We all know that a “nose job” — or, to use the official term — rhinoplasty is the name of the operation performed on the nose to change its shape, its size, or both. Since many people are unhappy with their noses, chances are that you, too, have considered having a nose job at some point in your life. The immediate results can be stunning, but what happens after? What might we expect after having a rhinoplasty?
Since this is such a common surgical procedure, or at least one that many people are considering having, info about this topic is always very valuable. In most cases, postoperative consequences are a common problem and many people would like to hear as much about this as possible.
What is rhinoplasty?
The nose is a dominant feature on the face, which is why all operations to change it must be planned with reference to other facial features in order to achieve facial harmony. To understand what surgery can achieve, an understanding of the basic anatomy of your nose is necessary.
The bony part of the nose is in the upper third, nearest to the forehead. This part is much like the sloping roof of a house, with two bony sides and a central vertical sheet called the septum. The septum contains both bone and cartilage. The tip of the nose is largely cartilage, and these components exist in a complex arrangement. This arrangement maintains the integrity of the structure and allows the nostrils to flare during the intake of breath without collapsing.
Reductive rhinoplasty procedure
The most commonly requested cosmetic operation to the nose is a reduction in size. Three principle areas are of concern: the hump, the tip, and the width of the nose. An individual may be concerned about one or all these features before the surgery.
n order to reduce the hump of the nose, a combination of the bony and cartilaginous apex must be cut away by your doctor. This leaves a flat top to the bridge of the nose, and so the nasal bones on each side divide and move in to recreate the rounded apex of the nose. The nasal tip consists of two pieces of cartilage on each side, known as the upper lateral cartilage and the alar cartilage respectively. These pieces of cartilage your surgeon can trim in order to reduce the size of the tip.
Most straightforward rhinoplasties go through scars placed inside the lining of the nose, so that there are no visible external scars. However, it is sometimes necessary to create scars in the nasal skin for complex problems requiring an open rhinoplasty. It is also a common situation when patient needs reducing the size of the nostrils.
Anesthesia and postoperative consequences
Surgeons in the UK conduct rhinoplasty under general anesthesia. However, the more straightforward procedures are common under local anesthesia supplemented by intravenous sedation, known as twilight anesthesia. After a rhinoplasty, a patient will either have tapes or a plaster over the nose. A patient might sometimes have packs ("tampons") within the nose as well. Usually the packs are removed two days after the operation whilst the tapes or plaster are left on for up to 2 weeks.
There may be considerable bruising after rhinoplasty along the sides of the nose. It could also happen beneath the eyes, which produces black eyes. The operations are not without discomfort, but usually it is possible to control the pain with simple over the counter painkillers starting with the day after the rhinoplasty. You will be advised to sit up and to avoid blowing your nose. You should clean the nostrils with a cotton bud instead.
After your surgeon removes the plaster or tapes, the overlying skin may be swollen and discolored. This discoloration and bruising may persist for a total of a month. However, the swelling may take a full 3 months to settle and reveal the final postoperative appearance you have been expecting.
f a person has had nasal augmentation there will of course be scarring and bruising around the donor site. This is more likely to occur if the doctor used one’s own bone or cartilage. There is a small but definitive risk of bleeding from the nose that can occur 7-10 days after a rhinoplasty.
Finally, you might also consider the risks from the anesthetic itself. Individuals with heart or lung problems should receive careful monitoring by their family doctor before a rhinoplasty.
Recovery after rhinoplasty
You will be happy to hear that the external cast or splint your surgeon will place can be removed soon after the surgery. However, your nose may be packed for 24 to 48 hours. The surgeon will probably remove the cast or splint in 7-10 days. You could easily control your initial discomfort with oral medications.
