Rhinoplasty(nose job) is the operation to reduce or reduce or refine the nose. Nasal surgery is very popular. The reason may be simply that the person is self conscious of a large hump or a prominent tip or it may be that this is the subject or irritating jokes. Some individuals may have sustained injuries to their nose, which have given rise to unsightly deformities. In either event, prominent nasal humps and tips are frequently associated with more masculine features and therefore if these are present on the nose of the female, may give rise to an overall harsher feminine facial appearance. In the vast majority of cases, men and women alike wish to have a normal, average nose that will blend into their face rather than dominate their features.

Am I suitable for this surgery?

Only a consultation can establish this. A consultation will determine a few things. You will be asked about your general medical history, which will include questions about any pervious nasal surgery or injury. If you require corrective surgery to the nose as a result of a previous rhinoplasty it is important to wait at least 6 months before any further surgery is attempted.

Inquires will also be made as to your breathing patterns and whether you suffer with any nasal obstruction. Many times this can also be addressed at the same time as a rhinoplasty. Dr. Loeb will then want to know why you are unhappy with shape of your nose. The most common request is to reduce the size and alter the shape of a large nose, but occasionally an increase in profile is requested. During any surgery, the greatest risk is that the surgeon will not give you what you want. This problem can be greatly obviated by ensuring that Dr. Loeb knows exactly what is it you want. With this in mind, we strongly recommend a computer imaging session with Dr. Loeb. During the session Dr. Loeb will discuss specific areas for improvement and you'll be able to see likely results! This way he can try to explain to you what can or cannot be done. Remember Dr. Loeb wants to give you a nose that he feels is attractive and proportional in size and shape to the rest of your face.

Many people like to bring in photographs of a nose which they would like to have. It is important to realize however, that every nose and face is different, you may not look good or be able to have a thin sharp nose if you have a broad face with thick skin. Computer imaging is very useful in making sure your expectations are realistic.

What does the operation involve?

The operation is usually performed through incisions inside the nostrils. Occasionally there are external scars, particular when reducing nostril size (alar reduction) or if complicated tip work is required. If alar base reductions have been performed then the scars will be found between the edges of the nostril and the cheeks. These are generally well hidden by the natural shadow cast by the position of the nose. In complex tip surgery, you may require an external incision careful placed in the columella(the lower middle segment of skin situated between your nostrils).

Any bump on the bridge is removed to give a new profile. The nasal bones, depending on the circumstances, are then usually broken and rest in a careful way to allow them to meet in the midline and narrow the bridge line. If any breathing difficulties exist, then the septum (structure separating the two nasal compartments) is altered accordingly.

Finally, the tip of the nose, and the cartilage beneath the skin, is adjusted in size and shape to refine the nose so that it matches the new profile. When the surgery is complete, small dissolvable stitches are used inside the nostrils and small nasal pads are inserted. These pads are used to control any bleeding which may arise after the operation as well as to ensure that the lining of the nose adheres and heals correctly. At the conclusion a plastic cast is placed on the bridge.

What type of anesthetic is used?

A Rhinoplasty is usually performed used a general anesthetic. Occasionally a local anesthetic can be used for more minor work such as narrowing of the nostrils. The surgery requires you to be observed and "iced" for a few hours post-op. You will be able to go home 3-4 hours after the surgery.

How long does it take?

A Rhinoplasty takes approximately 2 hours to perform.

What happens after the Surgery?

After the surgery you will be propped up in bed with a couple of pillows in order to elevate your head and reduce the swelling around your nose. It will be difficult to breathe through your nose. This will be because you will have pads placed inside each nostril. So try to remember to breathe through your mouth. Most patients report that the pads are the most unpleasant part of the whole operation. This is not because these are painful, but because you are forced to breathe through your mouth until these are removed.

The bridge of the nose is usually protected for seven days after the operation by a plastic cast. You should avoid blowing your nose, stooping, and any vigorous activity for three weeks.

What kind of after effects should I expect?

