Rhinoplasty To Breathe Or Not To Breathe

What is rhinoplasty?

Rhinoplasty Surgery is an operation designed to reshape the bones and cartilages of the nose in order to improve nasal breathing and/or appearance. Frequently, the operation involves straightening of the nasal septum (the partition between the right and left nasal passages) in order to improve breathing. In these cases, the procedure is known as septorhinoplasty.

Who performs septorhinoplasty?

Septorhinoplasty can be performed by any qualified facial plastic surgeon (either general plastic surgery orotolaryngology/facial plastic surgery ). Unfortunately, rhinoplasty is probably performed more poorly than any other plastic procedure. It requires a degree of expertise and experience that is typically found only in surgeons who make this the focus of their surgical careers. Surgeons who perform only occasional rhinoplasties tend to have less desirable and less predictable results. Unfortunately, once cartilage has been altered or removed, subsequent correction (revision rhinoplasty) can be quite difficult.

Do I need to worry about anything other than the way my nose looks?

Yes. Many surgeons try to sell their patients on the benefits of enhancing their nasal appearance. The nose however, is a physiologically important component of the upper respiratory tract. In addition to providing an unobstructed conduit for the passage of oxygen, the nose both humidifies air and filters its particles and pollutants.

How is rhinoplasty performed?

Endonasal Rhinoplasty means that no cuts are made on the nasal skin and there are no scars. Occasionally, an external approach is required. This involves as small zig-zag cut on the skin between the nostrils at the base of the nose. This leaves a nearly invisible scar. Cuts are made in the nasal bones and cartilages to give the desired cosmetic appearance. In some cases cartilage grafts either from the ear or redundant nasal cartilage is reshaped and added to the nose as grafts to optimize the noses shape.

What type of anesthetic is used?

Most patients have their procedure performed under a light general anesthetic. The case is performed as day-surgery — meaning that you arrive and go home on the same day as your operation. Some miner operations can be done with local anesthesia alone or with some sedation although the method depends on the type of surgery and the surgeon’s preference.

Why is it important for my surgeon to have expertise and long-term experience in rhinoplasty?

In general, one wants their surgeon to be experienced in any procedure that they are providing. This is particularly true however, in rhinoplasty. As you age, your nose changes with time. Most children have tiny, turned-up noses and most seniors have ptotic (down-turned) nasal tips. This occurs because the nasal cartilage loses strength and elasticity with age. Some surgeons utilize aggressive cartilage-removing procedures to get quick, dramatic results. Few of their patients, however, are happy several years down the road when their weakened cartilages can no longer support their nasal tip and airway collapse results in severe nasal obstruction.

Most patients have gauze packing in their noses for one to two days following surgery. Packing serves to minimize bleeding and also acts to hold structures in place during the initial healing period. Some patients will also have silastic(surgical grade plastic) stents placed in the nose. These act like an internal cast and are removed eight to ten days postoperatively. The nose is quite stuffy for two weeks after surgery, until most of the internal swelling has subsided. Nasal discomfort is usually mild to moderate and is present for two to three days. Strong pain-killers are prescribed for all patients. Externally, patients wear a cast for eight to ten days. Nasal swelling and bruising around the eyes are present for up to two weeks. While some patients will return to school or work within three to four days, the majority of patients take two weeks to recover. At that point, most friends and colleagues will not even recognize that a surgical procedure has been performed.

There is no such thing as a risk-free operation anywhere on the body. For that matter, even driving to the hospital carries with it some degree of risk. Fortunately, the risks of rhinoplasty are quite low as this operation is typically performed electively on young and healthy individuals. The most important risk of rhinoplasty is that you may be unhappy with the cosmetic outcome (usually related to problems experienced during the healing process). You can rest assured, however, with the knowledge that our surgeon’s expertise and experience minimize these risks.

Grafts are strips of cartilage, bone or foreign material (e.g. Gortex) that are placed in order to help recontour the nose or aid in supporting the nasal skeleton. Cartilage (the most commonly used material) is usually harvested from within the nose as part of the already planned operation and no additional cuts are necessary. It is occasionally necessary however, to look elsewhere for more cartilage (typically, in revision surgery). In these cases cartilage can be taken from the ear through an incision made on the back side (this does not disfigure or scar the ear). Foreign materials as these have a propensity for infection and extrusion.

Patients will see 80% of the final result two weeks after surgery. More subtle changes, such as those to the nasal tip however, can take up to a year to be fully evident. In patients with very thick skin, nasal refinement can occur even more slowly. Also remember that the nose is a dynamic organ which changes throughout your entire life. The changes incurred in rhinoplasty surgery will affect the appearance of your nose at every stage of life.