The Nose Is the Most Prominent Feature of the Human Face. with Its Central Location And

RHINOPLASTY

The nose is the most prominent feature of the human face. With its central location and prominence, the nose’s aesthetic presence contributes to both the character and personality of an individual. Harmonious beauty depends upon an aesthetic balance between the nose and the remaining features of the face. Inherent to each individual nose is an identifiable shape, size and contour. Our current concepts of beauty and the aesthetic profile began with the historic cultures of the Egyptians, Romans and Greeks. With our ever-evolving culture of social emphasis on appearance, aesthetic norms are influenced and created.

The presence of the nose serves to function not only as structure of human recognition, but also as a channel for air exchange. It is a natural pathway for respiratory purposes.

Rhinoplasty is the name of the cosmetic procedure that surgically corrects deformities of the external nose. It entails restoring, repairing, and enhancing one’s aesthetic appearance. It addresses one of the most symbolic features of the human body.

In the younger patient, rhinoplasty can correct a birth defect, or an external deformity (i.e., a hump on the nose, a wide nose, or a nasal irregularity) which has focused social criticism or ridicule. In the midlife or older patient, it also can improve an overt deformity that has been carried through life, or restore the aging nose which has become physically elongated or droopy, or functionally impaired.

Rhinoplasty can be performed in conjunction with reconstructive nasal surgery to relieve obstructions inside the nose. This procedures is called septorhinoplasty. By modifying both the external and internal nose, form and function are addressed. This technique may be applied to cases of nasal injury, congenital malformation, and defects resulting from the involvement of the nose with both benign and malignant tumors.

The consultation provides a personal interaction between the surgeon and patient. It is at this time that your cosmetic inquiries will be thoroughly reviewed and discussed. It is important as a patient, to openly discuss your motivations for seeking the cosmetic consultation; and express your honest perceived expectations from the procedure in order to allow an accurate assessment to be made as to whether these expectations are acceptable realistic goals. It is important that you understand that there are limitations to what any surgical procedure can achieve due to the anatomical characteristics and physical variations. Furthermore, the outcome of any surgical procedure is highly dependent on the individual patient, because significant differences involving how live tissue reacts to surgery, and/or how this tissue heals is not predictable. It is also important to realize that the goal of the surgery is not to achieve perfection, but rather to improve the appearance. Your emotional state is also very important when undertaking such a surgical procedure, as this procedure involves a recovery period. Mental attitude is as important as the ability to heal.

Emotional stability is very important for any cosmetic procedure. After surgery some patients experience melancholy or slight depression. There is usually an emotional recovery period of readjustment for some patients to their new aesthetic image. This is a common response, because there is a recovery period prior to achieving your final cosmetic result.

Your consultation will include a thorough physical examination of both the internal and external aspects of your nose. It is important to note that individual faces are not perfect, and possess asymmetry when both sides are compared. At times, placing a nose exactly in the middle of an asymmetric face will exaggerate various disproportion’s of the other facial features. Facial computer analysis is available upon request to help you visualize these asymmetries and the changes that might be possible or any facial asymmetries that may be present. The service of facial analysis is provided for the purposes of illustration only and does not guarantee specific outcomes of the surgical procedure.

Facial analysis also demonstrates the intricate relationships of the nose to the overall facial balance and how facial proportions become modified by nasal alterations. Furthermore, additional cosmetic procedures may be reviewed, to offer additional alternatives for achieving facial harmony. These particular procedures may be performed at the time of your rhinoplasty.

It is important that you discuss all your questions during the consultation for your clarification and understanding. Often you may require another preoperative visit to further discuss any needs or to clarify any uncertainties.

Once the consultation has been completed, and the surgery agreed upon, preoperative photographs will be taken on all patients to provide documentation for surgical planning and postoperative comparison. Postoperative photographs will be taken on a periodic basis to study your healing process.

Procedure

Rhinoplasty can be performed in a physician’s office, an outpatient surgical facility, or hospital, dependent upon the individual case and preferences. All procedures are routinely performed on an outpatient basis. Out of town patients are instructed to arrange for lodging to allow for initial postoperative care. All patients are required to be transported and accompanied by a responsible adult, who shall assist and observe your progress during the first 24 hours after surgery. Preoperative medication to alleviate anxiety will be prescribed and local, intravenous sedation, or general anesthesia may be used.

