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RHINOPLASTY – NOSE SURGERY

What is Rhinoplasty ?

Rhinoplasty is literally “nose reshaping” and colloquially a “nose job”. It is a surgical procedure intended to reshape or repair a nose by improving facial harmony, the appearance and proportions of a nose, and the breathing function of the nose. Another procedure associated with rhinoplasty and which can be done at the same time is septoplasty, a procedure that improves up nasal passages restricted by a bent septum.

Rhinoplasty – What can it do?

Nose surgery may be performed for cosmetic reasons or for reconstructive purposes, such as correcting breathing problems. Nose surgery can change the size of the nose as well as its width and profile. The nose tip, shape of the nostrils and balance of the nose (nasal symmetry) can also be altered. Nose surgery aims to achieve any of these results:

  • Straighten a crooked nose
  • Make the nose look more symmetrical (keeping in mind that perfect symmetry is not always possible)
  • Make the nose look more in balance with a face (again keeping in mind that perfect balance is not always possible)
  • Make the nose a little smaller or larger
  • Restore the height of a flat nose
  • Increase width at the bridge
  • Alter the appearance of a nasal tip that is enlarged or bulbous, drooping, upturned or hooked
  • Reduce the size, flare and position of large wide or upturned nasal openings
  • Correct a hump deformity
  • Improve the look of the nose in relation to the upper lip
  • Correct birth defects
  • Repair damage caused by injury
  • Repair damage caused by disease, such as infection or skin cancer
  • Open up nasal passages and improve breathing often by performing a septoplasty (surgery on the nasal septum as well as rhinoplasty)’

Of all our visible features we are most sensitive about our noses. We are critical of perceived tiny imperfections, sometimes even to obsession. Adjustments as small as a few millimetres to the tip, the width, the flare of the nostrils, the hump, or droop (if such they have) can have a huge impact on the way they feel about their nose. If you desire a more symmetrical nose, keep in mind that everyone’s face is asymmetric to some degree.

Rhinoplasty to correct a deviated septum

Septoplasty – nose surgery that’s done to improve an obstructed airway requires careful evaluation of the nasal structure as it relates to airflow and breathing.
Correction of a deviated septum, one of the most common causes of breathing impairment, is achieved by adjusting the internal nasal structure to produce better alignment.

Preface and Disclaimer.

Before reading further note that I compiled this page from the very good and authoritive information on the websites of American Society of Plastic Surgeons (ASPS) and Australian Society of Plastic Surgeons’ procedures website : The Australian Foundation for Plastic Surgery

After reading this page you are welcome to find more about rhinoplasty from the links here, but you must not decide on any action until after you have consulted a medical professional. The information here is not personal medical advice for you. That can only come from a medical professional after consultation with you.

Rhinoplasty – Is it right for me?

Nose surgery is a highly individualised procedure and may not be suitable for everyone.
Always talk to your Plastic Surgeon before making a decision.
Your surgeon will assess your condition and general health, and plan the treatment that is best suited to you.
You may be a good candidate for rhinoplasty if:

  • Your facial growth is complete
  • You are physically healthy
  • You don’t smoke
  • You experience breathing problems
  • You are self-conscious about the appearance of your nose
  • You are physically healthy and you do not have medical conditions that can impair healing or increase risk of surgery
  • You have a positive outlook and realistic goals in mind for the improvement of your appearance

Then there are some other important issues to keep in mind:

  • Your surgeon can only work with the bone and cartilage structure that is there,
    so there are limits to how far you can alter the shape of your nose.
  • For a complete reconstruction after, for instance an accident or cancer, cartilage and bone pieces will need to be taken from elsewhere on the body.
  • If you need surgery to repair a broken nose, it is best to seek medical attention straight away to reset the bone and attend to the swelling and damage. Any cosmetic surgey needs to wait for healing.
  • Your surgeon will need to carefully evaluate your nasal structure to ensure that surgery does not interfere with breathing.
    This may prevent you from having certain procedures.
  • The final results may take up to 12 months to emerge, at which point your surgeon will assess the need for further surgery

For a young person the bones of the face and nose need to have stopped growing before nose surgery can be performed. For boys, the nose will have taken its final shape by about 17 years, and a girl’s nose by about 16 years. Nose surgery performed while the nose is still growing can interfere with its normal growth and give unpredictable results. Nasal surgery done on the very young, to correct a deformity for instance, will need to be adjusted later.

