Board Certification: American Board of Plastic Surgery
Manhattan Eye, Ear & Throat Hospital, Fellowship in Aesthetic Surgery
Board Certification: American Board of Plastic Surgery
Manhattan Eye, Ear & Throat Hospital, Fellowship in Aesthetic Surgery
Rhinoplasty(Nose job) can have both functional and aesthetic benefits. There are a variety of maneuvers that can be performed to alter the appearance of the nose. The nose can be straightened, made more narrow or wide, the hump can be brought down (reduced) or built-up (augmented), and the tip can be brought up (rotated) or down (de-rotated). In addition, the nose can be altered to project more (projected) or less (deprojected) to a certain degree based on the patient’s preoperative anatomy and desires.
The most common maneuvers that I perform to achieve my patients’ goals are dorsal hump reduction, tip rotation, and tip refinement. That being said, every patient is different. Careful preoperative analysis and discussion are required to achieve optimal results.
In addition to altering the aesthetics of the nose, the airway can be treated during a rhinoplasty with specific cartilage grafts or by performing a septoplasty.
Rhinoplasty, sometimes referred to as a “nose job,” is a popular option for individuals that are unhappy with the shape or size of their nose. This procedure has well-known cosmetic benefits but also can improve quality of life. Rhinoplasty can be performed to reverse the damage from trauma or to help improve the breathing problems that can sometimes affect exercise tolerance or sleep quality.
Individuals who are interested in rhinoplasty should be in good health and be fit for elective surgery. Patients should avoid smoking and nicotine-containing products that can affect blood flow and, ultimately, healing. Similarly, patients should avoid intranasal drugs before surgery, during recovery, and after rhinoplasty. In addition to the general health risks of smoking and intranasal drugs, both increase the risk of complications and risk poor healing and tissue loss.
In general, rhinoplasty should be performed once an individual reaches skeletal maturity. This avoids unpredictable changes to the nose from midface growth. Skeletal maturity is generally 17 to 18 years of age for men and 15 to 16 years of age for women.
The short answer is no. While most patients tend to be younger, patients can enjoy the results of rhinoplasty in their 50s, 60s, and even 70s. As long as you are healthy enough for elective surgery, there is no age that is considered too old for rhinoplasty.
I feel that a patient should not concern themselves with open versus closed rhinoplasty when choosing a surgeon. Some surgeons are more comfortably with one technique than another. Some surgeons advertise a closed rhinoplasty as a “scarless rhinoplasty.” This is somewhat misleading. Even with closed rhinoplasty, there are scars within the nose similar to that of an open rhinoplasty. The only difference is that an open rhinoplasty has a small incision across a few millimeters of the columella (the base of the nose) that typically heals very well.
A rhinoplasty, depending on the complexity, takes between 1.5 and 3 hours. Additional operative time may be needed for revision cases. The total operative time may be longer when accounting for anesthesia time at the beginning and the end of the procedure.
Rhinoplasty is not a particularly painful procedure. You will have discomfort for several days. You will be swollen and may have bruising depending if your nasal bones need to be fractured during your surgery (osteotomies). Most surgeons place a splint on the nose after rhinoplasty which typically is removed at the first postoperative visit. Sutures are generally removed at this visit as well. Some surgeons place packing or splints in the nose for various reasons related to their training or what was seen during the operation. These materials are generally removed a few days after surgery. The most common complaint during the first week of recovery is that the patient feels congested from the swelling.
All surgeons have slightly different protocols so each patient should follow their surgeon’s protocols. In general, rhinoplasty should be treated similar to other major surgeries with the avoidance of strenuous activity and exercise for the first 4-6 weeks after surgery. Patients should avoid blowing their nose (or reverse blowing their nose) to avoid additional trauma to the healing septum. Patients should elevate their heads as much as possible to help with the swelling. Patients should sit up while watching TV and use several pillows at night when they sleep. Most importantly, patients should avoid trauma to the healing nose.
I tell my patients that their nose will be swollen for at least 1 year. That being said, the majority of the swelling will subside by the 3-month mark, 75-80% at the 6-month mark, and 95-100% at the 12-month mark. Every patient is different but patience is necessary after rhinoplasty when judging the final result.
