Rhinoplasty

The term rhinoplasty means "nose molding" or "nose forming," a procedure in plastic surgery in which the structure of the nose is changed. The change canbe made by adding or removing bone or cartilage, grafting tissue from anotherpart of the body, or implanting synthetic material to alter the shape of thenose. This procedure is often called a "nose job."

Rhinoplasty is most often performed for cosmetic reasons. A nose that is toolarge, crooked, misshapen, malformed at birth, or deformed by an injury can be given a more pleasing appearance. If breathing is impaired due to the formof the nose or to an injury, it can often be improved with rhinoplasty.

The best candidates for rhinoplasty are those with relatively minor deformities. Nasal anatomy (structure) and proportions (size) are quite varied and thefinal look of any rhinoplasty will be a combination of the patient's anatomyand the surgeon's skill.

The quality of the patient's skin plays a major role in the outcome of rhinoplasty. Patients with extremely thick skin may not see a definite change in the underlying bone structure after surgery. On the other hand, thin skin provides almost no cushion to hide the most minor of bone irregularities or imperfections.

Rhinoplasty should not be performed until the pubertal growth spurt is complete--between ages 14 to 15 years for girls, and older for boys.

The cost of rhinoplasty depends on the difficulty of the work required and onthe specialist chosen. Prices run from about $3,000 to more than $6,000. Ifthe problem was caused by an injury, insurance will usually cover the cost. Arhinoplasty done only to change a person's appearance is not usually coveredby insurance.

During the initial consultation, the patient and surgeon will determine whatchanges can be made in the shape of the nose. Most doctors take photographs at the same time. The surgeon will also explain the techniques and anesthesiaoptions available to the patient.

The external nose is composed of a series of interrelated parts which includethe skin, the bony pyramid, cartilage, and the tip of the nose, which is both cartilage and skin. The strip of skin separating the nostrils is called thecolumella.

Surgical approaches to nasal reconstruction are varied. Internal rhinoplastyinvolves making all incisions inside the nasal cavity. The external or "open"technique involves a skin incision across the base of the nasal columella. An external incision allows the surgeon to expose the bone and cartilage morefully and is most often used for complicated procedures. During surgery, thesurgeon will separate the skin from the bone and cartilage support. The framework of the nose is then reshaped in the desired form by removing bone, cartilage, or skin. The remaining skin is then replaced over the new framework. Ifthe procedure requires adding to the structure of the nose, the donated bone, cartilage, or skin can come from the patient or from a synthetic source. When the operation is over, the surgeon will apply a splint to help the bones maintain their new shape. The nose may also be packed, or stuffed with a dressing, to help stabilize the septum.

When a local anesthetic is used, light sedation is usually given first, afterwhich the operative area is numbed. It will remain insensitive to pain for the length of the surgery. A general anesthetic is used for lengthy or complexprocedures or if the doctor and patient agree that it is the best option.

Simple rhinoplasty is usually performed in an outpatient surgery center or inthe surgeon's office. Most procedures take only an hour or two, and patientsgo home right away. Complex procedures may be done in the hospital and require a short stay.

Patients usually feel fine immediately after surgery; however, the first daythere will be some swelling of the face, and patients should stay in bed withtheir heads elevated for at least a day. The nose may hurt, and a headache is not uncommon. The surgeon will prescribe medication to relieve these conditions. Swelling and bruising around the eyes will increase for a few days, butwill begin to diminish after about the third day. Slight bleeding and stuffiness are normal, and vary according to the extensiveness of the surgery performed. Most people are up in two days, and back to school or work in a week. No strenuous activities are allowed for two to three weeks.

Patients are given a list of postoperative instructions, which include requirements for hygiene, exercise, eating, and follow-up visits to the doctor. Patients should not blow their noses for the first week to avoid disruption of healing. It is extremely important to keep the surgical dressing dry. Dressings, splints, and stitches are removed in one to two weeks, and patients shouldavoid sunburn.

Any type of surgery carries a degree of risk. There is always the possibilityof unexpected events, such as an infection or a reaction to the anesthesia.

When the nose is reshaped or repaired from inside, the scars are not visible,but if the surgeon needs to make the incision on the outside of the nose, there will be some slight scarring. In addition, tiny blood vessels may burst,leaving small red spots on the skin. These spots are barely visible, but maybe permanent.

About 10% of patients require a second procedure.

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