The rhinoplasty procedure is performed with incisions placed just inside the rim of the nose. Occasionally, a small indistinguishable incision at the base of the nose (between the nostrils) will be utilized. The soft tissues of the nose are then carefully separated from the underlying cartilage and bone. The offending nasal structures are then removed, and the remaining cartilage and bone are reshaped and sculpted. If the nasal septum is also corrected for functional purposes, the interior of the nose will be restructured using the same incisions.

All incisions are closed with suture and a small nasal splint will be applied to the external nose. Loose packing may be placed in the nose to support the internal nasal structures. This will usually be accompanied by nasal obstruction until they are removed.

The surgical procedure lasts between one and two hours depending upon the amount of surgical work that must be done. Additional surgery such as facelift, eyelid, or chin implantation requires additional time.

After the procedure, you must understand that there will be a recovery period during which swelling, bruising and adjustment will occur. You should expect some swelling of varying degrees both inside and outside the nose. Internally, nasal obstruction and alterations of smell can take weeks to resolve. Externally, swelling usually involves the nose, eyelids, lips and midfacial areas. The majority of the swelling will resolve within the first few days, with progressive improvement over the next few weeks. Bruising generally occurs around the nose and eyes, and usually resolves over a couple of weeks. Both bruising and swelling vary considerably with each individual. You should set aside approximately two weeks for recovery. At this time, most patients are able to appear in public and can camouflage residual bruising and scars with makeup. Sensory skin changes will occur after surgery with decreased sensation to the tip of the nose for months. After septal surgery, some patients experience sensory changes to the front teeth. All patients have nasal drainage during the healing period and varying degrees of nasal obstruction. Postoperative symptoms of nausea, drowsiness and lightheadedness may occur during the recovery period from the anesthesia. There may be mild discomfort for a short time after surgery, but this is usually controlled easily with medication. Significant pain is quite rare.

It is not uncommon for you to experience feelings of anxiety, melancholy or a temporary period of slight emotional depression following the surgery, during the period of time when you look your worst. This is quite normal and should not alarm you. It is not easy to look bruised and swollen, particularly when natural expectations are toward improvement of your appearance. Fortunately this period passes rather quickly.

Try not to scrutinize your nose under the splint too closely. Remember that it is swollen and taped in a high position so that it may appear too short. However, after the bandages are removed the nose will “drop” slightly. Many months are required for the final subtle changes in the nose to appear, so be patient. Softening of the nasal tip usually occurs last. Please understand that healing is a gradual process and the extend of improvement depends upon each individual’s healing ability and the extent of surgery.

Risks

The risks of rhinoplastic surgery are minimal, but should be noted. One should understand that as with any surgical procedure, certain risks can occur even when the surgeon exercises the utmost surgical skill and judgment during the operation. The healing characteristics of each patient are variable, precluding guarantee of surgical results. Infrequently risks associated with rhinoplasty and any cosmetic surgery include bleeding, infection, prolonged swelling, and excessive scarring. Infrequently additional surgery may be required to further modify the nose or address breathing problems. Other rare complications may include nostril changes, skin disruptions or loss, cysts, increased capillaries, or an anesthetic allergic reaction. Extremely rare, but reported complications occurring with extensive septal surgery include septal perforations, visual impairment and infection associated with drainage of brain fluid. I would like to emphasize that these complications are very rare and I have included them for completeness and disclosure.

I must add that rhinoplastic surgery is very common and that the vast majority of patients are satisfied with their results. Cosmetic surgery can be a very exciting and rewarding experience for you as a patient.

Fees

Fees for cosmetic surgery depend upon the extend and complexity of each individual case. The cost includes the use of the surgical facility, anesthesiologist and the surgeon’s fee. The payment for cosmetic surgery usually is not covered by insurance. If the purpose of cosmetic surgery is to correct functional impairment, an insurance company may allow partial payment. In this instance, the insurance representative will be contacted about your particular claim prior to surgery.

I look forward to personally working with you for your cosmetic needs. I feel that it is important to communicate with you as my patient. My staff and I will address any questions you have and offer any support you need throughout your recovery period.

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Rhinoplasty

Page 1 of 3, Last Update: April 19, 2003