Rhinoplasty

Rhinoplasty is a procedure of correcting external nasal deformity due to trauma or due to the genetic way the nose is formed, to change the appearance to make this more cosmetically pleasing. Procedures are done generally by incisions made within the nose. 30% of the procedures are done through an open Rhinoplasty approach, which entails incisions on the outside of the nose. These are to afford better visualization of the nasal tip area, to provide the maximum cosmetic result, Incisions are also made on the external portion of the nose, if the nasal is the lateral part of the opening of the nose on each side, is to have the contour changed. Generally, nose bone and cartilage is removed in order to correct deflections, or depressions of nasal bones and/or to remove nasal humps, which are related to cartilage or bony accumulation, either congenitally or what you were born with, or secondary to trauma. These are done the combination of sharp and blunt dissection, nasal rasp, and there are high power instruments available for this purpose as well. The nasal bones in a Rhinoplasty are usually moved into different positions once the defect has been removed, in order to accomplish more pleasing cosmetic results, and this is usually done with osteotomes. This does require breaking of the nose and of course nasal bones that are fractured require two months to completely heal. In the post-operative period, this causes significant facial swelling on occasion, and this can be decreased by use of steroids in the preoperative and post operative period. swelling is also decreased by patients sleeping sitting up and not lying flat for the first seven days post-operatively. Usually paper tape and metal splints are placed on the outside of the nose, as well as silastic splints placed on the inside of the nose. usually secured with a suture.

These splints are usually removed at 7 days post operatively, but can be removed as early as four days depending on the patient and the surgeon’s judgment. Expectation is for facial swelling. There should not be, but can be, complications related to the orbital cavity, sense of smell, but these are very uncommon at less than 1/10th of 1% of the time. Patients are usually seen at 1 week post-operatively,1 month post-operatively,3 months post-operatively, and 1 year post-operatively. These visits, on occasion, will be associated with pictures. Usually pictures are taken preoperatively and post-operatively at 3,6,and 12 months. Most often, if there are any significant defects noted from the scarring or healing process, these are usually corrected by the surgeon under local anesthesia with sedation in the office. The procedures can be done under those same circumstances, but commonly patients request that these are done under a general anesthesia. It should be made clear to the surgeon what type of anesthesia the patient wishes prior to the surgery. It is important that patients be explicit in their discussion with their surgeon about the changes they wish to have made, and that they are comfortable in that they feel that the surgeon is going to be able to accomplish those requests without much difficulty.

It is important that any procedures done on the nose be done in conjunction with each otherwise turbinoplasty or septoplasty, and it is important to try and obtain the desired result in one procedure. Additional procedures are fraught with complications and should be avoided unless necessary. It is then on revision rhinoplasty, that the patient communicates what their desires are and that it be made clear to them that their surgeon can accomplish the goals for which they have asked.