All You Want to Know About Rhinoplasty or “Nose Job”

If you’re considering Rhinoplasty, this information will give you a basic understanding of the procedure and the process associated with being evaluated by me to undergo a nose operation customized to you. You’ll learn when Rhinoplasty or Septorhinoplasty can help you, how nose surgery is performed, and what results you can expect. It is likely that I won’t have answered all of your questions about Rhinoplasty or nose surgery here, since much depends on your individual concerns and your anatomy. However, the basic principles of Rhinoplasty or Septorhinoplasty are common to most nose surgery procedures.

Rhinoplasty, more commonly known as “nose job”, is one of the most common of all plastic and cosmetic surgery procedures. The goal of Rhinoplasty is to create an attractive nose which brings natural balance to your face. This may require work on the tip, the dorsum, the base of the nose and nostrils or any combination of these. For some, breathing through the nose may also be a problem. In such cases, I will discuss with you internal nasal surgery, such as septoplasty, to straighten the nasal septum (the internal wall which separates the airflow of each nostril from the other), or reduction of internal structures called turbinates, which may help relieve some breathing issues. We will also discuss other changes which may be used to improve breathing.

The consultation

I find that most patients who are unhappy with the cosmetic appearance of their nose have spent a significant amount of time figuring out what exactly it is about their nose that they don’t like. And, what they do like. The consultation will give me a chance to hear your concerns and at the same time examine your nose. We will then discuss a surgical plan for improving the shape and function of your nose. Age is a consideration in nose surgery. For younger patients reading this, ideally you will have completed your growth spurt. For girls, this is usually around the age of 16 and for boys, about the age of 18. The reason age is a consideration in Rhinoplasty is to avoid any disturbance of the natural facial growth patterns as a result of surgery performed too early. During your consultation with me, I will discuss with you other factors which may influence the outcome of your surgery. Such as the structure of your nasal bones and cartilages, the shape of your face and the thickness of your skin. We will discuss the techniques which I use, the type of anesthesia, and the potential risks. Our patient coordinator, Anna, will discuss scheduling, our surgical facilities in Walnut Creek and San Francisco Area, and the costs involved with you. Most insurance policies don’t cover cosmetic surgery; however, if part of the procedure is performed to correct breathing problems, then that portion of the procedure may be covered either partially or fully by your insurance. My office will help you determine if your insurer does, in fact, provide this type of coverage for Septoplasty and other internal nasal procedures and will also help you get clearance from your insurance before the surgery.

You must share your complete medical history during the consultation. These include your general health, history of previous nasal surgery and any injury to your nose, even if it was many years ago. I would also want to know if you have any allergies or breathing difficulties; if you’re taking any medications, vitamins, or recreational drugs; and if you smoke. Moreover, the consultation is the time that you get to ask your questions. Don’t hesitate to ask any questions you may have regarding your expectations and concerns about the results. You will also have a chance to go over things again during your preoperative visit to my office in the San Francisco Area. For those who come from out of town, my office can help you coordinate your pre and postoperative visits with your surgery so that you can make maximal use of the time you spend in the Walnut Creek-San Francisco Area.

Preparing For Your Surgery

In preparation for your surgery, I will ask you to avoid certain medications, limit drinking of alcoholic beverages, stop smoking two weeks before surgery, and avoid taking certain supplements and vitamins before your surgery. You should arrange for someone to drive you to and from the surgery center and to be available to take care of you for a few days after the operation. Most patients need only some help after a Rhinoplasty. Prepare your house such that you will have a place to sleep with your head elevated for the first week after surgery. You can do this by sleeping with several pillows under your head and back, or by sleeping in a recliner chair.

The Surgery

I will perform your nose surgery in Walnut Creek at the Aspen Surgery Center outpatient facility. This is a private surgery center located on the first floor of the John Muir Medical Center in Walnut Creek. You will be asleep for the surgery, usually through general anesthesia. This provides maximal comfort for you during the surgery and maintains the safety of your airway. Minor nose procedures may be performed under sedation. During your nose surgery, the bone, and cartilage are sculpted to the desired shape. The reshaping of your nose may require controlled fracturing and repositioning of your nasal bones. The intricacies of Rhinoplasty surgery, however, center more around the refinement of the nasal tip cartilages, proper reshaping of the middle portion of the nose and delivering a balanced and natural-looking nose for your face. I use both the “open” and “closed” Rhinoplasty techniques. In open Rhinoplasty, a small stair-step incision over the skin between your nostrils, called the columella, allows direct access to the cartilages and bones of the nose. The open technique is extremely precise and allows me to directly visualize the structures which need to be reshaped. In the closed Rhinoplasty, I place the incisions inside your nose. This technique has the advantage of less swelling after the surgery and is ideal for those who do not require significant reshaping of the cartilages of the nose. I will discuss with you the appropriate procedure for your nose during your consultation in my office. When your nose surgery is complete, I will apply a splint to the outside of your nose to help your nose maintain its new shape. Moreover, if any internal nose work was done, I will place internal nasal splints to stabilize the septum and minimize the risk of bleeding.

