Rhinoplasty

Overview

Before and after rhinoplasty

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

The surgeon takes into account nasal features, the overlying skin of the nose, and what you would like changed. The nose's upper half is bone, and the lower half is cartilage. Nose surgery can modify bone, cartilage or both.
Mayo Clinic's experienced board-certified facial plastic surgeons customize rhinoplasty to meet your needs. The medical team and surgeon explain in detail what will happen before, during and after nose surgery to ease your concerns. Surgeons who perform rhinoplasty at Mayo Clinic also conduct research on variations of surgical techniques to provide the best, most up-to-date surgical options for patients.

Deviation of the nasal septum (the cartilage and bone structure that support the nose and separate it internally into two sides) is a common condition. A deviated septum can cause breathing difficulty. That problem, if present, is corrected during the surgery. This procedure is known as septoplasty. Rhinoplasty or septoplasty does not improve allergies or nasal swelling.

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. It is common for the nose to be asymmetrical, with one side longer than the other. Because the chin is an important reference point in relationship to the nose, chin enhancement may be recommended to further enhance your 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 must be willing to become accustomed to a new nose and the way it alters their appearance. Good communication with the surgeon is essential.

Most patients are pleased with the results of rhinoplasty. The surgery can inspire new confidence and reduce feelings of self-consciousness.

Despite taking steps to minimize risks associated with the surgery, the possibility remains that rhinoplasty surgery will not meet your expectations. Approximately 10 to 20 percent of patients are not as satisfied as they had hoped with the results of surgery. Some need further surgery to achieve their desired results.

What to expect

The approach used for surgery depends on the desired results and the surgeon's decision on how to perform the procedure. The surgeon may make incisions only inside the nose (closed rhinoplasty). Or the surgeon may elect to perform open rhinoplasty. which involves 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 of the nose's internal structures.

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 taken from elsewhere 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 that can then be hidden in the nose's natural creases.

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 may be placed inside the nostrils, particularly if one goal of the procedure was to improve breathing. Patients will be provided with ice packs for their eyes to be used for three days after surgery to reduce swelling and bruising. Elevating the head is also recommended for three days following surgery.

Splint on nose after rhinoplasty

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
• Potential obstruction of nasal passages that drain the sinuses, causing sinus infection.
• Irregularities of the cartilage, bone or a nasal obstruction that cause breathing difficulties. Additional surgery may be required to improve breathing.
• In some cases, a patient's sense of smell is diminished temporarily.

If the outcome of nose surgery does not meet expectations, 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 elasticity, also factor into the final results.