Rhinoplasty: The Rundown

According to the ASPS, cosmetic rhinoplasty is the third most common plastic surgery procedure. In 2016 ASPS revealed that Americans spent over $1 Billion on cosmetic rhinoplasty. This means that despite it being quite a daunting procedure, the certified professionals are capable of pulling it off. 

Rhinoplasty is a surgical solution aimed at correcting either functional or medical issues of the nose. Bone, cartilage, skin or all three are modified to change size, shape and even proportions . A rhinoplasty is quite different from a septoplasty. A septoplasty corrects septum issues. The septum is the wall separating the nostrils. 

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Complicated Procedure

It may seem simple because it is an outpatient procedure requiring little recovery time but it is actually very complicated. See, the nose is a three-dimensional feature smack in the middle of the face. Add that to the fact that even a millimeter of change will cause a significant shift in appearance and/or function. Another issue is that there really is no standard way to perform a rhinoplasty. Each situation requires a custom plan. In some cases, the anesthesia may cause swelling making it harder to determine the extent of change. So caution must is paramount in choosing the surgeon who performs the procedure. One must also be very sure of their need for the surgery if it is cosmetic. 

Types of Rhinoplasty

There are two major types of rhinoplasty, cosmetic and medical. A nasal deformity warrants a corrective rhinoplasty if it is preventing proper breathing. The deformity may be a birth defect or from an injury. The injury may cause a deviated or otherwise deformed septum thus causing a blockage in the airway. Nasal vestibular stenosis is another common medical reason for a rhinoplasty. This is a case where the sides of the nose cave inwards making the airways too narrow for proper breathing. Everyone has had turbinate issues at some point in their lives. This makes an enlarged inferior turbinate a very common medical reason for a rhinoplasty. The turbinate is a screen that filters the air we breathe. Swollen inferior vestibular tissue compromises the airway and deters breathing.

Cosmetic surgery comes in four general classes. The first is open rhinoplasty. In this case, the surgeon cuts the columella vertically. This is the slip that separates the nostrils. The flap of skin is lifted to give a good view of the nasal anatomy. There is also a closed procedure where incisions are made inside the nose. The skin is separated from the nasal frame to allow adjustment. Then there is a secondary rhinoplasty which is like a procedure to correct a botched operation or to enhance a previous rhinoplasty. It is best to go for the secondary rhinoplasty a year or longer after the first one. One surgeon says that the nose can change a lot over one year which might take away the need for a secondary rhinoplasty. The final class is the filler rhinoplasty where there is a use of injectable elements to correct sharp angles. 

Why Do A Cosmetic Rhinoplasty?

A cosmetic rhinoplasty may be done to correct the radix which is the upper bony part of the nose or to straighten a crooked nose. It may also be used to correct the tip of the nose by manipulating the rotation. Rotation is the upward or downward turn o the nose. The projection of the nose is the distance from where it meets the upper lip to the tip. This distance affects the seize appearance in proportion to other features. The width might also be the problem which is corrected by manipulating the pyriform aperture. This is the nasal triangle and correction is done by making angles steeper. 

Consulting Phase 

The first meeting with the surgeon will involve some the medical history. The doctor will ask about nasal obstruction and previous surgeries. The doctor will also need to know about bleeding disorders. A bleeding disorder might disqualify one from being a rhinoplasty candidate. After which, the surgeon might suggest something different manipulate the appearance. Then comes laboratory tests and a physical exam. The doctor will need to know about the thickness of the skin and the strength of the cartilage. See, these will be paramount to the results of the surgery. They will help determine the surgery plan. The doctor will also look at the impact the surgery might have on breathing. 

Then photographs will be taken from different angles. The doctor might then use computer software to come up with different possibilities. Some surgeons are against this and say that the human touch is much better. The pictures will help segue into goals and expectations. At this point, it is helpful to be as open as possible about the motivation for wanting the surgery. The doctor should be very open about the patient’s expectations and how these match to reality and practicality. 

