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Rhinoplasty (nose repair)

Rhinoplasty -Nose repair

Derived from German term ‘rhinoplastik’ meaning changing the nose shape, rhinoplasty involves accessing bone and cartilage support of the nose. ‘Sometimes referred as ‘nose reshaping’ or ‘nose job’, rhinoplasty is performed for both medical and cosmetic reasons like reducing airway obstruction, improve breathing, reshaping the tip, changing the angle between nose and upper lip, correcting the bridge of the nose etc. Most commonly done for cosmetic purposes, rhinoplasty enhances the facial harmony and self-confidence by improving the appearance and proportion of the nose.

Rhinoplasty is the most common cosmetic surgery among American teens done at about 15-16 years age in girls and a year or later in boys. It is important to consult a plastic surgeon before the surgery, to make sure that the teen has realistic expectations from the surgery like getting the surgery done for proper reasons and is mature enough to handle it and also the changes involved in the recovery, from swelling redness etc; and learn about the risks and benefits of the surgery.

Though Rhinoplasty is classified as open or closed, based on the surgical incision (columellar incision in open rhinoplasty and endo-nasal incisions in closed rhinoplasty), most common types of rhinoplasty involve corrections like hump removal, straightening the bridge, nostril size alteration, correcting after an accident, re-sizing the nose, etc.

Even though other procedural steps are similar in both open and closed types, closed rhinoplasty involves some cool features like: lesser nasal tissue dissection, avoiding excessive nasal tip cutting, lesser post-operative edema, visible scarring and iatrogenic damage to the nose, shorter operating time, quicker surgical recovery time and allowing palpation by the surgeon to feel interior changes of the nose.

Both open and closed procedures can resolve intrinsic and extrinsic nasal pathologies, disproportionate / unaesthetic nasal appearance, failed primary rhinoplasty, nasal airway obstructions, congenital nasal defects and deformities like cleft lip/palate and acquired abnormalities like fractures, inflammatory disorders, neoplasms, septal hematomas, venereal diseases like syphilis, connective tissue disorders etc;

What to expect?

Unlike any surgery, rhinoplasty also involves bleeding, infection and allergic reactions to anesthesia. Nose bleeds, numbness, scarring at nasal base, swelling, rupture of blood vessels on skin, permanent nerve damage and need for re-operation are some of the side effects to be remembered when deciding on a nose job and it is important to consult a surgeon to find out the risks versus benefits in each individual case.

Initial reconstructive, functional or aesthetic corrective surgery on the nose is called primary rhinoplasty while a failed primary needing a revision in 5-20% cases is called secondary/ revised rhinoplasty. In a secondary rhinoplasty, cosmetic corrections are involved where the un-addressed nasal fractures; defective nasal tips are corrected along with restoration of the airways. Revised rhinoplasty is mostly an open approach the deformities from primary rhinoplasty like nasal bridge are corrected by recreating the nasal support through auricular or costal cartilage grafts.

A plastic surgeon performs rhinoplasty under local or general anesthesia occasionally using autologous cartilage or bone graft or both, and monitored in the post anesthesia recovery area until discharge where most patients are left with little or no pain after the surgery. Even though most patients complain of discomfort from limited nasal breathing due to intranasal swelling in the first few days of the surgery, any nasal discomfort from surgery by itself can be relieved with mild pain medications. Intranasal sutures are generally absorbable and any external sutures are removed within 5-8 days.

Follow up care being the clue to successful surgery, it is important to use cold compresses to minimize bruising and any discomfort and minimize the intranasal swelling with head elevation for at least 24 hours. It is important to remember to not perform any activities that increase risk of injury like blowing the nose, lifting heavy objects and sun exposure. Unexpected swelling, bleeding or any fever should be reported, and taken care of as needed along with keeping up with the scheduled appointments.