Rhinoplasty (Nasal Reshaping)

The Basics
The face is the most visible part of the body, but the nose is its most prominent feature. It is not surprising therefore that the nasal surgery is one of the most common cosmetic procedure all over the world. Rhinoplasty is the term used for cosmetic surgery of the nose.

Rhinoplasties can be classified into three different types.

• Reduction Rhinoplasty is done to reduce a large nose.

• Making the small nose larger is called Augmentation Rhinoplasty. This may involve adding cartilage from the nasal septum or from the ear to the bridge and tip of the nose. Silastic (silicone) implants are also frequently used.

• Third kind is limited Rhinoplasty which is usually done to improve isolated nasal tip problems.

Initial consultation involves assessment of facial symmetry, including the neck, upper lip forehead, cheek-bone and especially the chin, by your Plastic Surgeon. Any difficulty with nasal obstruction is also assessed ,which could be corrected simultaneously.

The surgical plan is discussed with the patient with sketches on the photographs before making final plan.

The Procedure
The surgery involves a series of incisions within the nose and occasionally across its base. These incisions enable the surgeon to reach the cartilage, bone, and fat of the nose. Depending on the goal, these tissue components will be modified to produce an esthetically pleasing result. The bone of the nose is often broken as part of the surgery, and this accounts for most of the bruising and swelling around the eyes following the procedure. The incisions are closed with sutures that are absorbed within 7 to 10 days following the surgery.

After the operation the nose is packed and the patient breaths through his mouth .The following day the packing is removed.

Aneasthesia
Most Rhinoplasties are performed under local anesthesia with intravenous sedation, or general anesthesia depending on the steps involved and patient’s desire.

Some amount of pain is expected after the procedure as the effect of the local aneasthetic wears off which can be managed with usual pain killers. Headaches following the surgery are common but are also managed with painkillers.

Post Operation
Patient has to take rest for couple of days and after that he/she can resume normal activities. There is plaster or the dressing on the nose for about a week .There is swelling and bruising around eyes which lasts for about three weeks. The swelling in the tip area remains there for quite some time.

Before	After

FAQs

• Will there be a scar?
  Most of the incisions are inside the nose and are not visible. Occasionally, a small scar may be seen at the base of the nose if the nostrils were narrowed or an external nasal approach was used.

• How long will it take to heal?
  Within 6 weeks, the swelling subsides in the upper portion of the nose. Due to the thickness of the skin over the nasal tip, however, it takes a longer period of time for the swelling in the lower part of the nose to subside. The tip of the nose feels firm and fibrous in the weeks following surgery. Gradually, the tip of the nose becomes more pliable. Complete healing of the tip of the nose usually takes 6 to 9 months, but in some cases might take as long as one year.

• Can surgery be redone?
  Surgery may be performed again if the original results are disappointing. A one year healing period must pass before further surgery to ensure that all scars within the nose have healed and that no further changes will take place. A follow- up appointment is made within one year to confirm that esthetic goals have been achieved. A second photograph is usually taken at this time.

• What are the possible complications of rhinoplasty?
  Complications are uncommon. An unsatisfactory esthetic appearance is the usual concern. Swelling, bruising, and a firm fibrotic feel to the nose are normal consequences of rhinoplasty, which goes away with time.

• When can makeup, glasses, and contact lenses be worn?
  Glasses sit quite comfortably on top of the nasal cast. Once the cast is removed it is preferable to wear contact lenses to avoid any pressure that glasses may exert on the recently fractured nose until the bones have healed completely. Makeup can be worn once the cast is removed.

• When can normal activities be resumed?
  Ordinarily, normal activities may be resumed with in 1 to 2 weeks. Driving can be resumed the following day, provided there is no excessive swelling about the eyes that restricts vision.

Myths
Many times The Plastic surgeon is asked to create the same nose as someone elses. It is however not possible to surgically duplicate a nose because anatomic characteristic differ from one person’s nose to another’s. A person with realistic goal to achieve is the one who is most satisfied with the surgery.