Rhinoplasty

Rhinoplasty (RIE-no-plas-tee), also referred to as nose surgery, is a surgery that changes the shape of the nose. The motivation for rhinoplasty may be to change the appearance of the nose, its function or both.

When planning rhinoplasty, your surgeon considers your features, the skin on your nose and what you would like to change. The upper portion of the structure of the nose is bone, and the lower portion is cartilage. Rhinoplasty can modify bone, cartilage, skin or all three. Talk with your surgeon about whether rhinoplasty is appropriate for you and what it can achieve.


Why it's done Risks How you prepare What you can expect

Rhinoplasty can change the size, shape or proportions of your nose. It may be done to repair deformities from an injury, correct a birth defect or improve some breathing difficulties.

Although, Rhinoplasty is a safe surgical procedure but every surgery carries some risks with it. Some of these risks are highlighted below.

  • Perforations or openings in the nose bridge
  • Heavy and uncontrolled bleeding from the nose
  • Changed shape of the nose
  • Reduced sense of smell
  • Numbness in the facial anatomical structures of the face especially, teeth or upper maxilla
  • Nasal hematoma (clotting of blood in the nose area needing immediate drainage)
  • Sometimes allergic reactions to the medicines used during the surgery
  • Heart issues, in rare cases
  • Recurrence of the nasal blockage requiring another surgical procedure
  • Difficulty in breathing
  • Uneven looking nose
  • Change in the color of the skin treated
  • Damage in the eyes
  • Urgent requirement of blood transfusion (rare cases)
  • Scarring

Some of the other risks associated with the surgery are as mentioned

  • Heavy bleeding
  • Infections
  • Cardiac arrest

After waking up from the effect of general anesthesia, some patients might face some of the following problems:

  • Nausea
  • Vomiting
  • Uneasiness
  • Dizziness
  • A temporary state of confusion
  • Impaired judgment
  • Slow reaction time
  • A feeling of cold or shivering

The doctor will explain the Rhinoplasty procedure to the patient in detail including the risks involved. Some preparations needed are as mentioned.

Before the procedure:

  • Medical history – The doctor will take a complete medical history of the patient and would ask the patient about all the conditions, allergies, any bleeding disorders, or surgeries if the patient had undergone in the past. Also, the doctor will ask about if the patient is taking any medications currently or has taken in the past.
  • Physical examination – A complete physical examination is done by the doctor, especially focusing on the in and out of the nose, to concentrate on the area to be fixed. The patient is also asked to go through some blood tests. The physical test helps the doctor to understand properly about the changes to be made and the physical features of the patient. Physical examination includes assessing the strength of the cartilage at the nose tip, the thickness of the skin of the nose and their potential impact on the procedure results.

In some cases, if the chin of the patient is small, the doctors suggest a surgical procedure to augment the chin.

  • Sometimes, the doctor may also take some pictures of the patient's nose from different angles, in order to either use it for discussion before the procedure, during or after the procedure as a reference. The doctor takes the before and after photos to compare the results from the procedure. The pictures, taken before the procedure also help in understanding the goals and preferences of the patient.
  • The doctor discusses the expectations of the patient from the Rhinoplasty procedure and informs the patient about the risks and the benefits of the procedure, for the specific case.
  • The patient is advised to inform the doctor if he/she is taking any blood thinning medications or any supplements. Accordingly, the doctor would decide if the medication is to be stopped or can be continued.
  • The patient is also advised not to eat or drink after midnight before the surgery day, especially, in case general anesthesia is to be administered in the procedure.
  • In case general anesthesia is to be administered, the doctor advises the patient to empty the stomach and the bladder, before going for the surgery.
  • The patient is advised to quit smoking as it delays the healing process after the treatment.
  • The patient may not be in a condition to drive back home alone and hence, is advised to get a companion along to take care of the patient.

 

Rhinoplasty does not include any fixed steps, and is instead, customized according to the preference and the specific anatomy of an individual.

The augmentation of the cartilage or the nasal bone can be done in several ways and depends on the amount of tissue to be added, the available material and the anatomy of the nose. If small changes are to be made, the surgeon uses the cartilage from the deeper tissues of the nose or the patient’s ear. If larger changes are required, then the surgeon uses the cartilage from the ribs, implants or bones from the rest of the body parts.

 

During the procedure:

  • The local anesthesia is given to the patient and is localized only to the patient’s nose.
  • In some cases, the surgeon might feel the need for administering general anesthesia, which is administered through an IV line (intravenously) or by inhaling. In this procedure, the patient’s complete body becomes numb and goes into a temporary state of unconsciousness, at least for a few hours.
  • The Rhinoplasty procedure can be performed inside the nose of the individual or by making a small incision at the base of the nose, or between the nostrils. This procedure involves the readjustment of the cartilage or bone under the skin of the nose.

 

After the procedure:

  • After the surgical procedure is completed, the patient is shifted to a recovery room wherein, the hospital staff monitors the patient’s vitals and condition carefully.
  • Depending on the condition of the patient after the surgery, the surgeon advises the discharge process. The patient is allowed to go home the same day of the surgery if the vitals are normal.
  • There might some side effects observed like nausea or vomiting in few cases due to general anesthesia. If the vomiting does not stop, the patient is advised to contact the doctor immediately as it may trigger the nose-bleeding and affect the healing process.
  • Due to the splints placed inside the nose, there might be some swelling observed, due to which there may a feeling of congestion for some time.
  • Sometimes, the surgeon places the splint with tape in the nose, to keep the nose intact and give protection and support to the nose. This taping of the nose splints remains in place for at least a week.
  • In some cases, the internal dressings remain in the same place for few days, after the Rhinoplasty.
  • The surgeon puts a drip pad of gauze under the nose of the patient to absorb all the drainage fluid or blood, if any. The patient is advised not to place the drip pad too tightly to the nose.
  • To prevent any post-surgical complications, the doctor advises the following pointers:
  • The patient is advised not to perform strenuous physical activities or exercises. This is to prevent nose-bleeding problems after the surgery.
  • Not to blow the nose as it may lead to the opening up of the sutures on the nose or disturb the healing process.
  • Keep the head or nose elevated while sleeping to decrease the swelling and bleeding.
  • Avoid wearing clothes that are worn from over the head. Instead, wear clothes which have buttons or tied from the front like shirts.
  • Sometimes, the patient might face drainage or swelling for a few days after the surgery. However, the swelling will go away eventually. In case of an emergency, the patient is advised to contact the doctor immediately.
  • Brush the teeth very gently to avoid the upper lip movement.
  • Eat a healthy and nutritious diet, rich in fiber content e.g. vegetables, fruits. Consuming fibers prevent the patient from having constipation and constipation causes strain on the surgical site.
  • Avoid taking showers and instead take bath normally for a few days.
  • Avoid wearing sunglasses or eyeglasses, until full recovery, as these rest on the nose. Instead wear contact lens if possible.
  • It is must to apply a 30 SPF sunscreen before going out in the sun, as the sun may cause serious and permanent discoloration to the skin of the nose.
  • Reduce the sodium intake in the diet as it will help the swelling to disappear faster.
  • Do not apply any ice or cold packs to the nose after the Rhinoplasty procedure.

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