Rhinoplasty, also known as a nose job, is plastic surgery done on the nose. Rhinoplasty can be functional, cosmetic or both. Cosmetic rhinoplasty is done to improve the patient’s appearance, often by making the nose more proportionate with the rest of the patient’s face.
Functional rhinoplasty is done to improve the patient’s ability to breathe through their nose. It can be done to repair an injury or to correct a congenital defect. In some cases, a person’s ability to breathe their nose declines with age. Some older people develop a condition called nasal valve stenosis in which the nasal valve or airway at the front of the nose weakens and falls inward. A nose job can strengthen the nasal valve and stop it from collapsing.
Rhinoplasty is a very individualized procedure; each operation is tailored to what the patient needs and wants. Functional rhinoplasty, for example, can involve repairing a broken nose or straightening a deviated septum. Cosmetic rhinoplasty can involve changing the size of the nose, removing a hump or bump, changing the width of the nostrils, changing the tip, or altering the angle between the nose and mouth.
This procedure can be open or closed. During an open or external rhinoplasty, the surgeon will make an incision along the columella or strip of tissue between the nostrils. During a closed or endonasal rhinoplasty, all of the incisions are made inside the nose.
Depending on what is being done, the surgeon may reshape, remove, or add bone and cartilage to the nose. For example, if the patient wants a smaller nose tip, the surgeon will remove some of the cartilage at the tip. They will carve it away in such a manner that the remainder looks natural.
A revision or secondary rhinoplasty is a procedure done to correct problems caused by the original rhinoplasty. Since the surgeon usually has less tissue to work with than during an original surgery, revision rhinoplasties tend to be more complicated and take longer. While an original rhinoplasty may take as little as an hour to complete, revision rhinoplasties often take at least three hours.
What Is the Recovery Like?
The patient may need pain relievers for the first two or three days after the procedure. The surgeon will put a splint on the patient’s nose to ensure that it retains its new shape. They will remove the splint and any stitches about six or seven days after the procedure.
Bruising is common and will fade enough by the second week that the patient will feel comfortable in social situations. Swelling is also common and can take months to fade. Consequently, many patients may not see the full results of their surgery for as long as six months.
Most patients can return to work within a week or two after the procedure. They should avoid strenuous activities for at least two or three weeks. The patient should not swim for at least a month; many people injure their noses swimming if they start too early.
Since heat can make the nose swell, the patient should avoid sunlight, tanning beds, and sun lamps for at least six weeks after the procedure.
The patient should not wear glasses or sunglasses that sit on the bridge of their nose for at least six weeks. If they need to wear prescription glasses, the doctor will teach them how to tape them to their forehead to avoid pressing down on their nose.
The patient should follow all of the post-operative care instructions given to them by the surgeon. They should take only the medications recommended by their doctor. Since the patient will not be able to drive home after the surgery, they should make arrangements to have someone pick them up at the hospital.
How Should the Patient Prepare?
A healthy patient will get better results and heal more quickly. They should thus take steps to improve their health. For example, eating nutritious foods and drinking plenty of water can do wonders for your system.
Since smoking increases the risks of complications like bleeding and slows healing, a patient who smokes should quit at least two weeks before the procedure. They should avoid smoking for at least another two weeks after their rhinoplasty to give their body a proper chance to heal. Similarly, they should avoid second-hand cigarette smoke.
Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and aspirin also cause bleeding. The patient should not take such medications for at least two weeks before the surgery. They should also avoid herbal supplements and Vitamin E for two weeks for the same reasons. On the other hand, they can take a multivitamin and acetaminophen.
The patient should stay out of the sun as much as possible for two weeks before the procedure. If they need to go outside, they should use a sunscreen with an SPF of at least 30.
Who Is a Good Candidate?
The ideal candidate for a rhinoplasty will be someone in overall good health with realistic expectations. The patient needs to understand that, while an improved appearance could boost their confidence, it won’t help them get a better job or find a new lover. Similarly, the surgeon is limited in what they can do by the patient’s existing nose and face. Every patient has a different bone structure, musculature, and skin thickness. A patient who hopes to have a nose like that of their favorite actor is probably going to be disappointed.
Plastic surgeons prefer to perform rhinoplasties on patients whose faces have reached “skeletal maturity” or stopped growing. Girls’ faces can be fully developed by the time they are 14 or 15 years old. Boys, on the other hand, continue growing for at least a year longer. One way to tell if a teenager might be a candidate for rhinoplasty is to check their feet. If a teenager’s feet have stopped growing and they haven’t changed shoe sizes in over a year, they may be physically ready.
This restriction applies mainly to cosmetic rhinoplasties. If a ten-year-old breaks their nose, the surgeon will repair it. As their face changes as they reach maturity, their nose may no longer be in balance with the rest of their face. They may thus need another surgery as they reach adulthood.
Plastic surgeons also want their patients to be emotionally mature and psychologically stable. They won’t accept anyone who shows signs of body dysmorphia, which is a chronic psychological disorder that causes the patient to obsess over their appearance, especially over perceived flaws that may or may not exist. People with the condition try to hide their flaws and improve their appearance – but they are never satisfied with the results or at least not for long.
Similarly, people with other severe psychological problems like depression are not good candidates. People who in the middle of a crisis like a divorce or the recent death of a loved one are not good candidates.
Plastic surgeons prefer to work with decisive patients who at least have some idea of what they want. They should know how they hope to look after the surgery. Plastic surgeons also prefer patients who are willing and able to educate themselves about the procedure and what they can realistically expect from it. They also prefer patients who will follow all of their instructions regarding preparation and post-operative care.
The candidate also needs to be very certain that they want a nose job. They need to be getting it for themselves and not to please a spouse, lover, or someone else.
As mentioned earlier, a candidate for a rhinoplasty has to be in good physical health. People with the following conditions are often not accepted as candidates for rhinoplasty:
• Heart disease
• Lung disease
• Bleeding disorders
• High blood pressure
• High cholesterol
Patients with allergies to any of the drugs used during or after a rhinoplasty are not good candidates.
The thickness of a patient’s skin can affect the results of a nose job. Generally speaking, patients with thin skin enjoy a number of advantages: they are less prone to swelling than are people with thick skin. Their swelling fades more quickly, and they are less likely to develop scars.
On the other hand, thicker skin makes imperfections less visible, while thin skin can highlight them. Even worse, thin skin often becomes tighter after a surgical procedure. As it tightens, it can put pressure on the underlying bones or cartilage, sometimes to the point of deforming the nose.
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