Rhinoplasty, the surgical process of reshaping the nose, is the fourth most common surgical procedure in the United States with more than 200,000 operations performed annually, often on individuals aged 18 and younger. It may be conducted for medically necessity or elective cosmetic purposes. When the procedure is undertaken by a maxillofacial surgeon or ENT surgeon its goal is generally corrective, to address breathing function or to repair damage and physical trauma. When conducted by a plastic surgeon, rhinoplasty (in common speak, a "nose job") is intended to address aesthetic issues and to achieve, most especially in the eyes of the patient, a more pleasing aspect to the features.
There is no widely accepted model of a "perfect" nose and the definition of such varies widely from individual to individual. In primary consultation with perspective rhinoplasty candidates, surgeons work with their patients to cultivate realistic expectations for the surgery's degree of perceived improvement. The size of the nose may be increased or decreased and the tip and/or bridge reshaped. The nostrils may be narrowed, or the angle between the base of the nose and the upper lip altered. Surgeons work with their patients to design changes that work in harmony with the individual's overall facial proportions.
Although attempted since ancient times, intranasal rhinoplasty has been performed since the mid-18th century. The technique is now sufficiently refined that it may be conducted in an outpatient setting or, for more complex work, in a hospital. (Generally with no more than a short overnight stay required.) The decision to use general or local anesthetic is normally made jointly by the surgeon and patient. When a local is used the area around the nose is numbed to insensitivity and the patient receives a mild sedative to reduce anxiety. During the procedure, depending on the nature of the desired alteration, bone and cartilage may be removed, reshaped, or even added with graft material or surgical implants used. The work can be completed in most cases in one to two hours.
Upon completion of the surgery, an external splint made of metal or plastic is used to preserve the newly acquired shape of the nose. Nasal packs may also be required inside the nostrils, but are discontinued in 3 to 5 days. Post-surgical pain and comfort is normal as are headaches and are controlled with pain medications. The area around the eyes will be swollen and bruised for about three days, a problem addressed by keeping the head elevated. Cold compresses are also recommended. Patients should not be alarmed by small amounts of bleeding from the nose initially, but must not pick at or blow their noses for at least a week. Within two weeks of the procedure none of these measures will be required any longer.
Patients are up and around in two days although some who are embarrassed by their appearance may choose to remain at home longer. Many individuals who undergo rhinoplasty are devastated and depressed by their initial appearance, but be assured that there will be daily improvement. In fact, the complete degree of change achieved by the procedure may not be totally evident for as much as a year. After 2 to 6 weeks, however, any remaining swelling will be too slight to be noticed by casual observation. Any kind of strenuous activity or exercise that would raise the blood pressure should be avoided for 2 to 3 weeks after the surgery and sun exposure severely limited for 8 weeks. Sun protection should be applied any time the patient goes outdoors, even on a cloudy day. The face and hair should be washed gently and cosmetics applied sparingly.
As with any procedure where anesthesia is used there is a risk of patient reaction to the medication or breathing problems. The rhinoplasty itself will cause some degree of bruising and bleeding, which raises the risk of infection. There is also a chance for the post-surgical appearance of small burst blood vessels adjacent to the nose that manifest as red spots. Although tiny and considered a minor consequence, the spots are permanent. Because most incisions are made inside the nostrils there is no scarring unless further incisions at the base of the nose have been required, for instance when narrowing the nostrils. These scars are made with extreme caution and are all but invisible to the naked eye.
Managing the reaction of others is a complication of rhinoplasty that can only be controlled by the individual. Family and friends may not like the change and may say unkind things. Even in the preparatory stages of considering rhinoplasty, this is a factor that must be considered. No one should more forward with a surgical alteration of his or her features with anything less that complete certainty that the change is what they want. This is especially crucial when the alteration is meant to change a characteristic considered ethnic in nature, a decision that may not be well-received by others in the same ethnic group. A rhinoplasty patient must be willing to "own" the change and to handle how others may perceive and comment on that change.
Annually Americans spend more than $12 billion on cosmetic procedures that are not covered by their health insurance policies. In cases where rhinoplasty is performed to correct breathing problems or to repair traumatic injury, insurance benefits do apply. (Patients should always confirm this with their individual insurance companies.) The expense of rhinoplasty varies greatly from individual to individual, but in general the range of cost is $4,000 to $12,000.
