Cosmetic rhinoplasty (nose job)

Whether due to an old fracture, prior surgery, or simply genetics, some people are unhappy with the appearance of their nose. Rhinoplasty, commonly known as a nose job, is a cosmetic operation designed to change the appearance of the nose. The rhinoplasty procedure is designed to minimally impact nasal breathing. Rhinoplasty can reduce or increase the size of the nose, straighten the nose, change the shape of the tip, narrow the width of the nostrils, or change the angle between the nose and the upper lip. This operation can also sometimes help correct birth defects, old nasal injuries, and help relieve some nasal breathing problems.

There is not a universal type of rhinoplasty surgery that will meet the needs of every patient. Rhinoplasty surgery is customized for each patient, and will vary depending on the patient's wishes, goals, and existing nasal anatomy. The ideal nose should balance well with the entire face and lead people to focus primarily on the beauty of the eyes, not the nose. Incisions may be made within the nose or placed in inconspicuous locations of the nose as in the open rhinoplasty approach. Internal nasal surgery, also referred to as functional nasal surgery, is designed to improve nasal breathing. This includes procedures such as septoplasty and/or turbinoplasty, both of which can be performed at the same time as a rhinoplasty.

The best candidates for this type of surgery are individuals who are looking for improvement, not perfection, in the appearance of their nose. In addition to realistic expectations, good health and psychological stability are important qualities for patients considering a rhinoplasty. Rhinoplasty surgery, being a cosmetic procedure, is not covered by health insurance. Financial arrangements must be completed with our office prior to surgery.

The indications and risks of surgery, as well as expected outcomes, must be understood prior to proceeding with your surgery. In addition, you must understand your alternatives to the surgery. Your alternative is not to have the surgery performed. This would leave you in your current condition.

RISKS/SURGICAL COMPLICATIONS

With any type of activity there is inherent risk. An individual’s choice to undergo a surgical procedure is based on the comparison of the risk to potential benefit. Although the majority of patients do not experience these complications, you should discuss each of them with your surgeon to make sure you understand the risks, potential complications and consequences of rhinoplasty.

Bleeding – It is possible, though unusual, that you may have problems with bleeding during or after surgery. Should significant post‐operative bleeding occur, it may require emergency treatment to stop the bleeding, or require a blood transfusion. Accumulations of blood under the skin may delay healing and cause unfavorable scarring and mild discoloration of the skin around the eyes.

Infection – Infection is quite unusual after surgery. Should an infection occur, additional treatment including antibiotics may be necessary.

Scarring – Although good wound healing after a surgical procedure is expected, abnormal scarring may occur within the skin and/or in the deeper tissues. Scars may be unattractive and of different color than the surrounding skin. There is the possibility of visible marks from sutures. Additional treatments including surgery may be needed to treat scarring.

Damage to deeper structures – Deeper structures such as nerves, tear ducts, blood vessels and muscles may be damaged during the course of surgery. The potential for this to occur varies with the type of rhinoplasty procedure performed. Injury to deeper structures is extremely rare, but may be temporary or permanent.

Unsatisfactory result – There is the possibility of an unsatisfactory result from the rhinoplasty surgery. The surgery may result in visible asymmetries, unacceptable visible or tactile deformities, loss of function, or structural malposition after rhinoplasty surgery. You may be disappointed that the results of rhinoplasty surgery do not meet your expectations. Additional surgery may be necessary should the result of rhinoplasty be unsatisfactory.

Numbness – Diminished (or loss) of skin sensation in the nasal region may occur. Permanent numbness is very rare, temporary numbness is normal and expected. The occurrence of this is not predictable.

Asymmetry – The human face is normally asymmetrical. Your doctor may point out your facial asymmetries prior to the surgery so you have a better understanding of your anatomy. There can be a variation from one side to the other in the results obtained from a rhinoplasty procedure. If significant, then revision surgery may be necessary.

Chronic pain – Chronic pain may occur rarely after rhinoplasty.

