Information, costs,
and side effects
Good
candidates for rhinoplasty surgery are patients
with a nose which is out of proportion with the rest of the face,
in good health, emotionally stable, and with realistic expectations.
During the Initial consultation
your doctor will likely ask you to describe in
detail what you would like improved. Be specific about what you
would like done.
Your doctor will be limited by the internal and external structures
of your nose. They cannot create any nose, but it can be helpful
to bring pictures of noses that you like. After examining your nose,
they can give you an idea of what improvements can be made on your
particular nose. If your surgeon fully understands your expectations,
they'll be able to determine whether your goals are realistic.
Your doctor will consider your entire face when planning the operation.
If you have a very weak chin, this may create the illusion that
your nose is larger than it is. Some patients choose to have chin
augmentation along with rhinoplasty. Your physician will discuss
this with you.
Be sure to tell your surgeon if you've had any previous nose surgery
or an injury to your nose, even if it was many years ago. You should
also inform your surgeon if you have any allergies or breathing
difficulties. You are at increased risk for complications if you
have diabetes, poor circulation, heart, lung or liver disease, smoke,
have a family history of blood clots, take certain medications,
etc. You'll want to discuss your medical history thoroughly with
your physician before you choose to undergo surgery.
The
average cost of Rhinoplasty
Nose Jobs Cost Range: $3,000 - $12,000
Average Total Cost: $4,500
Surgeons fee: $3,000
Anesthesiologist: $700
Facility fee: $800
Average cost by procedure:
Primary open rhinoplasty $3,152 - $6,500
Primary closed rhinoplasty $2,879 - $5,800
Primary Septoplasty/Turbinectomy $3,500 - $6,500
Secondary open rhinoplasty $7,000 - $9,000
Secondary closed rhinoplasty $2,643 - $10,000
Basic
procedures and techniques
Anesthesia: General or Sedation
Location: Hospital, surgical center or office
Surgery time: 1-4 hours
Nose jobs are one of the most common procedures plastic surgeons
perform, and also one of the most difficult as the surgeon performs
it mainly by feel. Rhinoplasty may be performed in order to increase
the patient's ability to breath, improve the nose by reducing or
reshaping it, and/or straightening an injured nose.
Techniques: There are two main options for the
incisions that your plastic surgeon can use: closed rhinoplasty
and open rhinoplasty.
Closed rhinoplasty involves incision confined to the inside of your
nose. Swelling improves soon and recovery is fast. However, your
surgeon may have a limited ability to achieve some changes in your
nose because of her or his inability to see parts of the inside
of the nose.
Open rhinoplasty involves a small incision across the columella,
between the nostrils, in addition to incisions on the inside of
your nose. Open surgery is usually preferred in more complicated
cases.
Some surgeons prefer the open rhinoplasty because it allows them
greater visibility of the nose. Swelling and bruising lasts longer
with open rhinoplasty. Either way, if you sleep with your head elevated
for the week following your nose surgery, the swelling will be minimized
and will subside much faster. When deciding on open vs. closed rhinoplasty,
you should follow the advice of your plastic surgeon.
The Operation: Nasal surgery can change your
nose by recontouring the underlying cartilage and bone. Your surgeon
can make your nose larger, shorter, smaller, straighter, or thinner.
Most of the incisions for reshaping the nose are made internally
and scars will not be visible.
How thick or thin your skin is plays a big role in the results of
the operation. Thick skin will not "drape out" as well
over the new underlying structure as thin skin. But, thick skin
will hide small irregularities of the cartilage and bone better
than thin skin.
The operation normally lasts about 1-2 hours. The surgery will either
be performed under local anesthesia with heavy sedation, or under
general anesthesia.
Common changes made:
Tip of the nose: corrected by adding or excising cartilage
at the tip and stitches the cartilage together. A low tip of the
nose can be raised by adding cartilage to support the tip, removing
excess cartilage in the septum, or repositioning the cartilage.
Dorsal bone: the hump of the bridge can be corrected by
removing (with a chisel or rasp) excess cartilage and bone, then
brings the nasal bones together.
Wide bony portion of nose: corrected by breaking the bones
of the nose and repositioning them inward.
Wide base of the nose: corrected by removing tissue at
the base of the nose and the nostrils moved closer together.
Nostrils too wide: corrected by removing small wedges
of skin from
their base and bringing them closer together.
Angle between nose and lip: corrected by trimming the
septum.
Recovery
Pain Level: Moderate-severe discomfort. 2-10 days of pain
medication
Swelling and bruising: 1-6 weeks for closed, 1-6 months
for open
Numbness: lasts several weeks (tip of nose)
Bandages: Changed in 5-10 days
Work: Return after 1-3 weeks
Exercise (including swimming): Wait 6 weeks
Sunblock: very important for first few months (long term
use recommended)
Final result: Seen 3 months-2 years
During Recovery your nose may be:
- asymmetrical
- crooked
- swollen
- bruised
- numb
- painful
For faster recovery:
- Apply cold, dry compresses often
- Avoid nasal medications for 3 months
- Use humidifier and saline spray for 2 weeks
- Keep head elevated to reduce swelling
- Avoid blowing your nose for the first 4 weeks to reduce bleeding
and abnormal healing
Immediately after surgery a splint is usually applied to the nose
to maintain the shape. Nasal packs or soft plastic splints also may
be placed in the nostrils to stabilize the septum. If it is necessary
to pack the nose, it is usually for 2-6 days. Most doctors recommend
ice packs over your eyes for the first 2 days to minimize swelling.
