Rhinoplasty

Rhinoplasty corrects deformities of the nose. The surgeon reshapes and rearranges bone or cartilage, removing any excess. Most surgery for the nose is performed in the outpatient surgery center, and patients go home the same day. The average patient returns to work about one week later. Actual surgery takes about one to three hours, depending on the specific needs of the patient. Rhinoplasties are usually performed quite simply, because people want to look better. They would like the shape and size of their nose to be in harmony with the rest of their features. Sometimes, people like models and performers are motivated by economic or career considerations. There are also many cases in which breathing difficulty occurs as the nose becomes progressively more disfigured because of aging. Some patients also have deformities inside the nose that impair breathing, cause headaches, or create sinus trouble which cannot be satisfactorily corrected without simultaneously straightening the external nose.Photographs are taken to supplement the “before and after” record of the nose and face. These photos are used in planning the operation, much the same way that an architect plans a house. During the consultation, Dr. Godin will show the patient many before and after photos of actual patients who have undergone rhinoplasty.The objective is not only to improve the shape of the nose, but also the appearance of the entire face. It is important that the patient understands rhinoplasty is done to make the nose blend better with the face and be less conspicuous. The procedure is a refinement of the existing nose, not the creation of a completely new one. All that the surgeon can do is attempt to improve what already exists. As long as the patient understands this and has appropriate expectations, there is an excellent chance that he or she will be satisfied with the result.

Following surgery, a white plastic splint is applied to the nose. Packing inside the nose is almost never used. Soft rubber splints with tubes that allow for breathing are frequently placed inside the nose for several days after the surgery. Upon discharge, patients receive easy-to-follow instructions for home care.

The dressing on the nose is removed at the office about five days later. When dressings are first removed, the nose usually appears somewhat swollen, compared to how the final result will look. Patients who expect to see a perfectly shaped nose right away must be careful not to become disappointed. After three or four days, the nose begins to approximate its eventual shape, and the average acquaintance would probably not notice any swelling.

At the end of one week, the swelling and discoloration around the eyes has disappeared in most cases. Some slight swelling of the nose, which the patient feels more than can be seen, is present, but it steadily diminishes over several weeks.

This swelling is particularly noticeable in the morning and goes down as the day progresses. The thicker the skin, the longer it takes for the nose to attain the final shape. It may be about one year before the last one or two percent of swelling is gone. This does not usually bother the patient nor detract from the improved appearance. A small amount of swelling can persist for several months, and all patients are told that they will not see their “final nose” until one year from the surgery. While this is true, the changes in the last few months are usually quite subtle.

If surgery is done on the septum (the partition in the middle of the nose), soft rubber splints may be placed in the nose for a period of approximately one week to encourage proper healing. These splints have tubes built into them so the patient can breathe through the nose, and are not usually visible to others.

After all dressings are removed, patients visit the office several times during a two-month period so the doctor can monitor progress. During this time, patients must be careful not to injure the nose and to protect it from prolonged exposure to direct sunlight. To avoid strain, it is not advisable to lift heavy objects for at least two weeks after the operation.

Pain is unusual in the the post-operative course, but pain relief medication is prescribed in case it occurs.

Finally, Dr. Godin has a great deal of experience with very challenging revision rhinoplasty cases. These surgeries are performed for patients who have had previous nasal surgery, often by other physicians, and desire additional improvements in appearance, breathing, or both. Since rhinoplasty is the most demanding of all procedures in plastic surgery, it is vital for patients who want to improve their noses to seek out a rhinoplasty surgeon with extensive experience. Dr. Godin’s enthusiasm for the art of rhinoplasty has led him to publish his new book, Rhinoplasty: Cases and Techniques, a must read for all practicing plastic surgeons and facial plastic surgeons as well as residents and fellows in training. Rhinoplasty: Cases and Techniques is available from Thieme Medical Publishers, Inc., New York. If you would like a personalized consultation with Dr. Godin to discuss changes that can be made to your nose, please contact us.

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