“I never liked my nose! It was the first thing people saw when they looked at my face,” says Mary who recently underwent rhinoplasty to improve the appearance of her nose. “My new nose looks great and is finally in balance with the rest of my face.”
Nasal surgery or rhinoplasty is an operation designed to improve the appearance of the nose. Most rhinoplasty patients desire an improvement in the appearance of the nose that is also harmonious with the rest of their face.
Rhinoplasty is as much artistic in nature as it is scientific, rarely are any two of our patients’ noses identical. We strive to balance each patient’s nose with his or her facial features. Like faces, every nose is different; some noses are too long, some too wide, some have large humps, some project away from the face, and so on.
With aging, the skin loses elasticity and the nasal cartilage begins to lose structural strength. As a result of these changes there is a loss of nasal support and subsequent drooping, giving the impression that the nose is actually getting longer or that a bump is growing on the bridge of the nose.
This longer drooping nose may be a “tell-tale” sign of aging, and repositioning the drooping tip of the nose can be performed to give a more youthful appearance. It is often done as part of a facial rejuvenation program with face lifting and eyelid plastic surgery, to improve the undesirable signs of aging.
The alterations necessary during rhinoplasty will be determined by many factors, including one’s height, skin thickness, ethnic background and configuration of other features such as forehead, eyes, and chin. All in all, we strive to achieve a natural looking nose, rather than one which appears to have been operated upon. No patients want an assembly line “nose job”, rather they want a nose individually tailored to their own features.
The structure of the nose is similar to an “A” frame house. The central wall is the nasal septum which divides the right nasal cavity from the left. The external nose is formed by a pair of bones in the upper third, a pair of cartilages forming the middle third and another pair of cartilages in the lower third of the nose. These structures, as well as the overlying skin, determine the shape of the nose.
Prior to surgery, photographs are taken and computer imaging may be done so that we may study the characteristics of the nose and face. The operation is planned in much the same way an architect plans a house; the goal is not only to improve the shape of the nose but also to have it enhance the appearance of the entire face.
We prefer “twilight” anesthesia in which the patient receives intravenous medications supplemented by local anesthesia. The operation consists of carefully removing any “excess” bone and/or cartilage while rearranging or reshaping the remainder.
This operation is performed from inside the nose, leaving no external scars except in special circumstances. At the completion of surgery, a small protective adhesive dressing and splint are applied to the nose which is removed in about one week.
We do not ordinarily “pack” the nose after surgery. Patients, therefore, are more comfortable and generally less swollen. With the elimination of nasal packing, pain, swelling, bleeding, discoloration, etc. are dramatically reduced making the recovery period much more pleasant for the patient.
A frequently asked question by patients contemplating rhinoplasty is, “do you have to break my nose?” In our technique, we make an incision into the nasal bones when they need to be repositioned thereby eliminating the more antiquated technique of “breaking” the bones and resetting them. We feel this technique allows for better control of the operation and reduces the patient’s anxiety about having surgery.
At the end of one week, in practically all our patients, most of the discoloration and much of the swelling has disappeared. The remaining nose swelling progressively diminishes over the next several weeks. Generally speaking, about 80% of the swelling disappears by two weeks; 90% by two – three months. The remainder disappears at the rate of about 1% per month. The “final” result is not present for about 1 year, occasionally longer.