Pain medication and sleeping pills can help with pain management.
The splint will be removed by your surgeon at your first post operative
visit (usually a week after the surgery).
After surgery, your nose and eyes will be swollen and bruised, they
may ache, and your face will feel puffy. The extent of this will
depend on the extent of the operation and if the nasal bones were
broken. The swelling and discoloration increase in the first few
days and then will subside after the first week or so. Your upper
lip and tip of your nose may feel numb for a few months. You'll
also feel like you have a cold for the first few weeks because of
the congestion of the nasal passageways. A little bleeding is common
during the first few days following surgery. Any sudden increase
in bleeding or pain should be reported to your physician.
If you swallowed a lot of blood during the procedure, you may be
more likely to feel nauseated and possibly vomit post-operatively.
Your stool may also be darker due to blood content.
Take the time to ensure that your nose properly heals. The nose
is delicate and you'll greatly reduce your chance of complications
and secondary surgery by following your doctor's advice carefully.
A good diet helps the healing process. Start your recovery with
a mild liquid diet (water, juice, soup or broth). It's important
that your stomach is settled before you resume normal eating and
drinking. Vomiting can interfere with your recovery and healing
time.
Keep your head elevated while you sleep. You should also keep your
head up during the day and avoid bending over. This will minimize
swelling. You may have a slightly longer recovery period if your
surgery required breaking the nasal bones. You are usually able
to return back to work in 10 days-3 weeks with make-up.
Although the final result will be apparent in about 2 weeks, small
changes may continue to occur over the next 6-12 months. The final
outcome depends upon your age, skin type, and healing ability.
Activity: The best rule is to avoid any activity
which causes you discomfort. Any strenuous activity or exercise
that has the possibility of resulting in a nose injury should be
avoided for at least 6 weeks. You'll also want to avoid bending
over. Check with your doctor regarding bathing and showering; generally
it is allowed as long as the nose splint remains dry.
Revisions: There is a 20% chance you will want
or need revision surgery. This is because plastic surgery of the
nose is difficult and your nose can also change in ways that cannot
be predicted following surgery. You must accept this risk before
having cosmetic nose surgery.
If you require revision surgery, wait at least one year from the
date of your last nasal operation. If revision surgery is performed
sooner, it will be less likely to accomplish your desired result.
Revision rhinoplasty is more complicated than original rhinoplasty.
If you need a second surgery, choose a doctor who specializes in
revisions.
Long term expectations: There should be no major
changes in your nose after rhinoplasty. The surgery is normally permanent.
Your nose will change slightly with the normal aging process.
Risks
and complications
When rhinoplasty is performed by a qualified plastic surgeon, complications
are rare and are usually minor. However, all surgery has the risk
of complications and undesirable outcomes. You can reduce your risks
by closely following your surgeon's instructions both before and
after surgery.
Burst blood vessels: After surgery, small burst
blood vessels may appear as tiny red spots on the surface of the skin.
These are usually small, but may be permanent. This rarely happens,
but it is a possibility you should be aware of.
Bleeding: Bleeding may occur for up to four weeks
after operation. The patient must resist any urge to blow the nose
to minimize bleeding.
Abnormal shape: An abnormal shape of the nose may
be due to an error during surgery, the patient not keeping their head
elevated, or sleeping on one side without proper support. The nose
can pull to one side if the cast does not support it properly. There
are other factors that go beyond human control as well.
Wound infection: The rate of wound infection following
rhinoplasty is less than 2%. Abscesses, cellulitis or granuloma may
be treated with antibiotics and drainage. Use of an implant increases
the chance of infection.
Risk of smoking: Smoking significantly reduces your
body's circulation and vascularity. This means difficulty in bringing
much needed oxygen to your tissues and greatly increases your risk
for slow healing and other complications. It is important to stop
smoking for at least 4 weeks before and after surgery.
Toxic shock syndrome: This is very rare, occurring
in only 0.016% of rhinoplasty surgeries. However, if it does occur,
the mortality rate is about 11%. Symptoms include fever, vomiting,
diarrhea, and a sunburnlike rash.
According to an article authored by S. Valentine Fernandes "the
complication rate for nasal surgery varies from 4-18.8%. In individual
hands, this rate generally falls as surgical experience accumulates.
Skin and associated soft tissue complications occur in up to 10%
of cases. According to estimates, severe systemic or life-threatening
complications occur in 1.7-5% of rhinoplasty cases. Intracranial
complications are rare."
The entire article is extremely informative and we highly recommend
reading it. You can access it at: www.emedicine.com.
Scars
Surgical scars are permanent. If you have a closed procedure,
your scars will be completely hidden inside then nose. If you have
an open procedure, you will have a small scar on the base of your
nose, between the nostrils. This is usually not noticeable upon
normal observation.
For more information, see rhinoplasty
before and after photos.
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