The surgical procedure to reduce or refine the nose is known as a rhinoplasty. The reasons for considering rhinoplasty vary from individual to individual. Some may be self-conscious of a large hump or a prominent tip while others may have sustained injuries to their nose resulting in a deformed or altered appearance. In the majority of cases, both men and women alike wish to have what is considered a normal and average nose that will blend into their face rather than dominate it.
Are You a Candidate for Rhinoplasty?
During your consultation, Dr. Javaheri will ask you about your general medical history including any previous nasal surgeries or injuries. If you require corrective surgery to the nose as a result of a previous rhinoplasty, you will need to wait at least one year before any further surgery can be attempted. Dr. Javaheri will also ask you about your breathing patterns and whether you suffer from any nasal obstruction.
Dr. Javaheri will inquire why you are unhappy with the shape of your nose and how you would like your nose to appear. The most common request is to reduce the size and alter the shape of a large nose, but occasionally an increase in profile is requested. It is useful to bring photographs of a nose which you would like to have to your consultation.
It is important to realize that every nose is different, and one cannot expect to have a very small, delicate nose made from one that has a large amount of thickened skin. At your consultation, Dr. Javaheri will give you an honest assessment of your options based upon you current nose structure and shape and your desired one.
It is important that you discuss your questions, expectations, and concerns honestly with Dr. Javaheri.
If you are a smoker you will be asked to stop smoking well in advance of surgery. Regular smoking constricts blood vessels resulting in decreased blood flow to given areas which can prevent normal healing.
About the Operation
The procedure is normally performed using incisions made inside the nostrils. In complex tip surgery, you may require an external incision carefully placed in the columella (the lower middle segment of skin situated between your nostrils), and you will be informed of this at the time of your consultation.
Using a delicate chisel, any bump on the bridge of your nose is removed, resulting in a new, refined profile.Depending on the circumstances, the nasal bones are usually broken and reset to allow them to meet in the midline, resulting in a narrowing of the bridge line. If you have any breathing difficulties, after this the septum (the structure separating the two nasal compartments) is altered appropriately.
Finally, the tip of the nose (comprising of cartilage beneath the skin) is adjusted in size and shape to refine the nose so that it compliments your new profile. Once the surgery is complete, small dissolvable stitches are used inside the nostrils and small jelly nasal packs may be inserted. The nasal packs are utilized to control any subsequent bleeding as well as to ensure that the lining of the nose heals correctly. The last step involves the placing of a plastic splint on the bridge of your nose.
A rhinoplasty can be performed using either a general anesthetic or local anesthetic with twilight sedation. In most cases, the procedure takes approximately one to two hours and is longer with complex cases.
What to Expect After the Surgery
After the surgery, in order to reduce the swelling around your nose, you will be propped up in a bed with a couple of pillows. At this time, you will immediately notice that it will be difficult to breathe through your nose.
For several days after your surgery, you may experience some pain and discomfort, which can be controlled with the use of a mild pain reliever.
The bridge of the nose will be protected after the operation by a plastic splint, which is worn in most cases for seven to ten days. You should avoid blowing your nose, stooping, and any physically vigorous activity for this period and the following three weeks. Once home, it is possible that you may experience a nosebleed. In the vast majority of instances, this bleeding will stop of its own accord following the application of gentle pressure. However, it is sometimes necessary for medical intervention to stop difficult bleeding.
As the nasal bones are usually broken and reset, you should expect to have “black eyes” and some swelling of the face. These “black eyes” usually disappear after two to three weeks. As soon as the splint is removed you may apply light makeup to conceal them. Please remember that once the splint is removed from the bridge of your nose, there will be a significant degree of swelling still present in most cases, and this will not accurately reflect the true shape and size of your new nose.
The swelling will rapidly decrease in the following three to four weeks. However, it is important to remember that the final size and shape of your nose will not be known until the healing process has completed which may take up to several months. During the healing process, scar tissue will form underneath the skin of the nose, which will have a subtle effect on the final shape.
In particular, it is important that the tip of your nose is regularly massaged in order to prevent the internal structures from becoming fixed in an undesirable position by the development of scar tissue. This process can take up to one year and sometimes even longer to complete.
During the initial weeks and sometimes months following your procedure, your nose tip may feel unusually numb. This will improve as the nerve supply to the skin regenerates.
Most people return to work after ten days. Although a slight swelling may still be present at this time, it is usually not noticeable to most people. After three to four weeks, most people are completely back to their normal routine. However, you will need to avoid any contact sports for at least three months while your nasal bones heal completely.
Individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable. As with any surgical procedure, the risk of infection is always a possibility. This can be minimized by the preventative administration of antibiotics both at the time of your surgery and afterwards while in recovery. However, on occasion, mild infection can occur and is relatively common, although it usually subsides after two weeks. In addition, though rare, a “blind boil” type of infection may occur on the skin of the nose. These are usually quite uncomfortable and normally take up to a week to disappear.
Irregularities of the skin, bone, or cartilage may occasionally appear following surgery. These may show up on the surface as slight depressions, dips, or bumps, though most of these situations improve with time. In some instances, additional surgery may be required for correction.
Following a rhinoplasty, it is rare but possible for a series of thread or spider type veins to appear. Unfortunately, these are permanent, but can be treated effectively by corrective laser procedures.
It is also possible that surgery on a badly deviated or bent nose may not result in a desired shape and size, thus potentially requiring additional rhinoplasty procedures. Dr. Javaheri will advise you at your consultation if he expects this to be the situation with you.