What is a Rhinoplasty?
A rhinoplasty is an operation performed to alter the appearance of the nose. The appearance of the nose is determined by the shape of the underlying bony and cartilaginous skeleton and by the thickness and pliability of the overlying skin. Most patients requesting nasal surgery have considered what type of nose they would like. It is not possible to accurately and consistently reproduce a specified nose. However, general changes can be made with a very pleasing result. Nasal surgery may be performed under a local anesthetic which numbs just the nasal area, or a general anesthetic. In a closed rhinoplasty all incisions are made inside the nostrils, leaving no external scars. In an open rhinoplasty, a small incision is made across the columella (the skin beneath the tip separating the nostrils) allowing better access but leaving a small inconspicuous scar. These incisions provide access to the cartilage and bone of the nose which can be cut, trimmed, and manipulated to reshape the nose and alter its external appearance.
What changes can be performed on the nose bridge (dorsum)?
The most frequent operation on the nose bridge is removal of a large dorsal hump. This is performed by sanding down the hump on the bone, leaving the bridge flat.
For a wide bridge, the bones can be weakened at their base at the cheek and then brought together to form a narrower nasal bridge. Alternatively, the dorsum can be narrowed by removing bone along the side of the nose.
For a "ski jump" type nose, the dorsum can be built up by adding either cartilage, bone, or an implant beneath the skin to augment the framework.
What changes can be done to the nasal tip?
A wide and bulbous nasal tip can be reduced by trimming the cartilage in this area. In this case, better results are achieved with an open rhinoplasty.
Can the nostrils be narrowed?
If nostrils are wide with a flared appearance, narrowing of the nostrils will require removal of skin wedges which requires external skin incisions. With external incisions, there will be scars but they will lie in the crease where the nostrils join the cheek so as to be inconspicuous.
Can the nose be shortened?
The length of the nose can be shortened or a drooping nasal tip can be elevated by trimming the septal cartilage (the internal cartilage separating the nasal cavities).
Can asymmetry be corrected?
Sometimes, injury to the nose may cause it to heal crooked. This can be corrected by re-fracturing and straightening the bones and cartilage. Unfortunately, it is often difficult to achieve a perfectly straight nose once injured and surgery may not fully correct the crookedness. Restoring the shape of a traumatized nose is covered under the B.C. Medical Services plan, but only for 12 months immediately following a documented fracture.
What is the recovery period like?
Following the operation, you will need a splint on your nose for about a week. There will be bruising and swelling around the eyes for 1 to 2 weeks. Pain is usually moderate, and can be controlled with oral medication. Numbness and swelling of the nasal tip and lining persist for some time, and nasal stuffiness will be present for several months. These factors result in a gradual contour change in the nose that continues for 1 to 2 years. Vigorous activity should be avoided in the first several weeks to avoid bleeding problems.
What are the limitations?
The character of the overlying skin can have a dramatic effect on the outcome of this surgery. Thick, oily, porous skin does not conform as readily to the underlying framework, and is therefore less likely to show changes, particularly at the tip of the nose.
The size of the nasal passages must be maintained, otherwise permanent nasal stuffiness will be a problem. This limits the amount of size reduction possible. The nose should harmonize with other facial features.
Internal scarring in the nose will also affect the appearance of the nose. Truly drastic changes are usually not compatible with the basic framework and soft tissue structure of the nose.
What are the more common complications?
The complications of anesthesia are part of the risk of even minor surgery. Serious complications are rare.
Infection can occur in 1-2% of operations, and may require the use of antibiotics. In 3-4% of patients a nosebleed can occur within the first several weeks of surgery and may require packing of the nose. The basic mechanisms of circulatory compromise, skin loss, and poor scar formation are possible complications of any surgery. Rarely, permanent bruising or pigmentation of the skin can occur. Damage to the tear drainage system is possible but very uncommon.
Occasionally, some local tenderness may persist for some time. Nasal stuffiness may occur from the swelling and can affect the sense of smell, however this is usually temporary. The most common problem is that of minor irregularities in contour, and for this reason touch-up procedures are fairly common.