Rhinoplasty is not a procedure with a set series of steps. Each operation is unique and is customized for the specific anatomy and goals of the person undergoing the procedure.
Rhinoplasty may be done inside the nose or through a small external incision at the base of the nose, between the nostrils. Your surgeon will likely readjust the bone and cartilage underneath your skin.
Your surgeon can augment your nasal bone or cartilage in several ways, depending on how much needs to be added, the structure of your nose and available materials. For small changes, the surgeon may use cartilage harvested from deeper inside your nose or from your ear. For larger requirements, the surgeon can use cartilage from the rib, implants or bone from other parts of the body.
During the surgery
Rhinoplasty requires local anesthesia with sedation or general anesthesia, depending on the complexity of the surgery and your surgeon's preferences. Discuss with your doctor beforehand which kind of anesthesia is best in your case.
- Local anesthesia with sedation. This type of anesthesia is usually used in an outpatient setting and is limited to a specific area of your body. Your doctor injects a pain-numbing medication into your nasal tissues and sedates you with medication injected through an intravenous (IV) line. This makes you groggy but not fully asleep.
- General anesthesia. You receive the drug (anesthetic) by inhaling it or through an IV line — a small tube placed in a vein in your hand, neck or chest. General anesthesia affects your entire body and induces a temporary state of unconsciousness. General anesthesia requires a breathing tube.
After the surgery, you'll be in a recovery room, where the staff monitors your return to wakefulness. You might leave later that day or, if you have other health issues, you might stay overnight.
After the surgery
After the surgery you need to rest in bed with your head raised higher than your chest, to reduce bleeding and swelling. Your nose may be congested because of swelling or from the splints placed inside your nose during surgery. In most cases, the internal dressings remain in place for one to seven days after surgery. Your doctor also tapes a splint to your nose for protection and support. It's usually in place for about one week.
Slight bleeding and drainage of mucus and old blood are common for a few days after the surgery or after removing the dressing. Your doctor may place a "drip pad" — a small piece of gauze held in place with tape — under your nose to absorb drainage. Change the gauze as directed by your doctor. Don't place the drip pad tight against your nose.
To further decrease the chances of bleeding and swelling, your doctor may ask that you follow these precautions for several weeks after surgery:
- Avoid strenuous activities such as aerobics and jogging.
- Take baths instead of showers while you have bandages on your nose.
- Don't blow your nose.
- Eat high-fiber foods, such as fruits and vegetables, to avoid constipation. Constipation can cause you to strain, putting pressure on the surgery site.
- Avoid extreme facial expressions, such as smiling or laughing.
- Brush your teeth gently to limit movement of your upper lip.
- Wear clothes that fasten in the front; don't pull clothing, such as shirts or sweaters, over your head.
In addition, don't rest eyeglasses or sunglasses on your nose for at least four weeks after the surgery, to prevent pressure on your nose. You can use cheek rests, or tape the glasses to your forehead until your nose has healed.
Use SPF 30 sunscreen when you're outside, especially on your nose. Too much sun may cause permanent irregular discoloration in the skin of your nose.
Some temporary swelling or black-and-blue discoloration of your eyelids can occur for two to three weeks after nasal surgery. Swelling of the nose takes longer to resolve. Limiting your dietary sodium will help the swelling go away faster. Don't put anything such as ice or cold packs on your nose after surgery.
Your nose changes throughout your life whether you have surgery or not. For this reason, it's difficult to say when you have obtained your "final result." However, most of the swelling is gone at a year.
Aug. 13, 2013
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