Rhinoplasty

WHO IS A CANDIDATE

• A nose that is cosmetically unattractive or does not "fit" with other facial features.
• This is a surgical procedure that is done to improve the appearance of the nose and/or the ability to breathe through the nose. This surgery, therefore, may be considered cosmetic, functional, or for some patients both. Nasal deformities may be present at birth or may develop with aging and growth. Traumatic injuries (broken nose) or changes from previous surgeries may result in significant deformity.
• Most often, patients request removal of a "hump" on the bridge of the nose, refinement of a round nasal tip or elevation of a drooping tip. Noses that are crooked, too wide, long, pointy or flat may be improved. Realistically, there are limitations in achieving the final goal and the ultimate outcome will vary from patient to patient.
• Frequently, the nasal septum (the cartilage separating the right and left nasal passages) is deviated and needs to be corrected. A crooked nose may worsen this disorder and therefore, require correction at the same time. This surgery is called a septo-rhinoplasy. Turbinates are parts of the nose that help to add moisture and filter inspired air. These structures can be enlarged for many reasons and contribute to airway obstruction. When this occurs, Dr. Hand will recommend their removal as part of the nasal surgery. Other problems, such as narrowed passages and airway "collapse", may require placement of cartilage grafts for structural support. Occasionally, scar tissue within the nose from previous injury or surgery may block airflow and require correction.

Before	After

INTENDED RESULT

• A more attractive nasal shape with the nose in better proportion to other facial features. Correction of breathing difficulties due to functional abnormalities.

PROCEDURE DESCRIPTION

• Cosmetic rhinoplasty may be done with local anesthesia and intravenous sedation in our surgery facility. General anesthesia may be used upon patient request or physician recommendation. Functional surgeries with septal turbinate, scar correction or the need for grafts usually require general anesthesia.
• Cosmetic rhinoplasties have incisions hidden within the nostrils inside the nose. More complex nasal operations often require a small incision in the skin at the base of the nose. This tiny scar is barely visible, yet it allows the surgeon to "lift" the nasal skin and directly view all of the cartilage and bone requiring correction. This is termed "open rhinoplasty". To narrow flaring nostrils, small incisions are placed in the groove where the nostril meets the cheek.
• Cartilage and bone grafts are most often taken from within the nose. Ear cartilage, rib and or hip are other possible sources of graft material. Synthetic nasal implants may also be used to build up portions of the nose.

Before	After

RECUPERATION AND HEALING

• An external cast or splint will be placed immediately after surgery. The nose may be packed for 24 to 48 hours. Your cast or splint is usually removed in 7-10 days.
• Initial discomfort is easily controlled with oral medications.
• The majority of swelling and bruising subsides progressively over 2 to 4 weeks.
• External sutures (if any) are removed in 4 to 6 days. The internal sutures will dissolve.
• A realistic approximation of your final result is evident in 3 months. The final result will continue to evolve and refine for 12 to 14 months.
• Areas of sensitivity or numbness will slowly resolve. Temporary conditions that may occur but will improve over the first several months are stiffness of the tip of the nose, nasal drainage, lumps and irregularities.

Before	After

OTHER OPTIONS

• Chin augmentation with a small synthetic implant may help create better facial harmony and an improved profile when used.