Rhinoplasty is usually done on an outpatient basis, for convenience and more affordable costs. It may be performed in a surgeon’s office-based operating room. More complex procedures may require a short inpatient stay.
During surgery, incisions are made to provide access to cartilage and bone. The skin of the nose is separated from its supporting framework and depending on your problem and your surgeon’s preferred technique, the new nose is sculpted to the desired shape. Finally, the skin is redraped over the new framework.
Whenever possible, incisions are made inside the nostrils but for more complicated cases, a small incision is made across the columella, the vertical strip of tissue separating the nostrils. If the nostrils are too wide, incisions are made at the base of the nose.
When the surgery is complete, a splint may be applied to help your nose maintain its new shape. Nasal packs or soft plastic splints also may be placed in your nostrils to stabilize the septum, the dividing wall between the air passages.
Although rhinoplasty usually takes only an hour or two, this operation is difficult to learn and difficult to perform well. A skillful surgeon knows where to make incisions so that they will be practically invisible after healing. With proper technique, scar tissue doesn’t interfere with achieving the desired results. A skillful surgeon also knows where to make incisions to minimize the amount of bleeding during the operation. The surgeon can have better results when there is less bleeding because he can clearly see what needs to be done. An experienced surgeon also knows how to minimize intraoperative swelling. Swelling can make it hard for the surgeon to see what the nose’s final shape will be and what needs to be done during surgery.
Rhinoplasty for Asians
Rhinoplasty performed on Asians has the same goal as rhinoplasty performed on Caucasians, which is to build a natural-appearing structure that blends harmoniously with the face. Usually, Asians require augmentation of the nose, while Caucasians usually require reduction. Southeast Asians (Filipino, Malay, southern Chinese) typically require the most augmentation.
In Filipinos and other Asians, the nasal bridge is often low. The nasal tip is also low and thick, and the base of the nose is wide. Hence the most commonly requested nasal surgery in the Philippines is the “noselift.” Most Filipino plastic surgeons use solid silicone L-shaped implants in order to increase the height of the nasal bridge and to increase the projection of the nasal tip. The bend of the L forms the new tip. The skillful surgeon takes great care in creating the look and feel that is most suitable to your face and features. Implants are individually sculpted to personally suit the shape of your face, resulting in a more “natural” look.
American plastic surgeons generally prefer the use of cartilage grafts or bone grafts to augment the nasal bridge and tip. However these kinds of grafts have been known to resorb and decrease in size over a period of time. Filipino patients also do not want an extra operation on another part of their body in order to harvest cartilage or bone. Also, most American patients request reduction rhinoplasty for large noses and hence American plastic surgeons have less experience performing noselifts.
Many Asian patients will also need an alar plasty operation to decrease the wide nasal base. A skillful surgeon will use a technique to remove small wedges of skin to bring the nostrils closer together and which will result in natural looking nostrils.
Your new nose
The challenge in rhinoplasty is in creating a new nose that will look natural. Your surgeon must have a fine aesthetic sense such that the surgical results of your nose operation will appear natural and unnoticeable. The new nose should look like it “fits” together with the rest of your features. The nose should be symmetrical and nostrils should have a natural curve.
A poorly done noselift can be easily detected by an observer because of the visible outlines of the silicone implant under the skin. The nose is also overly prominent and does not blend in harmony with the contours of the rest of the patient’s face. In a poorly done alarplasty, nostrils look unnaturally narrow when compared to the rest of the nose.
When incisions are inside the nose, there is no visible scarring at all; when an “open” technique is used, or when the procedure calls for the narrowing of wide nostrils, the small scars on the base of the nose are usually not visible.
After surgery, your surgeon will instruct you to stay in bed with your head elevated during the first twenty-four hours. Your face will feel puffy and you may have a headache. Your nose may also ache. Take the pain medication prescribed by your surgeon to control whatever discomfort you feel.
It is common to have a little bleeding during the first few days after surgery, and you may continue to feel some stuffiness for several weeks. Your surgeon will probably ask you not to blow your nose for a week or so, while the tissues heal.
It is normal to have some swelling and bruising around your eyes specially after two or three days. Applying cold compresses will reduce this swelling and relieve some of the discomfort. Most of the swelling and bruising should disappear within two weeks or so.
In the days following surgery, many patients feel depressed because of their bruised and swollen faces. This stage will pass and your spirits will improve as your nose heals.
If you have nasal packing, it will be removed after a few days. Dressings, stitches and splints are usually removed after one week and you can usually return to school or sedentary work within this period.
Although you will feel much better after two days, it may take several weeks before you’re back to normal. Your surgeon will give you guidelines about when you can resume your normal activities. Usually, for two to three weeks after surgery, he will ask you to avoid strenuous activities such as sports or sexual relations as these will increase your blood pressure.
You will also have to be gentle with your new nose. If you wear glasses, you will have to make sure they don’t rest on your new nose until it is completely healed. This will take about six to seven weeks. You should also avoid hitting or rubbing your nose or getting it sunburned.
In the months after surgery, your surgeon will schedule frequent follow-up visits to check on the progress of your healing. In between visits to your surgeon, if you notice anything unusual or have any questions about symptoms, or what you are allowed to do, don’t hesitate to call him.