RHINOPLASTY

Also known as: Nose-job

Procedures
Face
Breast
Body
Hair
Non Surgical

Indication

Primary Rhinoplasty

This is surgery for reshaping of nose in a patient who has never undergone nasal surgery before.

Indications of Primary Rhinoplasty :
1. Congenital defects like secondary cleft lip nose deformity
2. Traumatic disruption of normal structure of nose so that the nose is asymmetrical.
3. Purely cosmetic reasons like hump correction, length correction, or for decrease in height of nose etc.
4. Correction of structural as well as functional deformity (deviated nasal septum with crooked or off-center dorsum , or damaged valves)
5. Nasal tip ; drooping, rotating, boxy, bulbous or bifid.
6. Excessively flared or pinched nostrils

Secondary Rhinoplasty

A secondary rhinoplasty or "revision rhinoplasty."  is corrective nasal surgery that serves to alter the form and/or function of the nose after a previous rhinoplasty.Secondary aesthetic and reconstructive nasal re-shaping is indicated for cosmetic or functional deformities not properly treated or made worse from the primary operation.


Patients request secondary rhinoplasty to address specific imbalances that persist, are newly created, or that have become more severe. Often the nose is imbalanced or in disharmony with the rest of the facial features due to an un-anticipated healing complication, improper, or incomplete surgical manoeuvres.

Common Indications for Secondary Rhinoplasty:

  • Nasal airway obstruction
  • Collapse of cartilage or nasal bones
  • Artificial cosmetic appearance to nose ("Overdone nose job")
  • Internal and external nasal valve collapse
  • Worsened asymmetry
  • Over reduction or inadequate reduction of dorsal height (bridge height/hump)
  • Incomplete shaping (not enough of a cosmetic change)
  • Excessive or inadequate tip projection
  •  Excessively narrowed nasal tip ("pinched tip")
  • Excessive internal and/or external scarring (thickened scar tissue)
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What does the procedure achieve?

Rhinoplasty (Greek: Rhino = nose + Plasty = to shape), commonly known as a nose job, is a plastic surgery procedure for correcting  the form (shape), restoring the function (breathing),  and aesthetically(cosmetically) enhancing the nose. 

While there is no one ideal nose that is suitable for all face types, having the rhinoplasty procedure done can deliver dramatic results for individuals who wish to improve the appearance and function of their nose. Aesthetics isn't the only reason people undergo rhinoplasty. Traumatic injuries to the nose, some types of cancer or birth defects can lead to decreased function of the nose, making breathing difficult, painful or even impossible without corrective surgery.

Contraindication

Any adult (>18 years of age) with perceived aesthetic issues or birth defect can opt for it. As the nasal cartilage is growing till the age of 18 years it is advisable to delay any corrective surgery of nose till this time. In extreme cases where there is severe breathing difficulty, it can be performed at 14 - 16 years of age.. Regardless of the reason for surgery, we recommend that girls wait until age 14 or 15, and that boys wait a few additional years to undergo rhinoplasty. By this time, the nose should have finished growing.  An emotionally mature and cooperative patient is also an essential requirement for a successful rhinoplasty.

Apart from this age criteria, any person who is medically and mentally healthy can be a suitable candidate for rhinoplasty.

Consultation

First and foremost, is a detailed consultation to know about patient's desires and expectations, to evaluate the patient's nose and to discuss the procedure, down time and expected/unexpected complications with the patient. Your expectations and goals need to be appropriate and thoroughly discussed with your surgeon. It may be helpful to bring in photos of your nasal appearance prior to your previous operation.

In patients with nasal skin of average thickness, small imperfections in the underlying nasal skeleton remain hidden and are difficult to detect. However, in patients with ultra-thin nasal skin, even small skeletal imperfections can become visible and spoil the cosmetic outcome. For this reason, the thin-skinned rhinoplasty patient is regarded as among the most challenging in cosmetic nasal surgery. At the other end of the spectrum, in patients with thick skinned noses, any changes made in the osteocartilagenous skeleton of the nose may not be clearly visible on the outside as they are hidden by the thick skin.

