Rhinoplasty 101: (Almost) everything you need to know
Rhinoplasty (or “nose job”) can be one of the most demanding and yet rewarding surgeries for many of us in the facial plastic surgery realm. The anatomy of the nose can be unforgiving, so meticulous attention to detail and a comprehensive understanding of the function aspects of nasal breathing are essential to successful surgery.
A desire for rhinoplasty can arise through many different avenues: for some, it is a parent or sibling going through the process, for others, it is a lifetime of difficulty breathing, a trauma that occurred or just a desire to have a bump or tip refined. The concerns and desires of each person can be vastly different-which is one reason why it can be such a fulfilling and challenging surgery. The process begins with a consultation with a facial plastic surgeon with a focus or significant interest in rhinoplasty. I am a supporter of patients who seek out at least two opinions so they are aware of different concerns, considerations and the differing styles of particular surgeons. It’s also encouraging if you feel like your surgeon would stand by you if there were any complications or need for further surgery or revision. If you feel like you would be dismissed for having concerns after your surgery, that office may not be right for you.
Your surgeon will discuss what your desires are, examine the outside and inside of your nose, possibly perform minor maneuvers to determine if there are functional issues at the same time, and possibly make recommendations based on their experiences. They may have you undergo computer imaging to facilitate a discussion of your desires and what they think is a realistic result. These discussions are critical to your understanding of what your surgeon views as aesthetically ideal and feasible, but are in no way guarantees of a result.
Once that process is complete, you may be considering surgery. A rhinoplasty typically can take anywhere from 1.5-3 hours depending on the amount of work that needs to be done. Most often, they are performed in an outpatient surgery center under general anesthesia. Once your surgery is complete, you will be able to go home, and likely will follow up with your surgeon the next day or by 1 week. It is common to have bloody drainage from the nose the first 24-48 hours after surgery. Congestion is also very common and is often a complaint of the recovery period. Significant pain is not the norm, but discomfort certainly is expected and pain medication is usually prescribed for several days. If the nose had to be “broken” as part of the narrowing or refining process, tape and a cast are often placed externally for the first week. This will be removed at your 1 week appointment, at which time you get the first opportunity to see your new nose! This can be an exciting time, but it can also be a stark reality check. It is normal to have significant swelling for the first week or two and because of that, only basic judgements about your final result can be made. Your surgeon will explain to you in your preoperative visit that the final results from a rhinoplasty are not truly settled until you are 1 year out from surgery. For the first 3-6 weeks, there will be significant fluctuation in tip and bridge swelling as well as breathing changes. After the first 6 weeks, things start to stabilize more. You will most likely see your surgeon every few weeks to start and then gradually increase the interval as time goes on. Make sure to mention your concerns as they arise, but know that time and patience will alter and resolve most of them and your surgeon may encourage you to continue to wait while your body handles the healing process.
The majority of rhinoplasty patients are very satisfied with their results and are happy with the decision to have undergone surgery. Although the first week of recovery can be challenging, the benefits do outweigh the risks and you will enjoy a new functional and newly refined nose for many years to come!
