Nose Job Procedure
Rhinoplasty is a procedure in which the shape of the nose is re-contoured. These changes can include reducing the size of a bump on the bridge of the nose, narrowing the bridge of the nose, narrowing the tip of the nose, or reshaping the nasal tip. A disproportionately large or unattractively shaped nose will draw attention away from the other facial features. The ideal result after rhinoplasty creates a natural-appearing nose that complements and enhances other facial features.
The rhinoplasty consultation provides patients with the opportunity to express their desired goals for surgery, to gain an appropriate expectation for the outcome of surgery and to understand the postoperative healing process. Patients have the opportunity to ask any questions they may have. At the end of the consultation, patients should have a better understanding of the process and feel comfortable with the surgeon and the planned results.
From the surgeon’s perspective, it is important that we have a good understanding of what changes you hope to achieve through surgery. If there are functional breathing problems that need to be addressed, this will also be reviewed. A history of prior nasal injuries or surgeries, known medical conditions, and medication usage should be provided during consultation.
After examining the nose and understanding your desires, we will have a discussion about what types of changes should be made and what are realistic expectations for the surgical outcome in your particular case. Imaging software helps to demonstrate the goal of your rhinoplasty surgery. In our office we use the Canfield mirror imaging program and 3-D Vectra program. With these imaging devices, we attempt to show a result that is realistic and appropriate for you. Importantly, imaging does not provide the actual exact result. Instead, it represents a planned goal we strive for and helps patients get a sense of what their new nose will look like. Preoperative imaging also helps to ensure that the patient’s and the surgeon’s goals are aligned.
Rhinoplasty Consultation – New Jersey – Dr. Robert Glasglod
Preparing for Rhinoplasty Surgery
Approximately two weeks prior to surgery, patients have a preoperative visit where they meet with a nurse or medical assistant who reviews what needs to be done in preparation for the rhinoplasty as well as the necessary postoperative care. This visit is also an opportunity to review the goals with your surgeon and ask any questions that you may still have. Prior to surgery, you will also be reminded to avoid the use of blood-thinning medications such as Motrin, Advil, products that contain aspirin, as well as homeopathic medications or supplements that may have a similar effect. A list of the items will be provided to you at the preoperative visit.
Rhinoplasty patients are instructed to use a prescription topical antibiotic ointment just inside the nostril starting one week before surgery and continuing for one week after surgery. Additional prescriptions will also be provided at the preoperative visit, including pain medications and antibiotics as needed.
Open Versus Closed Rhinoplasty Techniques
Rhinoplasty can be performed through either an open or closed (endonasal) approach. In our practice, almost all surgeries are performed through the open technique. An open approach combines the use of incisions inside the nostrils with an additional small incision that is well hidden in the columella (the skin between the nostril openings). The advantage of the open technique is that it provides better visualization of the underlying nasal structure with the ability to more effectively and precisely re-contour the nose.
Reshaping the upper portion of the nose (aka the bridge or dorsum) involves alterations in the bone and cartilage. When reducing a bump, the bone and cartilage components can be shaved down. In instances where the dorsum needs to be elevated, this can be accomplished either with the use of cartilage grafts or implants. Reshaping the nasal tip requires alterations of the cartilaginous structural components that are responsible for the external appearance of the tip. Depending on the desired changes in the nasal tip, the tip cartilages can be altered by removing excess cartilage that is responsible for a wide-appearing tip, suturing the existing cartilage to change its shape and adding cartilage to strengthen areas that are weak or to create a more defined nasal tip shape.
The addition of cartilage in the nose is termed “cartilage grafting” and is important tool for reshaping the nasal tip. The open technique allows precise placement and suture stabilization of these grafts. The preferred source of cartilage for the grafts is the nasal septum; this involves removing a non-structural component of the septum and creating the necessary grafts from it. When there is an inadequate source of septal cartilage (usually due to patients having prior septoplasty and/or rhinoplasty surgery), auricular (ear) or costal (rib) cartilage can be used.
Open vs Closed Rhinoplasty – New Jersey – Dr Alvin Glasgold
Your Rhinoplasty Surgery
Rhinoplasty surgery is performed at one of three locations – our accredited in-office surgical suite, an out-patient surgery center (University Surgicenter in East Brunswick), or at Robert Wood Johnson University Hospital in New Brunswick. The location of surgery will be determined based on several factors, including the type of anesthesia needed and whether functional breathing issues need to be addressed. The surgery can be performed under general anesthesia or with intravenous sedation. If the surgery is performed under general anesthesia, the rhinoplasty surgery will be performed at the surgery center or hospital. The type of anesthesia used will be discussed at the consultation and is dependent on the type of procedure being done, the patient’s preference, and the age of the patient.
Length of Rhinoplasty Surgery
The length of surgery is usually three to four hours. After the surgery is completed, patients rest in the recovery room for approximately two hours before they are discharged home. Recovery room time is shorter if the surgery is performed under intravenous sedation. Patients need to be accompanied by a family member or friend who will drive them home from surgery. Patients must also plan on having someone stay with them until at least the morning following surgery.
After surgery, there will be tape and a small medal splint on the bridge of the nose. Additionally, there is a small gauze pad (drip pad) that is taped under the nostrils after surgery. You will be provided extra gauze and instructed on how to replace it. Unlike the bandage on the nose, the drip pad is changed as needed. The frequency of changing the gauze lessens over the course of the first few post-operative days. Many patients find that within 48 hours drainage has reduced to the point where the gauze does not need to be replaced. The first postoperative visit will be at 6 or 7 days after surgery at which time the tape, splint, and sutures will be removed. In most cases, there are just three sutures in the columella that need to be removed. All other sutures are dissolvable. Once the bandage is removed, make-up can be applied as desired.
Following surgery, there are varying degrees of bruising and swelling. Bruising tends to occur under the eyes, and most bruising resolves within 7 to 10 days. Postoperative swelling usually peaks a few days after surgery and will then begin to decrease. When patients have their dressing removed, they will be able to appreciate the change in their profile. At one week after surgery, however, it is common for the nose to look wider than expected on front view due to swelling. The appearance of the nose will narrow as swelling dissipates.
Most patients are comfortable returning to work or school by ten days after surgery; However, this is just an estimated time frame, due to individual variations in healing time. It is important that patients inform us of any significant events they may have scheduled following surgery so that we can adequately discuss their expectations for recuperation and recovery time.
After the first postoperative visit, patients return for their second visit in one month. At this time, patients have experienced significant progression in the healing process. However, there is still some swelling in the nose at this time. Subtle changes and decreases in the swelling will gradually occur over many months.
Patients can return to full strenuous activity three weeks after surgery. The primary area of caution in the months following surgery is to avoid a deep tan or sunburn to the nose, as this will cause nasal swelling. Judicious use of strong sunblock is recommended.