A Comprehensive Guide to Rhinoplasty Surgery

Introduction to Rhinoplasty

Rhinoplasty which is often called “nose job” in colloquial terms is a popular plastic surgery performed throughout the world to correct nasal defects. People who want the shape and size of their nose to be changed usually go for this surgery.

nose jobSince nose is the center of the face and the first thing to be noticed about a person, it is apparent that most people who have slight defects want it to be corrected and yet maintain their natural appearance.

Nose reshaping or restructuring procedures improve the appearance of the nose along with adjusting the shape, size, proportion and symmetry considering the overall facial and personality traits of the person.

During a Rhinoplasty procedure, the surgeon makes incisions along various parts of the nose and corrects the internal structure of the nose consisting of cartilages, tissues and tiny bones. The idea is to makes corrections in such way that the nasal profile is adjusted to the desired shape and size.

An experienced surgeon will usually take into account various aspects to the patient’s nose type, personality and ethnic identity, and decides on the best technique and procedure to be carried out in order to get the perfect results.

When a highly reputed and experienced surgeon performs the nose job, it can change the life of the person as they see an overall improvement in the appearance and the nose looks more natural and complimenting to their overall face.

A successful nose job is one which does not leave any scars or weird looking marks on the nose and provides the patient with the confidence for being their true self. If the person gets compliments on his appearance by others but they cannot pin-point what exactly has changed in his personality then we can safely assume that the procedures were a total success.

 

Defects Corrected by Nose Job

Nose job can correct many defects pertaining to the alignment of the nose and the shape or size of the nasal traits. The defects are mainly categorized into two types

Functional Defects – These are the aspects related to the working of the nose and the functions it performs. People with these defects usually face health issues and require immediate medical intervention to ease them of the pain.

Deviated septum is one of those serious issues which lead to a lop-sided nasal profile causing breathing and other respiratory problems to the patient. The septum causes obstruction in the breathing leading to lack of oxygen to the vital organs in the body.

By operating on the tissues, cartilages and nasal bones the surgeon can fix the septum and ease the airflow through the nasal passage. This correction will automatically lead to more straighter and attractive looking nose. It also helps in improving his overall health.

Cosmetic Defects – These are the slight or sometimes more prominent physical features and appearance of the nose which the person wants to correct. These are usually related to how the nose looks and whether the person feels it is congruent with other facial features.

Rhinoplasty surgery is also an aesthetic enhancement surgery where the surgeon makes slight corrections to the nasal profile and improves the overall appearance of the nose.

The defects corrected by nose job are

  • Nasal asymmetry and dislocation of prominent nasal parts
  • Uneven nostrils making the nose look disfigured
  • Upturned, hooked, flat, crooked, celestial, pointed, protruding, drooping nose
  • Visible humps, bumps, depressions and protrusions on the nose
  • Enlarged nostrils with smaller upper nasal structure
  • Bulbous nostrils with excessive volume and flesh with weaker or narrower nasal wall
  • Excessive or too narrow width of the nasal bridge
  • Perforated nasal septum or other damaged internal parts
  • Weaker cartilages and bones leading to drooping and disfigured nose (elderly rhinoplasty)
  • Excessive inflammation of the nasal walls due to allergies
  • Correction of Sinusitis, Asthma, Bronchitis and other respiratory diseases
  • Correcting enlarged and swollen turbinates
  • Nasal polyps growth due to allergies and irritation
  • Radix correction (upper bony portion of the nose)
  • Tip rotation and reduction
  • Projection and nasolabial (area above the upper lips) adjustments
  • Alar base correction to make the nose fit in
  • Deviated septum correction
  • Congenital defects or under-developed nose
  • Tight or closed nostrils creating health issues to the patient
  • Females with male nasal profile and vice versa
  • Wounds, injuries or fractures caused by accidents
  • Any foreign objects stuck inside the nose
  • Failed or unsatisfactory primary nose job

 

Medical Terms Used By the Surgeons

The medical fraternity is known for using some words and terms which goes beyond the understanding of a common man. This makes the entire discussion meaningless to that person. To avoid this scenario and to prepare you for the upcoming consultation sessions we have created a list of common medical terms used during Rhinoplasty.

