under general anesthesia. Most rhinoplasties will take 1 to 3 hours; complex revision cases will take longer. Patients will wake up with a small cast on the bridge of the nose and (if the open approach was used) a few stitches across the columella.

Rhinoplasty Recovery

  • There is a small amount of bruising under each eye that lasts 7-10 days if work was performed on the nasal bridge.
  • Swelling is variable and decreases rapidly over the first 2 to 4 weeks.
  • Strenuous physical activity and exercise are avoided for the first 1-2 weeks.
  • One common misconception regarding rhinoplasty is that the nose must be packed with gauze afterwards. Although some surgeons still prefer packing, it can be very uncomfortable and is not necessary. Patients without nasal packing will generally have some blood-tinged mucous drainage for the first 24 hours that collects on a piece of gauze taped under the nose.
  • Pain is often minimal, and many patients require only Tylenol.
  • The cast and any external sutures are removed after one week.

Rhinoplasty is considered by many surgeons to be the most difficult of all plastic surgical procedures. It is therefore important to choose a surgeon who frequently corrects both cosmetic and breathing problems of the nose. A successful rhinoplasty maintains a functional airway, leaves a durable structure, and creates a natural nose that harmonizes with the face.