Rhinoplasty Surgery & Facial Aesthetics
The purpose of nasal surgery, including both rhinoplasty (aesthetic nasal surgery, or nose job) and septorhinoplasty (functional nasal surgery) is to improve the appearance and function of the nose. Aesthetically speaking, facial appearance is created from many different aesthetic components of the face. The eyes, nose, lips, chin, and hair all contribute to one’s overall facial appearance. Balancing these components will provide an overall pleasing appearance to the face – an appearance that we refer to as “harmonious.” When one of these components stands out from the rest and becomes abnormal, it can change the overall harmony of the face often causing dissatisfaction. If one’s nose is proportionally too big, too small, too crooked, or otherwise unpleasing, it may detract from one’s overall facial appearance and appear to stand out.
When this imbalance becomes bothersome to a patient, it is a good time to discuss surgery. The goal of surgery is to restore overall facial harmony by sculpting the nose to a more pleasing size and shape, resulting in a natural, well-proportioned nose. A result that looks overdone, or “surgical,” will continue to distract from one’s overall facial harmony. Specific ethnic traits should be preserved at the patient’s request. The ultimate goal is to retain your natural, original look and have your nose fit better into your overall facial harmony.
Cosmetic versus Functional Nasal Surgery
The nose has both an aesthetic and a functional purpose. These two aspects are correlated and both will be discussed in every rhinoplasty consultation. The term “rhinoplasty” is generally used to describe surgery of the nose related to the aesthetic component. The term “septorhinoplasty” is generally used to describe the functional aspect of nasal surgery, because it refers to surgery on the septum of the nose. The septum is a leading cause of nasal airway obstruction and breathing difficulties. In reality, these terms are used quite interchangeably.
Many patients present with only complaints of breathing difficulty, with no concern of the way their nose looks aesthetically. It is possible to assess, and treat, patients with isolated breathing difficulties without altering the look of the nose. Alternatively, surgery can be done to change the look of the nose without addressing the functional component. Any patient presenting for consultation regarding aesthetic rhinoplasty will also be assessed for breathing issues to ensure an overall excellent result.
The Psychological Aspect of Rhinoplasty
The appearance of one’s nose and how it fits into overall facial harmony can become distressing for many people. The majority of patients considering rhinoplasty say they have been thinking about undergoing surgery for a long period of time, but haven’t had the courage to go through with it. Many worry about what others will think of them when they have cosmetic surgery.
Creating a more harmonious facial appearance through nasal surgery can allow a patient to have a better sense of self, an increased quality of life psychologically, and more self-confidence. It is true that undergoing elective surgery requires an investment in terms of time, courage, and money. But once patients understand what surgery can accomplish and what surgery entails, they are often reassured and decide that they can do it. The goal is to make you look better and more natural each and every day for the rest of your life.
Another fear that patients often present prior to surgery is, “Will undergoing surgery be worth the final result? What if I’m unhappy after surgery?” The best way to avoid being unhappy after surgery is to find a doctor you’re comfortable with and to make sure that he or she clearly understands your concerns regarding your nose. Additionally, it is important that you understand what can, and cannot, be accomplished through surgery. As long as you feel that you are on the same page with your surgeon regarding these aspects, then your chances of being satisfied are very high. Your ultimate satisfaction requires thoughtful and thorough discussion with your surgeon in addition to a good doctor-patient relationship.
Changing the Appearance of the Nose
The ultimate goal of aesthetic rhinoplasty surgery (also known as “nose job”) is to make your nose feel more harmonious with the other features on your face. There are many different aspects of the nose that can be altered to achieve a more pleasing appearance. The nose can be made smaller, bigger, narrowed, shortened, or lengthened depending on your specific concerns. The tip of the nose can be better defined, rotated up, rotated down, or treated so that it doesn’t get pulled down when you smile. If your nose is crooked, it can be made straighter and overall symmetry can be improved. The profile (side view) of your nose can also be changed by altering the bridge of your nose either up or down. Additionally, the nostrils can be made smaller or more proportionate with the rest of the nose. There are many changes possible, and each surgical plan depends on the patient’s specific concerns.
Often cartilage from your own body will be used to strengthen areas of the nose that are weak. This cartilage usually comes from structures inside of your nose, but your surgeon may find it necessary to take cartilage from other parts of your body. Fortunately, cartilage removed from the inside of the nose, from the ear, or from other parts of your body does not alter the shape of these structures.
