The Ultimate Guide to Rhinoplasty: Before, During, and After Nose Surgery

Thinking about rhinoplasty?

Get the information you need here:

A rhinoplasty is meant to change a nose’s shape to improve its visual characteristics, whilst having a well-functioning organ.

The very first matter is to ensure you can identify what is it you do not like or want to change in the appearance of your nose. A problem well identified is a problem half solved! See if the modification may be brought by a cosmetic procedure, that can be as superficial as laser, in the case of a thick or sebaceous skin. If surgery is necessary, can a reversible intervention, such as an augmentative surgery with a silicon implant bring you the desired results? It might be worth to explore some of the “lighter” options you have before going for a more intrusive operation. In such a case, the procedure should be very well thought first and perfectly executed to avoid disappointments and expensive ulterior corrective surgeries. Hence the importance of talking to a team of specialists!

Well planned and executed, a good rhinoplasty results in the creation of a functional nose, with an optimal balance between the three segments (upper, mid and lower), congruous with the other facial features. A successful rhinoplasty must follow logical and purposeful steps: it must incorporate a full understanding of the dynamic changes that will incur with the surgery itself and later on, with the ageing features of the face.

The majority of the techniques utilized to redefine the nose, are reductive in nature, they are meant to take care of an excess of anatomic components. Rhinoplasties then are seen as a mean to smooth a nasal hump or to refine a bulbous nose, to shorten a long tip or to narrow the width of nostrils. If the intention of the rhinoplasty is to elevate the height of the bridge or to elongate the tip of nose, the use of implants or autologous cartilage grafts becomes necessary, and some of these interventions pose more challenges to the surgeon than reductive rhinoplasties.

Consulting about a rhinoplasty

It is advisable before deciding for a non-reversible, surgery, to investigate various surgeons. When inquiring about for themselves, patients should present standard photographs of their noses, including the frontal, oblique, lateral, and basal views, as they are an important component of the preoperative evaluation.

Here are some of the things you should either look for or watch for when having a talk with a prospective surgeon:         

🚩 Red flags:

1. Will you have to sign a Nondisclosure Agreements (NDA) before the procedure?

A NDA will basically bind you to secrecy with the surgeon, preventing you to publish negative comment, for an example.

2. Surgeons not showing you the noses from all angles, including the basal view of the nostrils.
3. The before and after pictures have been taken less than a year apart.

Check boxes:

A thorough nasal history is an important component of the pre-evaluation. Sometimes, we may present some aberrant nasal physiology, that could be due to allergy or malfunction. It is important for the physician to know of any laterality, duration, and time of onset of such symptoms, so to take note of them. Similarly, any mitigating factors that contribute to worsening or alleviation of these symptoms, the presence of headaches, visual disturbances, other otologic symptoms, and/or seasonal allergies should be told of. Other aspects of the nasal history, including any history of trauma, previous surgery, medication use (with particular attention to vasoactive nasal sprays), and/or use of tobacco, alcohol, or snorting drugs should be notified to the surgeon.

Because rhinoplasty is a surgery that comes with a high revision rate, some non-permanent options might be better suited to patients with a desire to alter the shape of their noses.

Closed and open rhinoplasties

Open or closed rhinoplasty refers to the dissection approach, or whether the opening to the internal structure of the nose is done inside the nose. In the endonasal approach, called “closed rhinoplasty”, the opening are made inside the ala of the nose, or along the septum. When they are done outside of the nose, on the columella, it is an open rhinoplasty.

Each method has its own advantages and disadvantages; however, rhinoplasty should ideally be performed by a surgeon who tailors the operation to the specific anatomy of each patient; thus, one should be familiar with both approaches.

The open approach lends itself best in three cases:

1. revisional surgery (secondary rhinoplasty)
2. posttraumatic deformities in which complete release of the intrinsic and extrinsic deforming forces is necessary
3. when complex tip modification (grafting, correction of a bulbous tip) is necessary.

The downsides of the open approach are the risks of complications incurred by the complexity of the procedure, the swelling and a lasting numbness of the nasal appendage than in the endonasal approach.

In terms of advantages and inconveniences, the closed approach offers invisible scars, a faster recovery, but a more limited view on the internal structures of the nose. It is best used in these cases:

1. bridge augmentation
2. hump reduction
3. alloplastic implants

Things to know:

The majority of techniques utilized to redefine the nose, which are reductive in nature, will also result in reduction in the airway. Spreader grafts, turbinectomy, septoplasty, insertion of alar rim graft, tip rotation cephalically, and lateral crura strut can all result in improvement in the airway. Bring your concern to specialists!