The nose is the central, most prominent feature of the face and a major factor in defining balance and harmony among facial features.  When the nose is out of proportion with other facial features or the nose does not complement the face, it can affect self-image and confidence.  In most cases, the specific characteristics of the nose are a result of heredity; however the appearance of the nose may sometimes be the result of injury or prior surgery.  If you are bothered by the size or shape of your nose, then cosmetic surgery of the nose, or rhinoplasty may be right for you.  In general, rhinoplasty improves the appearance and proportion of the nose, enhancing facial harmony and self confidence.  Surgery of the nose may also correct impaired breathing caused by structural defects in the nose.

 

What is cosmetic surgery of the nose?

 

Cosmetic surgery of the nose, or rhinoplasty, is a procedure to improve the appearance of the nose.  Specific features addressed in cosmetic surgery of the nose, and strictly for appearance enhancement, include:

Nose size, in relation to facial balance

Nose width, at the bridge or in the size and position of the nostrils

Nose profile, with visible humps or depressions on the bridge

Nasal tip, that is enlarged or bulbous, drooping, upturned or hooked

Nostrils that are large, wide or upturned

Nasal asymmetry

 

These features are generally caused by heredity, however they can be caused by injury.  In some cosmetic cases, the characteristics of the nose are not the only factors contributing to facial imbalance.  The facial structure-especially a small chin, weak cheeks and/or lower jaw-may also contribute to imbalanced facial proportions.  In these cases, surgery of the nose may be performed in conjunction with placement of facial implants or other procedures to achieve overall facial harmony.

            When nose surgery is performed to improve breathing function, the cause is most commonly an obstructed airway.  This procedure, whether performed alone or in conjunction with cosmetic surgery of the nose, is considered reconstructive and may be covered by insurance.  This requires a great detailed examination to verify the cause of your breathing impairment and prior authorization from your insurer.

            Whether you have a personal desire to improve your appearance or you seek to improve breathing function, surgery of the nose is best performed when facial growth is complete, beginning around age 15.  Good candidates are:

Healthy individuals who do not have a life-threatening illness or medical conditions that can impair healing

Non-smokers

Individuals with a positive outlook and specific goals in mind for improvement

 

My Nose Surgery

 

Cosmetic surgery of the nose is an individualized procedure that takes into account all the specific characteristics that contribute to the overall appearance of the nose and its relation to other facial features.  Your plastic surgeon will carefully evaluate your individual case and goals for improvement to determine specific features to address through surgery of the nose.  Appropriate techniques will then be defined and may include:

Alteration of the nasal bridge

Reshaping the nasal bridge

Reducing the shape or width of the nose

Reshaping the nasal tip

Reducing the width or size of the nostrils

Adjusting the angle between the nose and upper lip

 

If you desire a more symmetrical nose, keep in mind that everyone’s face is asymmetric to some degree.  Results may not be completely symmetric, although the goal is to create facial balance and correct proportion.  Facial augmentation with implants of the chin, cheeks and jaw further enhance your outcomes.

            Nose surgery to improve an obstructed airway is also a very individualized procedure.  It requires careful evaluation of the nasal structure as it relates to airflow and breathing.  Correction of a deviated septum, one of the most common causes of breathing impairment, is achieving by adjusting the nasal structure to produce better alignment.

            Surgery of the nose is performed either using a closed procedure, where incisions are hidden inside the nose, or an open procedure, where an incision is made across the columella, the narrow strip of tissue that separates the nostrils.  Through these incisions, the soft tissues that cover the nose are gently raised, allowing access to reshape the structure of the nose.

            Surgery of the nose can reduce or augment nasal structures with the use of cartilage grafted from other areas of the body.  Once the underlying structure of the nose is sculpted to the desired shape, nasal skin and tissue is redraped and incisions are closed.  Additional incisions may be placed in the natural creases of the nostrils to alter their size.

            Splints and packing will likely support the nose as it begins to heal.  While initial swelling subsides within a few weeks, it may take up to a year for your new nasal contour to fully refine.  During this time you may notice gradual changes in the appearance of your nose as it refines to a more permanent outcome.

 

Preparing for your Surgery

 

Your plastic surgeon will carefully explain the surgical procedure recommended for your specific case.  Prior to surgery, you will be given specific instructions that may include:

Pre-surgical considerations, diagnostic testing and medications

Day of surgery instructions and medications

Specific information related to the use of anesthesia

Postoperative care and follow-up

 

In addition, you will be asked to sign consent forms to assure your plastic surgeon that you fully understand the procedure you will undergo and any risks or potential complications.  The risks associated with surgery of the nose include infection, nosebleed or rupture of small surface vessels of the nose.  Surgery of the nose is a procedure in which aesthetic outcomes can be unpredictable, and in some cases a second procedure may be necessary to achieve your goals.  These risks and others as well as those associated with anesthesia will be discussed prior to your consent.  It is important that you address all your questions directly with your plastic surgeon.  It is natural to feel some anxiety, whether excitement for the anticipated outcomes or preoperative stress.

 

Following Surgery

 

Once your procedure is completed, a splint and/or packing will likely be placed inside your nose and a splint or bandages placed on the outside to support and protect the new structures during initial healing.  Before you are released following surgery, you and an accompanying family member, friend or caregiver will be given specific instructions that may include:

How to care for the surgical site

Medications to apply or take orally to aid healing and reduce the potential for infection

Specific concerns to look for at the surgical site or in your general health

When to follow up with your plastic surgeon

 

Progress and Healing

 

            Initial healing may include some swelling, bruising, headache and discomfort that can be controlled with medication and cold compress.  These are all common conditions.  Your plastic surgeon will instruct you to keep your head elevated at all times until initial swelling has subsided, and to keep any nasal packing in place at all times.  Following all postoperative instructions carefully is essential to the success of your outcome.  A return to light, normal activity is possible as soon as you feel ready, usually within a few days of surgery.  Any packing or splints will likely be removed after the first week, although you may need to wear the splint for an additional week or two.  You will be ready to return to work and normal activity at this time.  Cosmetics can camouflage any bruising or redness that remains.  Healing will continue for several weeks as swelling continues to dissipate and the improved appearance of your nose begins to become apparent.  Diligent sun protection is recommended as you continue to heal.  You must also protect your nose from injury during any physical activity for the next 4 to 6 months.

 

Results and Outlook

 

The outcome of your nose surgery will appear gradually over time.  At a minimum, a year is considered normal for the outcome of surgery of the nose to fully refine.  In general, the results of nose surgery are permanent; however, cartilage, the main supporting structure of the nose, is continually growing and moving tissue that may change the outcome over time.  You should be pleased with the improved balance among your facial features resulting form the surgery of the nose.  Achieving your personal goals for an enhanced appearance will likely increase your self-confidence.