Rhinoplasty

A rhinoplasty, also referred to as a nose job, can improve the shape and the function of a nose. Defects of the nose can be congenital or as a result from trauma of multiple surgeries.

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RHINOPLASTY

A rhinoplasty, also referred to as a nose job, can improve the shape and the function of a nose. Defects of the nose can be congenital or as a result from trauma of multiple surgeries. A rhinoplasty can be performed to improve on your functional complaints, such as a blocked nose or headaches. It can also be that you are not content with the shape and appearance of the nose. The operative treatment of the shape of the nose can be to make the nose smaller, improve the shape of the tip of the nose, remove the hump of the nose and/or to straighten a crooked nose. The shape of the nose is very personal and needs to be assessed individually. It has to be clear that the patient wants a correction and that it is not a request from others. The results of a rhinoplasty are permanent.

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DETAILS OF THE TREATMENT

THE FIRST CONSULTATION

During the first consultation your motivation and desires are discussed and if your expectations can be met. Important is that your expectations are realistic. Pictures will be made and with the aid of a morphing program a simulation is made of your nose correction to obtain an idea of your goals. The simulation is a useful tool for communication, it but does not guarantee that the actual final result will be exactly the same. Furthermore, the procedure will be discussed, the management before and after and the possible complications. Because a rhinoplasty will result in a permanent change to the appearance of your face, it is desirable that a second consultation will take place before a correction under taken. This is to provide you with sufficient time to process all the information and to have any questions and uncertainties cleared during a second consultation. Before an appointment is made for the actual procedure both you and the surgeon need to be in agreement with regard to the goals of the correction and have realistic expectations with regard to the possible outcome.

THE PROCEDURE

A rhinoplasty is normally performed under a general anesthetic, but small corrections can be done under a local anesthetic. Normally the procedure takes place as a day case. A “closed” rhinoplasty is performed through incisions within the nostrils and scars will not be visible. Often a “closed” rhinoplasty is performed where the incision in the nostrils are connected in the columella between them after which the skin of the nose is lifted upwards. This creates a direct vision of the underlying bony and cartilaginous framework of the nose for accurate adjustment and correction. When the alae are wide and enlarged a wedge excision can be performed which will result in well hidden scars in the alar groove. Also the scar in the columella heals well and becomes unobtrusive.

AFTER THE PROCEDURE

In general there is little pain after a rhinoplasty. Often plugs will be placed through the nostrils, which necessitates breathing through the mouth. Normally the plugs will be removed the next day. To remove a dorsal hump or a correct a crooked nose the nasal bones need to be fractured. This can cause significant swelling of the eyelids of which most will have settled down after a week. It is therefore important to raise your head with an extra pillow at night and use cold compresses on the eyelids. There will be a synthetic splint on the nose and a gauze under the nose to collect any drainage. The splint and the stitches will be removed after a week. Initially most of the swelling will subside quickly, but the residual swelling may take many months to settle. Bear in mind that if the nasal bones have been fractured you cannot wear glasses for 4 weeks. The nose and the scars should be protected from the sun in the first couple of months with a sun block. In most cases you can continue with your normal daily activities, such as school and work, within 10 days. Strenuous activities should be avoided for 4 to 6 weeks.

RESULTS

The success of a rhinoplasty not only is determined by the surgeon, but also by the quality of the tissues of the nose and the wound healing process. The procedure offers improvement, not perfection. Often a rhinoplasty improves self-confidence. The final goal is that you are content with the improvement. To achieve this your expectations should be realistic through comprehensive preoperative information.

RISKS AND COMPLICATIONS

As with any operation complications can occur like for instance anesthetic problems, thrombosis, bleeding, infection, complicated wound healing, necrosis of tissue, numbness, asymmetries or a disappointing result. Even in the hands of the most talented plastic surgeon a patient can be disappointed with the result. Esthetic surgery and plastic surgery is not an exact science. No guarantees on the result or on uncomplicated wound healing can ever be given. Sometimes it is necessary to perform an additional procedure to obtain a good final result. Reoperations can only be performed after one year when the healing process is complete and may involve additional costs. Also, before secondary procedures there should be realistic expectations.

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