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Rhinoplasty – also referred to as “Nose Refinement Surgery” or, more casually, a “nose job” – is one of the most common of all plastic surgery procedures performed today. There are many surgeons who also feel that it is one of the most intricate, and perhaps the most difficult, of cosmetic surgeries. Because the nose tends to be the most defining characteristic of the face, the desire to alter its appearance is not uncommon. Even the slightest of alterations can greatly improve upon one's image.

Rhinoplasty surgery can alter the look of the nose by reducing or increasing the size, narrowing the span of the nostrils, changing the shape of the tip or bridge of the nose, or changing the angle between the nose and upper lip. Rhinoplasty can also correct a birth defect or injury, or help to relieve breathing problems.

Rhinoplasty performed today is often referred to as “Natural Rhinoplasty". The goal of Natural Rhinoplasty is to emphasize the positive features while subtracting the negative aspects. Because a beautiful nose has no set dimensions, but rather should fit the aesthetic proportions of the face while allowing the delivery of air to the lungs, the Natural Rhinoplasty aims to restore harmony in a person's appearance by creating a natural-looking nose that best fits the face and other features without the obvious look of surgery.

The best candidate for rhinoplasty is a person looking to improve upon the way that they look and are in good physical health, are psychologically stable, and have realistic expectations. Rhinoplasty is not only about a patient's wishes, but about what surgery can realistically offer as well. Many surgeons will not operate on children or teenagers, preferring instead to wait until after they have completed their growth spurt, which tends to occur around the age of 16 for girls, and after the age of 19 for boys.

Procedures and techniques will vary among surgeons, but on the whole you can expect the following: Rhinoplasty surgery generally takes between one and two hours, though more complicated procedures may take longer. 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.

Immediately following surgery, your face will feel puffy, your nose may ache, and you may experience a dull headache. If packing has been placed inside of the nose during surgery, it will be removed after the first twenty-four to forty-eight hours. Plan to stay in bed with your head elevated for the first day. Pain medication prescribed by your surgeon should help control any pain or discomfort.

You will likely experience swelling, along with bruising around the eyes, which can increase during the first two to three days. Cold compresses applied to the area will help to reduce the swelling. The majority of this swelling and bruising should disappear within two weeks following surgery. Some minor bleeding can also occur during the first several days following surgery, and you may feel some stuffiness for several weeks following surgery. It is important that you not blow your nose for at least a week following the surgery while the tissues heal.

Most patients are up and about within two days following surgery, and able to return to work or school within a week's time. Within five to eight days following surgery, the splint will be removed. After six to ten days, the dressings and stitches will be removed as well. If absorbable sutures were used, they need not be removed but will dissolve instead.

Your surgeon will provide you with specific guidelines for gradually resuming your normal activities. Some activities will be prohibited in the weeks following the procedure, but generally avoid any strenuous activities for two to three weeks afterwards. Avoid sun exposure, exertion, and risking injury, and be gentle while using cosmetics, and washing the face and hair. For those who wear glasses, special arrangements will need to be made in order to ensure that they do not rest on the bridge of the nose. It is essential to keep any follow-up appointments with your surgeon so that he or she will be able to best monitor the healing process. Be sure to immediately report to your surgeon anything unusual that you may encounter.

Your nose will gradually improve day by day, and though it will take months for the final results to emerge, you will likely begin to feel pleasure with your new appearance within a week or two following surgery. “Semi-final” results should become clear around 3 months following the surgery, though it can take anywhere from 12 to 14 months for the actual final results to be evident, which is the time necessary for complete tissue softening.

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