The nose has been called “the most defining characteristic of the face,” yet many of people are dissatisfied with the appearance of their nose. Whether due to a birth defect, age, trauma ( the most common cause of nasal deformity) or just unhappiness with the nose they were born with, men and women of all ages want their noses reshaped to better complement their other features.
For such people the Facial and Cosmetic Surgery Center at the Massachusetts Eye and Ear Infirmary offers rhinoplasty (Greek : rhinos, “nose” + plassein, “to shape”). People come to our office seeking correction of a nasal hump, or of a nose that is off-center, too large, too flat, and/or too wide at the base. Some seek only a subtle aesthetic enhancement that will improve their looks, health and self-confidence, but everyone wants a natural appearance.
During a patient’s complimentary first visit, a full medical history will be taken. There will be a nasal examination, noting factors such as age, ethnicity, skin type and thickness, and any prior fractures or surgical procedures. The surgeon will ask what you like, and dislike about your nose. Be very specific when you answer. If your surgeon understands your expectations, then mutual, realistic goals can be set.
During consultation, surgeons will discuss rhinoplasty options and techniques with the aim of correction and improvement to achieve their patients’ aesthetic goals. The surgeon will also go over which surgical procedure and type of anesthesia is most appropriate, and discuss post-operative recovery and any possible risks. Many patients find it helpful to bring a list of questions to their first appointment.
Combining Rhinoplasty with other Medically Necessary Surgery
At Mass. Eye and Ear, patients have the option of combining cosmetic procedures, which are not covered by insurance, with medically necessary procedures which are. For example, a patient may experience a nasal trauma resulting in a nasal fracture which needs repair. At the same time as the repair, a patient may elect to also have a cosmetic rhinoplasty to improve their appearance. As well as fracture repair, other associated medically necessary procedures include correction of nasal obstruction, deviated septum, septal perforation, and prior nasal surgery.
Types of Rhinoplasty
There are two basic types of rhinoplasty, open and closed. In an open rhinoplasty an inconspicuous incision is made in the skin below the tip of the nose that separates the nostrils (columella). A closed rhinoplasty uses an intranasal approach with incisions inside the nostrils. If the nasal structure is weak, a small piece of cartilage or bone may be used to build up the structure.
The surgeons at the Facial and Cosmetic Surgery Center are also specialists in revision, or secondary rhinoplasty which is performed to revise an unsatisfactory outcome from a prior rhinoplasty. Revisions rhinoplasties can be quite complex, as the basic nasal framework may have been changed by earlier surgery, and often requires a graft.
The surgeon first separates the skin and soft tissues of the nose from the underlying structures. The bone and cartilage are reshaped and the tissues are then draped over the new framework. Incisions are usually closed with dissolvable sutures. A stent or packing may be placed inside the nose to prevent bleeding or soft-supports may be placed in the nostrils to aid post-operative breathing. The exterior of the nose may be protected with a splint or cast.
For two weeks prior to surgery, patients are required to avoid alcohol, smoking and all aspirin products. Smoking interferes with circulation and healing, and products containing aspirin or ibuprofen increase the risk of bleeding.
Rhinoplasty patients usually go home the same day. Antibiotics and pain killers will be prescribed. If there is packing, it can be removed the morning after surgery. Patients should expect swelling and bruising to last about a week; black eyes are not uncommon (most patients say they look much worse then they feel).
Patients are advised to avoid strenuous activity and the sun (with SPF 15 or higher), and to avoid blowing their nose for the first week or so. Nasal dressings and splints are usually removed after a week.
Post-operative bleeding is fairly common and usually resolves itself. Infections and hematomas (accumulations of blood under the skin) are rare, as are septal perforations. Risks will be discussed in greater detail during consultation.
The very best way to determine if rhinoplasty is right for you is to come in to the Facial and Cosmetic Surgery Center at the Massachusetts Eye and Ear Infirmary for a consultation with one of our surgeons.