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Every
year, half a million people who are interested in improving the appearance
of their noses seek consultation with facial plastic surgeons. Some are
unhappy with the noses they were born with, and some with the way aging
has changed their nose. For others, an injury may have distorted the nose,
or the goal may be improved breathing. But one thing is clear: nothing
has a greater impact on how a person looks than the size and shape of
the nose. Because the nose is the most defining characteristic of the
face, a slight alteration can greatly improve one's appearance.
If you have wondered
how nose surgery, or rhinoplasty, could improve your looks, self-confidence,
or health, you need to know how rhinoplasty is performed and what you
can expect. No pamphlet can answer all your concerns, but this one can
provide answers to many of the questions you may have.
Successful facial
plastic surgery is a result of good rapport between patient and surgeon.
Trust, based on realistic expectations and exacting medical expertise,
develops in the consulting stages before surgery. Your surgeon can answer
specific questions about your specific needs.

As
with all facial plastic surgery, good health and realistic expectations
are prerequisites. Understanding nasal surgery is also critical. Since
there is no ideal in rhinoplasty, the goal is to improve the nose aesthetically,
making it harmonize better with other facial features.
Skin type, ethnic
background, and age are important factors to be considered in discussions
with your surgeon prior to surgery. Before the nose is altered, a young
patient must reach full growth, usually around age fifteen or sixteen.
Exceptions are cases in which breathing is severely impaired.
Before deciding on
rhinoplasty, ask your facial plastic surgeon if any additional surgery
might be recommended to enhance the appearance of your face. Many patients
have chin augmentation in conjunction with rhinoplasty to create a better
balance of features.

Whether the surgery is desired for functional or cosmetic reasons, your
choice of a qualified facial plastic surgeon is of paramount importance.
Many facial plastic surgeons are trained in both ear, nose, throat, and
facial cosmetic surgery, which provides you, the patient, with the highest
level of training and expertise. Your surgeon will examine the structure
of your nose, both externally and internally, to evaluate what you can
expect from rhinoplasty. You are most likely to be pleased with the results
of your surgery if you have a realistic idea of what nasal surgery can and
cannot do.
You can expect a
thorough explanation of the surgeon's expectations and the risks involved
in surgery. Following a joint decision by you and your surgeon to proceed
with rhinoplasty, the surgeon will take photographs of you and discuss
the options available. Your surgeon will explain how the nasal structures,
including bone and cartilage, can be sculpted to reshape the nose and
indicate how reshaping the chin, for example, could enhance the desired
results.
After conducting
a thorough medical history, your surgeon will offer information regarding
anesthesia, the surgical facility to be used, and the costs for the procedure.

The
definition of rhinoplasty is, literally, shaping the nose. First, incisions
are made and the bone and cartilage support system of the nose is accessed.
The majority of incisions are made inside the nose, where they are invisible.
In some cases, an incision is made in the area of skin separating the nostrils.
Next, certain amounts of underlying bone and cartilage are removed, added to,
or rearranged to provide a newly shaped structure. For example, when the tip of
the nose is too large, the surgeon can sculpt the cartilage in this area to
reduce it in size. The angle of the nose in relation to the upper lip can
be altered for a more youthful look or to correct a distortion.
The tissues are then
redraped over the new frame and the incisions are closed. A splint is
applied to the outside of the nose to help retain the new shape while
the nose heals. Soft, absorbent material may be used inside the nose to
maintain stability along the dividing wall of the air passages called
the septum. Alternatively, soft nasal supports that permit nasal breathing
post-operatively can be placed.

Immediately after surgery, a small splint will be placed on your nose
to protect it and to keep the structure stable for at least five to eight
days. If packing is placed inside the nose during surgery, it is removed
the morning following the surgery. Your face will feel puffy,especially
the first day after surgery. Pain medication may be required. Your surgeon
will advise you to avoid blowing your nose for seven days after surgery.
In the immediate days following surgery, you may experience bruising and
minor swelling in the eye area. Cold compresses often reduce the bruising
and discomfort. Absorbable sutures are usually used that do not have to
be removed. Nasal dressing and splints are usually removed six or seven
days after surgery.
It is crucial that
you follow your surgeon's directions, especially instructions to keep
your head elevated for a certain period after surgery. Some activities
will be prohibited in the weeks after the procedure. Sun exposure, exertion,
and risk of injury must be avoided. If you wear glasses, special arrangements
must be made to ensure that the glasses do not rest on the bridge of the
nose. Tape and other devices are sometimes used to permit wearing glasses
without stressing the area where surgery was performed.
Follow-up care is
vital for this procedure to monitor healing. Obviously, anything unusual
should be reported to your surgeon immediately. It is essential that you
keep your follow-up appointments with your surgeon.
Insurance does not
generally cover surgery that is purely for cosmetic reasons. Surgery to
correct or improve nasal function or surgery for major deformity or injury
may be reimbursable in whole or in part. It is the patient's responsibility
to check with the insurance carrier for information on the degree of coverage.
This section © Copyright 2000 American
Academy of Facial and Reconstructive Plastic Surgery
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