NOSE JOB ( RHINOPLASTY )

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It is also referred to as 'nose job', rhinoplasty is the surgery of the nose. A rhinoplasty addresses appearance and function of the nose. It is a technique for improvement of height, tip, width of nose and airway issues (obstruction). Nose occupies a central part of the face. Needless to say deviations in the appearance of the nose are easily observed by others. The shape of a good nose is such that it should not draw attention to itself. It is one part of our anatomy which shows enormous variation depending upon our ethnicity. A rhinoplasty is considered as among the more difficult of cosmetic surgery procedures since many parameters affect the final appearance of the nose. It is usually not a simple addition and subtraction procedure. 

An initial consultation is important to assess the individual expectations and to know if the person is a good candidate for surgical correction. Treatment options are based on the physical characteristics, associated airway issues and needs (expectations) of the individual. During the consultation various treatment options, risks and complications are explained to the patient. Sometimes an appointment with an ENT doctor may be scheduled for assessment of airway problems. This may involve tests such as nasal endoscopy. Airway issues due to the septal abnormality can usually be treated at the same time as rhinoplasty. In some cases, surgery may be declined if the doctor feels that there may not be any significant improvement in the appearance of the patient. 
Like other major cosmetic surgery procedures, a second appointment may be scheduled along with the spouse or immediate caregiver. Preoperative pictures are obtained. The outcomes and possible complications are also reviewed.


Surgery is performed under general or local anesthesia. Longer procedures are done under general anesthesia. The incision is placed on the inside of the nose and a small part of it is visible on the under-surface of the nose. The scars usually settle well. The procedure depends on the abnormality and the steps tailored to correct these. This may include 

1.  alteration of the tip with removal, addition or alteration of the shape of the cartilages which form the nasal tip. 
2. increase or reduction of the dorsum of the nose. Additional cartilage may be harvested from within the nose, ear or near the ribs. 
3. reconstruction of internal and external valves of the nose. 
4. alteration of the septum of the nose. 
5. narrowing of a wide base of the nose with the removal of a small disc of tissue. 
6. correction of asymmetry of the nose by manipulation of bones and cartilages. 
7. alteration of certain lip muscles to better improve the relation of nose and upper lip. 

The exact steps taken depend on the preoperative diagnosis of the deformity. Sometimes a small pack may be placed inside the nose which is removed painlessly by the next day. The patient may be asked to wear a splint for a week in the case of a bone alteration. The patient is encouraged the use of cold compresses and additional pillows during the initial days. 

The patient can usually return to work in 5 days. The splint is removed in a week. Improvement in the appearance is visible in spite of the swelling by the end of 2 weeks. Most of the swelling is usually goes by the end of the first month. The nose settles into the final appearance by the end of the first year.

You can read more about post operative instructions of rhinoplasty  here.

For more information about revision rhinoplasty (secondary correction) visit here. 
 

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Pre and post operative pictures of nasal cleft treated with nasolabial flap and dermabrasion.  

Cleft of the lower part of left side of the nose.

Improved balance with nasolabial flap cover and dermabrasion.

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To learn more about Tip-plasty ( surgery of tip of nose), click here. 

Broad tip of the nose.

Improved definition after tip correction.

Hump of the dorsum of the nose.

Hump removal with up-rotation of tip.

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Crooked nose with broad tip

Septo-rhinoplasty with tip-plasty, septal resection and external low-low osteotomies

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External valve collapse with difficulty in breathing. Treated with auricular cartilage graft to the ala.

Flaccid ala with reduced support

External valve collapse with resulting difficulty in breathing

Early postoperative picture with improvement in the alar support

Early postoperative view with improved size of nostrils and functional improvement

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Revision rhinoplasty done in an individual with nasal obstruction and tip and dorsal deformity. 

Before: With nasal obstruction and deformity of the tip, lateral walls and dorsum

After: revision rhinoplasty done with dorsal, spreader, lateral wall and septal extension cartilage grafts and lateral and medial osteotomies.

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Reconstruction of nose in complex central facial injury

Central facial injury with loss of skeletal support of nose

Postoperative image after open rhinoplasty with primary bone grafting

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Before: Post-trauma crooked nose

After: Rhinoplasty with asymmetric osteotomies and cartilage grafts

Before: Saddle deformity

After: Saddle deformity treated with extended spreader and septal brace

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Before : Secondary rhinoplasty

After: Secondary rhinoplasty with septoplasty, tip-plasty, dorsal augmentation and multiple osteotomies

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