Nose surgery may not be a good option for you if you are:

  • A smoker – smokers are at increased risk of complications, and should quit smoking to have effective and safer surgery.
  • Not able to have an anaesthetic
  • Prone to bleeding tendencies or have poor healing ability
  • Have too a high risk of having surgical complications

Will I need anaesthesia for rhinoplasty?

Most nose surgery procedures are performed under general anaesthesia. Modern anaesthesia is safe and effective, but does have some risks. Ask your Plastic Surgeon and anaesthetist for more information. Your surgeon and/or the anaesthetist will ask you about all the medications you are taking or have taken, and any allergies you may have. Make sure you have an up to date list before the surgery.

Before having rhinoplasty

Before undergoing surgery, it is important that you:

  • Be as fit as possible to help the recovery process
  • Check with your surgeon about your medications as some may need to be stopped
  • Stop smoking
  • Prepare a “recovery area” in your home. This may include pillows, ice packs, a thermometer and a telephone within easy reach.
  • Arrange for someone to drive you to and from the hospital or clinic. Someone should also stay with you for at least 24 hours after you return home.

Your surgeon should give detailed preoperative instructions. Follow them carefully.
You will also be asked to provide a complete medical history for your plastic surgeon including any health problems you have had, any medication you are taking or have taken, and any allergies you may have.
Unless your surgeon advises differently, you will be able to continue taking most medicines that you have been taking, but …
You may be advised to stop taking certain medicines such as non-steroidal anti-inflammatory drugs (NSAIDs), aspirin, and medicines that contain aspirin. You may also be asked to stop taking naturopathic substances such as garlic, ginko, ginseng and St John’s Wort as they may affect clotting and anaesthesia. Always tell your surgeon everything you are taking.
Your surgeon will also advise you if any other tests are required, such as blood tests, X-ray examinations or an Electrocardiograph (ECG) to assess your heart.

Rhinoplasty – The Procedure

Rhinoplasty surgery includes the following steps:
Step 1 – Anesthesia
Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation or general anesthesia. Your doctor will recommend the best choice for you.
Step 2 – The incision
Rhinoplasty is performed either using a closed procedure, where incisions are hidden inside the nose, or an open procedure, where an incision is made across the columella, the narrow strip of tissue that separates the nostrils.
Through these incisions, the skin that covers the nasal bones and cartilages is gently raised, allowing access to reshape the structure of the nose.
Step 3 – Reshaping the nose structure
An overly large nose may be reduced by removing bone or cartilage. Sometimes surgery of the nose may require the addition of cartilage grafts.
Most commonly, cartilage from the septum, the partition in the middle of the nose, is used for this purpose. Occasionally cartilage from the ear or rarely a section of rib cartilage can be used.
Step 4 – Correcting a deviated septum, if necessary
If the septum is deviated, it can be straightened and the projections inside the nose reduced to improve breathing.
Step 5 – Closing the incision
Once the underlying structure of the nose is sculpted to the desired shape, nasal skin and tissue is redraped and incisions are closed.
Additional incisions may be placed in the natural creases of the nostrils to alter their size.
Step 6 – See the results
For a few days splints and gauze packing will likely support the nose as it begins to heal.

Get more information about rhinoplasty results below.

Rhinoplasty – What are the risks?

The decision to have plastic surgery is extremely personal. You will have to decide if the benefits will achieve your goals and if the risks and potential complications of rhinoplasty are acceptable. Modern surgery is generally safe but does have the potential for risks and complications to occur.
Your plastic surgeon and/or staff will explain in detail the risks associated with surgery. You really do need to understand all possible risks because you will be asked to sign consent forms to ensure that you fully understand the procedure and any risks or potential complications…and that consent means you are informed and not able to say “but I did not know…” in any subsequent claim.

