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Rhinoplasty
Plastic surgery of the nose

One of the most common plastic surgery procedures is a rhinoplasty. The plastic surgeon can change the nose in several ways including size, shape and angle and, in addition, may help relieve an obstruction to breathing.

Anatomy

The anatomy of the nose relative to the rhinoplasty procedure is as follows.

  • The nose is attached to the forehead at the bridge of the nose. The slope of the nose towards the tip is called the dorsum
  • Two openings, the nostrils, are found between the tip and the upper lip. The strip of skin between the nostrils is called the columella
  • The upper portion of the dorsum of the nose is supported by the nasal bone while the lower part is composed of cartilage (Figure 1)
  • In the midline lies the septal cartilage, portions of which extend to each side as the lateral cartilages. On each side are several pieces of cartilage, the alar cartilages that round out the support for the nostrils
Figure 1 - The anatomy of the bone and cartilages of the nose that is involved in the rhinoplasty procedure. © N. Gordon

Indications

Having a rhinoplasty is a voluntary act and, therefore, there are no specific indications for the procedure, however

  • Having a rhinoplasty is a voluntary act and, therefore, there are no specific indications for the procedure
  • Most individuals who request this procedure are under the age of 30
  • In some individuals breathing problems is an indication for this surgery
  • The individual is unhappy with the look of his/her nose but does not have an unrealistic desire for perfection (Figure 2A)

Contraindications

  • There are no specific contraindications to this surgery other than the person may have a medical condition such as severe heart disease
  • There are relative contraindications
    1. Teenagers should wait until after there growth spurt before having a rhinoplasty
    2. A blood clotting problem may lead to bleeding. Aspirin may affect clotting and, therefore, should be reported to your surgeon
    3. The individual should not smoke for at least two to four weeks prior to surgery since nicotine may delay healing
    4. The person may be a keloid (a heavy thick scar) former
    5. The individual should be realistic as to what to expect from a rhinoplasty, especially teenagers and their parents. A rhinoplasty may make a person look better and enhance self-confidence but it cannot create a different person or completely different look
    6. Prior nose surgery may cause a problem. Be sure the plastic surgeon knows of the prior surgery

Surgical Procedure

  • A rhinoplasty may be carried out either in a hospital, an outpatient or ambulatory care facility under either a general anesthetic (asleep) or with local anesthetic (awake) and a sedative
  • The surgery involves lifting the skin of the nose off of the underlying bone and cartilage, remodeling the bone and cartilage and allowing the skin to re-drape over this reshaped base
  • Some plastic surgeons make the incisions for this procedure within the nostrils while others may make an incision across the columella (Figure 2B)
  • Once the skin has been lifted off the cartilage and bone, the dorsum of the nose is straightened by fracturing and resetting the nasal bone and trimming the septal cartilage (Figure 2C)
  • Wide nostrils can be narrowed by removing small wedges of skin from the base of the nostril on each side (Figure 2B)
  • During the remodeling, the tip of the nose may be reshaped and/or the angle between the nose and upper lip may be changed
  • Following surgery, a metallic splint is applied over the dorsum of the nose to maintain the new shape (Figure 2D)
  • Nasal packs (sometimes soft plastic splints) are inserted into the nostrils to support the cartilaginous septum
Figure 2a - Before the surgery the dorsum of the nose is very prominent due to the position of the nasal bone and septal cartilage. © N. GordonFigure 2b - The incision may be made in the columella or hidden inside the nostril. To reduce the width of the nose, small wedges are removed from the base of the nostril on each side. © N. Gordon
Figure 2c - The nasal bone and cartilages are remodeled to remove the prominent dorsum of the nose. The result is a more pleasing shape for the nose. © N. Gordon Figure 2d - Following surgery, a metal splint is applied to the nose to maintain the new shape. © N. Gordon

Complications

  • Infection
  • Bleeding from the nose
  • Poor healing of the skin
  • Excessive scar formation
  • Tiny red spots may be present on the skin from torn blood vessels. These usually disappear but may be permanent
  • Allergic reaction to the anesthetic

Care After Surgery

  • Pain can usually be controlled with pain medication taken by mouth, however, a sudden increase in pain should be reported to the surgeon
  • Swelling and bruising of the ski usually increases for the first few days and then gradually disappears over several weeks but this may even take months
  • There is usually also swelling and bruising around the eyes
  • Bed rest with the head elevated for the first few days reduces swelling
  • The nasal packing is usually removed after one to two days. The splint is usually worn for one to two weeks
  • Any sutures are removed after the first week · Some bleeding after the first few days is not unusual
  • All patients have some numbness after surgery, which usually disappears after a variable length of time
  • There may be some asymmetry of the nose after surgery. Perfect symmetry should not be expected
  • The return to normal activity is gradual with no heavy work being done for two to four weeks. Follow the surgeon's instructions for returning to normal activity
  • Care must be taken not to injure the nose until completely healed, which takes about eight weeks. This includes not wearing glasses over the bridge of he nose (the glasses can be taped to the forehead).
  • Care must also be taken in washing the face