Rhinoplasty (RIE-no-plas-tee) is plastic surgery performed on the nose. Rhinoplasty may be to change the appearance of the nose (sometimes referred to as a “nose job”), to improve breathing problems caused by structural defects in the nose, or both. Reconstruction of the nose is one of the most common cosmetic surgery procedures available. The upper portion of the structure of the nose is bone, and the lower portion is cartilage. Rhinoplasty can modify bone, cartilage, skin or all three and can be performed under local or general anesthesia, depending on the exact procedure and the person’s preference. It is performed in a surgeon’s office, a hospital, or an outpatient surgery center. Complex procedures may require a short hospital stay. It is important to note that your insurance plan might not cover rhinoplasty whether chosen to enhance appearance or to improve breathing problems.
Surgeons who do rhinoplasties typically have training in either plastic surgery, otolaryngology (ear, nose, and throat specialty), or both. The surgery is usually done through a cut (incision) made inside the nostrils. In some cases, the incision is made from outside, around the base of the nose to perform work on the tip of the nose or if you need a cartilage graft.
A splint (metal or plastic) may be placed on the outside of the nose. This helps maintain the new shape of the bone when the surgery is finished. Soft plastic splints or nasal packs also may be placed in the nostrils. This helps keep the dividing wall between the air passages (septum) stable. The splint and bandaging around your nose will be removed in about a week.
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Treatment
Rhinoplasty requires local anesthesia with sedation or general anesthesia, depending on the complexity of the surgery and your surgeon’s preferences. Discuss with your doctor beforehand which kind of anesthesia is best in your case.
Local anesthesia with sedation is usually used in an outpatient setting. Your doctor injects a pain-numbing medication into your nasal tissues and sedates you with medication injected through an intravenous (IV) line. This makes you groggy but not fully asleep.
General anesthesia affects your entire body and induces a temporary state of unconsciousness. You receive the drug (anesthetic) by inhaling it or through an IV line — a small tube placed in a vein in your hand, neck or chest. General anesthesia requires a breathing tube.
Once you’re numb or unconscious, your surgeon will make cuts between or inside your nostrils. They’ll separate your skin from your cartilage or bone and then start the reshaping. If your new nose needs a small amount of additional cartilage, your doctor may remove some from your ear or deep inside your nose. If more is needed, you might get an implant or a bone graft. A bone graft is additional bone that’s added to the bone in your nose.
The procedure usually takes between one and two hours. If the surgery is complex, it can take longer. After surgery, your doctor may place a plastic or metal splint on your nose. The splint will help your nose retain its new shape while it heals. They may also place nasal packs or splints inside your nostrils to stabilize your septum, which is the part of your nose between your nostrils.
You’ll be monitored in a recovery room for at least a few hours after surgery. If everything is okay, you’ll leave later that day. You’ll need someone to drive you home because the anesthesia will still affect you. If it’s a complicated procedure, you might have to stay in the hospital overnight.
After the surgery you need to rest in bed with your head raised higher than your chest, to reduce bleeding and swelling. Your nose may be congested because of swelling or from the splints placed inside your nose during surgery.
In most cases, the internal dressings remain in place for one to seven days after surgery. Your doctor also tapes a splint to your nose for protection and support. It’s usually in place for about one week.
For a few days after your surgery, you might experience drainage and bleeding. A drip pad, which is a piece of gauze taped below your nose, can absorb blood and mucus. Your doctor will tell you how often to change your drip pad.
To minimize the chances of bleeding and swelling, your doctor may ask that take precautions for several weeks after surgery such as avoiding strenuous activities taking baths instead of showers while you have bandages on your nose etc. Always follow the directions you were given by your doctor.
Some temporary swelling or black-and-blue discoloration of your eyelids can occur for two to three weeks after nasal surgery. Swelling of the nose can take longer to completely disappear.
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Being prepared will help you get the most out of your appointment. Please bring a list of medications you're currently taking and any pertinent test results—such as labs or imaging—to your appointment. Additionally, let your provider know of any drug allergies or medical conditions you have or for which you are being treated and if you've had any prior surgical procedures.