Rhinoplasty (Nose Job)
During a rhinoplasty, the height and shape of the nose are changed by operating through cuts made inside the nostrils, or occasionally, through a small incision on the undersurface of the skin between the nostrils.
A Rhinoplasty is a surgical reshaping of the cartilage, bone and the soft tissues of the nose to produce a natural and pleasing appearance. It is one of the most common of all plastic surgery procedures and can reduce or increase the size of your nose, change the shape of the tip or the bridge, narrow the span of the nostrils, or change the angle between your nose and your upper lip. It can also correct a birth defect or injury and help relieve some breathing problems. What can and should be done in your case will depend on the consultation with Dr. Coville. Please feel free to ask him about anything you do not understand. However, the following introductory paragraphs will provide a general outline.
Is It Right for Me?
Rhinoplasty can change your appearance; moving it closer to your ideal and so improve your self-confidence. However, it cannot change your looks completely or cause other people to treat you differently. Before you decide to have surgery, you must discuss and agree on your goals with your Dr. Coville. The best candidates for rhinoplasty are looking for improvement, not perfection. If you’re physically healthy, psychologically stable, and realistic, rhinoplasty may be for you. With teenagers, many surgeons prefer not to operate until after they’ve completed their growth spurt, around 14 or 15 for girls, a bit later for boys. Reputable surgeons always consider a teenager’s social and emotional adjustment and make sure that surgery is what the individual wants, and not just what his or her parents want. Dr. Fred will take the time with you to make sure you are both “on the same page.”
Are There Any Risks?
Choose a well-qualified and experienced plastic surgeon and any complications are likely to be minor. Even so, because individuals vary greatly in their reactions and in their ability to heal, outcomes are never completely predictable. There are some complications relating to the operation. In the first few days after surgery these include infection, which is rare, and the potential for bleeding. If bleeding is severe and not controlled by simple packing, you may require a return to the operating room.
To reduce this risk, all patients are advised not to take drugs containing aspirin, ibuprofen, or gingko biloba, for at least ten days prior to their operation as these can alter the clotting of the blood. Just one tablet can affect your clotting for up to two weeks. Smoking affects your skin blood vessels and decreases the amount of vitamin C in your system. This makes both bleeding after the operation and the risk of skin dying more likely. Dr. Coville will insist that you refrain from smoking for at least six weeks prior to surgery. Remember that you have absolutely nothing to gain by concealing a smoking habit from your surgeon.
After surgery, small burst blood vessels may appear as tiny red spots on the skin’s surface. Usually these are minor but can in some instances, be permanent. When rhinoplasty is performed from inside the nose, there is naturally no visible scarring. Yet, even when an ‘open’ technique is used, or when the procedure calls for narrowing of flared nostrils, the small scars at the base of the nose are not usually visible. In about one case out of ten, a second minor procedure may be required, for example, to correct a slight deformity. These relatively rare problems are unpredictable and can happen even to patients in the hands of the most skilled surgeons.
Good communication between you and your surgeon is essential. Dr. Fred will ask what you would like your nose to look like, evaluate the structure of your nose and face, and discuss possibilities with you. He will also explain the factors that can influence the success of the procedure including the structure of your nasal bones and cartilage, the shape of your face, the thickness of your skin, your age, and your expectations. Dr. Coville will also explain the techniques and anesthesia he will employ, the facility where the surgery will be performed, the risks and costs involved, and any other options you may have. You may find that some of your desires can be achieved without any surgery at all. You can refer to our section on Aesthetic Medicine to see what non-surgical options might be right for you.
Most private insurance policies do not cover purely cosmetic surgery. On the other hand, if the procedure is performed for reconstructive purposes, it may be completely or partially covered. Check with your insurer, and obtain payment authorization before any surgery. Also, be sure to tell Dr. Coville if you have had any previous nose surgery, or an injury to your nose – even if it was many years ago. You should also inform him if you have any allergies or breathing difficulties; and if you are taking any medications, vitamins, or recreational drugs, or if you smoke. Do not hesitate to ask our staff any questions you may have, especially those regarding your expectations and concerns about the results.
