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Samer Al-Khudari
Jay M. Dutton, MD
Rhinoplasty, commonly known as a "nose job" is a surgery aimed to change the functional performance and appearance of the nose. First performed in 500 B.C. one can imagine the advancements that have been made over the years. Well over a 150,000 people undergo rhinoplasty each year, making this one of the most common facial plastic surgeries. The nose is one of the most prominent structures of the face, and subtle or major changes can have dramatic improvements in the patient's overall appearance.
Rhinoplasty reshapes the nose for both aesthetic and functional purposes, improving both the appearance of the nose and nasal airflow. Whether the issue is birth defect, injury, or age-related changes, rhinoplasty can help provide balance and proportion to the nose and face.
Rhinoplasty can be performed as an outpatient procedure (no overnight hospital stay) and depending on patient and physician preference it can be performed under local or general anesthesia. Prior to the surgery photographs should be taken from various views and these will help guide what type of results may be expected. Patients and physicians can use these to ensure that their overall goals are similar. Adjunctive procedures such as chin implant may be recommended to improve the overall balance and proportion of the face
Two major approaches to rhinoplasty are commonly used, the open and closed technique. Depending on the changes desired and the preference of the surgeon one of these two approaches will be utilized. The closed approach may be less invasive therefore leading to quicker healing and less swelling, but this approach may be limited in the extent of reshaping allowed. The open approach often entails a longer operating time, a longer healing process, but may allow for greater reshaping. Each procedure has its own benefits and drawbacks and these should be discussed with the operating surgeon.
Complications are rare but do exist. These include (but are not limited to): infection, bleeding, skin loss, scarring, impaired nasal airflow, poor cosmetic result, the need for revision surgery and the risks of the anesthesia (blood clots, heart and lung complications). Complications need to be recognized immediately; as a result patients are seen multiple times in the office in the period shortly after surgery. Post-operative care is nearly as important as the surgery itself. The healing processes and thus the final results of surgery take at least 6 months to be complete. In the first few post operative days patients can expect facial swelling and discomfort that should resolve shortly. Patients will have to refrain from heavy lifting, strenuous activity, and be prepared to abstain from eyeglass use for 4-6 weeks. Post operative instructions vary slightly by the particular surgeon and these instructions should be completely discussed with the doctor prior to surgery.
Patients should make sure to discuss all of aspects of the surgery with the surgeon. One of the most important factors leading to a successful outcome is a having a thorough discussion with the doctor and having realistic expectations for the surgery. When this surgery is purely for cosmetic reasons, generally insurance will not provide assistance. If this surgery is part of a treatment to improve function of the airway, trauma, or birth defect, insurance may provide partial or complete coverage. These issues should be discussed with both the doctor and the insurance carrier.
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