Rhinoplasty
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
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.
Teenagers should wait until after there growth spurt before having a
rhinoplasty
A blood clotting problem may lead to bleeding. Aspirin may affect clotting and,
therefore, should be reported to your surgeon
The individual should not smoke for at least two to four weeks prior to surgery
since nicotine may delay healing
The person may be a keloid (a heavy thick scar) former
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
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 2b - The incision may be made in
Figure 2a - Before the surgery the dorsum
the columella or hidden inside the nostril.
of the nose is very prominent due to the
To reduce the width of the nose, small
position of the nasal bone and septal
wedges are removed from the base of the
cartilage. N. Gordon
nostril on each side. N. Gordon
Figure 2c - The nasal bone and cartilages
Figure 2d - Following surgery, a metal
are remodeled to remove the prominent
splint is applied to the nose to maintain the
dorsum of the nose. The result is a more
new shape. N. Gordon
pleasing shape for the nose. 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
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