Cosmetic Surgery

Nose Surgery at Mayo Clinic

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(Synonyms: rhinoplasty)

Rhinoplasty, cosmetic surgery of the nose, brings the nose into harmony with the face by modifying the shape, size and general appearance. Because the nose is a central feature of the face, it can have a significant influence on self-image. Rhinoplasty can shorten or lengthen a nose, change its shape or contour, narrow the nostrils, or lift and define the tip.

The surgeon will take into account nasal features, the overlying skin of the nose, and what the patient would like changed. The upper half of the nose is bone, and the lower half is cartilage. Surgery can modify the bone, cartilage or both.

It is common to have a deviation of the nasal septum (the cartilage and bone structure that support the nose and separate it internally into two sides). A deviated septum can cause difficulty in breathing, and, if present, is corrected as part of the surgery. This procedure is known as septoplasty. Neither allergies nor nasal swelling will be improved by rhinoplasty or septoplasty.

Someone may be a good candidate for rhinoplasty if:

• The nose appears too large or wide for your face.
• the nose is crooked or off center.
• A previous injury makes the nose look asymmetrical.
• The nose has a hump or depression when seen in profile.
• The tip of your nose droops or plunges or is thickened or enlarged.
• Nostrils are excessively flared.
• An airway obstruction makes breathing difficult.

The surgeon may use photographs of the patient's face and nose to determine the best angles between specific features of the nose and the rest of the face. Keep in mind that everyone's nose is asymmetrical and that one side is probably longer than the other. Because the chin is an important reference point in relationship to your nose, chin enhancement may be considered to further enhance the profile and make the chin more prominent.

Because rhinoplasty involves changing the bone and cartilage of the nose, it is considered among the more complex cosmetic surgeries. The risk of complications exists, as does the potential need for revision surgery to improve the initial result. It is essential to find a surgeon who is experienced in this procedure and who clearly understands how the patient wishes to change the nose's appearance.

A successful outcome is most likely if patients know what they want to change and are willing to accept the limitations of surgery. Patients will need to be willing to become accustomed to a new nose and the way it alters their appearance. Good communication with the surgeon is essential.

Do not use nasal medications, such as nasal sprays or steroids, or abuse drugs, such as inhalants. Tell the surgeon if you have used any of these substances. Stop using nasal medications at least three months prior to surgery to reduce risk of bleeding and healing problems. If a person is using or has previously used cocaine, inform the surgeon. It is important to have stopped cocaine use for one year prior to rhinoplasty.

To help prepare

• As your surgeon has instructed, avoid medications that may complicate surgery or recovery.
• For at least six weeks before and after surgery, abstain from nicotine products (cigarettes, gum, chewing tobacco) and avoid secondhand smoke.

Most patients are pleased with the results of rhinoplasty. The surgery can inspire new confidence and help people feel less self-conscious.

Despite taking all steps to minimize the risks associated with the surgery, it is still possible that surgery will not meet a patient's expectations. Approximately 10 percent to 20 percent of patients are not as satisfied as they had hoped with the surgery. Some people may need another surgery to achieve the results they seek.

What to expect

The approach used for surgery will depend on the desired results and the surgeon. The surgeon may make incisions only inside of the nose (closed rhinoplasty). Or the surgeon may do open rhinoplasty, making a small incision at the underside of the nasal tip across the columella (the vertical strip of tissue separating the nostrils), as well as within the nose. This approach allows the surgeon to see more internal structures of the nose.

Working through the incisions, the surgeon sculpts bone and cartilage to achieve the desired shape. The surgeon may reposition the bones in the nose or build up certain areas using cartilage or bones from another site on the body. The skin and soft tissues are then repositioned over the reshaped nose. If the nose is being narrowed or the nostrils reduced, wedges of skin at the base of the nostrils will be removed through incisions hidden in natural creases of the nose.

Following surgery, the surgeon will prescribe medications to control any discomfort. A splint will be applied to the bridge of the nose to protect it and to stabilize internal tissues. A bandage may be applied beneath the nose and/or packing inside the nostrils, particularly if part of the procedure was done to improve breathing. Patients will be provided with ice packs for their eyes to use for three days after surgery to reduce swelling and bruising. Elevation of the head is also recommended for three days following surgery.

Risks

The risks associated with rhinoplasty may include, but are not limited to:

• Problems related to anesthesia
• Bleeding. Nasal packing may be used to control bleeding.
• Infection
• Nasal swelling
• Nasal passages that drain the sinuses may become obstructed, causing a sinus infection.
• Irregularities of the cartilage, bone or a nasal obstruction that causes difficulty breathing. Additional surgery may be required to improve breathing.
• In some cases, patients temporarily experience a diminished sense of smell.

If the outcome of surgery does not match expectations, an additional surgery may be an option. Nine to 12 months is needed for healing before another surgery can be performed.

Healing takes time as the skin reshapes over its new framework. The quality and age of the skin, including its elasticity, also are factors in the final results.

This procedure is performed by specialists in Facial Plastic and Reconstructive Surgery (Otorhinolaryngology).