  • Rhinoplasty – Surgery to reshape or restructure your external nose and internal nasal parts
  • General Anesthesia – Administration of gas through a mask to make the patient unconscious
  • Local Anesthesia – Numbing agents injected in and around the place where surgery is to be performed.
  • Intravenous injections – Sedative drugs are injected through the veins to calm to nerves and help the patient relax
  • Deviated septum – misaligned nasal wall separating the nostrils. This causes breathing problems as well as crooked nose
  • Cartilage – Connecting and supporting tissues in the nose
  • Columella – the skin from upper lip to the nasal tip and where incisions are made
  • Cartilage harvesting – Taking cartilages from other parts of the body like rib or ear for supporting the nasal structure
  • Grafting – polishing the cartilage harvested from other parts and transplanting them inside the nasal structure
  • Septal Hematoma – bleeding and pooling of blood in the nasal cavities and area where surgery is done causing severe infection
  • Revision Rhinoplasty – Corrective procedure to make good any mistakes from first surgery

Things to Look for in a Cosmetic Surgeon

Rhinoplasty is an important surgery for your personality and life. It is also a complex surgery requiring an expert hand at work. In order to get the best results possible from the surgery, you have to make sure that you get along well with your doctor.

Before committing with a surgeon for the nose job you have to make sure that you are thoroughly convinced that the surgeon is the perfect person for operating on you and he completely understands what you desire out of this surgery.

Building a good rapport in the initial consultation sessions by interacting with your surgeon will help you to know many things about the surgery, the surgeon’s style, important things that matter during and after surgery etc.

You can ask the surgeon some questions while talking to him. But, you need to maintain the casual tone and not go overboard while interviewing him. You do not want to intimidate him with your constant questioning, which after some time, may seem like interrogation.

Usually the surgeon would have answered these questions many times in the past and created a brochure or pamphlet to be given to the new patients on arrival. The common questions are usually answered here along with highlighting the reputation, experience and past successful surgeries performed by the surgeon. You can go through it to get most of your questions answered.

Some of the questions to ask your surgeon while making the final decision are

  • Are you certified by the American Board of Plastic Surgeons (equivalent board for your country of choice)?
  • The American Society of Plastic Surgeons (ASPS)
  • The American Academy of Facial Plastic and Reconstructive Surgery
  • Are you a permanent member of (country) Medical Association and Medical Professionals?
  • Were you trained in the field of plastic surgery and especially Rhinoplasty?rhinoplasty-surgery-procedure
  • What is the experience you have in nose job procedures?
  • Where would you be conducting the surgery?
  • Does your clinic have license to perform such surgeries?
  • Will you be using the surgical facility of hospitals or other medical centers?
  • Am I fit for nasal surgery?
  • How can I prepare best for the surgery?
  • Which surgical technique are you going to use?
  • Are your methods conservative or radical?
  • How long will it take to recovery completely in my case?
  • What complications may arise during surgery and how will you handle those?
  • What are the changes which can be seen overtime in my nose?
  • What options do I have if I am dissatisfied with the results?
  • Do you provide financing options or discounts for full cash payments?
  • Can I see some before and after pictures of your past Rhinoplasty patients?

 

Am I a Good Candidate for Rhinoplasty?

In order to have a successful nose job you have to check whether you are ready for this change in your physical appearance, your personality and the overall change it will cause in your life.

Expecting unrealistic results will usually lead to disappointment and a vicious cycle of re-examination of your nose by a different surgeon and a revision Rhinoplasty. If you understand the limits of what can be achieved you will usually be very happy with what you get.

Here are some questions which are warning signs for you to stop and reassess your decision. These questions hint more towards your psychological setup, emotional stability, rationality and connection to the reality.

