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Facial Plastic and Reconstructive Surgery Handbook |
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Rhinoplasty
Rhinoplasty is the operation that changes the appearance of the nose. Septoplasty is an operation which rearranges the inside of the nose to improve a patient's breathing. When these two procedures are performed together, the operation is called a septorhinoplasty. Insurance may pay for part or all of a septorhinoplasty if you have some element of nasal airway obstruction due to an anatomical blockage inside your nose or if your nose is obviously crooked or deformed following a traumatic accident. The goals of a septorhinoplasty are 1) to improve the breathing and 2) to improve the appearance. The surgery can be performed under local anesthesia or under general anesthesia. The majority of people in my experience prefer, if they can afford it or if the insurance company is paying for it, to have a general anesthetic. The operation consists of a very complex series of steps designed to straighten the septum, which is a piece of cartilage on the inside of the nose, refine the soft, cartilaginous tip of the nose, and normally to reduce the bony prominence on the upper third of the nose. Occasionally, particularly when a revision rhinoplasty is being performed, the goals will be to build up the tip of the nose and to build up the bony dorsum of the nose as well. Most nasal surgery is performed through small incisions placed inside the nose. At the end of surgery, all of the tissues of the nose must be splinted in place. A cast on the outside of the nose holds the tissues in place. By adjusting the cast, one can mold this dressing to hold the nose in the desired shape.
For additional information, please review the consultation for rhinoplasty .
Postoperatively, patients have only minimum discomfort, which is normally relieved with Tylenol, and occasionally with Tylenol with codeine. The cast is removed 3 or 4 days after surgery. (You can view the complete set of postoperative instructions.) While initially the airway is excellent, there is a tendency for the nose to crust for the next couple weeks. Ten to twenty percent of patients will get black eyes from a septorhinoplasty. This is more common in red haired, fair skinned individuals, but can happen to anyone. Since the bones in the nose have been broken, one must be very careful for a period of six weeks not to hit the nose for fear that it will be knocked crooked. The crusts in the nose can be softened by applying a small dab of Vaseline or bacitracin ointment to each nostril. This can be done three or four times a day. For the first two weeks, one should not blow one's nose or cough or sneeze vigorously. Starting at two weeks after surgery, one can begin to blow the nose gently and one can begin exercising, working up to a normal exercise routine by four to five weeks. You should be able to breathe normally through your nose beginning about three weeks after surgery and should expect improvement in the breathing over the next three to six months. The appearance of your nose will also continue to change for a long period of time. The best idea of its final appearance comes when the cast is first taken off, for after this the nose will swell. This swelling goes down dramatically in the first six weeks. Most patients notice some numbness and tingling on the skin over their nose and may feel a number of small bumps and depressions that they were not aware of prior to surgery. These are all normal, and as long as the nose continues to appear smooth and balanced, you should not be concerned.
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To demonstrate the thinking that is involved in cosmetic surgery, let me show you an exemplary patient. Figure 1 shows a front, and Figure 2 a side view of a young girl who sought consultation for nasal surgery. A tracing was made from the lateral photograph, and this tracing is shown in Figure 3. Additional tracings were made to see the effect of changing her nose, her chin or both, and these are shown in Figures 4, 5 and 6. The first (Figure 4) simply changes the appearance of the nose. The second (Figure 5) augments the chin as is described in the following section. Note that by increasing the forward projection of the chin that the deformity of the nose, namely the hump, is less prominent. By performing a chin augmentation, one very often needs to do less nasal surgery and will end up with a superior facial balance. The third tracing (Figure 6) shows the patient with the nose corrected, and the chin augmented. Obviously, this is the ideal. Figures 7 and 8 show the patient approximately one year after surgery, with a very pleasing, aesthetically balanced appearance. You do not need to look at your nose this critically, but if you wish to, this picture will help you communicate your ideas to your surgeon.
Terence Davidson, M.D., F.A.C.S.
UCSD Otolaryngology Division
200 West Arbor Drive
San Diego, CA 92103-8895
(619) 543-6631 |