A rhinoplasty is the surgical alteration of the shape of the nose. Rhinoplasty is occasionally referred to as a “nose job,” rhinoplasty is one of the more difficult procedures for a plastic surgeon to perform correctly, and one of the most common procedures requiring revision surgery. The fundamentals of 21st century technology and the art of sculpting are intertwined as a nose has its shape changed. Form and function must both be respected or unacceptable results can occur. A rhinoplasty can be done purely for cosmetic reasons, purely for functional (nasal breathing) reasons, or a combination of both. Insurance will often cover nasal procedures done for functional reasons, but rarely if the change desired is purely cosmetic. Other surgery such as sinus surgery can be done at the same time as a rhinoplasty if necessary.
There are a few things that patients can do to prepare for rhinoplasty surgery to optimize the outcome. If any medical conditions exist, a visit to your primary care physician prior to surgery is a good idea. Any medication changes that need to be made should be done several months prior to surgery. If you smoke and plan to quit, it is best to do so at least 3 weeks prior to surgery to give your lungs a chance to clear the mucous that will develop with cessation. Ibuprofen (and non-steroidals such as motrin, advil, naprosyn, etc), aspirin, Vitamin E, and herbal supplements should be discontinued at least 10 days prior to surgery. If your primary care physician is uncomfortable with this plan, or has prescribed other blood thinners such as coumadin, please notify Dr. Winslow immediately. These medicines can increase the bleeding during surgery. This can lead to an increased risk of complications such as nasal bleeding and increased bruising and swelling.
A diet high in protein, low in salt and with plenty of water should be employed for a week before surgery and two weeks after to decrease the swelling. Homeopathic medications such as Arnica Montana may help to reduce the swelling and bruising after surgery. Ask Dr. Winslow if you are interested in obtaining this.
Your normal activities may be continued up until the day of surgery. It is important to remember not to eat or drink anything after midnight the night before your surgery. No lotions, make-up or creams should be used on your face the day of surgery.
The first thing to remember is that healing is a process. It begins with the first incision and is not complete until 6 to 12 months after surgery, when the scar has matured. The healing process begins immediately after the incision. Factors in your system rush in to assist your body in healing. These factors also cause swelling, bruising and pain. The degree of swelling and bruising depend on the type and extent of surgery, in addition to your own body factors. Ice will help decrease the swelling, and should be used 20 minutes on and 20 minutes off for the first 48 hours. If your nasal bones were fractured, ice should not be applied directly on the bridge of the nose. A nasal dressing (packing inside the nose) may be applied to help reduce bleeding. You may take a shower the first day after surgery, and a hand-held shower device works best. Baby shampoo is wonderful for being non-irritating to the wounds. Gently pat dry the areas that have been operated upon. Make-up may be applied on regions that do not have an incision, although generally it is prudent to wait a full week for application. A foundation with a green tint will help offset any red still present in the incision.
Keeping an antibiotic ointment (like Bacitracin) on the incisions will promote healing. Laying on your back will help avoid any pressure induced changes to the nose, and will prevent the nasal bones from shifting if they have been broken. Elevation of the head of the bed helps gravity remove the fluid (swelling) from the operated area. As the swelling and bruising start to subside, most patients notice that one side of the body seems to heal faster and better than the other side. This is very common and speaks for our own inherent asymmetry in the lymphatic and venous drainage of each side of our face and neck. Lumpiness or firmness is common and can last for days to months, depending on your level of self-care and your body’s intrinsic properties. After the first few days, you will start to see gradual resolution of the swelling and the bruises will take on a progressive change in color. The bruising may last for a week to 10 days, and the swelling is most prominent for the first 7-14 days. Firmness to the skin and underlying tissues is commonly present after two weeks, and can last weeks to months. Gentle massage or facials can enhance and speed the healing process. Once the sutures are gone from the incision, a cream containing Vitamin E may be started to promote healing. The scar will change from a red color to white after 3-12 months (average 6-7).
As with any surgery, complications are possible although rare. It is important to note again the link between form and function. Disturbances in nasal breathing are common for the first 2-6 weeks due to swelling. However, it is possible to have problems that are permanent. Pre-operative breathing problems may not be completely improved.
Bleeding, infection, pain and asymmetry are possible with any surgery. Bleeding is usually minimal, although it may be annoying for the first day or two. Infection is quite rare. It is more likely if implants are used in the nose, and may necessitate removal of an implant. Pain is proportional to the amount of surgery needed, whether the bones need to be broken, and an individual’s own pain tolerance. All these factors vary widely from patient to patient.
Cosmetic changes to the nose occur over months to years. It is possible to discover that unacceptable results happen after 3 to 5 years, well after the normal healing period. Significant deformities are very rare. Lumps, bumps, over-rotation of the nasal tip, a prominence of the area above the tip (“polly beak”), asymmetries and prominent scars are unlikely but may occur. It is very common for people to heal asymmetrically, and during the healing process you may have noticeable differences between the right and left sides.
Internal or external scarring may occur, and may cause problems with breathing. It is possible for patients to feel there is not enough, or too much, change in the appearance of the nose. Irregularities or bumps are possible. A hole in the middle partition of the nose, or septal perforation, may occur if a septoplasty is done with the rhinoplasty.
If the outcome of a rhinoplasty surgery is less than ideal, revision surgery often can improve the form and function. Cartilage is often needed to make changes. If the septal cartilage has previously been removed, cartilage can be harvested from the ear. Revision surgery can be performed at any time after the original surgery, but waiting 6-12 months is advisable.
Frequently asked questions
- Will my insurance pay for my surgery?
This depends on why the surgery is being done. If it is being done because you cannot breathe from your nose, insurance will likely cover the cost. If the surgery is to alter the shape and there is no problem with breathing, it likely will not be covered by an insurance policy. If it is done to perform both, often times part of the procedure will be covered, but you will be responsible for the remaining cost to cover the cosmetic portion of the procedure.
- How long will I look funny?
Everyone heals at a different rate. Most commonly, bruising and swelling last for 1 to 2 weeks before it is difficult to tell that you had anything done. The first week is the worst. The nose also may be stuffy, making your voice very nasal- as if you had a cold.
- How long before I can play sports again?
Contact sports are not recommended for the first 6 months after a rhinoplasty if the nasal bones have been broken. Non-contact sports may be resumed after two weeks.
- How long before I can breathe well through my nose?
It varies from patient to patient, but usually the breathing is acceptable by two to three weeks following surgery and continues to improve until healing is complete (6 to 12 months).
- Where are the scars on my nose?
Some procedures call for an incision under the base of the nose. This scar is very difficult to see (look at the third picture- basal view- above, and find the scar). Some procedures can be done with incisions placed inside the nose so no scars are visible at all.