Rhinoplasty, one of the most commonly performed plastic surgery procedures in the world, is specifically designed to address both cosmetic and functional issues with the nose. Many patients who come into my office interested in nose surgery have questions about what they can expect before, during and after a rhinoplasty procedure. Here is a brief overview of what exactly is entailed.
Every rhinoplasty that I perform, whether it is done for primarily cosmetic or functional purposes, begins with an in-depth consultation. In this initial encounter, I document significant nasal history such as trauma or previous surgery and perform a detailed external and internal nasal examination. Nasal allergies, smoking history, use of topical or systemic medications, and overall physical health can all play a significant role in the ultimate outcome of a rhinoplasty procedure. Then I sit down with my patients and together we discuss their goals and expectations, often with the use of computerized facial imaging to give patients a chance to view their potential surgical results and to give me a detailed template to which I can refer during surgery.
During the procedure itself, I prefer an external “open” approach using a transverse columella incision. An incision is made across the columella, the narrow strip of tissue that separates the nostrils, allowing for easy access and complete visualization of the entire nasal anatomy. This approach makes it possible to perform precision sculpting and grafting of the bones and cartilage within the nose, allowing me to achieve more predictable and natural looking results.
At this point the bone separating the two chambers of the nose, called the septum, can be easily accessed and any deviated portions removed. Additional functional concerns can be addressed at this time, followed by changes to the underlying structure of the nose. Various techniques can be used to reduce the width of the bridge, or remove a bony dorsal hump by trimming or sculpting the underlying bones. Finally, the cartilage that makes up the nasal tip can be shaped or even enhanced with grafted cartilage taken from the septum or (in some cases) from behind the ear.
After the surgery, nasal dressings consisting of adhesive strips and a custom-fitted plastic splint will remain in place while you recover. I generally recommend that patients keep their head elevated for the first five days and they use cold packs to reduce the swelling for the first 24 hours. The plastic splint, along with all nonresorbable sutures, will be removed at a follow-up appointment around 5-7 days after the surgery. At this point, moderate exercise can be resumed, but heavy contact should be avoided for at least six weeks. Nasal congestion and swelling may persist for anywhere from six weeks to a year, and the final rhinoplasty results may not be fully apparent until the delicate tissues have completely healed.
Despite the fact that rhinoplasty is an extremely technical and demanding surgical procedure with one of the highest revision rates of all cosmetic surgeries, in my practice revision surgery is necessary in less than 5% of patients. If you are interested in a plastic surgery procedure I perform, please contact me, Dr. Fernando Burstein, today. Be sure to connect with me on Facebook, Twitter, and Google+ for the latest facial plastic surgery news.