After Your Surgery

You may go home the same day after the surgery. If you are here from out of town, I would like you to stay the night in the San Francisco Bay Area or at a hotel in the Walnut Creek Area. You will have pain medication prescribed for you to keep you comfortable after your nose surgery. There are two things for you to be vigilant about right after the Rhinoplasty. The first is to maintain your head elevated at all times for the first week after surgery. Use two or three pillows, or a recliner to sleep. This will reduce swelling and minimize the risk of bleeding after surgery. The second is to make sure your splint stays on your nose by keeping it dry. Avoid hot, steamy baths or showers as this will cause the nose splint to loosen.

After Rhinoplasty surgery, particularly during the first forty-eight hours, your face will feel puffy, your nose may ache, and you may have a dull headache. Plan on staying in bed with your head elevated, except for going to the bathroom, for the first couple of days. The swelling and bruising around your eyes will increase at first, reaching a peak after two or three days. You’ll feel a lot better than you look after the first couple of days, and most of the swelling and bruising will disappear within the first ten days to two weeks. A little bleeding is common during the first few days following surgery, and you may continue to feel some stuffiness for several weeks. Avoid blowing your nose for the first two weeks after your nose surgery, while the tissues heal. The nasal splints will be removed around 7–8 days after the surgery. The sutures I use are usually self-dissolving and do not need to be removed. In the days following surgery, when your face is bruised and swollen, it’s easy to forget that you will be looking better. In fact, many patients feel depressed for a while after plastic surgery-it’s quite normal and understandable. This may be exacerbated by disrupted sleeping patterns and use of pain medication in the first few days. This stage will pass. Day by day, your nose will begin to look better, and your spirits will improve. Within ten days to two weeks, you’ll no longer look as if you’ve just had surgery.

Most of my Rhinoplasty patients are up and about within two days, and able to return to school or sedentary work a week or so following surgery. However, it will take a few weeks before you are back to your preoperative self. Avoid strenuous activity (jogging, swimming, bending-any activity that increases your blood pressure) until I have given you clearance. For the first six weeks after nose surgery, avoid hitting or rubbing your nose, and avoid wearing glasses which rest on the bridge of your nose for three months. You can wear contact lenses as soon as you feel like it. Once the splint is off, glasses will have to be taped to your forehead or propped on your cheeks to avoid forming a bump on your nose, until your nose is completely healed at three months. Your nose will sunburn easily in the first few months after surgery, so apply sunscreen. You will follow up with me for about a year after surgery. After the initial couple of visits, I would like to see you back at six weeks, three, six and 12 months after your Rhinoplasty operation. In addition to these visits, feel free to contact me at any time if you have some concerns.

Most of the swelling in your nose will resolve by six weeks. However, a residual amount will remain, especially in the tip area. The final results of Rhinoplasty may not be apparent for a year or more. Furthermore, keep in mind that after your surgery, you might experience some unexpected reactions from family and friends. They may say they don’t see a major difference in your nose, or they may act resentful, especially if you’ve changed something they view as a family or ethnic trait. If that happens, try to keep in mind why you decided to have this surgery in the first place. If you’ve met your goals, then your surgery was a success.

Risks

Complications in Rhinoplasty are infrequent and usually minor. Nevertheless, there is a low possibility of complications, including infection, nosebleeds, or a reaction to the anesthesia. You can reduce your risks by following the instructions that I provided above for before and after nose surgery. Occasionally, small burst blood vessels may appear as tiny red spots on the nose skin’s surface; these are typically minor but may be permanent. Scarring from Rhinoplasty is often minor. Once the initial healing and redness of the incision resolves, in most people, scars are typically very difficult to see. Infrequently, a small second procedure may be required to correct a minor deformity.

I look forward to seeing you in person at my office in Walnut Creek.