Rhinoplasty surgery risks include:

  • Anesthesia risks
  • Heavy bleeding from an operated site causing hematoma beneath an incision site that may require drainage
  • An infection that may require treatment with antibiotics or further surgery in some cases
  • Allergic reaction to sutures, dressings or antiseptic solutions
  • Pain, bruising and swelling around the operated site, usually temporary, but sometimes not
  • The nose may be slightly swollen for months
  • Skin under the eyes may be darkened for a period of over six months
  • Nose may feel numb or have altered sensation after the bruising and swelling subside
  • Sense of smell may be impaired, and in rare cases lost or distorted
  • The upper front teeth may feel numb temporarily
  • Short-term nausea following general anaesthesia and other risks related to anaesthesia
  • Poor wound healing caused by other conditions such as smoking or diabetes
  • Incomplete healing or separation of wound edges
  • Keloids and hypertrophic scars that are raised, red and thickened scars. These may form over the healed incisions. They may be itchy, annoying and unsightly but are not a threat to health
  • Change in skin sensation (numbness or pain)
  • Skin discoloration and swelling
  • Possibility of revisional surgery being needed…because of
  • Unsatisfactory nasal appearance
  • Underlying support structure of the nose being weak and causing the nose to flatten
  • An implant (if one was inserted) extruding into the nose or through the skin
  • Major airways may become narrowed, causing difficulty in breathing through the nose
  • Pain that may be severe and ongoing
  • Nasal septal perforation (a hole in the nasal septum) requiring additional surgical treatment to repair the septum, maybe not possible to correct. This is rare.

During your rhinoplasty consultation with intended surgeon be prepared to discuss:

  • Your goals, with regard to both appearance and breathing
  • Medical conditions, drug allergies, and previous medical treatments
  • Current medications, vitamins, herbal supplements, alcohol, tobacco, and drug use
  • Previous surgeries

Your rhinoplasty surgeon may also:

  • Examine your general health status and any pre-existing health conditions or risk factors
  • Determine the options available to you for nose reshaping
  • Examine and measure your face
  • Take photographs
  • Discuss your nose surgery options with you
  • Recommend a course of treatment
  • Discuss likely outcomes of a nose surgery and any risks or potential complications

Be sure to ask questions. It is important that you do know all that is going to happen because you will have to sign consent forms saying that you do know. You will not be able to claim afterwards that you “did not know” (unless, of course something was not disclosed)

Questions to ask your rhinoplasty surgeon :

  • Are you certified by top level accreditation?
  • Are you a member of the Australian Society of Plastic Surgeons? (or American, or other equivalent)
  • Were you specifically trained in the field of plastic surgery?
  • How many years of plastic surgery training have you had?
  • If the procedure is being done at a hospital do you have hospital privileges to perform this procedure?
  • Is the procedure is done at a clinic is it’s surgical facility accredited? and is it Medicare certified?
  • Am I a good candidate for this procedure?
  • What will be expected of me to get the best results?
  • What surgical technique is recommended for me?
  • How long of a recovery period can I expect, and what kind of help will I need during my recovery?
  • What are the risks and complications associated with my procedure?
  • How are complications handled?
  • Are necessary revisions covered?
  • How can I expect my nose to look over time?
  • What are my options if I am dissatisfied with the cosmetic outcome of my nose surgery?
  • Do you have before-and-after photos I can look at for this procedure?

and to ask about your recovery :

  • Where will I be taken after my surgery is complete?
  • What medication will I be given or prescribed after surgery?
  • Will I have dressings/bandages after surgery? If so, when will they be removed?
  • Are stitches removed? When will they be removed?
  • When can I resume normal activity and exercise?
  • When do I return for follow-up care?

and about whether you will have scarring :
Nose surgery is usually performed  through the nostrils, which means there are no visible cuts (or subsequent scars) to the face. Occassionally scars will be placed between the nostrils or at the base of the nose. Your plastic surgeon will endeavour to minimise scarring and to keep your scars as inconspicuous as possible by locating the incisions in easily hidden sites. That way, scars will be along natural skin lines and creases. Scars may fade with time and become barely noticeable. If you are prone to scarring, you should advise your surgeon.

It’s very important to understand all aspects of your rhinoplasty procedure. It’s natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of preoperative stress. Don’t be shy about discussing these feelings with your plastic surgeon.

Recovery from rhinoplasty surgery

During your rhinoplasty recovery, a splint and/or packing will likely be placed inside your nose and a splint or bandages placed on the outside to support and protect the new structures during initial healing.
While initial swelling subsides within a few weeks, it may take up to a year for your new nasal contour to fully refine. During this time you may notice gradual changes in the appearance of your nose as it refines to a more permanent shape.
Swelling may come and go and worsen in the morning during the first year following your rhinoplasty surgery.

