Rhinoplasty- Know Your Nose

Whether you call it a “nose job”, “nose reshaping”, or “nose refinement”, all of these are the commonly used terms used to describe one of my favorite operations: Rhinoplasty.

The vast majority of patients that I see for rhinoplasty specifically are seeking to improve the appearance of their nose, which really is the topic of this article. It is critical to understand, however, that one of the nose’s many functions is the passage of air for breathing, and that this function can also be improved during rhinoplasty, e.g. by fixing a deviated septum.

Of the many reasons people come to me seeking nose reshaping, the most common are to remove the “hump” on the bridge of the nose, to change the shape and definition of the tip of the nose, to lift up the tip of the nose if it is “droopy”, or just to reduce the size of a large but otherwise pleasant appearing nose. Most often, these problems are just a reflection of a person’s natural anatomy, but they can also be a result of prior injury or birth defect.

The nose is a very complex anatomic structure and it must remain in harmony with the proportions of the face. A nose that looks beautiful on one person’s face might look terrible on another’s, depending on the overall facial proportions. Rhinoplasty is often described as being a “surgery of millimeters”, since even the most minor alterations can result in dramatic changes in appearance and function. The way your nose appears depends on the interplay between many structures:

  1. The nasal bones: the hard part of the nose that attaches to your face
  2. The upper and lower lateral cartilages: the firm but flexible bottom 2/3 of your nose
  3. The septum: the internal cartilage in your nose that divide it into right and left nostrils
  4. The skin and fat: the covering of your nose that has to be thin enough to reveal the shape of your nose but thick enough to soften sharp angles and edges

Any or all of these structures may need to be trimmed, shaved, moved, sutured, removed or added to achieve your individual goals.

The key challenges for plastic surgeons are to be able to determine what the individual goals for a patient are, determine if these goals are reasonable and attainable, determine what surgical steps are necessary to accomplish those goals without compromising the function of the nose, and then to carry out the operation as planned. Since the external nose is composed bone, cartilage, and soft tissue, many variables are involved in the overall appearance of the nose, and this is why rhinoplasty is thought to be one of the most challenging operations in cosmetic surgery.

When it comes to how a rhinoplasty is actually performed, there are hundreds of minor variations and techniques. Each surgeon will have a different set of the techniques and skills that he or she will use to perform the surgery, but the overall technique can be simplified into two major approaches: closed or open. A closed rhinoplasty is an approach where the entire surgery is performed from the inside of the nose, without leaving any visible external scars. An open rhinoplasty is an approach where all the cartilage and structure of the nose is exposed by making an incision across the bottom of the nose, through the columella (the part of the nose that separates your two nostrils at the bottom). I personally prefer the closed rhinoplasty since it does not leave a visible scar and I believe it provides faster healing time with less swelling. However, in very complex cases, the open rhinoplasty can be necessary.

The surgery itself is performed under anesthesia, whether it is “twilight” anesthesia with light sedation and your nose numbed with medication, or under general anesthesia, where you are completely asleep throughout the entire operation. The whole operation usually takes between 1-2 hours, and you go home right after surgery with a plastic splint on your nose and possibly packing inside your nose.

After surgery, there will of course be some discomfort for several days, but pain medication will help relieve it. You should expect bruising of the nose and around the eyes as well as swelling of the nose. The bruising will usually last 1-2 weeks, while the swelling takes about three months to completely dissipate. After the splint comes off in 1-2 weeks, you will notice gradual changes occurring to your new nose for the next several months, until the skin finally conforms to the new dimensions of your nose.

So should you call up a plastic surgeon immediately to schedule your consultation? Only if you have already thought long and hard about what you want and why. The best candidates for rhinoplasty are people who have realistic expectations and can communicate their desires to their surgeon. A rhinoplasty can be a life-changing event by providing improved self-esteem and increased self-confidence, releasing you from constantly feeling self-conscious about your nose. As long as you are physically, emotionally, and psychologically mature, you can have a rhinoplasty, whether you are 16 or 60.

Note:

Some of you reading this article may be surprised to know that the earliest recorded rhinoplasty surgery was actually developed in ancient India about 2600 years ago, by Sushruta. The nose has been called the “organ of respect” in many cultures, and, therefore, was often subject to mutilation as penalty for various crimes in ancient India. In his text, Sushruta Samhita, Sushruta details the procedure that was commonly used to reconstruct a nose using skin from the forehead, a principle that is still used to this very day!

Dr. Edwin Williams is an Orange County plastic surgeon. Dr. Savalia performs both surgical and non-surgical cosmetic procedures including rhinoplasty, Botox treatments, facelifts, breast augmentations, liposuction, and more.

 

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