Aesthetic Rhinoplasty

For those patients dissatisfied with the size or shape of their nose, a rhinoplasty can be performed for reshaping purposes. Nasal airway and breathing issues can be treated at the same time as an aesthetic rhinoplasty (see Functional Rhinoplasty  below).

A rhinoplasty often involves removal of a hump, refining a  bulbous or thick tip, and narrowing the nose.  This can improve the  proportionality of the nose to other facial features and thereby create a  more smooth and harmonious appearance.  Sometimes we are up building  the nose as in the case of asian, african-american, or some hispanic  patients who lack an adequate bridge (nasal dorsum) or definition or  support in the tip.  The surgery is done on an outpatient basis under  general anesthesia.

Functional Rhinoplasty

In  cases where there is some associated nasal breathing obstruction,  internal nasal surgery such as a septoplasty, internal spreader grafts,  and/or turbinate surgery can be performed to improve breathing.   These procedures specifically address functional aspects of the nose.   This is often covered by insurance companies and can be combined with an  aesthetic rhinoplasty.  The septum is sometimes warped or curved (also  known as deviated), blocking the normal flow of air through the nose and  internal passage ways.  Sometimes an accessory structure within the  nose, the turbinate, is also enlarged and blocking airflow.  The curvy  part of the septum is partially removed and straightened and when  indicated the turbinate is reduced in size to improve airflow within the  nose.  Sometimes spreader grafts made from your own nasal cartilage, an  internal ‘breath rite’ type procedure, is also done to help keep the  airways open.  Typically a significant improvement in nasal breathing is  realized after the initial post surgical swelling goes down.

Post Surgical Care

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Rhinoplasty surgery is done on an outpatient basis under general anesthesia. In addition to the nose itself, the eyelid region may become quite swollen and bruised. Only patients who have airway procedures at the same time will have nasal packing, which is removed in the first few days. There is usually some type of external splint which adheres to the nose; this is removed 5-8 days after surgery. Any stitches inside the nose dissolve, while those externally are removed at the same time as the splint. The incisions are very well hidden across the columella, the fleshy structure between the nostrils, and internally in the nose. The final result may not be apparent for several months and it usually takes a full year to completely appreciate the final result.

Splints and tape

After your procedure you may notice that your nose is taped and covered with a splint. This is to protect the delicate work that was done and limit your swelling. This will be removed by me or one of our nurses.

Stitches

Tiny stitches insides and on the surface of your nose may be in place. The internal stitches will dissolve on their own and do not need to be removed. The ones on the surface are removed about 5 to 8 days after surgery when the splint and tapes come off.

Packing

If you had internal nasal surgery done to improve airflow in your nose, chances are you have packing. Usually the packing is removed within a few days after surgery. This is probably the most uncomfortable part of the post surgical experience. Usually there is much relief once the packing is removed.

Humidified air and Ointment

After nose surgery, sometimes the membranes inside the nose do not humidify inhaled air as well as usual. It may be beneficial, particularly in the winter, to use a humidifier for a short period of time after surgery to help keep the inside of the nose moist. Petroleum based ointments (ex. Bacitracin or Neosporin) are also used to help keep the inside of the nose moistened.

Keeping the nose clean

The inside of the nose may have some crusted blood. This should be cleaned with a Q-tip dipped in hyrogen peroxide (available at most pharmacies over the counter). Use gentle strokes. If you experience excessive discomfort, stop.

Getting back to daily activity

Usually by the time the splint and stitches are removed patients are comfortable being seen in public and going back to school or work. By two weeks after surgery about 80% of the swelling and bruising is gone. The last 20% or so will take longer to go away. I recommend that patients take it easy for two weeks and avoid exercise or strenuous activity so the healing process is not delayed.

Medications after surgery

The goal after surgery is to keep you comfortable and help your swelling and bruising go away as fast as possible. All patients will have some pain killer tablets. In addition a short course of anti-inflammatory steroid tablets will help your swelling go away faster. Arnica montana tablets and topical cream will help your bruising go away faster. A full list and description of your medication will be supplied by the office.
One of the important aspects of obtaining the best result and getting back to regular activity is post surgical care.