Skin disorders/skin cancer – Rhinoplasty is a surgical procedure designed to reshape the internal and external structure of the nose. Skin disorders and skin cancer may occur independently of a rhinoplasty.

Allergic reactions – In rare cases, local allergies to tape, suture material, or topical preparations have been reported. Systemic reactions which are more serious may occur to drugs used during surgery and prescription medicines. Allergic reactions may require additional treatment.

Delayed healing – Wound disruption or delayed wound healing is possible. Some areas of the face may not heal normally and may take a long time to heal. Areas of skin may die. This may require frequent dressing changes or further surgery to remove the non‐healed tissue. Fortunately, these types of problems are extremely rare.

Long term effects – Subsequent alterations in nasal appearance may occur as the result of aging, sun exposure, or other circumstances not related to rhinoplasty surgery. Future surgery or other treatments may be necessary to maintain the results of a rhinoplasty operation.

Nasal septal perforation – If septoplasty is performed simultaneously, there is the possibility that surgery will cause a hole in the nasal septum to develop. The occurrence of this is rare. However, if it occurs, additional surgical treatment may be necessary to repair the hole in the nasal septum. In some cases, it may be impossible to correct this complication.

Nasal airway alterations – Changes may occur after a rhinoplasty operation that may interfere with normal passage of air through the nose. Keep in mind that reductive rhinoplasty – making the nose smaller – will reduce the size of your air passages. If functional surgery (septoplasty or others) is to be performed simultaneously, usually the improvement in breathing from the functional portion of the surgery will gain more that is lost from the cosmetic portion of the surgery.

Anesthesia – Both local and general anesthesia involve risk. There is the possibility of complications, injury, and even death from all forms of surgical anesthesia or sedation. Fortunately this is exceedingly rare.

GENERAL POST‐OPERATIVE CARE INSTRUCTIONS:

Swelling and bruising ‐ Each surgical operation is accompanied by some swelling and bruising of the surrounding tissue. Remember, 90% will rapidly subside within several weeks after surgery, but due to continual healing, improvements/changes will continue to occur for the next 12‐18 months following surgery. You can help diminish swelling by following some suggestions.

  • Ice compresses for 12‐18 hours after surgery.
  • Keep head elevated – sleeping on several pillow for the first week may reduce early swelling.
  • Avoid strenuous exercise and lifting for six weeks after surgery.
  • Avoid getting hit or bumping your new nose, especially by small children.
  • Avoid excessive sun for six months – use brim hat or sunscreen with high SPF number.
  • Use brush to apply lipstick to upper lip and soft toothbrush for teeth – do not purse lips and avoid excessive chewing.
  • Eyeglasses may be worn on the cast. Once the cast is removed, we will show you how to tape glasses to forehead or use cotton under the bridge of your glasses.
  • Contact lenses may be worn after surgery, and is preferred for the first 6 weeks.
  • One may use makeup to cover up bruises.

Nasal Drainage ‐ Congestion and nasal drainage are common after surgery, including some crusting in the nostrils which is temporary. You may clean the dried blood or crust with half strength peroxide and also use Bacitracin ointment in each nostril two or three times/day for 1‐2 weeks. You can also mist in an OTC saline spray to soften crusting. Avoid blowing your nose vigorously for the first week. Afterwards, you can gently blow through both nostrils. A small amount of bloody drainage is normal for the first 24 hours, but if it persists, contacts us. If there is excessive bleeding, call 911.

Diet – As tolerated. Excessive salty foods may increase swelling for a couple of months, so try to avoid these sorts of foods.

Medicines – You will be prescribed pain medicines and antibiotics. Use these as directed. Post‐operative office visits – We will typically see you about 2 days after surgery, sometimes 4‐5 days after surgery, then 7‐8 days after surgery. If these visits have not already been scheduled, please call our office to make the appointments. We will also ask you come to see us several times over the next several months.

At Suburban Ear, Nose and Throat Associates, Ltd., we go to great lengths to try to help you understand your plan of care. If at any time during your care you have questions or concerns, please call us at 847‐259‐2530.