Nose Surgery (Rhinoplasty)

Overview | Patient Specific Questions | Photo Gallery

1. What is the history of nasal surgery?
2. Am I a good candidate for nasal surgery?
3. What does nasal surgery involve?
4. How do I plan my nasal surgery?
5. How do I prepare for nasal surgery?
6. What results can I expect after nasal surgery?
7. Where will my nasal surgery be performed?
8. What type of anesthesia will be used for my nasal surgery?
9. What should I expect after nasal surgery?
10. will I be able to return to work following nasal surgery?
11. Are there any side effects associated with nasal surgery?
12. Are there any risks associated with nasal surgery?

What is the history of nasal surgery (rhinoplasty)?

The first reported nasal surgery was performed by a physician named Sushruta who lived in ancient India around 500 B.C. Sushruta, who is often regarded as the “father of plastic surgery” began performing nasal surgery to reconstruct noses that had been amputated, an ancient punishment for criminals.

Am I a good candidate for nasal surgery (rhinoplasty)?

Most patients who seek nasal surgery (rhinoplasty) have a dislike of their external nasal contour. Some patients additionally have difficulty breathing. As such, patients who desire nasal surgery must have a thorough evaluation of not only their external nasal contour but also of their internal functional structures. Patient’s nasal contour deformities and/or breathing difficulties may be developmental or arise from external trauma. Patients with external contour deformities may demonstrate an elongated nose, a short nose, a dorsal hump, a widened nasal base, up-turned nasal tip, down-turned nasal tip, crooked nose, twisted nose, and poorly defined nasal tip. Patients may also have concurrent breathing difficulty, which will require concurrent surgical treatment during external nasal contouring.

What does nasal surgery (rhinoplasty) involve?

Nasal surgery (rhinoplasty) involves accessing and modifying the underlying infrastructure of the nose in order to improve external contour appearance. The nose is comprised of three segments, which include the upper 1/3rd segments (bony infrastructure) versus the lower 2/3rd segments (cartilaginous infrastructure). When the upper 2/3rd of the nose requires modification, then a “closed rhinoplasty” can be performed which uses incisions that are isolated to the inside of the nose. This incision bypasses the nasal tip infrastructure, which cannot be modified by this technique. When the nasal tip requires modification, then an “open rhinoplasty” is required which extends the internal incisions across the bottom of the nose (the columella), thus allowing the surgeon to completely peel up the nasal skin in order to directly visualize all of the infrastructural elements. Regardless of the technique chosen, the surgeon is able to modify exposed bony and cartilaginous structural supporting elements and thus alter the nasal contour appearance.

How do I plan for nasal surgery (rhinoplasty)?

On your initial visit, your surgeon will evaluate your health status by ordering blood work. If you are 45 years or older your surgeon may order a EKG to rule out any heart conditions. If you have had a history of breathing problems, your surgeon may order a CT scan to evaluate the status of your internal supporting structural elements specifically evaluating the septum (the central pillar). If you are a smoker, you should quit for 1 month prior to your nasal surgery to minimize the risks of infection especially if your surgery will require use of cartilage grafts to reinforce your supporting structures. In addition, it is prudent to quit smoking for 6 weeks following surgery to ensure a well-healed surgical incision. Finally, you will need to arrange for a friend if you don’t have a spouse to care for any small children who may need to be lifted or carried, as any possible risk of external trauma to your nose should be avoided.

How do I prepare for nasal surgery (rhinoplasty)?

Since your surgery will require general anesthesia, you must take several precautions prior to surgery. First, you will have to avoid eating and drinking after midnight on the day before surgery. This precaution ensures that your stomach is clear of digested foods that could potentially be aspirated and contaminate your lungs during induction of anesthesia. Since, you will have anesthetic medications administered throughout the case, you will remain groggy for several hours and will require a ride to and from the surgery center. You should choose a caretaker who is conscientious and who can spend the first night with you.

What results can I expect after nasal surgery (rhinoplasty)?

Patients who undergo nasal surgery (rhinoplasty) are extremely satisfied with their surgery and their more proportioned nose and facial features. By providing a thorough preoperative workup, safe intraoperative course, and frequent postoperative visits, patients should expect a speedy recovery and return to a more aesthetically proportional nasal contour and pleasing face. Patients are extremely pleased following nasal surgery (rhinoplasty) and demonstrate increased physical and mental confidence. Patients should expect significant reduction in nasal swelling at three months and full resolution of swelling at 1 year.

Where will my nasal surgery (rhinoplasty) be performed?

Since nasal surgery (rhinoplasty) will require general anesthesia, it may be performed in an operating room that is part of a hospital institution or outpatient surgery center. Frequently, patients may be operated on in an in-house office based operating room, but it is of utmost importance for patients to make sure that a surgical accreditation body such as AAAASF accredits the office facility.

What type of anesthesia will be used for my nasal surgery (rhinoplasty)?

For the routine nasal surgery (rhinoplasty), the breaking (infracture) of the nasal bones requires general anesthesia. For certain individuals, desiring only nasal tip refinement a conscious sedation (sedation through intravenous medications only) will suffice.

What should I expect after nasal surgery?

