Rhinoplasty 101 – What Is A Nose Job?

More and more people are turning to plastic surgery to improve self-esteem and correct areas of their body they aren’t happy with. By far, one of the most desirable plastic surgeries today is rhinoplasty.

Known more commonly as a “nose job” or nose reshaping, rhinoplasty has become the second most popular plastic surgery next to breast augmentation.

In 2014 alone, 217,124 rhinoplasty procedures were performed in the United States.

Though extremely popular, rhinoplasty can be an intimidating procedure. The good news is it has been performed repeatedly for a very long time. Rhinoplasty techniques have been perfected to create an experience that is as efficient and pain-free as possible.

When performed by a skilled surgeon, rhinoplasty is a very safe procedure that can leave the patient much happier with their physical appearance.

Despite how common it is, many people considering rhinoplasty find themselves with a lot of questions. Today, we’ll answer those questions and provide an overview of the rhinoplasty procedure.

Are You A Rhinoplasty Candidate?

Almost anyone is eligible to have a nose job, though you should consult with your doctor to determine your specific limitations. Since the skeletal structure of the nose needs to be fully formed, rhinoplasty is generally not performed on adolescents. Since girls mature faster than boys, they may be able to have rhinoplasty as early as 15 years old. Teenage boys typically cannot get rhinoplasty until they are 17 or older.

From a cosmetic standpoint, rhinoplasty may be a good option for people whose nose:

  • Is crooked or asymmetrical
  • Is too large or too small when compared to other facial features
  • Has a bump on the bridge of the nose
  • Is too wide
  • Has a tip that is droopy or enlarged
  • Has nostrils that are too wide or narrow
  • Obstructs the ability to breath

How A Nose Job is Performed

Rhinoplasty is an outpatient procedure. Patients do not have to stay overnight in a hospital and can go home after a brief recovery period in the surgery facility.

To prepare for surgery, the patient’s face is washed thoroughly and an IV delivers medications and fluids during the operation. Some procedures are performed under general anesthesia, allowing the patient to sleep through the surgery. Others are done under local anesthesia, where the nose is numbed and the patient is conscious but sedated to help them relax.

Once the patient has been successfully sedated, the surgery begins. What happens next depends on the type of rhinoplasty the patient is having. Some may require small incisions inside the nostrils to allow the doctor to lift the skin and remove or add structure as desired.

Grafting will be used to add shape to a small or narrow nose. If a large or wide nose needs to be made smaller, the surgeon will use an osteotome to remove the existing bone. This tool resembles a small chisel and is carefully used to break nasal bones with precision. The excess bone may also be shaved down using a nail file-like tool called a rasp.

Once the nose has been reshaped according to the patient’s needs, the incisions are closed and packing is inserted into the nose to help it keep its new shape and reduce bleeding and swelling. After packing is inserted, the nose is taped and a small cast is applied to help maintain the new shape during the first phase of healing.

Types of Rhinoplasty

When a plastic surgeon performs a rhinoplasty, there are two methods they can choose from.

Closed Rhinoplasty: In this procedure, the surgeon makes incisions inside the columella, the vertical piece of skin the separates the nostrils. They then raise the skin and other tissues so that they are separated from the bone, giving the surgeon greater access to the interior of the nasal passages. Closed rhinoplasty is minimally invasive and does not leave scar tissue.

Open Rhinoplasty: An open rhinoplasty gives plastic surgeons even more access to the bone structure. In this procedure, the doctor makes a horizontal incision across the columella so that the tip of the nose can be lifted and shaped. This method will leave some scar tissue and possibly a small scar on the bottom of the nose.

Whether open or closed, there are several different kinds of rhinoplasty that are chosen based on the patient’s needs and what they hope to achieve through plastic surgery.

Revision Rhinoplasty: Sometimes called secondary rhinoplasty, this procedure is performed on patients who had rhinoplasty in the past. It is used to correct any issues or cosmetic changes that need to be made after the patient’s first rhinoplasty.

Filler Rhinoplasty: This is a non-permanent solution in which surgeons use injectable fillers, such as Juvederm or Restylane, to even out imperfections in the nasal structure.

Reduction Rhinoplasty: If the patient feels their nose is too large or their nostrils too flared, they can have reduction rhinoplasty performed to remove bone and/or cartilage and shape the nose so it is more proportionately equal to their other facial features.

Augmentation Rhinoplasty: If a patient has a nose that they feel is too small, plastic surgeons can use bone or tissue grafting to reshape the nose as desired.

