PLASTIC SURGERY OF THE NOSE (RHINOPLASTY)

Indications - Nose reshaping, or rhinoplasty, is one of the most common plastic surgery procedures performed today. Often, the structure or size of the nose is not proportionate with the other features on the face. Nose reshaping procedures can help to correct the disproportionate appearance of the nose by altering the size or shape of the nose, the span of the nostrils, or the angle between the nose and the upper lip. In addition, nose reshaping procedures may be performed to correct a nasal birth defect or injury as well as chronic breathing problems. It is important to realize that individuals considering a nose reshaping procedure should be at least fifteen years of age, as this procedure should only be performed after the nose has finished developing completely.

Preoperative period (before surgery) - Some exams are previously requested. The use of medications containing salicylic acid or vitamin E should be avoided 10 days before surgery. Smokers should quit smoking 15 days before surgery. It is necessary to stop any oral intake (not even water) 8 hours before surgery.

Surgical Technique - the surgery is usually performed as an outpatient procedure in a hospital. A rhinoplasty may last approximately two to four hours. Prior to the start of your procedure, the treatment area will be cleansed and an anesthesia will be administered. Anesthesia can be general or local combined with a sedative. Then, small incisions across the columella, which is the tissue that lies between the nostrils at the base of the nose, and inside each nostril are done and the skin is lifted away from the bone and cartilage of the nose. In doing so, the nasal framework can be examined and precise adjustments to its shape and structure can be done. The framework of the nose is primarily made of bone and cartilage. The upper portion of the nose is supported by bone. Dorsal humps, which are areas of built up cartilage or bone, can form along the dorsum, or ridge of the nose. The lower portion of the nose is supported by different plates of cartilage that extend laterally from the center of the nose, while the cartilage in the lower portion of the nose is what determines the shape and appearance of the nasal tip. The nose is then reshaped by removing or adding bone, cartilage, or tissue to achieve the desired appearance. In patients whose nasal tip is wide or bulbous, a portion of the alar cartilage from the tip of the nose is removed, and sutures are applied to bend or pull the alar cartilages inward to create a narrower tip or adjust its position. One of the primary goals of nose reshaping is often to remove a dorsal hump. The dorsal hump usually consists primarily of cartilage and some bone. In order to remove the dorsal hump, an osteotome is used, which is a chisel-like device used to cut bone.  Following the removal of the dorsal hump, the nose may have what is known as an open roof, which is an open space between the nasal bones. Then, an osteotomy to reposition the nasal bones and close the open roof is done. Once the reshaping of the nose is finished, the incisions inside the nose will usually be closed with dissolvable stitches. The non absorbable stitches are removed in 7 days. A nasal splint is applied. The bandages and splint help the tissues heal and conform to the new cartilage and bone structure.

Postoperative period - The patient goes home around 3 hours after surgery, with a dressing to be kept dry. Swelling around the eyes can be alleviated with cold compresses. It is also recommended to keep the head elevated during recovery, in order to reduce bruising and swelling in the area. The patient is oriented to rest until the removal of the first dressing 3 days after surgery. At this time another dressing is done and the patient is free to take a full shower. After that the patient can resume most of his normal activity, and return to work, including driving vehicles. However, it may take 30 days to be able to return to full normal activity including heavy lifting and strenuous exercise. Stitches, bandages, and the nasal splints may stay in place for approximately 7 days. Some bruising and swelling particularly in the upper portion of the face and around the eyes will begin to dissipate within the first few days following surgery. Although it is important to realize that nose reshaping procedures are not intended to achieve perfection, by adjusting the proportion and profile of the nose, nose reshaping can help to significantly enhance self-confidence and appearance.