Nasal Surgery- Rhinoplasty

The goal of nasal surgery is to achieve an improved but natural appearance and to correct internal structural deformities responsible for any breathing problems that may coexist. This goal is not always achieved simply by the removal of portions of bone and cartilage as was the routine years ago. The modern approach to nasal surgery therefore is to use a combination of techniques that include tissue removal, cartilage reshaping with sutures, and adding cartilage grafts to produce the best aesthetic and functional result.

Traditional rhinoplasty techniques use incisions hidden inside the nostrils for access to the underlying cartilage and bone. This approach is still ideal for those that require only simple internal changes such as removal of a bump and minor modification of the tip.  It is also applicable to those who only require work on the internal part of the nose in order to correct a breathing disorder. The advantage of this method is that there is less swelling postoperatively. The disadvantage is that the visibility of structures inside of the nose is more restricted for the surgeon.  The “open” method is a more recently developed technique that provides the surgeon with a wider range of options for making internal changes to the nose. The scar is typically insignificant.

The skill of the surgeon is an obvious key determinant of the final result of nasal surgery. There are other factors such as the thickness of the nasal skin that influence the final outcome and cannot be completely controlled. Thick skin, for example, can mask fine sculpting of the underlying nasal tip cartilages and thereby limit the amount of tip definition possible. Tip cartilage that is either strongly bent or weak and flimsy can also impose limitations on what can be achieved surgically.  Fortunately, in most cases there are no major limiting factors.

Surgery is performed under general anesthesia.  At the end of surgery the nose is taped and a plastic splint applied. These are removed five to six days later.  The nose is not deeply packed but a small piece of gauze is placed in each nostril and usually removed the next day.  Stitches inside of the nostrils are of the dissolving type and do not need to be removed. If there are skin stitches between the nostrils, they are removed after five to six days.

The pain associated with nasal surgery is generally mild and usually lasts for less than 24 hours. Oral pain medication is sufficient but often is not needed.

Swelling of the nose and bruising around the eyes is typical after nasal surgery and begins to subside after 48 hours. It is usually possible to return to school or work seven to ten days after surgery. Most types of exercise may be resumed after three weeks.  Ball sports are not recommended for at least six weeks.

Complications are rare in nasal surgery. The most common problem is bleeding. While this may be troublesome, it almost always stops spontaneously. Rarely the nose must be packed for a few days. Infection is also possible but is extremely rare.

While every effort is made to make the nose as aesthetically pleasing and symmetric as possible, minor irregularities or asymmetry may occasionally become apparent months later.


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