  • Do I want to get the surgery done to look like my favorite celebrity?
  • Am I doing this to please my spouse, partner or someone I admire and want to emulate?
  • Is this surgery purely meant to help me in my career or relationships?
  • Am I over critical about my appearance and always think what others might be thinking about my nose and overall appearance?
  • Do I want a picture perfect nose created by the surgeon?
  • Do I spend most of my day looking at my nose and its shape in the mirror?
  • Do I have emotional balance to live with the current nose that I have?
  • Will I still be happy and satisfied in my life if I do not get this nose job?
  • Am I still a teenager who is going through the growth phase?
  • Have I gone through multiple cosmetic surgeries in the past?
  • Am I attaching all my failures and disappointments to the defect of nose?

If you said ‘yes’ to any of the questions above, it shows that, to some degree, you are relating your self-worth to the shape of your nose. While, getting a nose job done to look better is not wrong, it shouldn’t become an obsession or a meter to measure your beauty and personality.

You would be a perfect candidate for Rhinoplasty if you expected just a minor change in your nose and would want to retain the uniqueness of your nose pertaining to your ethnicity. Of course, some nose jobs require a complete reconstruction and makeover in order to make the nose look normal, but most cases require just a minor adjustment.

You will be most happy and contended after your nose job if your expectations are realistic and understand the limitations of Rhinoplasty surgery.

 

Preparation for a Successful Nasal Procedure

Rhinoplasty procedure will be successful when the patient discloses his medical history to the surgeon and all the steps go smoothly without any complications.

The patient should block out at least two weeks from his schedule for the surgery. The entire operation will be done within a few hours and the patient will be given discharge within a day.

The patient has to maintain a good and healthy diet to be physically healthy and sustain the stressful event of surgery. He should maintain proper nutrition to speed up healing after surgery. He should eat plenty of fruits and vegetables, whole grains and lean protein. Vitamin supplements of A and C are usually recommended by the doctors.

Smoking and drinking alcohol should be avoided before and after the surgery for at least a few weeks. This may slow down healing or may create undue complications during the surgery. Any herbal medication or supplements should also be stopped or discussed with the surgeon to take his consent for consumption.

Surgeons also warn against certain foods which can cause surgical complications and are known to be blood thinners. These make it hard for the blood to clot and keep wounds fresh after the surgery. The surgeon may also prescribe certain additional supplements if he finds your pre-surgery tests are not up to the mark.

The patient should maintain a proper sleep cycle and get plenty of rest before and after the surgery. He should also maintain proper hygiene and avoid any makeup or other creams before coming to the surgical facility.

During the initial phases of the surgery the patient should remain calm and follow instructions. Placing trust in your surgeon’s ability will help immensely in remaining relaxed throughout the surgery.

Recovery phase is as important as the surgery itself. After the surgery the patient is given many instructions for proper and speedy recovery. He should record everything sincerely and follow the advice to the T.

 

Rhinoplasty Techniques

There are many types of Rhinoplasty surgeries which vary according to the requirements of the patient. But, the surgeon typically uses either of the two techniques while performing these surgeries.

Open Rhinoplasty – This procedure involves making incisions along the columella and making adjustments or reshaping. The overlaying skin on the nose is raised and secured and the surgery is performed.  This gives the surgeon visual access to the inner structure of the nose. This has an advantage of ease, perfection and total control over the other technique.

Closed Rhinoplasty – This procedure involves making incisions inside the nostrils. The scars are hidden and the recovery is faster than the open technique. But, this is difficult when compared to the prior.

The technique chosen for the surgery is left at surgeon’s discretion. He decides which one would be the best option for the case and the goals of the surgery.

Types of Rhinoplasty Surgeries

Nose restructuring surgery can be divided into various types depending on the goals to be achieved.  Some of them are

Reduction Rhinoplasty – This surgery is performed to address bumps or humps on the nose along with reshaping the nose to fit in to the overall face. Any excessive features like elongated nose tip, bulbous nostrils, excessive width of the nasal bridge and voluminous nose are corrected through this surgery.