Post-Traumatic Rhinoplasty: If the patient has suffered a traumatic injury, it can affect both the cosmetic appearance of the nose and its ability to function. This kind of rhinoplasty is commonly used for fixing a broken nose or correcting an injured nasal septum.

Reconstruction Rhinoplasty: Patients who require reconstructive rhinoplasty have often lost a portion or all of their nose after an accident, injury, or serious illness, such as cancer. Reconstruction rhinoplasty is advanced and can be complicated, as it requires surgeons to rebuild the nose and may take several operations to complete.

Health Risks of a Rhinoplasty Procedure

Though rhinoplasty is considered fairly safe, as with any surgery, risk and complications can occur during or after the procedure. Common risks during rhinoplasty can include:

  • Infection
  • Bad reactions to anesthesia
  • Bleeding
  • Difficulty breathing
  • Septal perforation (hole in the septum)
  • Numbness
  • Scarring
  • Chronic nosebleeds
  • Blood clots
  • Burst blood vessels
  • Unsatisfactory results
  • The need for revision rhinoplasty
  • Death

Recovering from a Nose Job

Despite being a relatively simple outpatient procedure, it can take patients a while to heal. Some surgeons suggest their patients take off as many as 7-10 days following surgery while the swelling subsides.

During the first few days of recovery patients are advised to:

  • Sleep with their head elevated. This will help reduce swelling and prevent blood from rushing to the surgery site.
  • Take care when brushing their teeth so as not to jostle the upper lip or nose.
  • Refrain from as much facial movement as possible.
  • Use ice to reduce swelling and alleviate pain.
  • Eat foods that are soft and don’t require much chewing.
  • Bathe instead of showering, to avoid water coming into direct contact with the nose and destroying the bandages.
  • Refrain from blowing their nose.
  • Wear clothes that button up instead of those that go over the head.
  • Change bandages as instructed by their surgeon.

Additionally, in the weeks following rhinoplasty, patients should:

  • Refrain from exercise and other strenuous activities until given the all clear by their doctor.
  • Wear SPF 30 or higher sunscreen outdoors.
  • Restrict sodium intake.
  • Refrain from wearing glasses or sunglasses for at least 4 weeks or until cleared by their surgeon.

If the surgeon’s instructions are closely followed, the majority of the swelling will go down within 10 days to 2 weeks. Most of the residual swelling will disappear within 4-6 weeks, but slight swelling may persist for up to 12-15 months after surgery.

This is concerning for many patients, as swelling can make the results look asymmetrical or imperfect when they’re not. Remember, your body reacts to surgery as if its gone through trauma. Only time will take the swelling away and allow the patient to truly appreciate their new look.

Finding the Perfect Plastic Surgeon

It is highly recommended that prospective rhinoplasty patients consult with at least two different plastic surgeons before making their choice. Below are some questions patients should ask themselves before settling on one doctor:

  • Do I like the results shown in this surgeon’s previous patients?
  • Is the surgeon’s style in line with my wants?
  • Are the results seen in other patients natural looking?
  • Can I envision myself with this kind of look?

The most important thing to do when considering rhinoplasty is to find an experienced plastic surgeon you are comfortable with. It’s also crucial that both the surgeon and the facility in which the surgery is performed is appropriately licensed.

Both Dr. Ronald K. Downs and Dr. Patrick J. Viscardi, are board certified to perform plastic surgeries by the American Board of Medical Specialties and have years of experience helping patients achieve the look they dream of. The Centre P.C. also provides an onsite, licensed surgical suite in addition to a rehabilitation center.

If you’re considering rhinoplasty at The Centre P.C. and have questions or concerns, we’d love to help! Contact us through our website or give us a call at 574-621-3108.

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Meet the Doctors
Dr. Downs
Dr. Downs

Ronald K. Downs, M.D., F.A.C.S. founded The Centre, P.C. in Elkhart, Indiana in 1992. He is an active member in the American Society of Plastic Surgeons. Dr. Downs is also a member of The American Society for Aesthetic Plastic Surgery, The American Medical Association, The Ohio Valley Plastic Surgery Society, The Rush Surgical Society, and The Indiana State Medical Association where he serves on the board of directors and has served as the president from 2003 to 2004.

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Dr. Viscardi
Dr. Viscardi

Patrick J. Viscardi, M.D. has been part of the surgical team at The Centre, P.C. since 1998. Dr. Viscardi graduated from Dartmouth College in Hanover, New Hampshire, as a summa cum laude. He received his Doctor of Medicine Degree from the University of Rochester in New York. Dr. Viscardi completed his internship and general surgery residency at the University of Louisville, where he served as chief resident from 1994 to 1995.

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