Rhinoplasty or "nose reshaping" is used to improve the function or appearance of the nose.  This surgical procedure has many variations and modifications in order to provide patients their cosmetic or reconstructive goals.

This surgical procedure can improve the height and shape of the nose (tip and root), diameter of the nostril and ala (alar plasty or nose trimming) and columellar lengthening (bridge of nose improvement)

What is rhinoplasty?
Informally known as a nose lift, rhinoplasty is a popular cosmetic surgical procedure designed to improve the aesthetic appearance of not only the nose, but also to create a harmonious balance of facial features. It is for those dissatisfied with the anatomical attributes of their nose and can not only help improve physical appearance, but boost self-esteem as well.  As it is a somewhat delicate operation, it is best performed by a board-certified plastic surgeon who has a good understanding of facial anatomy. A number of procedures can be performed, including decreasing or increasing the size of your nose, reshaping the tip, or even reducing its width.

What to expect during consultation

Description of the procedure
The procedure is performed on an outpatient basis. Patients undergoing rhinoplasty stay for a while under observation, then go home. The actual procedure takes approximately one to three hours, but can be longer.  It is usually performed with local injections of anesthesia with intravenous sedation, or in some cases, under general anesthesia. If you are to be sedated or undergo general anesthesia, you will be asked not to take anything by mouth for at least 6 hours prior to the procedure.  You may also be given pre-operative antibiotics and pain relievers.

The techniques performed depend on the type of correction desired. In most cases, it entails one or more incisions, discreetly placed so that excess skin may be removed. It can also involve altering or removing cartilage, inserting an implant or modifying the bone structure through an incision. Two primary techniques are in use today: open and closed rhinoplasty. Closed rhinoplasty involves making an incision on the inside rim of the nostril. The other, open rhinoplasty, includes one more incision made on the columella (i.e. the tissue that separates the nostrils), often in a zigzag shape.

Specifically, rhinoplasty can help correct the overall size and shape of the nostrils. Usually, this involves removing a portion of the skin where the nostrils meet the face. Known as the Weir Excision, this allows for any resulting scar to remain very discreet, since it is located in a natural crease. Flared nostrils can be reduced by placing one or more incisions on the inside of the nose and suturing the incisions. In most cases the bridge needs to be heightened, in which case one of the following may be added: an implant, cartilage, or soft tissue.  Any bumps on the bridge of the nose can also be removed.  Also, the actual angle of the nose relative to the upper lip can be changed.  Rhinoplasty can also improve the tip of the nose, making it less bulbous, pointy, squared or hooked. Modification can include altering the actual cartilage maintaining the shape or just the soft part of the nose. Finally, the length of the nose can be moderately decreased by targeting the septum at the base and removing part of it.

Potential risks / complications of the procedure
Bloody drainage is common in the first 48 hours after surgery and blood-tinged nasal discharge may persist for 1-2 weeks following surgery. Profuse bleeding is unusual. Nasal swelling is expected and may not be readily noticeable until after the splint is removed. Most of the swelling subsides in 4-6 weeks, but subtle swelling may persist for 6-12 months. In certain situations, the doctor may inject a small amount of steroid into your nose to help reduce the swelling. Bruises following nasal surgery usually manifests as "black eyes" and usually resolves in 2-3 weeks and may be concealed with makeup. Nasal breathing may be difficult for 2-3 weeks after surgery due to swelling inside the nose. This "stuffiness" will subside gradually and IS NOT improved with nasal sprays. Itching, numbness and a "wooden feeling" to the nose are common. All of these do subside, although, it may take months for your nose to feel completely "normal".

Permanent risks include tiny burst blood vessels in the nose and scarring.  Some more serious risks are those related to any surgical procedure, such as bleeding, infection and complications arising from the administration of anesthesia.

What to expect following nasal surgery
Recovery depends on the extent of correction. Patients generally return to work/school within one to two weeks, while strenuous activity that raises blood pressure should be avoided for up to three weeks. While the nose heals, it should not be touched or rubbed. Activities that involve bodily contact, such as basketball or other sports, are to be avoided until full recovery is completed. This may take up to several months. Swelling may last up to a year.  Though a change is immediately apparent following surgery, bandages, swelling and bruising may "hide" results. The true results from rhinoplasty appear in the months following surgery. Complete recovery from swelling may take up to a year, however patients usually notice improvement earlier.