The doctor removes small amounts of cartilages, bones and tissues from the nose to cause the reduction in the size and contours of the nose.

Augmentation Rhinoplasty – This is the opposite of the prior type. The surgeon adds volume and cartilages to places which either lack volume or have collapsed due to ageing, wound, infection or congenital defects.This procedure usually requires cartilage harvesting and grafting to achieve the desired goals.

The surgeon uses computer 3d programs to simulate the end result. Dermal injectable fillers may also be used to achieve the desired increase in shape and size. This is a non-surgical approach to Rhinoplasty.

Ethnic Rhinoplasty – This is a procedure performed for individuals based on their racial and ethnic characteristics. It refers to people from African American, Afro-Caribbean, Asian, Hispanic, Middle Eastern and other racial origins.

This surgery requires a thorough understanding of the unique facial contours of the racial type. They should then be matched with the desires of the patient and a delicate approach should be adopted to bring about the changes while maintaining their uniqueness.

Reconstructive Rhinoplasty – This is a complex surgery where the patient has lost most or all parts of the nose due to some infection, cancer, accident, wound or other serious conditions. The surgeon has to make usetypes-of-rhinoplasty-surgeries of grafting procedures for skin and cartilages, flap techniques and other advanced methods.

This procedure calls for multiple surgeries over a period of time to get the exact results. This specialized operation may prolong over several months and also has to be done by a highly experienced surgeon.

Post Traumatic Rhinoplasty – This surgery is done for people who have suffered an injury to the nose causing functional as well as cosmetic damage.The doctor may have to fracture the nose to set it right and help the patient breathe freely with a proper looking nose.

It is advisable to visit the doctor immediately after the injury. If the patient delays, the body will start its natural course of healing and create further damage to the weakened septal structure.

Teenage Rhinoplasty – This is a surgery meant for the adolescents. The doctors usually recommend them to wait until they are adults when their nose is fully grown. But some cases require surgical intervention to correct health issues or trauma to the nose.

Unlike a normal adult surgery, this operation requires the doctor to take extra care of the tender nose structure of the young patient and also make him/her feel at ease while consultation sessions and operation.

Elderly Rhinoplasty – This procedure is carried out for people whose nose is degenerating due to old age or other degenerative diseases. Our body has a natural capacity to replenish the dead cells and tissues with the new ones. But as the body ages, it loses its capacity.

The nose will start losing its shape and volume and may look distorted.The surgeon can make corrections either through cartilage grafting or through dermal fillers to add volume and shape and create a normal looking nose.

Revision Rhinoplasty – This is also called secondary nose job where the imperfections of the first nose job are fixed. A Revision procedure may not include a full-fledged operation but may be completed by using dermal fillers. The surgeon may use this to complement the primary surgery and fill in the areas on the nose which require minute changes.

 

Cost of Nose Surgery

The costs vary widely depending on various factors and the type of Rhinoplasty surgery to be done. Each case is unique posing new and complex challenges to the surgeon. The cost of surgery will usually be in the range of 900kd to 3000kd.

The surgeon may make use of advanced technology to achieve perfection and reduce recovery time. Newer and improved methods may cost more for the patient.

The costs are directly proportional to the experience of the surgeon. Higher the reputation and experience of the surgeon, more will be the fees. The physical location of the surgical facility will also make a difference in the overall costs. A surgery in metro city will cost you more than one in a smaller town.

During the surgery any emergency procedure carried out to contain the situation from going out of control will also add up to the overall costs.

