Frequently Asked Rhinoplasty (Nose Surgery) Questions

1. How is the shape of the nose changed with a Rhinoplasty?

The shape of your nose is primarily determined by the shape of the bones and cartilage under the nasal skin with a small contribution made by the skin itself. During a Rhinoplasty, the skin is lifted off of the underlying bone and cartilage and to allow for exposure. A variety of methods are then use to alter the shape of the cartilage and bones. Excess bone on the top (dorsum) of the nose is generally shaved off with a rasp while excess cartilage is typically removed with a scalpel. Malformed segments of cartilage are them reshaped with permanent sutures, scoring (partial thickness cuts) or both. Cartilage grafts are often added for support or to further alter the shape of the nose. A chisel may be used to gently fracture the nasal bones to straighten or narrow the nasal dorsum. No skin is generally removed from the nose during a Rhinoplasty. 

2. Where are the scars from a Rhinoplasty?

Most of the scars from a Rhinoplasty are hidden inside of the nostrils and, therefore, are not visible. During an “open” Rhinoplasty, these intranasal incisions are connected by a short, stair-step shaped cut across the skin bridge between the nostrils (columella). This scar generally heals as a very fine line. If segments of the outer portion of the nostril rim are removed to narrow the nostrils, there will be a potentially visible scar along the outer portion of the nostril rims where they attach to the cheek. 

3. How much pain is there with a Rhinoplasty?

Most patients are surprised at how little pain they have after a Rhinoplasty. The average patient takes the pain medication only a few times after surgery. Keeping your head elevated and using ice packs helps to reduce swelling and pain after surgery. 

4. Will I have a lot of bruising with my nose surgery?

Most of the bruising after Rhinoplasty surgery comes from breaking the nasal bones. There is normally very little bruising when only tip work is done. Prior to surgery, you should receive a list of medications to avoid for two weeks before surgery; most importantly any medication that contains aspirin. Take this list very seriously. Keeping your head elevated for several days and using ice packs for the first 36 -48 hours can significantly reduce the amount of bruising. 

5. Are the nasal bones always broken during a Rhinoplasty?

The nasal bones are normally only broken during a Rhinoplasty when a significant dorsal hump is going to be removed or when a crooked nose is going to be straightened. 

6. Will there be packing in my nose after surgery?

Not every patient will have packing in their nose after a Rhinoplasty. Generally only those who have the nasal bones broken or who have work done on their septum to improve breathing or to harvest a cartilage graft will have packing. The packing should be removed within 48 hours of surgery. 

7. How long will I have the splint on my nose after surgery?

Most patients will have a plastic splint placed on their nose after surgery. The splint is typically left in place for approximately one week. 

8. What kinds of changes are possible with a Rhinoplasty?

There are many things that can be done to a nose during a Rhinoplasty. The most common Rhinoplasty patient is one who desires to have a dorsal hump removed and a smaller, more “defined” nasal tip. The dorsum of the nose can be made flatter by either removing a hump or by adding grafts to eliminate a sunken appearance. The nose can be made straighter, longer, shorter, thinner or wider. It can be made to project out more from the face or less. The nasal tip can be made to rotate upwards or downwards. The columella (area between the nostrils) can be made more prominent, less prominent or straightened. The nostrils can be made smaller and the tip can be smaller, more symmetric and less round or boxy. 

9. How do I know if my surgeon is qualified?

True plastic surgeons are the only physicians who learn cosmetic surgery as part of their required surgical training. There are many untrained surgeons and actually many physicians who aren’t even surgeons trying to perform plastic surgical procedures. This can be very dangerous! Most of them only do the procedures in their office or their own surgical suite because they are not trained to perform the procedure and, therefore, cannot be credentialed to perform the operation at a hospital or legitimate surgical center. In these offices is where most of the serious complications occur. Neither the internet nor the telephone book care about your safety, the truth, adequate training or credentials. If you’re going to spend money on plastic surgery, don’t take unnecessary chances. At least make sure that your surgeon is trained and experienced in plastic surgery and is not just dabbling in something in which they have no expertise. Dermatologists are medical doctors, not surgeons! They are not trained to perform plastic surgery and have no business doing so.