It is important you follow our instructions on how to prepare for your surgery. They will cover eating, drinking, smoking, taking or avoiding certain vitamins and medications and washing your face. If you are a smoker, it is especially important that you stop at least four to six weeks before and after surgery; smoking inhibits blood flow to the skin, and can interfere with healing. The longer you stop smoking before a procedure, the better your results will be. Dr. Coville will need you to be honest about your smoking and may even test your blood for nicotine levels if there is any doubt. Be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.
Where Is the Surgery Performed?
Dr. Fred Coville performs procedures such as rhinoplasties at one of the private and fully accredited surgicenters on the Southern New Jersey Shore. The choice of center will depend on availability of operating room time, Dr. Coville’s schedule, and your timetable. This procedure is done on an outpatient basis, for reasons of cost and convenience.
What Exactly Happens?
Rhinoplasty usually takes an hour or two, though, of course, complicated procedures may take longer. The skin of the nose is separated from the supporting bone and cartilage, which is sculpted to the desired shape, using the technique your surgeon has decided on. The skin is then redraped over the new framework. Rhinoplasty can be performed from within the nostrils of the nose or by using an ‘open’ procedure where a small incision is added across the columella, the vertical strip of tissue that separates the nostrils. After surgery, a splint will be applied to help your nose maintain its new shape. Although we try to avoid them, you may also have some temporary packing placed within the nose for a period of time to help control swelling and bleeding.
For the first twenty-four hours after surgery your face will feel puffy, your nose may ache and you may have a dull headache, however, prescribed pain medication can control this. Plan to take it easy with your head elevated for the first few days. You’ll notice that the swelling and bruising around your eyes will increase initially, reaching a peak after two or three days. Cold compresses will reduce this swelling and make you feel a bit better. In any case, you’ll feel a lot better than you look. Most of the swelling and bruising should disappear within two weeks or so, although some subtle swelling – unnoticeable to anyone but you and your surgeon – will remain for several months. A little bleeding is common in the early days after surgery, and you may continue to feel some stuffiness for several weeks. You will probably be asked not to blow your nose for a week or so to allow the tissues to heal. If nasal packing has been used, it will be removed after a few days and you’ll feel much more comfortable. By the end of one week, all dressings, splints, and stitches should be removed.
Most rhinoplasty patients are up and about within two days of surgery, and able to return to school or sedentary work after just a week. It will be several weeks, however, before you’re entirely up to speed. Our staff will give you more specific guidelines for gradually resuming your normal activities. For two to three weeks you’ll be asked to avoid strenuous activity – jogging, swimming, bending, sexual relations or any activity that increases your blood pressure. Avoid hitting or rubbing your nose, or getting it sunburned, for eight weeks. Be gentle when washing your face and hair or using cosmetics. You can wear contact lenses as soon as you feel like it but, until your nose is completely healed, you must be careful with glasses. Once the splint is off, they’ll have to be taped to your forehead or propped on your cheeks for another few weeks. Our office staff will schedule frequent follow-up visits in the months after surgery to check on your progress. If you have any unusual symptoms between visits, or any questions about what you can and can’t do, don’t hesitate to call.
Key Aftercare Points
- There may be bruising around your eyes following surgery. This will take approximately three weeks to settle
- Swelling will be evident on and around the nose, and can take several months to settle completely
- Your throat is likely to feel sore and your nose will feel congested after your operation. Drinking plenty of fluids will help alleviate these symptoms.
- You will need to sleep on four pillows for the first five nights, and avoid bending, to help reduce any swelling.
- It is important not to blow your nose for two weeks following the operation. If you feel your nose is running, then sniff rather than blow, and gently dab your nose if necessary. Do not place anything inside your nostril.
- Depending on how the operation is performed, there may be stitches on your septum (the part of your nose that separates your nostrils). There may also be stitches that run through the inside of your septum, and a soft silicone sheet to support it inside your nose. If so, these will be removed in 4 to 7 days.
- Your nose may feel numb or stiff after the operation, but this will return to normal within several months. To avoid burning, it is wise to wear sun block and a brimmed hat when in the sun.
- Depending on your occupation, you may consider returning to work in 7 to 10 days, bearing in mind that the bruising and swelling will not have settled by this stage.
- For the first month, try to avoid situations where your nose may be knocked, for example dancing and carrying or playing with children. Contact sports should be avoided for 3 to 6 months.
- While we do our outmost to achieve the desired result, we cannot guarantee to make your nose the exact shape you desire. If subsequent revision procedures are required, there may be additional fees.
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