Resources, procedures & doctors, and Rhinoplasty Nose Surgery

The procedure can be performed in a hospital, surgical center, or office, usually on an outpatient basis, while the patient is under either general anesthesia or local anesthesia combined with heavy sedation.

An incision must first be made in order to access the bone and cartilage support system. There are two types of incisions, the use of which determines the type of rhinoplasty you receive. Incisions can be made externally, or on the outside of the skin, resulting in what's called an “open” rhinoplasty; or there may be no incisions made on the outside skin, but rather confined to the inside of the nose, resulting in a “closed” rhinoplasty. With closed rhinoplasty, the incisions are invisible, meaning that you will have no resulting scars. Additionally, any swelling you may experience tends to improve quicker, and you generally recover faster, with closed rhinoplasty.

The downside of closed rhinoplasty is that, because of a limited ability to see parts of the inside of the nose, the surgeon may be unable to achieve certain changes. For open rhinoplasty, a small incision is placed across the columella, or the area of skin on the underside of the nose separating the nostrils, in addition to incisions made on the inside of the nose. For more complicated cases, open rhinoplasty is more commonly used. Many surgeons prefer open rhinoplasty due to the increased visibility of the inside of the nose, but swelling and bruising generally last longer with open rhinoplasty. Your surgeon should be able to determine the best option for your particular procedure.

Once the incision has been made, the skin of the nose is then separated from its supporting framework of bone and cartilage. The bone and cartilage are then sculpted to the desired shape by removing, adding to, or rearranging. The exact extent and nature of the sculpting will depend upon your surgeon's preferred technique, as well as your problems or desired results.
Some common changes are as follows:

• Wide Nostrils are made smaller by eliminating small pieces of skin from the base of each nostril, then bringing them closer together.
• A Hump On The Bridge Of The Nose , or the dorsal bone, is corrected by removing excess cartilage and trimming the bone, then bringing the nasal bones together.
• The Angle Between The Nose & Lip is altered by trimming the septum.
• The Tip Of The Nose is altered by adding to or removing cartilage. If the tip of the nose is too low, it can be raised by adding cartilage which will support the tip, by removing extra cartilage in the septum, or by repositioning cartilage.
• Wide Upper Nose , or the bony portion of the nose, is made smaller by first breaking the bones and then moving them inward.
• Wide Lower Nose , or the base of the nose, is made smaller by removing tissue at the base of the nose, then moving the nostrils closer together.

Once the desired shape has been achieved, the skin is then re-draped over the new framework and the incisions are closed. The thickness of the skin is an important factor in the end result. Thinner skin will “drape out” better over the new framework than thicker skin. But thicker skin will better hide small irregularities of the cartilage and bone.

Once the skin is re-draped and the incisions closed, a splint will be applied to the outside of the nose to help maintain its new shape while the nose heals. Following surgery, many surgeons will often place nasal packs or soft plastic splints inside of the nostrils which help to maintain stability. Many patients find this unpleasant or uncomfortable so be sure to ask your surgeon if he follows this practice and if it will be necessary for you. In most cases, you will be able to go home the same day, though be sure to have someone available to drive you as you will not be able to do so yourself.

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