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By Mayo Clinic staff
Rhinoplasty is usually done inside the nose. Your surgeon readjusts the bone and cartilage underneath your skin. The surgeon usually makes cuts inside the nostrils. Sometimes he or she makes cuts in the septum between the nostrils. Then your surgeon separates the skin from the underlying bone or cartilage and mucous membranes, and follows a series of steps to cut, trim or build up (augment) the nasal bone or cartilage.
Your surgeon can augment your nasal bone or cartilage in several ways, depending on how much needs to be added, the structure of your nose and available materials. For small changes, the surgeon may use cartilage harvested from deeper inside your nose or from your ear. For larger requirements, the surgeon can use implants or bone grafting. Bone grafting is a procedure in which bone material (the graft) is inserted into another bone (the host bone) to enhance the host bone.
During the procedure
Rhinoplasty requires local or general anesthesia, depending on the complexity of the surgery and your surgeon's preferences. Discuss with your doctor beforehand which kind of anesthesia is best in your case.
- Local anesthesia. This type of anesthesia is usually used in an outpatient setting and is limited to a specific area of your body. Your doctor injects a pain-numbing medication into your nasal tissues and sedates you with medication injected through an intravenous (IV) line. This makes you groggy but not fully asleep.
- General anesthesia. You receive the drug (anesthetic) by inhaling it or through an IV line — a catheter placed in a vein in your hand, neck or chest. General anesthesia affects your entire body and induces a temporary state of unconsciousness.
After the surgery, you’ll be in a recovery room, where the staff monitors you for any complications. You might leave later that day or, if the procedure is done in a hospital, you might stay overnight.
After the procedure
After the surgery you need to rest in bed with your head raised higher than your chest, to reduce bleeding and swelling. Your nose may be congested because of swelling or from the cotton packed inside your nose during surgery. In most cases, the dressings remain in place for one to seven days after surgery. Your doctor also tapes a splint or plaster cast to your nose for protection and support. It's usually in place for about one week.
Slight bleeding and drainage of mucus and old blood are common for a few days after the procedure or after removing the dressing. Your doctor may place a "drip pad" — a small piece of gauze held in place with tape — under your nose to absorb drainage. Change the gauze as directed by your doctor.
To further decrease the chances of bleeding and swelling, your doctor may ask that you follow these precautions for several weeks after surgery:
- Avoid strenuous activities such as aerobics and jogging.
- Don't swim.
- Don't blow your nose.
- Avoid foods that require heavy chewing.
- Avoid large facial expressions, such as smiling or laughing.
- Brush your teeth gently to limit movement of your upper lip.
- Wear clothes that fasten in the front; don't pull clothing, such as shirts or sweaters, over your head.
In addition, don't rest eyeglasses or sunglasses on your nose for at least four weeks after the surgery, to prevent pressure on your nose. You can use cheek rests, or tape the glasses to your forehead until your nose has healed.
Also, avoid exposing your skin to the sun for two to three months after surgery. Too much sun may cause permanent irregular discoloration in the skin of your nose.
Some temporary swelling, black-and-blue discoloration of your eyelids and numbness can occur for two to three weeks after nasal surgery. Rarely, this may last up to six months, and subtle swelling may take a year to resolve entirely. Ice packs or cold compresses can help reduce swelling and discoloration around your eyes.
Because of the slow healing process, you might not see the final results of your surgery for up to a year.
- Tardy ME Jr, et al. Rhinoplasty. In: Flint PW, et al. Cummings Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa.: Mosby Elsevier; 2010. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-0-323-05283-2..00037-9&isbn=978-0-323-05283-2&type=bookPage§ionEid=4-u1.0-B978-0-323-05283-2..00037-9&uniqId=234039683-2#4-u1.0-B978-0-323-05283-2..00037-9. Accessed Jan. 21, 2011.
- Ramirez AL, et al. Rhinoplasty. In: Lalwani AK, et al. Current Diagnosis & Treatment in Otolaryngology - Head & Neck Surgery. 2nd ed. New York, N.Y.: The McGraw-Hill Companies; 2008. http://www.accessmedicine.com/content.aspx?aid=2833146. Accessed Jan. 20, 2011.
- Becker DG, et al. Reducing complications in rhinoplasty. Otolaryngology Clinics of North America. 2006;39:475i.
- Nose surgery. American Society of Plastic Surgeons. http://www.plasticsurgery.org/Patients_and_Consumers/Procedures/Cosmetic_Procedures/Nose_Surgery_.html. Accessed Jan. 2, 2011.
- Anesthesia and you. American Society of Anesthesiologists. http://www.lifelinetomodernmedicine.com/Who-Is-An-Anesthesiologist/Anesthesia-for-Same-Day-or-Outpatient-Surgery.aspx. Accessed Jan. 21, 2011.
- Harsha BC. Complications of rhinoplasty. Oral Maxillofacial Surgery Clinics of North America. 2009;21:81
- Kim DW, et al. Functional rhinoplasty. Facial Plastic Surgery Clinics of North America. 2009;17:115.
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