If your nasal bones are not narrowed you will have very little bruising. However, if the nasal bones are broken and reset, you should expect to have "black eyes" and some swelling of the face. This usually settles by 2 weeks although as soon as the plastic cast is removed you may, in fact, apply light make-up to mask this.

It is important to realize that even once the plastic cast is removed from the bridge of the nose there will almost certainly be significant degree of swelling still present. Therefore the shape of the nose at this stage is not the final one. This obvious swelling will rapidly decrease in the ensuing 3-4 weeks. However, remember that even after this time, the shape of the nose is still not the final one. This is partly because of scar tissue which will form underneath the skin of the nose, as a result of the surgery, and which will have a subtle volume effect on the final shape. These internal scars gradually change their shape (called scar maturation) and resolve in time. It is important that the tip of the nose in particular is regular massaged in order to prevent the internal structures from becoming fixed by this scar development, in an undesirable position. You will be instructed in this.

The process of scar maturation will take up to one year to complete and therefore only after this time will the final shape of your new nose be apparent. However, the good news is most people see 80% the result at 3 weeks and 90% at 3 months. As a simple guide in assessing the progress of your nose, you should gently squeeze the tip of a normal nose, and then your own to compare the firmness. The firmer it is, the more time is required for it to settle.

During the initial weeks, and sometimes months, the nose tip usually feels numb. This variably recovers as the nerve supply to the skin regenerates.

Is it painful?

Remarkably enough, pain aft this operation is not usually a problem and is easily relieved by an injection in the first few hours and a mild analgesic such as Vicodin as necessary afterwards.

What are the Scars like?

In most instances, all the incisions for rhinoplasty. Are placed within the nostrils and therefore cannot be seen. However as mentioned already (see Operation), in some instances external scars may be needed to reduce the nostril size or to perform more complex nasal tip work. Although these scars are usually red and lumpy for the first few weeks, they do tend to settle in time. However, you must bear in mind that it is impossible to predict the final appearance of any scar.

What could go wrong?

All surgery carries some uncertainty and risk. When rhinoplasty is performed by a qualified Plastic Surgeon, complications are infrequent and usually minor. Still individuals vary greatly in their anatomy, their physical reactions, and their healing abilities.

Infection, as in any operation can occur but is thankfully quiet uncommon. Occasionally though, a "blind boil" type infection may occur on the skin of the nose. These can be quite uncomfortable and may take a week or so before they finally settle.

After your discharge from the surgery center it is possible that you may experience a nosebleed. In the vast majority of times this bleeding ceases of its own accord following elevation and icing. However, rarely it is necessary for medical intervention to stop difficult bleeding.

Irregularities of skin, bone or cartilage may occasionally appear following surgery. These may show up on the surface as slight depressions, dips of bumps. Most of these situations improve with time or additional injections. About 10% of the time additional minor surgery may be needed.

Following a rhinoplasty of a badly deviated or bent nose the results may not be a perfectly straight, well-aligned nose. Many reasons may be responsible for this but is conceivable, in particular difficult situations, that two or more procedures may be required to remedy these diffcult noses. You will be advised at the consultation what the likelihood of this occurrence will be with you.

Overall however, there is a definite incidence of about 5% of patients who, with their surgeon, feel that the shape of the nose at the end of 9-12 months is not quite what was intended. This happens more frequently in noses that have been the subject of severe nasal injury or previous nasal surgery. In these situations further, usually small procedures may be necessary to achieve correction. When secondary (from a previous operation) or revision surgery is carried out however, a higher incidence of complications and higher degree of uncertainty with respect to the final results can be expected

How long before I'm back to normal?

Most patients like to stay out of the public eye while their cast is on. Once this is removed however, you will gradually start to resume you daily activities. This will largely depend on the amount of bruising and swelling you will experience. Most bruising has dissipated by about 2 weeks. Most people are back to work by 7 days. Although slight swelling may still be present at this time, it is not usually noticeable to the majority of people. By 3-4 weeks most people are back to their normal routine and are enjoying their nose. You will however need to avoid any contact sport for 3 months, while the nasal bones heal completely.

Summary