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Candidates:
Girls should be at least 14 or 15, boys 16 to
17 before they can have nose surgery, because the structures of the face change
with growing and it is better to wait until full development of the face is
achieved to perform the surgery. Younger patients should be advised carefully,
to understand the reasons that motivate to want to change their noses. It is
important to realize the change should satisfy the patient, avoiding influences
from relatives and friends. The upper age limit for rhinoplasty depends on
health conditions and psychological motivations that provoke the need for the
change. A classical reason for nose surgery in older patients is the
rejuvenating effect that can be produced to correct a drooping tip, when
performed together with a facelift. Breathing problems can be corrected at the
same time. A computer consultation is the best way to evaluate the change that
can be obtained through plastic surgery of the nose. If the nose has a "ball" at
the tip, if it is too large for the face, if there is a hump in profile, or if
it is too wide, crooked or asymmetrical.
Objectives:
Reshape the
nose by reducing or increasing size, removing a hump, changing shape of tip or
bridge, narrowing the nostrils, or changing the angle between nose and upper
lip. It may also relieve some breathing problems. The skin quality and the size
and shape of the nose in relationship to the face are studied. Sometimes
correction of the chin can be done together with nose surgery to balance the
face.
Incisions and technique:
Results from rhinoplasty will vary
according to several factors, type of skin, shape of the nose, etc. Results are
individual and should not be compared with others. The nose can be increased or
decreased, nostrils can be narrowed, the tip reshaped and elevated. Usually all
of the incisions will be placed inside the nose. To reduce the base of the nose
or the nostrils small incisions are placed at base of the nostrils, hidden in
the natural crease. Sometimes a small incision is made in the columella, the
tissue that separates the nostrils. This can be used in more difficult cases or
in re-operations. Though the small incisions cartilage and bone are treated to
narrow and straight the nose. To augment the nose cartilage from the septum or
the ear can be used.
Operating Time:
1 to 2 hours or
more.
Anesthesia: Local with sedation, or
general.
In/Outpatient:
Usually outpatient.
Side
Effects: Temporary swelling, bruising around eyes and nose. Some
bleeding.
Recovery:
Bruising around the eyes and cheeks can
appear three days after surgery and should disappear around the second week.
Cover-up makeup can be used to conceal the discolored skin. Most of the swelling
disappears on the first month, but there can be residual swelling up to the
sixth month. Usually the final result of rhinoplasty is obtained around the
eighteenth month. Packing can be used in the first 24 hours to avoid bleeding
although it is not absolutely necessary in every case. A nasal splint, when used
is usually removed between the 5th and 7th day after surgery. Back to work: 1 to
2 weeks. Strenuous activities: 2 to 3 weeks. Sun exposure: one to two
months.
Risks:
Serious complications from rhinoplasty are not
common. Potential complications include hematoma (an accumulation of blood under
the skin which may require removal), infection and reactions to anesthesia.
Numbness of the skin following rhinoplasty may occur but is usually temporary.
Occasionally, further improvement can be obtained through a second
procedure.
Details:
There should be no pain after rhinoplasty. Dressings usually stay for seven
days. Stitches usually reabsorb and do not have to be removed. During the first
two days after surgery it is necessary to sleep with the head elevated to reduce
swelling and the possibility of minor bleeding. A small amount of bleeding on
the dressing is not uncommon on the first two days.
Duration of Results:
Permanent.
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