Rhinoplasty
What is it?
Rhinoplasty is surgery performed on the nose to modify its structure, improving its appearance or respiratory function. During the procedure, the plastic surgeon may alter the bone, cartilage, skin or all of these elements to achieve the desired shape or improve nasal functionality.
The surgery can be performed under general or local anesthesia with sedation, and the precise methods used depend on the desired results and the complexity of the changes required. Incisions can be internal (closed rhinoplasty), meaning they are made inside the nostrils, or external (open rhinoplasty), usually performed on the columella, the small strip of tissue that separates the nostrils, giving the surgeon wider access to the nasal structures for more precise shaping.
What are the main differences between aesthetic and functional rhinoplasty?
Cosmetic Rhinoplasty: This variation of the procedure focuses on altering the appearance of the nose. Patients seeking cosmetic rhinoplasty often want to correct or alter what they perceive as defects—such as an overly large or crooked nasal bridge, a bulbous or drooping nasal tip, or general asymmetries. The goal is to improve facial harmony and, consequently, the patient’s self-esteem. Let’s be clear that there is no ideal nose shape.
Functional Rhinoplasty: Functional rhinoplasty is performed primarily to address respiratory problems associated with internal abnormalities of the nose, such as a deviated septum, hypertrophy of the nasal turbinates, or damage caused by injury. Although it can also improve the aesthetics of the nose, the primary focus is on restoring adequate respiratory function and alleviating symptoms such as chronic nasal obstruction and difficulty breathing.
Both types of rhinoplasty can have a significant impact on a patient’s quality of life, whether by improving breathing or self-image. In many cases, both aesthetic and functional goals can be achieved simultaneously, offering the patient both functional and aesthetic benefits.
Who is rhinoplasty indicated for?
Rhinoplasty is indicated for individuals who wish to correct aesthetic or functional problems with the nose. Aesthetic indications may include dissatisfaction with the shape or size of the nose, the presence of a prominent nasal hump (a small lump in the nose), a nasal tip that is too large, too small, drooping or crooked, and other issues that affect facial harmony.
Functional indications are generally aimed at correcting breathing difficulties caused by structural irregularities, such as a deviated septum, which can compromise airflow and lead to problems such as snoring and sleep apnea.
Age
The minimum recommended age for rhinoplasty is usually after adolescence, when facial growth is complete. This usually occurs around the age of 18.
Expected result: the importance of aligning aesthetic expectations
Having realistic expectations is crucial to being satisfied with the results of a rhinoplasty. During the initial consultation, the surgeon will assess the patient’s expectations and discuss what is realistically achievable.
The best candidates are those who seek improvement rather than absolute perfection. Clear communication about desired and possible results is essential to aligning the patient’s expectations with what the surgery can actually provide.
In summary, rhinoplasty is recommended for people who are looking to correct aesthetic imperfections or resolve functional problems of the nose, who are in good general health with a surgical procedure, and who have realistic expectations about the results of the intervention.
How is rhinoplasty performed?
Depending on the complexity of the procedure and the patient’s comfort, rhinoplasty can be performed under general anesthesia or local anesthesia with sedation. The choice of anesthesia influences how the patient experiences the surgery—completely asleep or relaxed and awake.
In open rhinoplasty, an incision is made in the columella, allowing direct access to the internal structures of the nose. In closed rhinoplasty, all incisions are internal, inside the nostrils.
The surgeon reshapes the structure of the nose as needed. This may include removing some of the bone and cartilage or adding grafts to alter the shape of the nose. The exact technique will depend on the specific goals of the procedure.
After reshaping, the incisions are sutured. With open rhinoplasty, there may be a small scar at the base of the nose, while closed rhinoplasty leaves no visible scars.
The patient usually spends a short period of observation before being released home with specific instructions for post-operative care.
Risks and complications
Rhinoplasty, like any surgical procedure, has common risks that must be considered:
Bleeding and Infection: These are complications inherent to any surgery. It is crucial to follow medical advice to minimize these risks.
Asymmetry and Irregularities: After surgery, there may be problems with the shape of the nose or results that do not meet expectations. In some cases, additional surgery may be necessary to correct these aspects.
Complications can vary over time, affecting the patient in different ways:
Short-Term Complications: Bruising, swelling and nasal discomfort are common in the first few weeks after surgery. These symptoms tend to subside as recovery progresses.
Long-Term Complications: These can include breathing problems, partial or total loss of smell and, in some cases, the need for additional corrective interventions to adjust the nasal structure.
Post-operative and Recovery
Immediate Care After Surgery
After rhinoplasty, it is essential to follow your surgeon's post-operative instructions to minimize the risk of complications and ensure a smooth recovery. Patients are usually given a nasal splint to maintain the new shape of their nose and may have nasal packing to control bleeding. It is recommended to keep the head elevated to reduce swelling and to avoid sleeping on the side or stomach.
When to Resume Daily Activities and Exercise?
Light activity can be resumed within a few weeks, but more intense exercise, such as running or lifting weights, should be avoided for at least 4 to 6 weeks.
What to expect in terms of appearance after surgery?
The final results of rhinoplasty can take up to a year to become fully visible as swelling gradually subsides. It is important to be patient during this time and maintain open communication with your surgeon.
Unique Aspects of Rhinoplasty in the Elderly
In older adults, rhinoplasty focuses not only on aesthetics but also on improving nasal function. Considerations include skin elasticity and slower recovery, which can influence both the procedure and the outcome.