Rhinoplasty Overview

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What Is Rhinoplasty?

Noses come in all shapes and sizes, and are often the focal point of the entire face. Today, noses can be reshaped, reformed and redesigned in nose surgery called "rhinoplasty," also known as a nose job. Rhinoplasty surgery can thin the nose, turn it up, augment it, shorten it, elongate it or otherwise bring it into balance with the rest of the face.

Although a nose job is often completely cosmetic—done strictly to improve appearance—it can include procedures that improve the function of the nose by helping open up the breathing passages. Septoplasty (surgery to reshape the septum, the vertical wall of bone and cartilage between the two nostrils) is done to ease breathing problems caused by blockages. It is often performed to correct a deviated, or crooked, septum. A deviated septum can be the root cause of a crooked nose, so septoplasty can have both cosmetic and reconstructive aspects.

A tiplasty is the procedure to reshape the tip of the nose and normally only involves the cartilage of the nose.

All three of these procedures — rhinoplasty, tiplasty, and septoplasty — can be performed together.

Rhinoplasty may be needed because of trauma to the nose, a birth defect or disease, in which case it is referred to as reconstructive rhinoplasty.

Your nose is a complex structure made of bone and cartilage, and lined with mucosa, the same type of membrane that lines your mouth. The tip and lower half of the nose is made of cartilage, which is rubbery and flexible, and the rest is bone. If there is an unattractive hump or bump on the nose, it is often located where the cartilage meets the bone. During a rhinoplasty, a surgeon can break the bones of the nose and sculpt the cartilage to reshape the nose.

The impact a rhinoplasty can have on your self-esteem and self-confidence can be astounding. People who feel their nose makes them unattractive can suffer from a pronounced lack of self-esteem. As with any cosmetic surgery, a rhinoplasty can make you look better, but it cannot change what is inside you. Cosmetic surgery can improve your physical appearance, but cannot correct serious mental conditions. If you are depressed or in an emotionally fragile state, you should put off any cosmetic procedures until you deal with those problems.

Are You a Candidate for Rhinoplasty?

A nose job is a very popular type of cosmetic plastic surgery. With more than 300,000 procedures performed in 2006, it was the second most common type of cosmetic surgery, behind only breast augmentation, according to the American Society of Plastic Surgeons.

The rhinoplasty procedure is often performed on relatively young patients. However, it is usually not done before a teenager has had his or her last growth spurt, around age 14 for girls and a bit later for boys. The nose needs to have completed most of its growth and the patient needs to have the emotional maturity to deal with the surgery and recovery.

An important aspect to consider before having rhinoplasty surgery is your overall health. Active diseases or other pre-existing medical conditions, such as diabetes, asthma, or a heart condition, will make it harder for you to endure the surgery and recovery period.

The healing time and possible bruising associated with a nose job  can be difficult and require a great deal of patience and mental stability. To be a good candidate, you should be mentally and emotionally healthy before undergoing rhinoplasty to ensure this stress does not worsen a pre-existing mental illness, such as depression.

If you are considering a rhinoplasty, you should discuss the results you want with your surgeon. This will help you ensure that what you want is possible and what procedures are needed to attain that goal. You and your surgeon can examine before and after rhinoplasty photos of his or her previous patients to be sure you are in agreement on how you want to look after surgery.

The goal of cosmetic rhinoplasty should be a nose that fits your individual face. Your facial features will dictate the dimensions your nose should have so that it will achieve a certain harmony with the rest of the face.

Medical insurance may not cover the cost of a rhinoplasty or may not cover all the costs if the procedure is being done to help correct breathing problems. You will be responsible for all costs that your health plan does not cover. Before you have surgery, find out what your health plan is willing to cover, and get this information in writing. Financing can be arranged for rhinoplasty that is strictly cosmetic.

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Rhinoplasty for the Ethnic Nose

If you are African-American or Asian-American, or have an "ethnic nose" that you want to change, make sure you are working with a cosmetic surgeon that knows the structure of your type of nose. A good rhinoplasty surgeon knows how to reshape the nose so that it complements the rest of the face.

For instance, if you want greater projection to the dorsum (the bridge) of your nose, your surgeon can use a small silicone implant placed through a small incision in the nose. This implant augments the bridge of your nose while leaving the tip of your nose the same. With subtle differences like this, the projection of your nose can be enhanced without changing the overall ethnicity of your face.

Although techniques and methods employed during rhinoplasty surgeries are the same regardless of race, there are some trends that apply to patients of certain ethnic backgrounds.

Asian-American Rhinoplasty: Asian patients often want their noses to appear narrower. This can be done through the use of infractures, where the nasal bones are broken and moved in or reset to thin out the nasal area and add projection in the process. (Outfractures, where the nasal bones are broken and moved outwards, are used to widen a too-narrow dorsum.)

African-American Rhinoplasty: One common trend in African American rhinoplasty is to narrow wide nostrils. This procedure may include removing sections of the base of the nostrils or sections of the nose where it meets the face. The tip of the nose can be restructured by removing tiny sections of cartilage.

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How a Rhinoplasty Is Performed

Depending on the technique your surgeon uses, and how much reshaping of the nose needs to be done, a nose job usually takes between 1 and 2.5 hours. Other cosmetic procedures such as a cheek implant, brow lift or face lift can be performed at the same time as a nose job, but this will add to the duration of the surgery.

Rhinoplasty can be performed as either an open or a closed procedure. In an open (or external) rhinoplasty, the surgeon makes incisions on the insides of the nostrils and across the columnella, the wall between the nostrils at the bottom of the septum. If the shape of the nostrils is being changed, incisions may also be made at the points where the nostrils meet the face. Scars from these incisions are either hidden or almost invisible after they heal. In a closed (or internal) rhinoplasty, all incisions are made within the nostrils. The amount of correction and reshaping that is possible with a closed rhinoplasty is limited, so the scope of the surgery you may need could dictate whether it will be open or closed.

A nose job can be performed in a doctor's office, a free-standing surgical clinic or in a hospital. Most people having a nose job can go home the same day as their surgery.

There are several phases involved in rhinoplasty surgery. These include:

Preparation: This is when you are "prepped" for surgery. Your surgeon will mark your nose where he or she will be making incisions. You will probably be given a cap to cover your hair and your face will be scrubbed with an antimicrobial agent to minimize the possibility of infection. You will probably be hooked up to monitors that will keep track of your respiration, blood pressure and heart rate. In most cases, you will also have an intravenous (IV) line started so that medications can be administered quickly.

Anesthesia: The choice of anesthesia should be discussed between you and your surgeon before your surgery date. The most common anesthesia choice for a nose job is either intravenous sedation or general anesthesia. In both, you are asleep through the procedure. Some more limited rhinoplasty procedures can be performed using only a local anesthesia and a mild sedative that makes you drowsy and relaxed.

Surgery: During the rhinoplasty surgery, your surgeon will carefully follow the premarked incision lines he or she drew during the preparation phase. When the procedure is finished, the incisions are sutured. For some types of rhinoplasty, the surgeon will pack your nose to help reduce swelling and bleeding.

Recovery: During the recovery phase, you will be awakened and moved to a recovery room where nurses monitor you for about 2 hours. After surgery, some patients may experience discomfort, emotional anguish, nausea or uncontrollable shivering. The staff will assist in recovery by supplying pain relievers, antinausea medications, warm blankets or other amenities.

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