Rhinoplasty surgery reshapes and resizes the nose to achieve an aesthetic goal. The appearance of one’s nose is a matter of personal preference. If you are unhappy with the appearance of your nose, rhinoplasty surgery can improve its appearance utilizing the most modern technology in cosmetic surgery today. Rhinoplasty can remove the hump on the bridge of the nose, reshape the tip, narrow the nostrils, reduce or increase the overall size of the nose, increase the angle between the nose and the upper lip, and offer many other improvements.
Many factors have to be considered in making sure a patient’s expectations are reasonable. These would include the thickness of the nasal skin and the underlying support structures of the nose. A person with very thick nasal tip skin will not have the same result as a patient with a very thin tip where cartilage can be seen underneath the skin. In addition, many people wish to retain the ethnic quality of their nose while changing a specific area.
Unless a congenital or traumatic nasal deformity has occurred, insurance will not cover this procedure. Surgery for nasal airway obstruction due to a deviated septum or enlarged inferior turbinates is often performed at the same time as rhinoplasty. These procedures may be covered by insurance. Sinus surgery may also be performed at the time of rhinoplasty.
Consultation
During your consultation, Dr. Graivier will inquire in detail about the areas of your nasal appearance that bother you. You may bring pictures of noses that you like to the consultation, but your anatomy may not make it possible to achieve those results. Dr. Graivier will examine the external and internal parts of your nose. He will also determine if you are having nasal airway obstruction, and if this needs to be dealt with at the time of rhinoplasty. You will then have pictures taken, and a digital imaging program will allow you to show Dr. Graivier what you would like your nose to look like.
It is imperative that you make your desires known to Dr. Graivier during your consultation. The digital images will be printed for you to take home before making final decisions as to your desired nasal appearance. Keep in mind that the final result after surgery is often better than the altered images.
The Procedure
The operation is done in an outpatient surgery center, usually under general anesthesia. The surgery can be done through either an “open” or “closed” approach. The open approach entails an incision on the columella, which is the area between the two nostrils. This approach leads to better exposure of the nasal tip cartilages and is often used in patients with very asymmetric tips or overly bulbous tips. In the enclosed approach, the incisions are on the inside of the nose. If the nostril bases are to be narrowed, there will also be an incision along the edges of the nostrils. These incisions heal extremely well and are barely perceptible in the future.
If the width of the nose needs to be narrowed, then the nasal bones will need to be fractured, which will cause more bruising and swelling than in those patients in whom fracturing is not necessary. An external splint will be placed after the surgery, which will remain for six days. If nasal packing is necessary, Dr. Graivier uses a small amount of absorbable material which usually goes away on its own. A nasal drip pad will also be placed and usually needs to be changed several times in the first 36 hours.
Recovery
You will use cold compresses on your eyes for the first 48 hours to help reduce swelling and bruising (although some is expected). You will sleep with your head elevated for two weeks following surgery. A humidifier by the bedside may be helpful, along with a glass of water to help moisten your mouth. Your diet will be limited to clear liquids for three days. The base of your nose should be cleaned with a Q-Tip and peroxide, and Vaseline should be applied twice a day. Do not: blow your nose for 10 days following surgery; bend over or lift heavy objects for at least two weeks; wear glasses for at least three weeks.
When the splint is removed six days after surgery, your nose may be larger than it was prior to surgery. This result of swelling is not unusual. It will take at least six weeks for much of the swelling to diminish. It will take even longer if an open approach was used. The nasal tip may be firm for quite some time, but this softens with time. Patience is a necessity after nasal surgery.