An overview of expenses is given below

  • Surgeon’s fees
  • Surgical staff and support staff fees
  • Anesthesiologist fees
  • Operation theater and surgical unit fees
  • Hospital room and other facilities availed
  • Clothing, gowns and other special facilities
  • Pre-surgery medical tests
  • Prescription of medicine
  • Seeking expert advice on complex cases
  • Emergency procedures for surgical complications
  • Transportation to and from the surgical unit
  • Visa, air fare and domestic traveling for foreign patients
  • Service tax of the hospital
  • Health care tax levied by local authorities
  • Miscellaneous expenses

 

Arrangement of Funds for Nose Surgery

  • Saving: Nose job requires you to plan in advance and save up funds. The expenses will vary depending on the complexity of your case and the procedures required. Therefore, it is wise to have a buffer stock of funds to meet any contingency. Setting aside a certain amount every month for a period of time will help you pay without creating any burden of debt in the future.
  • Insurance Coverage: Insurance companies provide health policies which can be tapped into to fund these surgeries. But, you have to be aware of their clauses and terms of settlement of claim. Having a discussion with your insurance agent will help you know exactly what will be covered and what is not. Most insurance providers do not cover cosmetic surgeries. Surgeries done for functional and health reasons are usually covered. However, you need to make sure whether it will be partial or umbrella coverage. This means, whether the insurance company will cover only the costs involved in surgery and fees of the surgeon or will it cover the entire amount that went into your Rhinoplasty surgery.
  • In-House Financing: A reputed surgeon will help the patient by availing various financing options. The patient can pay the amount in a few installments for either a small interest rate or no interest.Some reputed clinics have a tie-up with banks and other financial institutions for providing financing for the surgery. They can help you get the loan quicker at a lower interest rate or sometimes zero interest financing.
  • Bank Loan: This is another option where you can directly approach a bank and take a person loan citing the reason. You may have to do a bit of research on whether your country’s bank gives loans for overseas procedures. You may also approach the bank in the country where you are going to have the surgery done. Depending on whether you are eligible for a loan you can make certain calculations on whether a loan in domestic country or foreign country will be beneficial to you through currency exchange rates.
  • Full Cash Payment: Most clinics give their patients discounts on making full cash payments. You will have to discuss it with the clinic staff to see how much you can save by making full payment. If you have the cash available you can settle your dues and get good discount.

 

Detailed Procedure of Nasal Operation

The surgeon may choose to operate on the patient with open procedure or closed procedure. The procedure involved in same for both with only an exception of where the incisions are made.

Step 1: Anesthesia – Once the patient is brought into the surgical theater he is made to feel comfortable by general talks and slight humor while the anesthesiologist prepares the equipment for administration.

The patient may be given either a general anesthesia or a local anesthesia. Usually the doctors prefer general anesthesia as it gives them total control over the patient and help them complete the work without any difficulty.

The patient is made to wear a gas mask through which anesthesia is given. Within a few seconds the patient become unconscious and the surgeon gets the green signal to proceed with his work.

Step 2: Incisions – Depending on the technique, the surgeon either starts making incisions along the columella (the part where the upper lip meets the base of nostrils) or inside the nostrils to access the nasal structure.

The skin is raised and secured with medical clips while other sensitive organs like eyes are secured with protective gear. The flesh is cut through to access the bony part of the nose which is to be operated upon.

Step 3: Correcting Deviations – The surgeon’s first preference will be to correct any functional problems. He corrects the deviated septum and anything which is causing health problems to the patient.

If cartilages or tissues are required to be placed inside the nose to correct the functional problems, the surgeon will harvest them from either an ear or through the right lower rib.

Step 4: Reshaping and Restructuring the Nose – After correcting functional problems, the surgeon heads towards making cosmetic changes to make the nose look beautiful and aesthetically fit in to the overall facial traits.

The surgeon may make use of implants or cartilage and skin grafts to achieve the exact shape and size desired. He may also make small fractures and remove parts of the bone to align the entire nasal structure perfectly.

After the procedure is completed the surgeon secures the new structure with dissoluble medical sutures (threads) while the body adjusts to the new shape and activates its natural healing mechanism.

Step 5: Closing the Incision – The skin is gently brought back to its original place and secured with medical stitches. Splints are placed within the nostrils and also over the nose to protect the newly created structure. Bandages are placed beneath the nostrils to soak blood and fluids oozing out.