When selecting a surgeon, at least make sure that he or she has had adequate training. Your surgeon should be certified by the American Board of Plastic Surgery. It is the ONLY legitimate plastic surgery board. It is the only one that evaluates a surgeon’s prerequisite training, plastic surgery training, practice performance and requires passage of rigorous written and oral examinations. You can contact the American Board of Plastic Surgery at (215) 587-9322. Another way to find out if your surgeon is trained is to see if your surgeon is a member of the American Society of Plastic Surgeons, Inc. (ASPS). Visit their website at www.plasticsurgery.org or call 1-888-4PLASTIC. All members of the ASPS are certified by the American Board of Plastic Surgery.

I would also recommend that you go one step further. To make sure that your surgeon specializes in aesthetic surgery and, therefore, is not only well trained, but is also very experienced, make sure that he or she is also a member of the American Society for Aesthetic Plastic Surgery (ASAPS). Surgeons that are members of ASAPS are all certified by the American Board of Plastic Surgery, members of ASPS, and have a practice that is dedicated to aesthetic surgery. Their web site is www.surgery.org and phone number is 1-888-ASAPS11.

Would you let a plumber do the electrical work on your house? Would you have a mechanic do your taxes? How about letting an orthopedic surgeon operate on your heart? Then why have an untrained physician, maybe not even a surgeon perform cosmetic surgery on you? If you wind up in someone’s office that doesn’t have the above credentials, don’t walk but run out of that office. And forget the consultation fee. They don’t deserve to be paid for trying to deceive you. 

10. I have trouble breathing through my nose; can this be helped with a Rhinoplasty?

There are a number of reasons for having difficulty breathing through the nose. A crooked nose can cause airway obstruction because of a deviated septum which can be straightened during a Rhinoplasty. There are several sponge-like bones in your nose that are covered with mucosa (nasal lining). These bones can become enlarged and contribute to airway obstruction. The bones can be compressed (out-fractured) or partially removed to improve your airway. These procedures may be covered by your insurance. 

11. What type of anesthesia is used for nasal surgery?

Most patients who have a complete Rhinoplasty, which includes breaking the bones and nasal tip work, undergo a general anesthetic, as do those who have work done on their septum. Those who work done strictly on the tip or nostrils may choose to have only local anesthesia with or without intravenous sedation. 

12. Will a Rhinoplasty change my entire appearance?

It is often surprising how little your overall appearance changes with a Rhinoplasty. Unless dramatic changes are made in your nose, the change to your overall appearance is generally very subtle. 

13. Is it possible to get an idea as to what my nose will look like?

Digital photography combined with computer imaging can give you an idea as to what you might look like after surgery. It is important to remember that the images are only as estimate and not a guarantee of results. You should use computer images as a way to make sure that you and your surgeon are working towards the same goal and so that you can agree on the proposed changes. 

14. What is the difference between an “open” and a “closed” Rhinoplasty?

Traditional rhinoplasties used a “closed” technique where all of the incisions were hidden inside of the nostrils. In the more modern “open” technique, the intranasal incisions are connected by a stair-step shaped incision across the columella (bridge between the nostrils). The “open” approach allows for greater visualization and is particularly used in cases where a lot of tip work needs to be done and in patients who have had a previous Rhinoplasty. 

15. How soon do I see the final result from my Rhinoplasty?

It takes three to four months to see the final result of most cosmetic surgeries. For Rhinoplasty, however, it takes up to a year for all of the swelling to resolve and for the skin to contract down to the new shape of the underlying bones and cartilage. 

16. I hate my profile because my nose is so big; is there anything else that can be done?

Many times a nose appears larger than it actually is on profile because of a weak or under projecting chin. This can be resolved at the same time as a Rhinoplasty by adding a small chin implant, creating a /h3er chin appearance and improving the overall facial balance. 

17. I just broke my nose and it looks crooked, do I need a Rhinoplasty?

If you have suffered a significant trauma to your nose and believe that it may be broken, you should be evaluated by a qualified physician to make sure that you do not have a hematoma of the septum. An unrecognized septal hematoma can result in a septal perforation (hole). If your nose is crooked after nasal trauma, you should undergo a closed reduction to shift the bones back into place after the swelling has gone down but before they have healed into place. This should normally be done within two to three weeks of the injury. If your nose is straight after an injury, no surgery is generally indicated even if you are having trouble breathing or you notice a bump on you nose that wasn’t there prior to your injury. These changes will frequently resolve over time and usually do not require correction. A formal Rhinoplasty should not normally be performed after trauma to the nose for at least six months. 

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