Rhinoplasty is a surgical procedure that changes the structure of the nose. Medical professionals involved in the rhinoplasty procedure include plastic surgeons, otolaryngologists, and oral and maxillofacial surgeons.

When used for aesthetic reasons to improve appearance, this kind of surgery is termed cosmetic surgery. On the other hand, rhinoplasty used to improve the functionality of the nose is known as reconstructive surgery. The upper portion of the nose is made up of small plates of bones whilst the lower portion is made of cartilage; both bone and cartilage are covered by the skin on the inside and outside. Rhinoplasty can manipulate all three (bone, cartilage, and skin) types of tissues or just one of them. Your surgeon will give you the options best suited for your desired result.

Before performing a Rhinoplasty, the surgeon usually analyses the patients’ facial features, the skin of the nose, and the desired appearance or functionality the patient is interested in. Along with a few other medical check-ups, these factors decide whether the patient can be a candidate for Rhinoplasty.

Rhinoplasty procedures can be covered by insurance companies, they may pay for it partially or as a whole, this usually depends on the goal of the surgery.

The general criteria for rhinoplasty candidates include:

• Patients in good health, with no underlying medical illness or chronic conditions.
• Patients who abstain from smoking or are capable of abstaining over long periods.
• Patients who are realistic about the outcome of their surgery, whether it be aesthetic or functional.
• Underage patients wanting to undergo rhinoplasty procedures should be above the ages of 15 or 16 as this is when the nose reaches its adult size.

Candidates opting for reconstructive surgery are usually motivated by:

• The need to resolve nasal injuries which may occur due to various traumas. For example blunt, and penetrating trauma and trauma caused by blast injury.
• Another reason for reconstructive surgery includes patients who suffer from birth defects which can include cleft lip, frontonasal dysplasia, Treacher Collins Syndrome haemangiomas, etc.
• Additionally, patients who suffer from conditions like deviated nasal septum, breathing problems, excessive snoring, and failed primary rhinoplasty also qualify for reconstructive surgery.

Candidates opting for cosmetic surgery are usually motivated by:

• Improving the bone structure of their nose. This can include straightening the bridge, reshaping the tip, changing the size of the nostrils, changing the general size of the nose, or removing a hump in the nose. Usually, cosmetic procedures involve more than one of these changes

The general steps for rhinoplasty surgery include the following.

1. Anaesthesia

This is a medication administered before the surgical procedure. It is used to numb up the surgical field so that the patient does not feel any pain during the procedure. Anesthesia can be local or general. During local anesthesia, the patient is awake. Whilst under general anesthesia, the patient is fully asleep during the procedure. Anesthesia is usually administered intravenously.

2. The incision

Rhinoplasty can be divided into two types according to the incision being given.

• Open Rhinoplasty: In an open Rhinoplasty the incision is given across the columella, this is the structure that separates the nostrils.
• Closed Rhinoplasty: In a Closed Rhinoplasty, the incisions given are hidden within the structure of the nose.

After these incisions are placed, the skin is gently lifted allowing access to the underlying cartilage and bones. The surgeons are then free to manipulate both these structures in order to achieve the patient’s desired results

3. Reshaping the nose

Reshaping the nose is done by making changes in the bony and cartilaginous parts of the nose. These changes can involve removing or reducing bone and cartilage and even adding cartilage grafts. These grafts can be made from cartilage from other parts of the nose and even other parts of the body. For example, the cartilaginous part of the ear or rarely a section of the second rib.

4. Correcting a deviated septum

Deviated nasal septum refers to the deviation of the bone and cartilaginous tissue that separates the nostrils of the nose. The septum can be deviated due to trauma or birth defects. Sometimes, the deviation can even present as difficulty in breathing and frequent nose bleeds.

The surgeon can straighten this septum and any other projections inside the nose to allow for a more suitable airway passage.

5. Closing

After the alterations to the bone and cartilage have been completed, the overlying skin is redraped over the new nose structure. This may sometimes involve additional incisions in the natural creases of the nose to allow for better fitting to the altered size and shape of the nose.

• The first week after a rhinoplasty usually involves some kind of supportive bandaging in order to avoid any damage to the fragile structure of the nose. This supportive bandaging can come in the form of a splint or gauze packing
• Patients are asked to keep their heads elevated for at least 24 hours after the rhinoplasty procedure
• An expected outcome of rhinoplasty is temporary bruising around the eyes and nose. This is normal and usually starts to heal after the third post-operative day. However, it can also last up to two weeks.
• Swelling around the nose is also normal after a Rhinoplasty procedure, this just indicates that the tissues are healing. However, this can last up to six months, which means the final result of the surgery may be delayed.
• It is also recommended that post-operative patients avoid any kind of strenuous activity at least three to six weeks after the surgery, this includes exercise and contact sports.

Advantages

• Balanced Facial Features

  In addition to changing the appearance of the nose, rhinoplasty also has a major impact on the general appearance of the face. After rhinoplasty, patients usually see that the rest of their facial features are better tied together with their new altered nose shape and size. As a result, this gives a more balanced look to the face.

• Improved Nasal Airflow

  Rhinoplasties have a functional purpose as well and that is to improve the airway passage of the patient. This is especially helpful for the patient suffering from the deviated nasal septum, trauma from accidents, etc.

  Additionally, a rhinoplasty can also include a procedure called Turbinoplasty for patients who need it. Turbinoplasty alters the shape of the inferior turbinate which is a shelf likes structure inside the nose. This structure can be abnormally enlarged on one or both sides of the nose due to birth defects or disease.

• Confidence Boost

  Many patients have suffered their whole lives due to their noses. Not just due to reduced functionality, but also due to reduced aesthetic. Patients undergoing Rhinoplasty often also have a boost in confidence and self-esteem as a result of the procedure.

Disadvantages

Rhinoplasty is a generally safe procedure with little to no disadvantages.

• Thick Skin

  Unfortunately, sometimes patients are unable to receive desired results from their rhinoplasty due to issues like a thick skin. Such restrictions reduce the overall result of the surgery, especially if the patient wanted a more defined look.

• Unrealistic expectations

  Sometimes, it is difficult for the patient to understand that the anatomy of the rest of their features play a big part in the Rhinoplasty. Often patients bring in a picture of their desired result, but the surgeon is unable to provide the desired result due to the distinct anatomical makeup of the patient.

Do I have to spend a night at the hospital?

No. Rhinoplasty is an outpatient procedure which means the patient is free to leave right after the surgery. However, arrangements should be made to make sure the patient has adequate help in getting home afterward.

How long does rhinoplasty take?

This procedure usually takes up to two hours, however, this may vary according to how complicated the surgery is.

Can I have other cosmetic surgery at the same time as my rhinoplasty

Yes. This is a common practice in cosmetic surgery. The most common type of surgery performed in the same sitting is chin advancement. This is usually recommended to improve the balance of the face. Other procedures are also performed, however, it is best to consult your surgeon first.

Can I have other cosmetic surgery at the same time as my rhinoplasty

As with any type of surgery, the major risks include:

• Bleeding
• Infection
• A reaction to the anesthesia

Specific risks for rhinoplasty include:

• Difficulty breathing
• Permanent numbness
• Uneven-looking nose
• Scarring