Any protective gear is removed and the patient is ready to be shifted to the room. The anesthesia effects will gradually wear out and the patient comes into full consciousness.

Step 6: Recovery and Follow up – The recovery period will take anywhere from a few weeks to a full year. The nose will gradually take the new form where the skin is adjusting to the internal structure.

The patient is required to visit the clinic for follow up sessions where the surgeon will check the progress and give prescriptions for medication.

 

Recovery Period for Rhinoplasty

The recovery begins after the patient is given discharge. Many instructions are given to the patient to be followed religiously in order to have speedy recovery.

For the first week there will be fluids and blood oozing out of the nostrils. The patient is required to frequently clean the blood and keep the area clean to avoid any kind of infection. The fluid should not be allowed to accumulate inside the nostrils as this might lead to crystallizing and causing more damage to the delicate inner structure.

The head should be rested on an elevated place and should be above the rest of the body. This helps the blood flow to be on the lower parts of the body and not cause pressure on the head and nose.

The medications are prescribed which should be taken properly while maintaining healthy diet with lots of fresh fruits and vegetables. The body should be given complete rest for the first few weeks when it is at its weakest.

The patient is advised to avoid any kind of strenuous physical activity during the first few months as this will lead to increase in the heart rate and corresponding faster breathing through the nose. The delicate structure which is still healing may be ruptured by this pressure and bleeding may occur internally.

After a month or two when the surgeon gives his consent, the patient can resume his day to day activities with low intensity exercise and aerobic activities. The nose will take shape and will be fully recovered by the end of the year.

Click here to read more on Rhinoplasty Recovery

 

Alternative to Rhinoplasty Surgery

Non surgical Rhinoplasty is a cosmetic surgery which does not create any incisions and scars on the patient’s nose. It is a non-invasive procedure done to correct minor defects and deformities of the nose.

non-surgical rhinoplastyThe surgeon makes use of dermal filler agents to be injected into the lower regions of the nose. The filler comes pre-packed with a hypodermal needle and syringe which are used to access the subcutaneous regions of the nose.

This procedure gives temporary results and is completely safe for most of the patients. Only the highly skin-sensitive may be required to have a test before deciding if the injection will work safely. Only the FDA tested and approved injectable fillers are used in the treatment.

Most dermal fillers are hyluronic acid based or calcium based. These are widely used filler agents. Some of the popular dermal fillers are Juvederm, Restylane, Voluma, Perlane and Radiesse.

Liquid medical grade silicone is also used through a microdroplet technique by the surgeons over multiple sessions. The gel is injected in small quantities over a period of time to get the desired results.

The patients who are wary of Rhinoplasty surgery or want just a minor adjustment can go for this alternative route.

 

Risks Involved in Nose Job

Although Rhinoplasty is a safe procedure and the surgeons take utmost care while operating on the nose there remains some degree of risk which has to be taken into account before opting for the surgery.

The risks involved are explained to the patient and his consent is sought before beginning the procedure.

Some of the risks involved are

  • Severe reaction to anesthesia
  • Allergy to medication, chemical smells and surgical instrument
  • Internal bleeding causing hematoma
  • Infection in and around the place of surgery
  • Numbness in and around the nose
  • Uneven healing and scars left behind after surgery
  • Perforation of nasal septum while operating
  • Swelling around the eyes and cheeks
  • Slow recovery
  • Results not par with the desired level
  • Possibility of a revision Rhinoplasty

 

Final Remarks on Rhinoplasty Procedure

Nose job is one of the common procedures done throughout the world for correcting many defects of the nose. With the advancements in the field of medical technology and continuous improvements in the surgical procedures, plastic surgeons are now able to make laser precision correction with reduced down-time.

If you are unhappy with the shape or size of your nose consult with the nearest surgeon and book an appointment for discussing the options that you have for correcting the defect.

Many people around the world have found new hope in their career, relationships and life in general due to improved physical appearance. A virtuous cycle sets in where there are improvements in all areas of their life and ultimately they lead a happy and fulfilled life.