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Rhinoplasty
By Mayo Clinic staffMayo Clinic Health Manager
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Definition
Rhinoplasty (RI-no-plas-tee), also referred to as nose surgery, is a surgical procedure that can shorten or lengthen the nose, change its shape or contour, narrow nostrils, or lift and define the tip.
When planning rhinoplasty, your surgeon considers your features, the skin on your nose and what you would like changed. The upper portion of the nose is bone, and the lower portion is cartilage. Rhinoplasty can modify bone, cartilage or both. Talk with your surgeon about what rhinoplasty can achieve for you.
Why it's done
Rhinoplasty can:
- Straighten the bridge of the nose
- Reshape the tip of the nose
- Reduce or add to the overall size of the nose
- Change the angle between the nose and upper lip
Rhinoplasty can also repair defects following an injury, correct a birth defect or improve some breathing difficulties.
Risks
As with any major surgery, rhinoplasty carries risks such as bleeding, infection and an adverse reaction to the anesthesia. Other possible risks specific to rhinoplasty include:
- Recurring nosebleeds
- Difficulty breathing through the nose
- Numbness in and around the nose
- Possibility of an uneven-looking nose
- Pain, discoloration or swelling that may persist
- Scarring
Talk to your doctor about how these risks apply to you.
How you prepare
Before scheduling rhinoplasty, you must meet with your surgeon to discuss important factors that determine whether the procedure is likely to work well for you. This meeting generally includes:
- Your medical history. Your doctor asks questions about conditions you have or have had, as well as any current medications. If you have a bleeding disorder, such as hemophilia, you may not be a candidate for rhinoplasty.
- A physical examination. Your doctor conducts a complete physical examination, including any laboratory tests, such as blood tests. He or she also inspects your skin and the inside and outside of your nose. The physical exam helps your doctor determine what changes need to be made and how your physical features — for example, the thickness of your skin or the strength of the cartilage at the end of your nose — may affect your results.
- Photographs. Someone from your doctor's office takes photographs of your nose from different angles. Your doctor uses these photos for before-and-after assessments, reference during surgery and long-term reviews.
- A discussion of your expectations. You and your doctor should talk about your motivations and expectations. He or she explains what rhinoplasty can and can't do for you and what your results might be.
Before rhinoplasty, you may also need to:
- Avoid certain medications. Avoid medications containing aspirin or ibuprofen (Advil, Motrin IB, others) for two weeks before and after surgery. These medications may increase bleeding. Take only those medications approved or prescribed by your surgeon.
- If you smoke, stop smoking. Smoking slows the healing process after surgery.
- Make arrangements for the day of the surgery. For the first 24 hours after sedation, you may have lapses of memory, slowed reaction time and impaired judgment. Therefore, arrange for someone to drive you home if you're having an outpatient procedure. Also, arrange for a family or friend to stay with you a night or two to help with personal care tasks as your recover from surgery.
What you can expect
Rhinoplasty is usually done inside the nose. The surgeon readjusts the bone and cartilage underneath the skin. The surgeon usually makes cuts inside the nostrils. Sometimes he or she makes cuts in the septum between the nostrils. Then the 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.
The surgeon can augment the nasal bone or cartilage in several ways, depending on how much needs to be added, the structure of the nose and available materials. For small changes, the surgeon may use cartilage harvested from deeper inside the nose or from the 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 the 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 this type of anesthesia 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 will 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.
Results
Very slight changes to the structure of the nose — often measured in millimeters — can make a large difference in how your nose looks. Most of the time, an experienced surgeon can get results both of you are satisfied with. But in some cases, the slight changes aren't enough, and you and your surgeon might opt for a second surgery for further refinements. If this is the case, you must wait at least a year for the follow-up surgery, because the nose can undergo changes during this time.
- Tardy ME Jr, et al. Rhinoplasty. In: Cummings CW, et al. Otolaryngology: Head and Neck Surgery. 4th ed. Philadelphia, Pa.: Mosby; 2005. http://www.mdconsult.com/das/book/body/113181920-3/0/1263/414.html?tocnode=49542906&fromURL=414.html#4-u1.0-B0-323-01985-4..50048-4_1754. Accessed Dec. 9, 2008.
- Ramirez AL, et al. Rhinoplasty. In: Lalwani AK, et al. Current Diagnosis and Treatment in Otolaryngology: Head and Neck Surgery. 2nd ed. New York, N.Y.: The McGraw-Hill Companies; 2008. http://accessmedicine.com/content.aspx?aid=2833146. Accessed Dec. 9, 2008.
- 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_consumers/procedures/Rhinoplasty.cfm. Accessed Dec. 10, 2008.
- Anesthesia and you. American Society of Anesthesiologists. http://www.asahq.org/patientEducation/anesandyou.htm. Accessed Dec. 15, 2008.
