Rhinoplasty (cosmetic surgery of the nose, or nose job) is one of the most frequently performed facial plastic procedures. The term Rhino-Plasty is a combination of two words: rhino meaning nose and plasty means to reshape. Cosmetic rhinoplasty is one of the most challenging and artistic procedure in the field of plastic surgery. The purpose of cosmetic nose job or rhinoplasty should be a nose that appears and feels natural, and is in harmony with the rest of the face without having an “operated-on” look.
Many unattractive features of the nose can be improved by rhinoplasty also known as a nose job surgery. This procedure can reduce the width, hump, length, or tip of a nose making it narrower, straighter, shorter, and cuter. Functional problems beside the aesthetic problems of a nose can also be fixed at the same. Deviated nasal septum may cause breathing problems that can be fixed by a septoplasty. Once rhinoplasty and septoplasty is combined to fix the aesthetic and functional part of a nose, then it is called septorhinoplasty. Nose job is indicated for men and women once they pass the age of sixteen. Many teens choose to fix their nose prior to attending college.
Mild bruising is common after a nose job. However both the doctor and the patient can drastically reduce the extend of it. An experienced surgeon will utilize special techniques to minimize nasal trauma in order to reduce bruising. The patient also needs to follow the preoperative and postoperative instructions very closely. Stopping all the blood thinners and starting on some herbal medications like Arnica Montana one week prior to the nasal surgery will significantly reduce the extend of bruising during recovery.
Not all revision rhinoplasties require cartilage grafting. It depends on the shape of the nose and how much cartilage and tissue was removed during the initial rhinoplasty. If cartilage grafting is required to reconstruct a nose during revision rhinoplasty, the surgeon has three options to obtain the cartilage. The first option is nasal septum cartilage, the second option is the ear cartilage and the last option is a rib cartilage graft.
During the initial week, a nasal cast with tape dressing will cover the nose to protect it. There may be mild bruising around the eyes which will typically subside after a week. Internal nasal swelling may lead to clogged nose which will be resolved in one week. Head elevation and icing will help to alleviate the swelling and bruising. Expert rhinoplasty surgeon familiar with modern techniques in nasal surgery usually do no pack the nose any longer. There is minimal discomfort during the first few days that can be managed be pain medications. One week is usually sufficient time to return social activities and light duty work.
A nasal bump also known as a dorsal hump is made of two components: bone and cartilage. A small bony hump can be treated by filling down the bone without breaking it. In some cases “non-surgical” rhinoplasty can help to reduce the appearance of the bump. Fillers like Radiesse are used to fill areas above the hump to camouflage its appearance. This method is quick and inexpensive, but the results only last about a year. However, large dorsal humps require a rhinoplasty to trim both the cartilage and the bone by breaking it (osteotomies), in order to create an aesthetically pleasing nose. Even if osteotomies are performed during a rhinoplasty, it is well tolerated procedure and it is less painful than it seems like.
It is certainly not normal to have frequent nose bleeds after a nose job. If you did not have any bleeding before your surgery, then there are several contributing factors causing that:
1-Septal perforation after rhinoplasty
2-Deviated nasal septum leading to chronic dry nose
3-Foreign bodies like sutures and grafts causing infection and bleeding
4-Bone and cartilage fragments
5-Excessive inferior turbinate resection
6-Thinned nasal mucosal lining
7-Occurrence of abnormal prominent blood vessels
You need to be evaluated by an experienced ENT or Facial Plastic Surgeon for proper treatment. It may require a simple treatment like moisturizing the nose or cauterization of blood vessels or more complex surgeries like septoplasty and repair of septal perforation or removal of foreign bodies.
A crooked nose is caused by trauma or is due to congenital deformities. In order to fix a crooked nose, an expert rhinoplasty surgeon must initially identify the cause of it. The following anatomical structures are contributing factors causing the nose to appear crooked: nasal bone, nasal septum, and nasal tip. The best way to correct a crooked nose is by an open rhinoplasty technique. Using this approach can straighten the crooked nose as well improve the breathing problems. Most often portion of the procedure is covered by insurances.
A revision rhinoplasty is referred to a procedure that corrects a nasal deformity or breathing issue when results from prior surgery are not satisfactory. You need to choose a surgeon who is experienced and expert in revision rhinoplasty, just being board certified surgeon is not sufficient. There are some board certified surgeons who are inexperienced rhinoplasty surgeons and end up having too many bad nose jobs.
It is very normal and expected to have swelling following rhinoplasty. This swelling happens both inside and on the outside of the nose. Two weeks following cosmetic nasal surgery, patients are in general ready for social appearance. About 80% of swelling after a nose job subsides less than 30 days after surgery. The remaining 20% of swelling will take about 9 months to a year to subside. Initial icing over the cheeks and sleeping slightly elevated during the first few days will help to reduce swelling and to expedite healing process.
Resuming normal activity after nose job will depend upon the extend of the surgery and should be gradual. However, as a general rule most rhinoplasty surgeons recommend the following:
A) Resuming light activities such as cooking, walking, reading, climbing the stairs can be started 2nd day after surgery.
B) Moderately intense activities such as aerobic exercises, running, biking, sexual activities can be resumed two weeks after surgery
C) Heavy lifting and intense activities such as playing tennis, basketball, or volleyball must not begin until two months post op, this time allows the bone to heal properly.
Each rhinoplasty surgeon may have different guidelines and recommendations regarding postoperative air travel restrictions. In general, most surgeons remove the nasal splint in one week and allow their patients to fly. The main risk or complication related to flying following rhinoplasty is bleeding. This is mostly caused by changes in air pressure. To prevent bleeding and nasal congestions during travel, nasal decongestions sprays like Afrin are recommended.
Like any other type of surgical procedure that require general anesthesia, rhinoplasty patients must have someone to drive them home and bring them back to the office for checkups. During the first three days, most patients are on pain medications and driving during this period is prohibited. Most rhinoplasty surgeons allow their patients to drive after 3-5 days.
The downtime following nose job varies depending on how much work is done and what rhinoplasty techniques are performed. For example if osteotomies are performed (breaking nasal bone), longer swelling and bruising is expected. Revision rhinoplasties require longer recovery time. Usual downtime with nose job is about one week. Most people return to work or school after one week. People with jobs requiring heavy lift are encourage to take at least 10 days off work.
If you are feeling depressed after your rhinoplasty, you are not alone. In fact, this is quite normal! Many patients have periods of let down immediately after cosmetic surgery procedures. They begin to second guess and question themselves whether they made the right decision. They begin to feel that with all the bruising and swelling, they look less attractive that before. As the swelling and bruising subsides and you’re in the road to recovery, these negative thoughts will dissipate very quickly. If you feel “let down”, understanding that this is a normal process of the healing may facilitate you to deal with it. However, if your sadness continues to be present weeks after your surgery, you must talk to your surgeon.