Patients will awaken from general anesthesia to find their nose covered by an external splint and gauze dressing covering the nasal opening. The external splint acts like a cast and allows the nasal bones to set and heal much like a cast that you would get if you broke your arm. The external splint also acts as a compression garment to eliminate any voids that could fill with blood and thus avoids hematomas. The external splint is kept in place around the clock for the first 7 days. Following your postoperative visit at 1 week following surgery, your splint will be removed and then is to be worn for another week only at nights. Swelling and bruising is typically minimal and resolves over the first month following surgery. Arnica gel is recommended for patients demonstrating increased bleeding intra-operatively in order to avoid excessive postoperative bruising. Patients are asked to avoid lifting of weights greater than 15 pounds for the first two weeks. Additionally, patients are asked to avoid contact sports for the first 4 weeks in order to avoid compression of the nasal bones while they are setting and fusing. For closed rhinoplasty only absorbable sutures are used and do not require removal. For open rhinoplasty sutures used over the bottom of the nose (the columella) are removed at one week following surgery. Patients feel comfortable attending social engagements as early as two weeks following surgery. Although swelling is minimal following surgery, nasal tip swelling following open rhinoplasty will gradually reduce over the first three months. Complete resolution of nasal tip swelling should be realized at one year following surgery.

When will I be able to return to work following nasal surgery (rhinoplasty)?

Patients can expect to return to work at 1 week following surgery once the external splint is removed and if they have a desk job. In general, patients are recommended to take 10 days off if their work permits. Weight restriction of 15 pounds for the first two weeks is recommended for patients who may have more physical jobs.

Are there any side effects associated with nasal surgery (rhinoplasty)?

Side effects are events that may be experienced by patients as a result of your surgery and should not be considered adverse events. Our patients are counseled regarding these effects and if experienced they are tolerable and often temporary in duration.

There are several side effects that have been associated with nasal surgery (rhinoplasty) and included:

1. Prolonged swelling up to 3 months is not uncommon due to poor lymphatic drainage especially following open rhinoplasty. Lymphatic drainage is compounded by extended surgical incisions used in open rhinoplasty and placed across the bottom of the nose (columella) when the nasal tip must be altered.
2. Temporary bruising is often associated with nasal surgery when nasal hump reduction and thus breaking of the nasal bones is required. Bruising is minimized by compression maneuvers during the operation, placement of an external splint following surgery, and icing of the eyes. Arnica gel is also recommended in patients who bruise easily. Most bruising subsides within 1 to 2 weeks.
3. Numbness: Numbness of the nasal dorsum and tip occur when sensory nerves are transected by virtue of elevating the nasal skin off of the underlying structural support elements. Since these nerves are microscopic in size, they cannot be visualized during nasal dissection. Fortunately, numbness is temporary and resolves itself over 2 to 3 months as the nerve endings grow back into the nasal skin.
4. Surgical scar redness: Hyperemia of the incision over the bottom of the nose (the columella) is to be expected and will resolve over the first month. Layered closure of the incision line is performed in order to minimize tension of the incision line and to enhance incision healing. Avoiding cigarette smoking for one month prior to surgery and six months following surgery is essential to optimizing healing.

Are there any risks associated with nasal surgery (rhinoplasty)?

Risks are unwanted events that may occur during or following surgery. These events are recognized as “complications” but their occurrence is minimized by appropriate patient selection, proper surgical decision making, effective surgical technique, and thorough preoperative and postoperative patient management.

1. Postoperative bleeding may occur following nasal surgery since the nose has numerous blood vessels supplying it. Appropriate clotting of these vessels (hemostasis) during the operation avoids postoperative bleeding. In addition, external compression provided by the external nasal splint further prevents postoperative bleeding. Finally, patients are tested preoperatively to ensure that they do not have a bleeding disorder. For patients identified as having bleeding tendency, intraoperative administration of DDAVP (a blood clotting factor) is utilized to avoid bleeding complications.
2. Poor nasal scarring is seldom observed when the surgical incisions are extended to the bottom of the nose in order to refine the nasal tip shape (open rhinoplasty). Patients prone to scarring and thus individual genetics of healing are largely to blame for poor scarring.
3. Local skin infection is not uncommon and is associated with complex nasal deformities and thus more extensive nasal surgeries requiring augmentation of nasal parts with cartilage grafts. Diabetes and nutritional deficiencies are largely to blame for the difficult healing of these patients. When cartilage grafts are required, measures are taken intraoperatively to avoid this complication.
4. Residual nasal distortion is uncommon but associated with a preoperative crooked nose deformity. Despite measures taken to correct the crooked or twisted nose, the underlying cartilages, which make up 2/3rd of the nasal infrastructure, have “memory” and will try to mold back into their old shape. Several measures are taken to avoid this complication and include: scorring (weakening) of the cartilage and “stitching down” the cartilage in its newly desired shape.
5. Deep vein thrombosis (DVT) may occur in the legs immediately following surgery. DVT refers to the clotting off of leg veins which may result in compromised blood flow return from the legs; a more critical consequence may develop from this clot if it is dislodged and travels to the lungs causing a pulmonary emboli. Although rare, pulmonary emboli are the leading cause of death following surgery. Measures are taken intra-operatively to avoid such a complication.