Rhinoplasty

What is rhinoplasty?

Rhinoplasty is surgery to change the size or shape of your nose. It is also called a nose job or nose reshaping. This procedure is often used to make the nose smaller or to narrow it. But it can also make the nose or nasal passages larger to help you breathe better.

Rhinoplasty can be done to change the way the bridge or tip of your nose looks. It can correct bumps or other problems. It can also change how your nostrils look.

In many cases, rhinoplasty is considered a cosmetic procedure and is not covered by insurance.

Why might I need a rhinoplasty?

In most cases, people have rhinoplasty because they don't like the way their nose looks. The procedure can also be used to help you breathe more easily. Or to fix an injury or birth defect. Rhinoplasty may be done to restore the normal structure and function of the nose in conditions such as a deviated nasal septum (DNS), a broken nose (nasal fracture), or cancer.

What are the risks of a rhinoplasty?

Some risks of rhinoplasty include:

• Bad (adverse) reactions to the medicines used during the surgery (such as general or local anesthesia)

• Bleeding

• Bruising

• Swelling or skin color changes

• Infection

• Blood clots

• Scarring or wounds not healing well

• Trouble breathing through your nose

• Feeling numb

• Pain

• Hole in the wall of tissue (the septum) that separates the nostrils

• Change in the shape of your nose over time

• Visible grafts in the nose

• Movement of grafts put in the nose

In some cases, you may not be happy with the results of your rhinoplasty. You may need to have another procedure to correct any problems.

You should not have rhinoplasty until you are near adult size and your bones have stopped growing.

You may have other risks that are unique to you. Be sure to discuss any concerns with your healthcare provider before surgery.

How do I get ready for a rhinoplasty?

The surgeon will examine your nose and face during an initial consultation. This meeting will give you a chance to discuss how you would like your nose to look. Your surgeon will also explain the results you can realistically expect from the surgery.

The surgeon will probably take photos of your face at this meeting.

• Your surgeon will explain the procedure to you. Ask any questions you have about the procedure.

• You will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if anything is unclear.

• Your surgeon will ask questions about your past health. You will also have a physical exam. This is to make sure you are in good health before the procedure.

• You will be asked to not eat or drink anything (to fast) usually after midnight before the day of surgery. Your surgeon will give you specific instructions. Ask if you can take your regular medicines on the day of surgery.

• Tell your healthcare provider if you are pregnant or think you may be pregnant.

• Tell your provider if you are sensitive to or allergic to any medicines, latex, tape, or anesthesia medicines (local and general).

• Tell your provider about all the medicines you take. This includes both over-the-counter and prescription medicines. It also includes nasal sprays, vitamins, herbs, and other supplements.

• Tell your provider if you have a history of bleeding disorders. Let your provider know if you are taking any blood-thinning medicines, aspirin, ibuprofen, or other medicines that affect blood clotting. You may need to stop taking these medicines before the procedure.

• If you smoke, try to quit smoking before your surgery. Smoking can make the healing process take much longer. Your surgeon may delay surgery if you continue to smoke.

• Your surgeon will ask if you use any illegal drugs that may affect your nasal passages.

• Most rhinoplasty procedures can be done on an outpatient basis. Make sure you have someone to drive you home afterward. You will not be able to drive after the surgery.

What happens during a rhinoplasty?

Rhinoplasty is often done in an outpatient facility or in a plastic surgeon’s office.

You may be given a general anesthesia medicine that puts you into a deep sleep. Or your nose area may be numbed with a local anesthesia medicine and you will have IV (intravenous) sedation to make you feel sleepy. Talk with your surgeon about the type of anesthesia that is best for you.

You can usually go home the same day you have the procedure. With more extensive surgeries, an overnight hospital stay might be needed.

Generally, rhinoplasty follows this process:

1. You will be asked to remove any clothing, jewelry, or other objects that might get in the way during the surgery.

2. You may be asked to remove your clothing and will be given a gown to wear.

3. You will lie on your back on an operating table.

4. An IV (intravenous) line will be started in your arm or hand.

5. In most cases, medicine will be used to numb your nose and the area around it. You will also be given medicine in your IV to make you relax and feel sleepy. In some cases, you may be given general anesthesia to put you into a deep sleep.

6. Your heart rate, blood pressure, respiratory rate, and blood oxygen level will be checked during the procedure.

7. The skin over the surgical site will be cleaned with a sterile (antiseptic) solution.

8. In most cases, the surgeon will make some small cuts (incisions) inside your nose so any scarring won't be seen. This internal approach is called a closed rhinoplasty. In other cases, the incision may be on the lower part of your nose above your lip, as well as inside. This is called an open rhinoplasty.

9. The surgeon will then work on the bone and tissue (cartilage) beneath the skin of your nose. Bone and cartilage may be removed, reshaped, or made larger. The bone may be fractured and moved into a better position.

10. The surgeon will then put your skin back into place and sew the incisions closed.

11. Once the surgery is done, the surgeon will put a splint over your nose. This will support your nose for about a week while it heals. Soft packing or tubes may also be put inside your nose for a few days. This will help your nose keep its new shape.

What happens after a rhinoplasty?

After the rhinoplasty surgery, you’ll be taken to a recovery area where nurses will watch you until you have recovered from the anesthesia. Once you are alert and stable, and can take fluids well by mouth, you will be able to go home. You will need someone to drive you home.

It’s important to follow all your surgeon's instructions and keep all your follow-up appointments. This way you can discuss any questions or concerns as they come up. Your splint and nasal dressings will be removed at one of these visits.

At home

During the first few days after surgery, you will likely feel sore and have trouble breathing through your nose. Your face may look swollen and bruised for a short time after the surgery. You may have headaches.

Your surgeon will give you medicine to relieve pain. Follow the instructions for taking any pain medicines or antibiotics. Your surgeon will let you know when you can restart your medicines if they were held before surgery.

At first, your nose may not look like you thought it would. The swelling and bruising will go away as you heal. Final results may not be seen for up to 1 year.

Follow your surgeon’s instructions on what types of foods to eat. You should be able to go back to a normal diet if your body can handle it.

You will slowly be able to go back to your normal activities over a few days. You may need to wait a few weeks before returning to physical activities. Ask your surgeon when it's safe to return to work or go back to certain activities.

For the first few days after the procedure, you should rest as much as possible. You may need to keep your head raised (elevated) at first. Other tips to follow:

• Prevent sun exposure to your face

• Don't wear glasses that sit on the bridge of your nose

• Don't blow your nose for 1 week after the surgery

• Sneeze and cough with your mouth open

• Don't put any pressure on your nose or rub it

• Don't strain, bend, or lift

Call your surgeon if you have any of the following:

• More pain or pain that's not relieved by prescribed pain medicine

• Increasing fluid leaking, bleeding, redness, or swelling around your nose

• Fever

• Trouble breathing, chest pain, or fast heartbeat (heart palpitations)

Next steps

Before you agree to the test or the procedure, make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems, including after office hours and on weekends and holidays.

• How much you will have to pay for the test or procedure