Rhinoplasty, or nose remodeling, is one of the most common aesthetic surgeries. Rhinoplasty can reduce or increase the size of the nose, modify the tip or the hump, reduce the nostrils, or alter the angle between the nose and the upper lip. It can also correct malformations or post-traumatic defects, removing respiratory problems. If you consider rhinoplasty, this brochure will give you the basics of these procedures – how it can help, how it is performed and what results you should expect – but does not include all the answers as there are individual factors for the patient and surgeon; the reason why you should ask your surgeon about everything you do not understand.
Rhinoplasty can improve your appearance and enhance your self-confidence, but it does not change your image according to the “ideal” or cause other behavior of others around you. Before deciding on the surgery, think well about your expectations and talk to your surgeon. The best candidates for rhinoplasty are those who are looking for an improvement and not perfection in their appearance. So, if you enjoy maximum health, a stable psychic and modest expectations, you can be considered a good candidate. Rhinoplasty can be performed to achieve aesthetic and reconstructive objectives to correct birth defects and respiratory problems. Age can also be a factor to be taken into account. Rhinoplasty is performed after 18 years old.
ALL SURGERIES INVOLVE A RISK! When rhinoplasty is performed by a qualified plastic surgeon, the complications are reduced and minor. However, certain complications may occur: infections, haemorrhages and adverse reactions to anesthesia. Risks of complications may be reduced by strictly following pre- and post-operative instructions. After surgery, small blood vessels may appear as fine spots on the surface of the skin, these being usually small and short-lived, but they can also be permanent. Scars in closed rhinoplasty may be totally invisible; when the open technique is performed, or where the procedure requires narrowing of the nostrils, small scars at the base of the nostrils are usually not visible. In a case out of 10, a reintervention is needed, for example to correct some shortcomings. These cases are unpredictable and can also occur to the most experienced surgeons, the corrective surgery being minimal.
SURGERY PLANNING Communication between you and your physician is essential. At the first consultation, the surgeon will ask you about the look for your nose and then evaluate the nose and face structure, explaining the options you have. You will be informed about the factors that can influence the surgery and the result. These factors include: bone structure and nose cartilage, face shape, skin thickness, age, and your expectations; the surgeon will explain the procedure, type of anesthesia used, where the surgery will take place, the risks, cost, and other options. Most insurance policies do not include aesthetic surgery, however, if the procedure is used for reconstruction, to correct breathing problems or post-traumatic defects, the repair can be covered by insurance. Tell your surgeon if you have had another nose surgery, even if they were done many years ago. It is also important to inform your surgeon if you are allergic to something, if you have breathing problems, if you are taking medicines, vitamins, drugs and if you smoke. Do not hesitate to ask your surgeon about any misconceptions you have, especially if it relates to your worries and expectations about the outcome.
PREPARING FOR SURGERY The surgeon will give you precise information on diet, medical treatment, smoking and facial hygiene. If you follow the instructions strictly, the surgery will be normal. It is very important to make sure that you have a companion to guide you home after surgery and bring you to the consultation and dressing.
TYPE OF ANESTHESIA The surgery can be performed under local or general anesthesia, depending on the procedure, the surgeon and your preferences. You will be sedated with local anesthesia before surgery and your nose and the surrounding area will be numb. You will be awake during surgery and you will not feel pain. Using general anesthesia you will sleep throughout your surgery.
Rhinoplasty usually lasts for about 1-2 hours, and more complicated procedures require more time. During surgery the skin will be removed from the osteocartilaginous skeleton; then the skeleton will be modeled to obtain the desired shape. This modeling depends on the particularity of the case and the technique preferred by the surgeon. Finally, the skin is set on the new skeleton. Many plastic surgeons prefer the endonasal method (closed method), in which the incision is made before the nostrils. Others prefer the open method, especially in complex cases; they make a small incision on the skin band that separates the nostrils. When the surgery is done, a splint will be applied to keep the new nose shape. These can also be used to stabilize the nasal septum – the partition wall in the middle of the nasal cavity – splints or internal meshes.
In the first 24 hours, you will feel the edema, nose pain and a headache. You can control these symptoms by analgesic treatment. Stay in bed with your head up (except going to the toilet) on the first day. You will notice that the ecchymosis and edema will increase around the eyes with the maximum point on the second or the third day. Applying cold compresses reduces edema and you will feel a little better. Anyway you will feel better than you look! Most edema and ecchymoses disappear within 1-2 weeks but a certain degree of edema will only be noticeable to you and the surgeon, and it persists for several months. Also, a small bleeding is common in the first few days after surgery and you will continue to feel for a few weeks with your nose congested. It is recommended not to blow your nose for a week, which will contribute to rapid mucosal healing. If you have meshes, they will be removed after a few days and you will feel more comfortable. After one or two weeks, all dressings, fixtures and wires will be removed.
GOING BACK TO NORMAL
Most patients who have had rhinoplasty can return to school or more sedentary activities one week after surgery. In order to resume normal rhythm it takes a few weeks. The surgeon will give you precise instructions to gradually resume your normal activity. These may include: avoiding jogging, swimming, sex, bending, generally any activity that leads to increased blood pressure (2-3 weeks). Avoid also knocking or rubbing your nose, and for 8 weeks exposure to the sun. The face and especially the nose will be washed delicately. Contact lenses can be worn as soon as you want. Instead, the glasses can be worn as soon as the splint is removed, but only if they are stuck with tape on the forehead or on the cheeks. This is valid for about 6 to 7 weeks, when the nose is completely cured. The surgeon will schedule multiple postoperative visits to check for healing progress, and if you have unusual symptoms or any questions, do not hesitate to call and ask the surgeon.
YOUR NEW “LOOK” in the days following the surgery. When your face is swollen and bruised, it’s easy to forget that you will look better. Most patients feel depressed for a while after surgery, which is normal and understandable. Rest assured that this stage will be over and your condition will improve. After a week or two you will not show that you have undergone the surgery, but healing is a gradual and slow process. Moderate edema will be present for several months, especially at the tip of the nose. The end result of the surgery is seen after one year and even more. During this time you can experience immediate reactions from family and friends. They can say they do not see any major difference in your nose. They will purposely do so, especially if you have changed something from your genetic heritage. If this happens, keep in mind why you have opted for this surgery and if you have reached your goal, then rhinoplasty surgery has been a success.