Rhinoplasty is not only the most common but also the most difficult facial cosmetic surgery. It can change a person’s entire face by improving the appearance of the nose. This is done by raising or refining the tip, removing bumps or dips in the bridge, and narrowing the bridge as well as by changing the size or position of nostrils that are excessively wide or upturned. In general, the purpose is to bring the nose more in line with the rest of the face, leading to a more balanced appearance.
Many patients opt for rhinoplasty to correct breathing problems caused by structural issues with the nose, such as a deviated septum, or to correct problems resulting from trauma. Simply improving the appearance of the face is an equally valid reason for surgery, though, since bringing your appearance in line with your self-image can radically transform your confidence and self-esteem.
The first step in any cosmetic surgery is the consultation. In your complementary consultation, you’ll meet with Dr. Masri to go over what you’d like to achieve. Think carefully beforehand so you can talk about each of the issues that you have with your nose. Dr. Masri will evaluate your existing facial and nasal structures and discuss what changes are realistic. During this part of the process, you should keep in mind your own unique facial attributes and remember that what you may see as the perfect nose on someone else might not work well with your face. To help with this, Dr. Masri offers computer imaging to help you visualize the potential changes. Remember that this will be permanent, so take full advantage of the consulting process to be sure you’re comfortable with your final decision.
In addition to discussing your cosmetic results, you’ll also discuss how the procedure will go and the steps you can take to reduce risks of surgery. Most patients will want to meet with their regular doctor for a check-up before undergoing surgery. It is also generally recommended that smokers stop using tobacco for several weeks before and after the rhinoplasty to minimize risks of complications.
The procedure is typically done with a sedative and local anesthetic to keep you comfortable, but if you prefer to be completely unconscious, a general anesthetic is also an option.
Once the surgery is started, there are two basic methods of approach. Most cases involve a closed, or endonasal, approach. With this method, all incisions are placed within the nostrils, which avoid any visible scarring. From there, Dr. Masri will shave and reshape bone and cartilage to achieve the desired look. The downside to the closed approach is that it offers limited visibility and narrow surgical openings, so for more difficult jobs, sometimes a different approach is necessary.
The open approach also uses incisions inside the nostrils but they are joined by another small incision at the base of the nose. This allows better access and accuracy, but it can potentially leave a 4-5 millimeter scar at the base of the nose. Typically this is used for major jobs like correcting defects and traumatic injuries, but it is also a possibility for aesthetic work.
In addition to the different types of approaches, there are also some options for augmenting your nose if the results you want can’t be achieved with simply reducing or reshaping what’s already there. The safest and most natural option is to add cartilage. Autologous cartilage grafts taken from the nasal septum integrate the best, but grafts from ear or rib cartilage are also used. Silicone is an option as well, but it has a higher risk of reacting poorly with existing tissues or becoming infected. Fillers or fat grafts are also an option to add volume in some areas.
Rhinoplasty is generally an outpatient procedure, so you will be able to go home a few hours after the surgery is complete. You will need to wear a nasal splint for the first week to shield your nose from accidental bumps while it heals. There will also be surgical packing inside your nose for several days to support the tissue while it heals in the new position. For the first three or four days, you can expect swelling and bruising around your eyes, and your nose will retain a small amount of swelling for up to a year, but this is minor enough to not be noticeable to anyone other than up. The final result will not be completely apparent until about a year after surgery.
After your rhinoplasty, you should be careful to avoid strenuous exercise for three to six weeks since elevated blood pressure will increase your swelling and bruising. You ought to be able to resume normal social activities within three weeks without anyone being able to tell you’ve had surgery.
Risks and Complications
Cosmetic surgery carries some of the same risks as all surgeries: Bleeding and infection. While always a potential problem, both of these are minimized through our good surgical practices.
Rhinoplasty does have some more specific risks. Many people experience a change in the sensitivity of their noses. While hypersensitivity is a possibility, most noses are numb for months after surgery. This typically resolves itself within the year as the nerves grow back and become accustomed to their new positions. Another potential complication is nasal blockage. Typically this is just from swelling and will go away in a few weeks as the inflammation subsides, but if stuffy nose symptoms continue, a minor follow-up procedure may be necessary to remove excess tissue from inside the nose. Finally, the most serious potential risk is skin breakdown from bandaging or from the grafting materials becoming exposed through the thin nasal skin. This is rare, but if it occurs, you will need to bring it to Dr. Masri’s attention immediately.
Q. What will the scars be like?
A. For the vast majority of patients who have a closed rhinoplasty, the scars will be inside your nostrils and therefore invisible. If you end up with an open approach, there is the possibility of a small scar at the base of your nose. This normally heals very well and is also in an unobtrusive spot, so it is generally unnoticeable as well.
Q. I’ve had a bad rhinoplasty in the past. How long do I need to wait to correct it?
A. A revision surgery is your best option for improving your results, but you’ll need to wait for your tissues to settle before undergoing another one. Operating before the swelling settles makes it much harder to see what’s going on and to do an accurate job as well, and it can increase the risk of scarring, bleeding, and other complications. The normal weight period recommended is 12 months, but it may take more or less time depending on how well you’re healing.
Q. My nasal skin is extremely thin. Will this prevent me from having good results?
A. It’s more challenging to work with thinner skin because it doesn’t hide small imperfections as well as thick skin does, but it’s by no means impossible. Good results can still be achieved with a meticulous hand and a little patience.
Q. What is the best age for rhinoplasty?
A. Since young people have the best healing response and nasal growth is typically finished by 15 or 16, late adolescence and early adulthood are considered the most promising ages for optimal results. That said, surgery is also possible for younger patients with structural defects and for older patients who are willing to live with the longer recovery time.
Q. What is the purpose of using grafts?
A. Grafts are not necessary if the primary goal is simply to narrow the bridge of the nose or reduce bumps, but if you’d like to have work done on the tip, the existing cartilage must typically be reinforced in order to avoid drooping and ensure an elegant result.