The medical term for a ‘nose job’ is rhinoplasty and it is one of the most common cosmetic surgeries that take place. Reshaping the nose can be done for cosmetic reasons, but many times the surgery will help to improve breathing and other nasal functions. There are many different processes that happen during a rhinoplasty, each one being unique and specialized for the patients needs.
Rhinoplasty will change many things about a person’s face, beyond just the size and shape of the nose. The entire facial profile will look different, even if only slight adjustments were made to the nose, the nasal passages, or the bridge of the nose. A nose job can change or correct several different nasal issues from a wide range of causes.
One Patient’s Experience with Rhinoplasty (Performed by Dr. Modricai Blau)
There are different types of rhinoplasty surgeries; open, closed, secondary, and filler rhinoplasty. Here is a listing of the different procedures and why they are different.
- Open Rhinoplasty – This procedure is done by making incisions into the strips of skin that separate the nostrils, which are called the columella. In this procedure the incisions are done externally. The skin and tissues are lifted up so the surgeon can get a clear view of the underlying nasal structure. This type of rhinoplasty is done for major reshaping.
- Closed Rhinoplasty – Less invasive than the open procedure, this surgery is done for only minor reshaping. The incision is hidden inside of the nose and then the skin is separated from the bone and cartilage, allowing from reshaping to happen. In this procedure there is less cutting, less scarring, a shortened operating time, and shorter recovery period.
- Secondary Rhinoplasty – This procedure is also referred to as revision rhinoplasty and is only done to correct problems that were created or developed after a previous surgery. These types of surgery can be done open or closed depending on the severity of corrections that need to be made.
- Filler Rhinoplasty – This non-surgical procedure is done by injecting fillers into the nose. This process will help to smooth out angles, restore symmetry, or make the nose appear smaller. This is not a permanent process as the body will absorb the filler over a window of time. Occasionally surgeons will use these fillers to smooth out any irregularities after an open or closed procedure.
Another Patient’s Experience with Rhinoplasty (Performed by Dr. Kim)
How do You Want Your New Nose to Look?
The first step after deciding that rhinoplasty is what you want to do is to talk to your doctor. There are many things that need to be taken into consideration to determine if you are a good candidate for the procedure. Your doctor will want to take photographs of your nose, face, and profile from many different angles. It is important that you are up front with your ideas and expectations so your doctor can confirm if what you want is possible.
Before going to see the surgeon it is a good idea to start looking at noses that you find appealing. Cut out pictures and bring samples of what you like with you. This way your doctor will have a clear idea of your ultimate vision. Your doctor should also be able to show you pictures of their previous patients that had similarly shaped noses and what their before and after shots look like.
Many surgeons can also show you a computer program of what your nose will look like once the procedure is completed. These programs are never 100 percent accurate, but they are a remarkable piece of technology that can give you a good idea of the direction you are headed.
Your surgeon might suggest that you look at other facial reconstruction procedures while getting the rhinoplasty. This isn’t because they are trying to get more money from you; rather they are working to create facial symmetry. Changing your nose can change the complete structure of your face and throw other features out of balance. Many patients often undergo a chin augmentation at the same time as rhinoplasty to create that perfect balance and symmetry in the facial features.
When meeting with your surgeon you need to give a full medical history which could include not only your physical health, but also your psychological health as well. It is important to be honest and forthcoming with your surgeon to help determine the right procedure for your overall wellbeing. Your motive for wanting rhinoplasty is an important key in helping the doctor determine the best procedures to use going forward.
Prior to the surgery your doctor will most likely require specific guidelines to be followed. Most often people are not allowed to eat or drink starting the night before the surgery. Smokers should also quit smoking as soon as possible before going in for rhinoplasty. Smoking can lead to serious complications like blood loss and longer recovery. Drinking alcohol for up to week before the surgery is often prohibited as well, as alcohol will interfere with healing.
If you are taking any medications or are on prescription drugs it is important that you share this information with your doctor. Some medications will need to be stopped before the procedure. But don’t stop taking any medications before discussing it with your physician first. This is also true for vitamins and herbal supplements that you may be taking. Some vitamins and herbs can increase bleeding risks so consult with your surgeon on everything you take on a daily basis.
A primary rhinoplasty procedure typically takes an average of two hours. A revision or secondary, on the other hand, can take much longer. The length of the surgery really depends on the specific procedure being done.
Most often the patient is put under general anesthetic, but it can also be performed while under a local anesthetic. The local anesthetic is typically a mixture of epinephrine, to stop swelling, and lidocaine for numbing. This mixture is injected directly into the area, which also helps to decrease bleeding.
From there the surgeon will separate the skin and soft tissue from the nasal framework. That gives them access to the nasal structure and allows for reshaping to happen. Once the reshaping is complete the incisions are sutured and often there is an external or internal stent applied. The nose is wrapped and taped to help prevent movement of the nasal area.
