The Face: Rhinoplasty or Refinement of the Nose

Cosmetic nasal surgery (rhinoplasty) is performed to bring the nose into harmony with the face, thereby improving overall appearance. There is no standard procedure for rhinoplasty. It is important for the surgeon to take into account those nasal features the patient would like changed and then to carefully examine the nose and overlying skin. With this information, the surgeon and the patient can discuss the nasal features that can be realistically modified to obtain the desired result. Often there is an underlying deviation of the nasal septum (the cartilage and bony structure that support the nose and separate it internally into two sides), which causes difficulty in breathing. If this condition is present, it is corrected at the time of surgery.

The surgery is performed primarily through incisions inside the nose. If external incisions are necessary, the scars are small and inconspicuously placed. During the procedure, the surgeon separates the skin of the nose from the underlying bone and cartilage, reshapes the bone and cartilage, and allows the natural elasticity of the skin to reshape over the new framework.

The surgery can be done under local anesthesia with intravenous sedation or general anesthesia in the outpatient facility. The patient can return home or to a hotel the day of surgery, provided he or she is under the care of a responsible adult.

Commonly performed procedures include removing a hump on the bridge of the nose, narrowing the nose, refining the nasal tip, and correcting a deviated septum. Chin augmentation may be suggested to further enhance the facial profile in selected patients. (See facial contour section.)

At the conclusion of the procedure, a small splint is placed over the nose for support and to reduce swelling. The external splint is removed on the fifth to seventh postoperative day. Rarely packing is needed for one to two days.

Swelling and bruising around the nose and eyes is expected for three weeks. Although most of the swelling subsides in four to six weeks, there continues to be some swelling that may take six months or longer to subside. Swelling inside the nose can persist for several weeks and cause nasal stuffiness.

In rare cases, an infection can occur and delay the healing process or result in the development of scar tissue. Other problems that can temporarily occur during the postoperative healing phase include bleeding and a diminished sense of smell. It is important to remember that healing continues for some time following surgery as the skin shrinks and adjusts to the new framework.

Rarely, the final result may not be what the patient and surgeon anticipated. Minor irregularities usually can be corrected with a revision procedure. The quality of the skin overlying the nasal cartilage is an important factor in the final appearance of the nose. Thick and oily skin does not conform as well and may compromise the result. Older skin does not possess the elastic properties of younger skin and may preclude an optimal result.

Following rhinoplasty, the nose has an improved aesthetic appearance as it blends into the face. The improved appearance of the nose is long-lasting.