By William D. Losquadro, MD |Facial Plastic & Reconstructive Surgery & Otolaryngology
The term “RHINOPLASTY” refers to plastic surgery of the nose. It is often performed to help people both look and breathe better and is among the top plastic surgical procedures performed each year in the United States.
The bridge and tip of the nose are commonly reshaped during a cosmetic rhinoplasty. Many patients wish to 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. 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.
It was common in years past for the same operation to be performed on everyone regardless of individual facial features. Female patients 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. 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.
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.
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.
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.
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.