Nose Surgery
What is it?For who?
The surgery
The risks
The costs
Nose surgery or rhinoplasty is a procedure that changes the size and shape of the nose, either by increasing or decreasing the bridge, changing the angle, narrowing the nostrils or reshaping the tip. Although many seek a rhinoplasty simply to change the shape of their nose, others may choose nose surgery after a facial injury or to help relieve nasal obstructions. When having surgery to correct such a functional problem, medical insurance may cover a part or all of the surgical costs.
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The best candidates are healthy individuals with realistic expectations. Although there is no upper age limit for nose reshaping and nasal reconstruction, most surgeons prefer to not operate on younger patients until they have completed their growth spurts, usually in the mid teens for girls and the mid to late teens for boys. A person’s social and emotional adjustment is also taken into consideration. This is especially true for teens.
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In the initial consulation the surgeon will ask what the patient would like his or her nose to look like, evaluate the structure of the nose and face and discuss the possibilities.
The surgeon will provide specific instructions on how to prepare, including guidelines on eating, drinking, smoking and taking or avoiding certain vitamins and medications. Rhinoplasty is usually performed on an outpatient basis. Complex procedures may require a short inpatient stay. The patient should arrange for someone to drive him or her home after surgery and to help out for a couple of days if needed.
Rhinoplasty can be performed under local or general anesthesia, depending on the complexity of the procedure. The operation usually takes an hour or two, complicated procedures may take longer.
During surgery the skin of the nose is separated from its supporting framework of bone and cartilage, which is then sculpted to the desired shape. The nature of the sculpting will depend on the problem and the surgeon's preferred technique. Finally, the skin is redraped over the new framework.
Many plastic surgeons perform rhinoplasty from within the nose, making their incision inside the nostrils. Others prefer an "open" procedure, especially in more complicated cases; they make a small incision across the columella, the vertical strip of tissue separating the nostrils.
When the surgery is complete, a splint will be applied to help the nose maintain its new shape. Nasal packs or soft plastic splints also may be placed in the nostrils to stabilize the septum, the dividing wall between the air passages.
During the first 24 hours after surgery the face will feel puffy, the nose may ache and the patient may have a headache. Any discomfort can be controlled with prescribed medications. The patient may have to keep the head elevated during the first day. The swelling around the eyes will increase at first. Applying cold compresses will reduce the swelling. Most of the swelling and bruising should go away within two weeks.
A little bleeding is normal during the first few days and the surgeon will probably ask the patient not to blow his or her nose for a week. The nasal packing will be removed after a few days. By the end of one or two weeks, all dressings, splints and stitches should be removed.
Most rhinoplasty patients are up and about within two days, and able to return to school or work a week following surgery. Strenous activity should be invoided for two to three weeks, including jogging, swimming, bending and sexual activity.
Healing is a slow and gradual process. Some subtle swelling may be present for months, especially in the tip. The final results of rhinoplasty may not be apparent for a year or more.
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When rhinoplasty is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Nevertheless, there is always a possibility of complications, including infection, nosebleed, or a reaction to the anesthesia.
After surgery, small burst blood vessels may appear as tiny red spots on the skin's surface; these are usually minor but may be permanent. As for scarring, when rhinoplasty is performed from inside the nose, there is no visible scarring at all; when an "open" technique is used, or when the procedure calls for the narrowing of flared nostrils, the small scars on the base of the nose are usually not visible.
In about one case out of ten, a second procedure may be required; for example, to correct a minor deformity. Such cases are unpredictable and happen even to patients of the most skilled surgeons. The corrective surgery is usually minor.
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Most insurance policies don't cover purely cosmetic surgery; however, if the procedure is performed for reconstructive purposes, to correct a breathing problem or a marked deformity, the procedure may be covered. Patients should check with their insurers, and obtain pre-authorization for the surgery. Costs vary, depending on the doctor, location, technique and the difficulty of the specific case, but the avarage is around $3500. This fee does not include anesthesia, operating room facility, hospital stay and other related expenses.
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