Nose surgery (rhinoplasty): Changing the appearance of your nose

It's the nose you were born with, but you're unhappy with how it looks and the way it makes you feel. You've thought about having cosmetic nose surgery (rhinoplasty), but you're unsure if this procedure is for you.

Educate yourself about what you can realistically expect and the benefits and risks involved. Understanding these issues can help you make the best decision for you.

Who is rhinoplasty for?
Rhinoplasty is for people who want to change the size or shape of their nose. It 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

This procedure can also repair an injury, correct a birth defect or improve some breathing difficulties.

How do you prepare?
Before scheduling rhinoplasty, you need to meet with your doctor to discuss the 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.
• A physical examination. Your doctor conducts a complete physical examination, including any laboratory tests, such as a blood test. He or she also inspects your skin and the inside and outside of your nose.
• 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 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 surgery, you may also need to:

• Avoid medications containing aspirin or ibuprofen for two weeks before and after surgery. These medications may increase bleeding. Take only those medications approved or prescribed by your surgeon.
• Avoid exposing your skin to the sun for one week before surgery and two to three months after surgery. Too much sun may cause permanent irregular coloration in the skin of your nose.
• Avoid applying makeup or facial cream the morning of the surgery.

How is rhinoplasty done?
Rhinoplasty is usually done inside the nose, with the surgeon readjusting 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 augment (buildup) 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 limited needs, 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.

What can you expect during the surgery?
Rhinoplasty requires local or general anesthesia, depending on the complexity of the surgery and your surgeon's preferences. Local anesthesia, usually used in an outpatient setting, is anesthesia 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.

For general anesthesia, you inhale the analgesic as a gas or receive it through an IV line. This type of anesthesia affects your entire body and induces a temporary state of unconsciousness. Discuss with your doctor beforehand which kind of anesthesia is best in your case.

Rhinoplasty usually takes one to three hours. After the surgery, you wake up in a recovery room, where the doctor's 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.

What are the results of rhinoplasty?
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, such 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" (small 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 bend down from your waist unless you flex or bend your knees.
• Don't lift anything weighing more than 20 pounds.
• Sleep with your head raised higher than your chest.

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.

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. Because of the slow healing process, you might not see the final results of your surgery for up to a year.

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.

What are the risks of rhinoplasty?
As with any major surgery, rhinoplasty carries risks such as bleeding, infection and an adverse reaction to the anesthesia. Other possible risks specific to this surgery include:

• Recurring nosebleeds
• Difficulty breathing through the nose
• Reduced sense of smell
• Numbness in and around the nose
• Possibility of an uneven-looking nose
• Scarring

Talk to your doctor about how these risks apply to you. Understanding what's involved in rhinoplasty and weighing the benefits and risks can help you decide if this procedure is a good option.

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