You will be given specific instructions that may include:

  • How to care for the are of surgery
  • Medications to apply or take orally to aid healing and reduce the potential for infection
  • Specific concerns to look for at the surgical site or in your general health
  • When to follow up with your plastic surgeon.

What to watch for after rhinoplasty surgery?

If you experience any of the following symptoms, notify your surgeon immediate:

  • Temperature higher than 38°C or chills
  • Heavy bleeding from the incisions
  • Worsening redness around the incision sites
  • Increasing pain or tenderness, or other problems that appear to be worsening

After surgery, your nostrils may be packed with cotton or soft splints to help align the nasal septum. You may have a splint taped to the outside of your nose to encourage the nose to keep its new shape while it heals.

You may experience pain, headaches, inability to breathe through the nose and facial puffiness. Elevating your head will help these side effects to settle. Rest in bed with your head on a few pillows for the first 48 hours. Using an ice pack will also help reduce swelling. Your plastic surgeon will prescribe pain medication as required.

Try to not blow your nose for at least seven days or rub your nose for a minimum of eight weeks. If you are sensitive to “things in the air” go to reasonable extent to avoid anything causing sneezing. It is also important to protect your nose from sunburn and accidental knocks for at least eight weeks.

Avoid heavy lifting, strenuous exercise, swimming and strenuous sports until advised by your surgeon.
Your surgeon will give you specific instructions on post-operative care. These instructions may include:
How to care for the area of your surgical, medications to apply or take orally to aid healing and reduce the risk of infection, specific concerns to look for, and when to come for a follow-up with your surgeon.

While initial swelling subsides within a few weeks, it may take up to a year for your new nasal contour to fully refine. During this time you may notice gradual changes in the appearance of your nose as it refines to a more permanent outcome.
As your body ages, it is natural to have some gradual changes to your face including your nose. Cartilage can continue to grow. But most of your improvement should be relatively permanent.
A healthy lifestyle and life-long sun protection will help extend the results of your new appearance.

Rhinoplasty – More Information

Rhinoplasty videos

You can view a 3D animation of rhinoplasty procedure here. It is not a direct link. You need to select “facial” and “rhinoplasty”

Descriptive Illustrated PDF

To see a good descriptive illustrated PDF prepared for American Society of Plastic Surgery all about rhinoplasty (nose job, if you like) (and copy it if you like)look here on the downloads page.

Rhinoplasty before and after photos

You can see some rhinoplasty before and after photos here.

What is the Cost of Rhinoplasty ?

According to 2013 statistics from the American Society of Plastic Surgeons the average cost of rhinoplasty in US is $US4,545.
That figure does not include anesthesia, operating room facilities or other related expenses.

Many surgeries quote the surgeon’s fee but not the other related expenses. These can be

  • Anaesthesia fees
  • Hospital or surgical facility costs, including recuperation if necessary
  • Medical tests
  • Post-surgery garments or splints and post surgery consultation
  • Prescriptions for medication

Some surgeons have their own, or partly owned, operating facility and can give a good estimate of total cost. Some are visiting surgeons at several hospitals whose costs that are passed passed on the surgeon’s patient vary. Sometimes a quote will be fixed and sometimes there will be time dependent costs that are only fixed afterwards. When comparing quotes from different surgeons try to compare like with like. Many cheaper advertised nose jobs are only cheap because extras are not included or the surgeon does not have good experience or reputation.

For such a big investment with such an effect on you you must at least do some research on the surgeon. Another important thing to include is the surgeon’s attitude and affinity. After your consultation you need to feel good about the surgeon.

A better idea of the total actual cost would be this from a compilation of 3467 patient reported reviews on Realself.com : $US6975
84% of those reporting there said it was “worth it” and they also posted a lot of before and after photos of their rhinoplasty and comments on how they feel about their rhinoplasty surgery.

Health Insurance Fund Coverage

The amount of coverage, or what you are refunded, depends on what Country or State you are in, whether you are a Public or Private patient, The Insurance or Benefit Fund you have. In general surgery to correct a defect or injury will be covered to some extent, and elective (ie cosmetic, or chosen by you) less so. You must enquire first so you know in advance the amount you have to pay yourself, and whether there are requirements, such as doctor’s referral.