Rhinoplasty (Plastic Surgery of the Nose)

Anesthesia Depending on the individual procedure the surgeon may choose local or general anesthesia . IV sedation medication may also be given. Description of the ProcedureThere are three main components of the procedure: Lifting the Skin of the Nose from the Bone and CartilageThe nose is injected with xylocaine (a numbing medication) and epinephrine (to discourage excessive bleeding). An incision is made either inside the nostril, or outside the nostril, across the ridge between the nostrils called the columella. The skin is then lifted off the cartilage of the nose. Remodeling Bone and CartilageDepending on the desired outcome, some nasal bone may be removed, fractured, and reset to a new shape. Cartilage may also be trimmed. Other techniques involve using a tissue graft (bone, cartilage, or skin) from the patient or a donor, or a synthetic graft to help remodel the shape of the nose. Redraping Skin Over the New BaseOnce the procedure is finished, the incisions are closed, and the skin is redraped over the new bone structure. The skin is tightly taped to keep it in place. Then a protective metal splint is applied on the outside of the nose to maintain the positioning during healing. Nasal packs, which may be either soft plastic splints or gauze packing coated with petroleum jelly, may also be inserted into the nostrils to support the cartilage during healing.

After ProcedureStitches will be removed after the first week. Nasal packing is removed after 1 to 2 days, and the splint is worn for 1 to 2 weeks. Numbness, swelling, or bruising of the surgical area and around the eyes should be expected. How Long Will It Take?The procedure typically takes 2 to 4 hours. Will It Hurt?Anesthesia prevents pain during the procedure, but there will be some pain for approximately 1 to 4 weeks after the surgery. You will be given pain medication to relieve this discomfort. Possible ComplicationsPoor healing of the skinDiscomfort and pain caused by gauze packingTiny red spots from torn blood vessels, which should recede, but may be permanentAllergic reaction to anestheticDevelopment of permanent excess scar tissuePuncture of septum or collapse of nose bridge (relatively rare)Increased risk of nosebleedsNeed for repeat operation to achieve desired resultInfectionUnsatisfactory cosmetic result Average Hospital StayRhinoplasty is generally an outpatient procedure. Postoperative CareFor the first few days after surgery, rest in bed with your head elevated to reduce swelling.Apply ice packs to your nose to relieve discomfort during the first two days, then use a warm compress to relieve pain.Take prescription or over-the-counter pain medications as directed by your doctor.Do not blow your nose at all during the first week, and do not blow your nose forcefully for one month.Protect your nose from any injury for 8 weeks, do not wear glasses, and be careful when washing your face.Avoid vigorous exercise for at least 3 weeks and contact sports for 6 months. OutcomeExpect swelling and bruising to worsen over the first several days after the surgery. You can also expect some bleeding from the nose, headache, and a feeling of nasal congestion. Once the swelling and bruising have diminished, expect full healing in about 3 to 4 weeks. Your facial appearance will be changed, and if surgery was done to correct a breathing obstruction, your symptoms should be alleviated.

Call Your Doctor If Any of the Following OccursSigns of infection, including fever and chillsRedness, swelling, increasing pain, excessive bleeding, or discharge from the incision siteCough, shortness of breath, chest pain, or severe nausea or vomiting RESOURCES: American Academy of Facial Plastic and Reconstructive Surgeryhttp://www.aafprs.org American Society of Plastic Surgeonshttp://www.plasticsurgery.org CANADIAN RESOURCES: Canadian Society of Plastic Surgeonshttp://www.plasticsurgery.ca/ Health Canadahttp://www.hc-sc.gc.ca/index_e.html References: American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) website. Available at: http://www.plasticsurgery.org . Accessed October 14, 2005. Medical encyclopedia: cosmetic nose surgery. Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/002983.htm . Accessed October 14, 2005. Last reviewed December 2007 by Elie Edmond Rebeiz, MD, FACSPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.