Anaesthesia

Rhinoplasty can be performed under local anaesthesia with local nerve blocks with or without sedation or under general anaesthesia.

Time For Procedure

Depending on the extent and nature of procedure a nose job may take as less as 1 hour, but in most cases may take upto 4 hours.

In preparing for a rhinoplasty, you may be asked to:

  • Get lab testing or a medical evaluation
  • Proper evaluation is then done by an anaesthetist as the surgery is usually done under general anaesthesia. Depending on the patient's age and medical history and the nasal architecture, tests including blood investigations, chest X-Ray and CT scanof the nose are done.
  • Take certain medications or adjust your current medications
  • Completely stop smoking at least a week prior to your surgery
  • Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding and bruising.

Rhinoplasty can be done through a "closed" or "open" approach. Closed rhinoplasty is when only internal incisions (endonasal) are made for access to the nasal structures. Open rhinoplasty refers to the addition of an incision in the skin bridge between the two nostrils (columella) in order to lift up the nasal skin for more direct visualization of the structures to be altered. Typically, if there are major structural changes required, an open approach may be preferred. Minor contour corrections can be performed via a "closed" technique. The decision to use either the closed or open approach in revision rhinoplasty is based on surgeon preference and each technique has its pros and cons.

Cartilage grafts (portions of cartilage from the septum, ear, or a rib) are often necessary to accomplish the cosmetic and functional goals in secondary rhinoplasty. It is very common for the primary procedure to have depleted much of the nasal cartilage. A lack of septal cartilage is the most common indication for needing ear or rib cartilage sources for graft material. These segments of cartilage are then shaped into structural and shaping pieces for use in the nose. Alternatively, artificial silicone implants may be used in some cases for enhancing the nasal projection or to refine the nasal tip.

Certain breathing problems (such as a crooked / pinched nose /post traumatic deviation or collapse) need reshaping of nose as well as straightening of septum. This procedure is called Septo-rhinoplasty which can improve both appearance and function.

 

The nose is supported by tapes and nasal splint. The nostrils may be packed following septo-rhinoplasty. Patients are advised to maintain head high position and apply cold compresses on the cheeks and eye areas to reduced swelling and bruising.

Patients must avoid bending down, probing their noses,facewash and any strenuous activities until advised by the doctor. In case of persistent sneezing or coughing, inform the surgeon immediately.

Minor corrections are done on Day care basis. Patients undergoing rhinoplasty where nose packing is not needed or no rib cartilage is harvested, usually need only overnight hospital stay. Patients undergoing extensive surgery and/or rib cartilage harvest usually need 2 days till nose remains packed and donor site pain is decreased/tolerable in cases.

The external sutures are commonly removed on day 5 to 7. The internal dissolving sutures will get absorbed by themselves. The nasal pack is removed in 24-48 hours, depending on extent of surgery and surgeon preference. The nasal splint is maintained in position for 10-14 days.

Patient should not use spectacles (eye glasses)and avoid exercises for 4-6 weeks

The actual result of the surgery become evident over time as the swelling resolves. The overall change becomes apparent by 3 months. But the nose may take as long as one year to settle down completely.

Complications

Rhinoplasty is usually a safe surgical procedure, but as with any surgery, things can go wrong. The most common risks during a rhinoplasty procedure are excessive bleeding or an adverse reaction to the anaesthesia. Another risk regarding cosmetic rhinoplasty is that you may be unhappy with the result and may need revision surgery. Asymmetry, possible recurrence of deformity and difficulty in breathing are other possible complications.

One must wait atleast six months to one year as healing from previous surgery continues for long time. Swelling takes long time to settle in the nose. Once swelling and stiffness of tissues settle completely that is the time when one should intervene.