Nose Surgery (Rhinoplasty): Are You a Candidate?
Reviewed by Yael Halaas, MD
If you are unhappy with the size or shape of your nose, a nose job (rhinoplasty) may help.
Many things can affect the look of your nose. Perhaps you were born with a bump, hook or drooping nasal tip, or an accident or injury may have changed the shape of your nose. Aging, too, can take its toll on the appearance of your nose. For some, a nose job can correct a functional issue such as breathing difficulty due to a deviated septum.
If you are considering rhinoplasty, consult with a board-certified facial plastic surgeon. During this visit, you can discuss your aesthetic and/or functional goals. You must explain what you hope to get out of your nose surgery to achieve the best results.
Do you want to improve your breathing?
Are your concerns purely cosmetic?
Or perhaps, you are looking to enhance your identity with ethnic rhinoplasty?
You may also want to correct a previous nose surgery with revision rhinoplasty.
Come prepared to your consultation. Bring photographs of celebrities whose noses you like and even those that you don't. These can help your surgeon better understand your goals. Remember that just because a button or ski-slope nose works on your favorite actress does not mean that it will complement your face. Trust in your surgeon's expertise. Before pictures of your nose will likely be taken during this visit, and some surgeons may also use computer imaging technology to show you how your new nose may look before your actual nose surgery.
Your surgeon will also review your medical history to determine if you are a good rhinoplasty candidate. Tell your surgeon about all the medications you take on a regular basis, including dietary and herbal supplements. If you smoke, quitting before your nose surgery is important. Smoking impedes your healing because it compromises blood flow to the skin. This can affect both your cosmetic and functional results. If you are having trouble kicking the habit on your own, ask your surgeon for guidance.
You should develop a preliminary game plan for your nose surgery during this visit. This includes information on the type of rhinoplasty, incision pattern, and anesthesia. If your surgeon feels that rhinoplasty may not address your concerns, he or she may suggest other procedures that can be performed in addition to or in place of rhinoplasty, such as chin augmentation surgery to better balance your facial features. You will also discuss rhinoplasty risks and rhinoplasty cost during this visit.
If you decide to go forward with rhinoplasty, the next step is your preoperative visit. This is another chance to ask questions and go over your goals with your surgeon. Your surgeon will likely give you a list of preoperative instructions.
The instructions will include detailed information on the specific medications you need to avoid before nose surgery such as non-steroidal anti-inflammatory drugs (NSAIDs), which increase the risk of bleeding. Certain vitamins and herbal preparations such as Vitamin E, gingko biloba, omega-3 fatty acids and green tea may also be on this Do Not Take List because they increase bleeding risks. Don't stop taking any medications without first discussing it with your doctor.
Some surgeons may suggest homeopathic therapies to minimize bruising and swelling such as Arnica Montana or bromelain. In addition, some surgeons also prescribe steroids before a rhinoplasty to decrease the initial swelling.
Drinking alcohol is also discouraged in the week or so before nose surgery. Alcohol can impair the healing process. In general, there is no eating or drinking after midnight on the evening before your rhinoplasty. You may need routine blood work and a physical exam before your nose surgery.
Follow these preoperative instructions carefully. They are for your own good.
The Rhinoplasty Procedure
Most rhinoplasties are performed as an outpatient procedure. The surgery can take anywhere from one to three hours to perform depending on the type of rhinoplasty that is performed.
Rhinoplasty is usually performed using local anesthesia with intravenous sedation, or general anesthesia. A revision rhinoplasty may involve general anesthesia because it is often a more complicated surgery, while a filler rhinoplasty that is performed using injectables only requires local anesthesia.
On the day of your nose job, your surgeon or members of his or her staff will start an intravenous (IV) line to administer fluids and medications. You will also be hooked up to monitors to track your vital statistics, and you may be given an oral sedative to keep you calm.
Next your surgeon will make the incisions. During a closed procedure, incisions are hidden inside the nose. In an open nose procedure, the incision is made in the vertical strip of skin separating the nostrils (the columella). The surgeon then raises the soft tissues that cover the nose through these incisions so he or she can reshape your nose.
After the reshaping, your nasal skin and tissue are redraped and the incisions are closed. Your surgeon may apply nasal packing to help reduce swelling and bleeding after your nose surgery.
Facial Plastic Surgeons and Plastic Surgeons
Most facial plastic surgeons do their residency training in otolaryngology (head and neck surgery), followed by fellowships in facial plastic surgery. Plastic surgeons do their residency training in general surgery followed by a fellowship in plastic surgery.
Plastic surgeons should be certified by the American Board of Plastic Surgery. Facial plastic surgeons should be certified by the American Board of Facial Plastic and Reconstructive Surgery. Board certification assures you that your surgeon has had extensive training and is up to date on new technology and techniques.