The majority of swelling and bruising subsides progressively over 2 to 4 weeks. Furthermore, your surgeon will remove external sutures if there are any, in 4 to 6 days, while the internal sutures will dissolve on their own, without further intervention. A return to work may be possible in about 7 to 14 days, depending on the nature of your responsibilities. The visual improvements and better breathing should be apparent relatively soon after the swelling diminishes. However, a realistic approximation of your result is evident in 3 months.
The result will continue to evolve and refine for the next 12 to 14 months. Areas of sensitivity or numbness will slowly resolve, and temporary conditions may occur, but will improve over the first several months. Common conditions are stiffness of the tip of the nose, nasal drainage, lumps and irregularities. You have to be aware that a little bleeding is common during the first few days following surgery, and you may continue to feel some stuffiness for several weeks. Some patients also feel claustrophobic and breathless. This feeling widely resembles a head cold or sinus infections, which are common problems.
If you had the cast after your nose job, your surgeon will remove it approximately 7 days post-operatively. You may feel a slight stiffness in the upper lift as the swelling moves downward your face. This will subside in a matter of hours, but you must be very careful not to bump it, as it is vulnerable to breakage. It is not a bone china figurine but it is not as strong as your nose was before the rhinoplasty. However, this should not worry you, because the bones will completely mend within 2 months, after which you can "use your nose normally" again. If you had a rhinoplasty where the surgeon narrowed your nostrils, you will need to have your sutures removed.
When are the results of rhinoplasty visible?
The nose will be very sensitive for approximately a month and a half, but the patient will start to see a difference immediately. You will still have some swelling, however. The swelling starts to disappear about a week after the surgeon removes the cast. Approximately 80% of the swelling and 100% of the discoloration will resolve itself by 2 weeks after surgery. Most of postoperative swelling is gone by two months after surgery and the rest slowly disappears over the next year. Although your nose will have some swelling after the first month, most people would not recognize this fact. The patient himself might not notice this swelling at all. Instead, most patients will notice that the nose becomes more refined with a better definition over the first year. The inside of the nose is swelling for approximately three weeks after the nose job surgery. Nasal breathing may be difficult during this time, but if the surgery’s goal was to straighten the nasal septum, you will experience an improvement in breathing after about 3 weeks.
What are the risks of rhinoplasty?
It is possible to develop tiny red marks and spots after rhinoplasty. This can be the result of blood vessels bursting under the skin’s surface during the surgery. Although this is extremely infrequent, it can still happen, unfortunately, and the spots may not ever go away.
Scarring is minimal if the incisions are inside of the nose. However when an open technique is used, or if there was nostril-narrowing work done, the scars made on the outside of the nose may be visible for an undetermined amount of time, usually until maturation.
Even when a highly skilled surgeon performs your surgery, sometimes your body may not heal correctly. In some cases, your body might have an adverse reaction causing undesired results. Some patients lose their sense of smell temporarily. Your nose may be slightly swollen for over a year, and scar tissue may heal in a way that may cause a whistling sound to be heard when you breathe in and out.
You should also know that this surgery has the highest rate of revisions. It seems that some people, especially mature people, may not readily accept the new look of their face. It is common that patients find out they were too well-accustomed to their old nose, so they just cannot seem to make the transition comfortably.
Moreover, a few rhinoplasties just do not heal correctly, due to something as serious as human error. When a qualified plastic surgeon is doing your rhinoplasty, complications are infrequent and minor. Nevertheless, there is always a possibility of infection, nosebleed, or a reaction to the anesthesia, as in any other surgery. You can reduce your risks by closely following your surgeon’s instructions both before and after rhinoplasty.
Secondary surgery
It is common for individuals to request a second or third operation to change the appearance of their nose. As a rule, surgery becomes more difficult and much more complicated after the first time. It becomes so stressful that the gains from subsequent operations are lower, as are the chances of success. A rhinoplasty is still a major operation and should not be undertaken lightly as some people do. That is why before you decide to have a rhinoplasty, you should talk to your doctor about the procedure. You should know what to expect, and have realistic expectations.