RHINOPLASTY
By Robert Caridi, M.D.
Westlake Plastic Surgery
A rhinoplasty is what is commonly referred to as a “nose job.” Most patients seek rhinoplasty because they want to improve the size and shape of their noses. It is one of the most intriguing and challenging plastic surgery procedures that I perform. The reason is, in part, because the nose is the center of the face and changes in the structure of the nose can have a profound effect on the general appearance of the face overall. It is, therefore, also my responsibility to spend time with you to find out exactly what changes you would find desirable and to impart on you my personal experience with this type of surgery, and to give you some feedback from my patients and what they experienced.
The purpose of cosmetic surgery is to make you look as good as it is possible for you to look. It cannot do more than that. If you are expecting a transforming miracle from surgery, unquestionably you will be disappointed. Plastic surgery is a combination of art and science. Surgery is not altogether an exact science and because some of the factors involved in producing the final result (such as the healing process) are not entirely within the control of either the surgeon or the patient, it is impossible to warranty or guarantee results. Surgical results from surgery on the nose, however, are more predictable in some patients than others. This is determined by a number of factors, such as thickness and shape of the bones and cartilage, the shape of the face, heredity, age, and the thickness and condition of the skin. The skin is a highly important factor influencing the result of nasal surgery, for thick skin precludes a delicate nasal tip. Every nose has a certain combination of these anatomic features that influence the outcome of the surgery and the predictability of the results. These will be discussed with you during your consultation. No two noses are the same; therefore the results of nasal surgery are never exactly the same.
During your consultation we will get to know one another. In addition it will be important that we speak the same language with regard to the anatomy of the nose. I don’t expect you to become a rhinoplasty expert, but it will be important that you specify the region of the nose that you would like to change as well as the changes that you would desire. It is important to be as specific as possible in describing changes you would like.
Remember that many of the changes that I perform during a typical rhinoplasty are fairly common to all patients. It may be a “hump” that is too prominent, a nasal tip that is too big, a nose that is too wide, or a nose that is not straight. Nevertheless, it is your nose and it’s not abnormal. People of different ethnicity have different noses. That in itself is what makes appearance interesting, unique and appealing. If you desire changes in the shape of your nose, I expect you to relate to me in understandable terms what changes you desire. Photographs from magazines can sometimes be helpful to illustrate what you would like. It is not possible for me to change your nose so that it resembles the ideal nose in your picture. I offer my patients computer imaging as a demonstration only of what simple changes may resemble on your nose. It is not meant to guarantee your result. You must be entirely realistic in your expectations so that you and I will be satisfied with your surgical outcome.
In addition to surgery to change the appearance of your nose, I also routinely perform surgery on the inside—the septum and the turbinates. The septum is the thin partition between your two nasal cavities. This can be curved or irregular in shape and can result in nasal obstruction and difficulty breathing. The turbinates are the air conditioning units of the nose. These can become quite enlarged and in some cases can contribute significantly to nasal airway obstruction. To correct these two problems I perform surgery to straighten the septum and reduce the size of the turbinates so as to create a clear, unobstructed pathway for airflow. It is analogous to fixing the plumbing.
A rhinoplasty can be performed as an open approach or an endonasal approach. In the open approach, a small incision is made in the columella of the nose (the small bridge of skin separating the two nasal openings) and the nasal skin is retracted to give direct exposure of the inner structures of the nose. An endonasal approach is surgery done with incisions made within the nasal passages themselves without the incision on the outside of the nose.
Insurance companies MIGHT cover a problem related to breathing. They do not cover changes to the outside of the nose. This is considered “cosmetic” in nature. If you had previous trauma to the nose that resulted in significant damage to the nose then it is possible this will be a covered procedure. However, I do not accept insurance payments for this procedure, so this would be a situation in which you would need to work with your insurance to be reimbursed.
A rhinoplasty is an outpatient procedure done in my office or a surgicenter. The operation typically lasts two hours or less. General anesthesia is recommended. Swelling of your nose and surrounding face can be significant after surgery. Therefore, it may be important to plan your surgery during a time when you have several days to allow for the swelling to subside. In fact, although you will notice a difference immediately after the procedure it typically takes several months for all the swelling to subside and to realize your final result. Nasal packing may be used and typically stays in the nose for several days. This is somewhat uncomfortable. You must mouth breathe during this time. Swelling on the inside can last for some time as well and explains the difficulty you may have breathing even after the packing is removed.
A primary rhinoplasty refers to a nose that has never been operated upon. A secondary rhinoplasty refers to a nose that has been previously operated upon. A secondary rhinoplasty is a much more difficult procedure and tests the rhinoplasty surgeon’s artistry, judgment and ingenuity.
The final result of a rhinoplasty, in my opinion, is to achieve a natural “non-operated” look. An over operated nose or “pig nose” is a result of a poorly executed operation. The change should be subtle and natural without the stigmata of the operated look. I hope you agree.
Complications with a rhinoplasty are, like most operations, uncommon. Nevertheless the following is a list of the most likely problems:
- Bleeding. The most common problem encountered after nasal surgery. Such bleeding can be troublesome but is fortunately uncommon, rarely serious, and usually amenable to conservative treatment.
- Infection. This is very rare and is usually treated with antibiotics.
- Swelling. A common sequelae of surgery. This subsides with time.
- Bruising. Again common but more frequent when the nasal bones are broken. This too resolves in a short time. It may last up to ten days after your surgery.
- Small, minor irregularities. Can occur in a small percentage of patients. This may resolve by itself or require a minor revision.
- Dissatisfaction with the cosmetic result. Not a true complication of surgery. Usually related to patient selection more than surgical manipulation. This is minimized by making sure the patient is well informed and entirely realistic about surgery.
Athletic activities must be limited within reason for several months. The nose is “healed” in about four to six weeks. At that time swimming, tennis, golf, horseback riding, and other sports that do not involve direct body contact are permitted. Body contact or team sports such as volleyball, football, wrestling, and so on are permitted after four months. Mainly, common sense is required in regulating your activities after surgery.
Your nose may seem stuffy or congested from time to time for several weeks after the surgery. This reaction is normal. Do not continuously use nose drops, however, as it is easy for habituation to occur.
If you have any other questions, be sure to get them answered in advance by my office staff or me. My nurse has been with me for many years and is thoroughly informed, trained, and able to answer your questions. Well-meaning friends are not a good source of information. Find out everything that you want to know. A well-informed patient is a happy one.
Robert C. Caridi M.D.