Improving the Function of the Nose
There are specific anatomical aspects of the nose that can be altered to improve airflow through the nose and improve your breathing. These functional aspects can be treated in isolation (if you have only functional issues and don’t wish to have the shape of your nose changed) or can be addressed in combination with aesthetic nasal surgery. The two major causes of nasal airway obstruction are related either to the structure of the nose or to the lining inside the nose (also called the nasal mucosa).
A structural problem, such as a deviated septum, can be addressed surgically. There are many different causes of structural obstruction and your surgeon will be able to pinpoint what the problem is. This evaluation starts in the office by your surgeon and may require further separate testing.
Mucosa-related nasal airway obstruction occurs when the lining inside your nose becomes thickened. This also happens for a variety of different reasons, like seasonal allergies or rhinitis, and is treated with medicine (not surgery). Again, the evaluation of nasal airway obstruction begins in the office. If a mucosa-related problem is a concern, you may be referred to another physician for further assessment and treatment.
Recovery from Rhinoplasty
Rhinoplasty surgery results in swelling, bruising, and mild pain. Most patients are surprised that rhinoplasty surgery is not as painful as they thought. However, there can be a significant amount of swelling associated with healing and there is a sense of congestion and resultant sense of discomfort. Fortunately, pain and discomfort can be reasonably controlled with medication following surgery. There may be nausea following surgery, which can also be reasonably controlled with medication. Your surgeon should be able to work with you to find the right balance of medication following surgery.
You may have a cast on your nose after surgery. In most cases, you will also have sutures that will need to be removed. Dr. Warner does not “pack” the nose as this only causes undue discomfort and is not necessary. The cast and sutures will be removed within 4-8 days following surgery.
Although you may be quite swollen for the first week following rhinoplasty surgery, most patients are “sociable” within 2 weeks. This means you can go out in public and not appear like you just had surgery on your nose. By six weeks the swelling will be resolved enough that your nose will resemble closely the final product. Most people are fully enjoying their new nasal appearance by 6-8 weeks and many enjoy it even sooner than that. Although your nose will be much improved by six weeks, it takes one full year for the last bit of swelling to resolve and for your nose to be completely healed. You need to be very careful with your nose during the healing process so that the bones and tissues set properly. Your surgeon can discuss specific post-operative instructions with you and answer any specific questions or concerns you have regarding the recovery process.
Patients should be aware that their closest family members, friends, and co-workers may notice something different at 2 weeks, but most people won’t be able to tell that the nose was operated on.
Functionally, you may be able to go back to work after a few days following surgery, but there will be limitations on your activity level that may prevent you from performing your work fully. Typically, patients return to work or school between 1-2 weeks. Your surgeon will have individualized guidelines regarding activity level and when you can return to work.
Procedure: Tiny incisions are made, allowing the surgeon to access the underlying nasal structure. Once the skin is opened, the cartilage and bones may be reshaped according to the patient’s wishes. Two basic methods are utilized for performing nose surgery: the ‘open’ and the ‘closed’ techniques. There are advantages and disadvantages of each technique. Dr. Warner will discuss the techniques during the initial consultation and help decide what is best for you. If functional surgery is also indicated, it will be performed during the same operation to maximize your outcome and take advantage of a combined recovery period.
In the vast majority of cases, insurance does not cover surgery on the nose if it simply to change the appearance. If rhinoplasty is being utilized to correct a breathing problem, the procedure may be covered under the patient’s insurance policy. Your surgeon will discuss this with you during your consultation and explore your options.
Anesthesia: General or local. Typically, general is safer than “twilight” if major work must performed. Minor surgical alterations can be done in the office under local.
Length of surgery: 1 to 4 hours
Length of stay: Outpatient (home the same day)
- Back to work : 1-2 weeks
- Exercise: May be resumed in 3 weeks
- Discomfort: Mild to moderate (anticipate 1-4 days of prescription pain medication)
- Swelling: Mild to moderate (should anticipate being “sociable” by 2 weeks)
- Bruising: Will decrease within 2 weeks
- Bandages: Cast & sutures will be removed in 4-8 days
- Final Result: Swelling will be minimized and results visible 1 to 2 weeks following
surgery, although appearance will improve over the course of the first year