Is it improper to ask to speak with previous patients who have had revision rhinoplasty done by the surgeon I am considering for the same procedure?
What is a "hanging columella"?
What is a rhinoplasty?
Rhinoplasty is cosmetic surgery of the nose. It is often called a nose job and occasionally known as nasal refinement. With rhinoplasty, the shape of the nose can be changed by infracturing or breaking the bones of the nose and resetting them narrower and straighter. Outfracture is when the bones are broken and moved out to widen the nose. This surgery can also remove a hump or bump to give a more pleasing, symmetrical look. The cartilage of the lower nose and nostrils can be molded and trimmed to create a more compact or pleasing shape.
Rhinoplasties are also done to correct breathing problems in the nose. The center vertical wall of the nose, the septum, may be misshapen and correction will help with breathing.
What does a typical rhinoplasty consultation entail?
First, your doctor will discuss your goals with you and he or she will explain what can be achieved realistically. A good doctor will not just slim your nose or shorten it, but will take into account what changes your facial features and bone structure would benefit from. There should never be a "one size fits all" when it comes to this procedure. It is all individual.
How is a rhinoplasty performed?
A rhinoplasty is usually performed under light sleep anesthesia, but can be performed using general anesthesia. The patient usually arrives early in the morning and goes home the same day. Depending on the surgery, the surgeon may operate using incisions inside the nostrils (closed rhinoplasty) or just under the nose (open rhinoplasty). The procedure may involve reshaping cartilage in the nose or breaking the bones of the bridge of the nose and reshaping them. A splint or cast is applied and will be worn for approximately 7 days.
What should I expect postoperatively?
After your surgery your surgeon will have placed dressings and possibly a cast or splint on your nose and a gauze pad underneath your nose to catch blood and mucous. Your nose may be packed with gauze or other materials. You will remove the pressure dressing after a few hours or as specified by your surgeon. You may be nauseous after surgery because some blood may have been swallowed during the procedure. You may vomit a black mixture of stomach acid and blood. This is normal and is usually over soon. Most people will also have black eyes for a few days after their nose job. If you continue to vomit and/or run a high fever, contact your doctor immediately.
However, patients do report being uncomfortable breathing with the packing and cast on the nose. Some patients feel claustrophobic if they cannot breathe through their nose. In some cases, the surgeon can place tubes or straws placed through the packing in each nostril to direct airflow through the nose.
Your nose will be sensitive for about a month and a half. This feeling widely resembles a head cold or sinus infection.
When will the cast be taken off and does this hurt?
The cast is removed about 7 days postoperatively. You may feel a slight stiffness in the upper lift as the swelling moves downward after the cast is removed. This will subside in a matter of hours. Removal of the cast usually does not hurt.
When will I be able to see the results?
You will start to see a difference in the shape of your nose immediately, but not the full extent of the change because it will still be swollen. The swelling starts to disappear about a week after the cast is removed. Approximately 80% of the swelling and all the discoloration are usually gone by 2 weeks after surgery. The rest slowly disappears over the next year. Although the nose is still swollen after the first month, most other people will not notice, but you might. As the swelling goes away, the shape of your nose will become more refined with better definition. The inside of the nose may be swollen for approximately three weeks after the surgery. Nasal breathing may be difficult during this time. If surgery is performed to straighten the nasal septum, an improvement in breathing will become apparent by about 3 weeks after surgery.
What are the risks of a rhinoplasty?
There are risks, as with all surgery, although they are rare. Even when a highly skilled surgeon performs your surgery, sometimes your body may not heal correctly or have adverse reactions causing undesired results.
It is possible to develop tiny red marks and spots, from blood vessels that may have burst under the skin's surface during surgery. The spots may be permanent.
Scarring is minimal or completely hidden in most cases. If narrowing of the nostrils is done, the scars made on the outside of the nose may be visible for a while until they mature. Some patients will lose their sense of smell, temporarily. Your nose may be slightly swollen for over a year. Scar tissue may heal in a way that may cause a whistling noise when you breathe in and out.
Rhinoplasty has the highest rate of revisions (second surgery) of any cosmetic procedure. Although there are a few rhinoplasties that just don't heal correctly or go badly, some people may not readily accept their new look. Being accustomed to their old nose, they just can't seem to comfortably make the transition.
At what age is it safe to have a rhinoplasty?
Usually rhinoplasty is performed, at the earliest, at 13 or 14 years of age in girls and 15 to 16 years of age in boys. This difference in ages is because girls physically mature faster than boys. The goal is to perform surgery when at least 90% of the growth is complete. There are major growth centers in the nose that affect the growth of the face and a rhinoplasty can disrupt them.
In cases of severe disfigurement or trauma to the nose, nasal surgery can be performed earlier in an attempt to restore the alignment of those centers. For lesser problems, surgery is deferred until after the teen stops growing. Rhinoplasties performed on teenagers and young adults, it seems, are often beneficial to the social development and self confidence of the individual.
It's been five months since my surgery and my nose drips when I run or work out. Is this normal?
Many patients complain of runny noses after rhinoplasty or septoplasty surgery. Most of the excess mucous production ceases at 9 months but it can continue well after that.
I'm going to get my nose done soon and my doctor has recommended that I get a chin implant because he says my chin recedes. Do people get both of these procedures at the same time?
Having a chin augmentation at the same time as a nose job is very common. A weak chin can make even an ideal sized nose look larger than it actually is. Chin augmentation is a relatively minor procedure.
What is a "hanging columella"?
The nasal columella is the fleshy bottom of the septum, the section of the nose that separates the nostrils. A hanging columella is one that is prominent or hangs down.
I had a rhinoplasty and septoplasty 6 months ago and I still can hardly breathe through one of my nostrils. Is this normal?
Usually by the sixth postoperative month breathing has been restored. Most patients notice improved breathing within a month or so of surgery if they had difficulty breathing beforehand. Have a follow-up visit with your surgeon and ask his or her advice to determine the cause of the problem.
Bitar Cosmetic Surgery Institute
3023 Hamaker Court
Fairfax, VA 22031
Bitar Cosmetic Surgery Institute
8650 Sudley Road
Manassas, VA 20110
George Washington University Hospital
2150 Pennsylvania Avenue
Washington DC, DC 20037