Nose Job

Nasal Surgery (Rhinoplasty)

Introduction:
It is important that you understand that no nose is perfectly symmetrical. Every attempt will be made during surgery to minimize your side to side dissimilarities, but such differences always persist to some degree even with the most successful operation. it is unnatural for a nose to be exactly in the center of the face, before or after operation. the two nostrils are never exactly the same shape or size. The irregularities and asymmetries will persist after a corrective operation. The facts are being stressed a many patients are not aware of pre-operative nasal irregularities and may be more critical of their appearance following surgery than pre-operatively.

Many patients have a fear that the nasal change will be as great as to create subject of discussion among family members and friends. Actually, following well done rhinoplasty, neither the patient nor the patient's friends and relatives usually remember the shape of the patients original nose a few weeks following surgery.

The patient's input is always sought regarding the desired nasal change, but the patient must accept the judgment of the plastic surgeon as to the type, shape and contour of the nose as he or she is more acquainted with limitation imposed by the patient's tissues and facial features. A nose that is attractive on one face may very well be inappropriate for another. Since no two people are alike, a patient should not expect to "select a nose" by studying other people's noses or photographs but such input is helpful in giving the surgeon a general impression of the patient's desires.

A surgeon must consider the patient's entire facial profile when planning nasal surgery. Patients with moderate sized noses but very weak chins will appear t have much larger noses than they actually have. in such cases, t is impossible to reduce the nose sufficiently to provide a satisfactory profile. Facial balance may only be achieved by simultaneous chin implant surgery. Additional ancillary procedures such as liposuction of the neck or a facelift may enhance the result of rhinoplasty even further by restoring facial harmony.
Occasionally, if in addition to a weak chin, severe malpositioning of the jaw and teeth is present, an evaluation of the dental abnormalities by an oral surgeon will be recommended before making a final decision about the nasal surgery. Conversely, it may be occasionally be necessary to reduce the size of an excessively large chin in conjunction with the nasal surgery if the ideal profile is to be obtained for the patient.

Surgical Procedure:
The operation is performed using local anesthetics with intravenous medications or a general anesthetic to make you comfortable throughout the procedure. The anesthesiologist monitors all patients to ensure their safety and comfort.
Most of the incisions for reducing or recontouring the external nose are made inside the nose. Occasionally, an incision will be made across the base of the columella, the strut between the two nostrils. Rarely incisions may be required at the base of the nostrils if they are to be narrowed. The skin is lifted away from the cartilage and bone and the excess tissue is removed. Instead of resenting tissue, it may be necessary to put grafts into depressed areas t reshape the nose satisfactorily. Such grafts may be taken from the septum. Or a silicone rubber implant may be discussed as an option to using your own cartilage.

The nasal tip cartilage will be refined and the nose shortened if necessary. The excess skin left by the reduction of the underlying bone and cartilage is elastic and readapts itself to the new framework.
An important aspect to the predictability of a desired result is the thickness of the patient's skin; thick skin will not drape out as well post-operatively over new framework as will thinner skin. Conversely, while minor irregularities of the cartilage or bone can be expected to be hidden by thicker skin, they may become clearly visible in the thin-skinned individual.

The operation is approximately one and a half hours.

Post-Operative Care: Immediately after surgery a conforming plaster splint is applied to the nose. The patient must place ice packs over the eyes for the first two days to reduce swelling and minor discomfort. Suitable pain medication and sleeping pills will be dispensed. The nasal protective splint is removed by your surgeon on the third post-operative visit approximately five to seven days after the operation. The majority of patients do not require nasal packing.

The patient will have the feeling of a minor cold from one to twelve weeks after the surgery due to the attendant congestion of the nasal passageways. Patients undergoing correction of an impaired airway will feel a definite improvement but cannot expect air to flow as well through he reconstructed airway as through an open mouth.

The eyelids will be discolored and swollen for a period of approximately five to seven days. residual bruising may be covered with cosmetics. the office staff will assist you if this is requested. Occasionally the whites of the eyes will become temporarily bloodshot which may last for several weeks but always resolves spontaneously.

The upper lip may feel stiff and unnatural for a varied period of time. Some numbness may be noted in the upper lip and over the tip of the nose for a period of up to six months.

Although the major effect of the nasal operation will be evident is two weeks, minor improvements continue to occur over a period of six to twelve months. These later changes are so gradual that the patient may not even be aware of them.

The final outcome depends upon the age of the patient, the type of skin and the patient's healing ability. The older the patient and the thicker the nasal skin, the longer the residual swelling will remain. In such cases it will be more difficult to achieve a thin, chiseled nasal appearance.