Be Ready for a Rhinoplasty

Abstain from aspirin, ibuprofen or any other drugs that could potentially increase bleeding. This should be done two weeks before and after the rhinoplasty. Also, stop smoking. This slows down the recovery process. There will be some medications prescribed, do not mix those with alcohol or other meds. The latter should be discussed with the doctor. 

Rough Idea of the Operation

Anesthesia will be used for the procedure. General anesthesia is administered by IV or inhalation. One will be unconscious and will sleep through the whole thing. There is also an option of local anesthesia. This is done by numbing the nasal tissue then one is sedated. Depending on the kind of procedure it is, the surgeon might harvest cartilage from deeper in the nasal anatomy. If larger pieces are required, they will be harvested from the ribs or other parts of the body. 

Upon Discharge

Within two weeks of the rhinoplasty, you should begin to feel more like yourself. The swelling will have gone down and there will be nary a sign that something was done. The surgeon will attach a nasal splint that will stay for around five days. There will be very minor swelling that might last up to six months but it will be negligible. There might also be some slight bleeding or mucus secretion. One will be provided with a drip pad in the form of gauze taped under the nose. Change it as directed and all should be well. 

Recovery

After the surgery, you should organize for transport as you will be allowed to leave later in the day. There is a small chance that you might stay overnight but only if there are slight complications. The anesthesia might cause some memory lapse, impaired judgment and slow reaction time. You might also suffer some throat discomfort if you were put under general anesthesia. This is because of the breathing tube. So also organize for someone to stay a night or two to help you out if this happens. According to a doctor at the Cleveland Clinic, these are very rare. One is however advised not to make any life-changing decisions within 24 hours of the surgery. There will be swelling so limit the sodium, but do not ice it. One surgeon suggested that the best time to get a rhinoplasty is in the cold seasons as recovery time is shortest then. 

Stay away from strenuous activity until after two weeks or a month. Any form of strain can be detrimental to healing. Take a bath and not a shower. Wear clothes that fasten at the front instead of those requiring you to pull them over the head. This should prevail at least until the splint is removed. 

Surgeon Selection

A rhinoplasty can be one by a plastic surgeon, facial plastic surgeon or otolaryngologist. He or she must be board certified. They must be experienced and skilled. Ask to see their previous work in the form of before and after pictures. You can go to RateMDs.com, Vitals.com or HealthGrades.com to find reviews and information about great surgeons. The surgeon should also have a great reputation. You should also ensure to get an accredited facility. Although, a study by the ASPS revealed that some people had their rhinoplasty done in mobile ambulances in 2017. 

How Much?

It takes between an hour and two to get a rhinoplasty done. The full cost includes anesthesia, facility fees, medical tests, post-op garments, prescriptions and surgeon’s fee. If there is the need for a secondary rhinoplasty, it will be an additional cost if it is done by a different surgeon. If done by the same, the surgeon’s fee might be waived. 

A 2017 study by the American Society of Plastic Surgeons revealed that the average cost of a rhinoplasty is $5,125. This is exclusive of anesthesia, facility fees, and other related expenses. New York is one of the most expensive places to get a rhinoplasty. The cost might go as high as $15,000. You should find out if the health insurance covers the procedure. If a cosmetic rhinoplasty may be joined with a corrective one. It is assumed that the whole procedure was corrective and might, therefore, be covered by the insurance. 

Is It Worth It?

There is a chance that one might suffer nosebleeds and deterred breathing. One might also suffer permanent numbness. The outcome might be an uneven nose. There could also be pain and scarring. In some extreme cases, there could be a septal perforation. 

The benefits of the corrective rhinoplasty are pretty obvious. A corrective rhinoplasty will increase self-esteem. It will improve facial aesthetics and enhance the natural beauty. It might even positively affect the professional life. Most people report a less than 4 on a 0-10 pain scale. There is also a relatively short recovery time. So yes, it really is worth it.

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