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Nose Reshaping (Rhinoplasty)
San Francisco - Oakland - Santa Rosa - Marin
Nose Reshaping or rhinoplasty can take the form of reconstructive surgery, aesthetic surgery, or a combination of both. The reconstructive aspects of rhinoplasty surgery usually involves improving the nasal passage. The aesthetic portion of rhinoplasty involves the appearance of the nose, including changing the tip, and/or dorsum and their relative proportions.
If you are considering surgery to change the shape of your nose, the current options are much greater than ever before. Rhinoplasty surgery has advanced in recent years, giving both surgeons and patients much more options. The surgeon can better diagnose the problems with nasal anatomy and therefore can customize the procedure to fit individual needs. Computer imaging has greatly enhanced the ability to customize nasal surgery. Dr. Delgado can give you a realistic “before and after" your procedure. Through an analysis of facial proportions, and angles, one can better fit one’s nose to the facial anatomy. Today the emphasis is on the individual customizing a surgical plan.
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The advancement of the “open approach” for nasal surgery has greatly improved the outcome of nasal surgery. With this technique, one is able to see the anatomy that needs to be changed opposed to operating with the skin sleeve attached and distorting the anatomy.
Indications
Rhinoplasty or nasal surgery can be performed in men and women at almost any age. However, it is usually recommended that young people wait until their facial growth is complete, usually thirteen or fourteen for girls and fourteen or fifteen in boys.
You may be a good candidate for rhinoplasty if you have any of the following conditions:
- Your nose is out of proportion to your face, either being too large or too small.
- There is a hump or depression on the nasal bridge when seen in profile.
- The nose seems too wide in front view.
- The nasal tip droops.
- The tip is thick or enlarged.
- The nostrils flare excessively.
- Your nose is crooked.
- A previous injury has caused asymmetry to your nose.
- You have airway obstruction.
If you have had past rhinoplasty surgery and are not happy, you may be a candidate for secondary nasal surgery. This deformity can take the form of either too much or too little bone or cartilage being removed. The nose may still be too large or crooked and breathing difficulties may be present. Often, too much tissue was excised and therefore the solutions would involve grafting bone or cartilage from other areas of your body.
Before Nose Surgery
A personal consultation is the first step for every patient considering rhinoplasty. During this appointment, Dr. Delgado will ask you to discuss your concerns about your appearance, and if there are any breathing difficulties. Dr. Delgado will use computer imaging to discuss your concerns and possible solutions. In addition, computer imaging can assess whether a chin implant would be advantageous for improved facial balance. Physical characteristics such as shapes and size of your nasal bones, and cartilage, as well as the thickness or thinness of your skin may effect the technical considerations.
Dr. Delgado provides a precise pre-operative booklet that provides pre and post operative instructions, including medications in advance of your surgery. All aspirin and aspirin containing products, including anti-inflammatory products must be stopped two weeks before and two weeks after surgery. Dr. Delgado’s pre-operative instructions will have a complete list of these medications to avoid. Tylenol may be taken during this time. Also you will be given a list of homeopathic preparations as well as vitamins to take prior to and after surgery. This is done to promote healing and limit bruising.
Anesthesia
Most rhinoplasty surgeries are performed under general anesthesia. This procedure is usually performed in an outpatient surgery center or hospital.
Operative Procedure
After anesthesia is given, a small incision is made within the nose. The skin is dissected from the underlying cartilages and the nasal bones. The nasal anatomy is then altered. First, cartilage, then the bone, and finally the skin is redraped over the new nasal anatomy. The incisions are closed with sutures, and a cast is placed on the nose.
If the “open approach” is used a small incision is made across the columella. This is the “skin island” that separates both nostrils. This technique provides greater exposure and more accuracy in the reconstructive process. The incision heals nearly inconspicuous within two to three weeks.If there is a breathing problem, then during the procedure the internal nasal deformity is corrected and possibly a nasal pack is used. The operation takes between two and two and a half hours.
Post-operative Period
The first hours are spent in the recovery room, until you are fully alert. At this point you are able to go home. It is of paramount importance that you maintain your head and back elevated at 45-60 degrees. This will greatly reduced the amount of swelling.
There is very little pain associated with nasal surgery, but the nose feels swollen and stuffy. Pain medications, and antibiotics are prescribed. If you have nasal packing, it will be removed in a few days. The sutures and nasal cast is removed in five to seven days. Make up can be applied when the cast in removed. You can return to work or social activities in one to two weeks. Strenuous exercise should not be done for four to six weeks. Contact lenses can be worn after a few days, however if you wear glasses, special tape should be worn to suspend the glasses from the forehead. It is important not to rest the glasses on the nasal bridge for approximately six weeks. A subtle degree of swelling will persist in the tip, anywhere between six and nine months
Risks and Complications
As with any operation, there are risks and complications. However, with a board-certified plastic surgeon and anesthesiologist, the complications are extremely rare. Like all surgeries, the risks of bleeding, infection, scaring, or anesthetic problems are present. In approximately five to ten percent of rhinoplasty cases, there may be a minor deformity present, and corrective surgery is usually minor in nature.
Outcome
The results of nasal surgery are an improvement in the aesthetic balance of your nose in relation to your face and improvement in the airway. The result should create a better balance between your new nose and your other facial features, and Dr. Delgado may suggest a chin implant to better balance your face. This is done in conjunction with rhinoplasty in over sixty percent of the cases nationwide. It is very important that the nose looks natural, well-balanced and without an artificial or surgical appearance.