The nose is the most defining characteristic of the face and even a slight alteration can cause a significant alteration in appearance. Rhinoplasty has one of the greatest impacts on how a person looks.
People seeking consultation for rhinoplasty are not comfortable with the nose they were born with, with the way aging has changed their nose or with the way an injury may have distorted their nose. From a functional standpoint, some may need change of their external nasal structure to improve breathing.
The surgeon has to change the shape of the nose, to achieve facial harmony or balance, while preserving intact both its support (outside walls) and its breathing function (inside wall). The resultant appearance should not look artificial or “operated.”
There is no ideal in rhinoplasty, however the goal of French rhinoplasty is to improve the nose aesthetically, making it harmonize better with your face.
Whether the surgery is desired for functional or cosmetic reasons, your choice of a qualified facial plastic surgeon is of paramount importance. Many facial plastic surgeons are trained in ear, nose, throat, and facial cosmetic surgery, providing you, with the highest level of training and expertise. Your surgeon will take photographs of you and discuss the options available. He will explain how the nasal structures, including bone and cartilage, can be sculpted to reshape the nose.
Rhinoplasty is usually performed under general anesthesia. The incisions for this procedure are inside the nostril and extend across the bottom of the nose in a zigzag fashion (fig 1). These incisions heal remarkably well and remain inconspicuous.
Through these incisions, we adjust the bone and cartilage framework which defines the shape of the nose (fig 2). The lower nose is supported by cartilage and can be accessed through these same incisions. Changing the shape of the cartilage, and thus the appearance of the nose, is often achieved by the placement of strategic sutures, small cartilage grafts, and careful incisions within the cartilage. When the goal of the surgery is to modify the upper one-third of the nose, the surgery will often require some manipulation to the nasal bones. This may include sanding down small bony irregularities or creating a controlled fracture of the nasal bones in order to make more dramatic changes such as straightening the nose or reducing a larger hump. The skin covering will then drape over this new structural support and the external shape of the nose is thus changed.
After surgery, the nose is taped on the top with a nasal splint (fig 3) to hold the support structures in place. Absorbable sutures are used inside the nose and, external sutures need to be removed from the skin 5 days after surgery. A small sponge is placed in the nose to prevent bleeding and a sponge is removed on the day 2. The tape and nasal splint are removed on day 7.
During this time, you can resume non-stressful activities like bathing, shampooing, and walking.
Mild to moderate bruising underneath the eye for 1-2 weeks is possible. Pain is well-controlled with pain medicine. Patients may return to normal physical exercise after one week, but contact sports should be avoided for six weeks following surgery.
It will take several weeks, however, before you are entirely back to your usual routine.
Your nose will continue to improve for at least a year following surgery. Therefore, do not expect to see your final result when the cast is removed. Do not be alarmed if the shape of your nose keeps changing during the first few months.
What are the possible complications?
All surgical procedures have risk. Although most procedures are successful, medicine is not an exact science and no one can guarantee that you will have the desired outcome. Your surgeon will openly discuss the risks and complications of any procedure with you.
Complications with nasal surgery are not common but on occasion some people have more bleeding than usual and a temporary pack within the nose may be necessary. As with all cosmetic surgery, the possibility exists that the aesthetic outcome is not precisely as you hoped and revision surgery may be called for.