Some rhinoplasty procedures require a cartilage or bone graft to be preformed. These grafts are done to strengthen the nasal passages. The cartilage is typically harvested from the septum, but might also be taken from the rib cage, or ear, if there isn’t a sufficient amount of cartilage available in the nasal passages.
Rhinoplasty can be done as an outpatient procedure or it could require a short hospital stay. Either way, once the patient is clear to go home, rest and recuperation are required. Patients are expected to spend at least one week resting with little activity. After that initial time, patients can start to venture outside. It is common for patients to be on several prescribed medications during recovering, including antibiotics, pain relievers, and occasionally steroids.
Immediately after the surgery patients are often uncomfortable. The ability to breathe through the nose will be difficult during at least the first twenty four hours. Swelling will happen and most often pain from this can be alleviated with simple pain medication. After about forty eight hours most patients are able to stop taking pain killers.
There will be a certain amount of bleeding that happens for the first few post surgery days. Often doctors will suggest a cold compress to lessen swelling and help stop bleeding. It is also important to keep the head elevated for at least the first twenty four hours.
The week following rhinoplasty it is necessary to avoid any potential trauma to the face or nasal area. This can include blowing your nose, which should not be done for the first few weeks. Often this leads to discomfort, but most patients are able to find relief from decongestants.
The healing and recovery time frame most often follows this pattern:
- External sutures are, most often, removed four to five days after the surgery.
- Stents are removed anywhere from four days to two weeks depending on the speed of the recovery process.
- Bruising around the eyes, often called ‘panda eyes’, typically clears up in two weeks.
- Up to a year after the surgery the tissue in the nose will continue to settle.
There are many complications that can happen from a rhinoplasty procedure, but since it is one of the top four cosmetic procedures performed, it is considered relatively safe. Of course, as with any surgical procedure there is a risk of death and other serious complications. For rhinoplasty, the risks run a wide range of possibilities, anything from and allergic reaction, to breathing complications, to dissatisfaction with the results, and even death are all possible. Most complications are rare, but it is still good to know what the potential issues are:
- Bleeding – Considered uncommon any bleeding usually clears up on its own, without medical intervention needed.
- Infection – Also rare, especially when taking antibiotics after the procedure. Problems arise when infection is not caught and ends up turning into an abscess. This requires surgical drainage.
- Scars – Occasionally scars can develop inside of the nasal passageways, which can lead to obstructed breathing. This type of scarring can require further surgeries to remove the scar tissues.
- Breathing Issues – Post surgery can leave nasal obstructions that weren’t there before the procedure. This can make breathing difficult and can often result in further surgeries being necessary.
- Deformity– If too much of the nasal framework has been removed it can cause a weakening of the external nasal skin. This leads to several different types of deformities.
- Polly beak: where the skin becomes shapeless and looks like the beak of a parrot.
- Saddle nose: where the bridge of the nose sinks in.
- Porcine or pig nose: when the tip of the nose can is overly rotated leaving the nostrils too visible.
- Pinched tip: if the nose tip can is overly adjusted.
- Numbness – If incisions are made incorrectly this can lead to numbness, which may or may not go away.
- Septum Perforation – If the septum is accidently perforated this can lead to chronic nose bleeding, whistling breathing, or a crusting over of nasal fluids.
- Stiffness – Occasionally, nerve damage can lead to stiffness in the upper lip. Most often this goes away on its own, but it can be permanent.
- Irregularities – It can take up to a year for the nose to settle after surgery. During that time there can be contour irregularities that can often be corrected with filler.
- Graft Migration – If a bone or cartilage graft is part of the procedure, these can migrate after the healing process, which means they slide out of place.
- Necrosis – The skin or tissue around the incision side can die and fall off.
- Heart and Lung Complications – Often called deep vein thrombosis, this happens when a blood clot develops in the body. This can cause a block in blood flow. It can be painful and life threatening.
Most of these issues are rare and the best way to prevent complications is to work with a highly trained, board certified plastic surgeon. Make sure that you follow all of their pre-op and post-op directions and you will be less likely to have problems.
The average cost of rhinoplasty is about $6,000 all inclusive. There are several fees that need to be considered into the overall cost of rhinoplasty. These fees include anesthesia, operating room costs, and the surgeon’s fees. Overall most procedures fall between $5,000 and $7,000. A secondary surgery can be over three times that amount because it is more complex; while filler procedures could be as low as $200. Obviously, the results of these procedures are very different.
Typically health insurance will only cover these costs for a medical reason, like breathing being obstructed, and not for cosmetic reason. Plastic surgeon’s offices are usually helpful in determining if your insurance will help to cover costs.