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Rhinoplasty - How it's Done

Rhinoplasty, commonly referred to as a nose job, is a surgical procedure used to reshape the nose to improve its function or appearance. Many people undergo rhinoplasty for cosmetic reasons to reduce or increase the size of their nose, change the size or shape of the tip, the bridge, or nostrils; however, rhinoplasty is more commonly used to correct breathing problems related to the nose or to correct disfigurements that occurred because of trauma or birth defects.

Surgical steps

1. The Anesthesia- For your comfort, a general or local anesthesia will be administered by your anesthesiologist after you are brought into the operating room. Your face will be washed with antibacterial solution and you will have fluids throughout the entire surgery.
2. The Incision- Once you are completely under general or local anesthesia, the surgeon will make the appropriate incisions for access to the inner structure of the nose. The two common methods are "open" rhinoplasty and "closed" rhyinoplasty.
3. The Reconstruction- Once the soft tissues that cover the nose are gently raised, the surgeon will begin re-shaping your nose. The surgeon can reduce or augment nasal structures with the use of cartilage grafted from other areas of your body like the septum or occasionally a piece of cartilage from the ear.
4. The final steps- After the surgeon has rearranged and reshaped the bone and cartilage to the desired shape, the skin and tissue is re-draped over the nose. A splint or internal tube is placed outside the nose to maintain the new shape as the nose heals. For additional support, your surgeon may place nasal packing inside the nose.
5. The end result- Although any initial swelling diminishes within a couple weeks, it may take up to a year for your new nasal shape to fully refine. Be patient during this time, as you will likely observe gradual changes in the appearance of your nose until its final contour is reached. You will have several doctor's appointments afterwards so the surgeon can evaluate your healing process and handle any questions or concerns. 

Just like with any other surgery, recovery and downtime with rhinoplasty is extremely important, so make sure you follow the necessary rules for healing.  Rhinoplasty is a very difficult surgery to perform, and about 1 in 10 patients return to have a secondary surgery or enhancement. That's why it's important to find a qualified rhinoplasty surgeon with experience and a reputable record.

Top 5 Rhinoplasty Questions

Rhinoplasty is a complex procedure that requires a delicate restructuring of the nose in order to mold it to a more desirable form for aesthetic reasons or to improve function. Since rhinoplasty is an intricately performed surgical procedure, many questions may arise regarding the operation. The top 5 rhinoplasty questions include:

1. Will insurance cover rhinoplasty? In most cases, insurance companies will not cover the costs of rhinoplasty unless it is being done out of medical necessity.  Elective cosmetic surgery will typically not be covered under your insurance plan. If your insurance company agrees to cover the surgery, the exact coverage amount will depend on your particular insurance carrier.
2. How long does rhinoplasty take? The actual rhinoplasty surgical procedure typically takes between one and two hours to complete depending on the complexity of the procedure and what all you are having done. Your plastic surgeon will be able to determine a more accurate time frame once they become familiar with your particular case.
3. At what age can rhinoplasty surgery be performed? For most healthcare professionals, health, rather than age, is the most important consideration in determining the maximum advisable age for rhinoplasty. In cases involving mild or severe disfigurement due to accidents or birth defects, surgery may be performed at any age in an attempt to restore the nose to a more pleasing form. This will not only improve the individual's nose function, but also their self-confidence. In general, though, rhinoplasty should be avoided until the nose fully matures; this means around age 16 for women and age 18 for men.
4. When will I be able to see the results? Unfortunately, the results of rhinoplasty will not be instantaneous. For the first few days your nose will look bruised and swollen. After about a week the swelling will start to decrease and discoloration will start to fade. By 2 months, nearly all of the swelling and bruising should be gone, unless you fall prey to the risks or complications of rhinoplasty. Often the subtleties and elegance of the surgery aren't revealed for up to 6 to 12 months after surgery. If the surgery was performed to improve functionality and breathing, you should be able to reap the benefits after week three once the major swelling subsides. 
5. How much does a rhinoplasty cost? It's important to remember that the cost of the surgery includes much more than the procedure itself. Other included fees are for the operating facility, the anesthesiologist, medicines, splints, packing, and other services and materials. The total cost really depends on where you live and the amount of work you need done. Prices can even vary from surgeon to surgeon depending on their popularity. You should discuss the fee for your rhinoplasty with your surgeon and get all the information in writing. The amount you pay will also depend on how much your insurance provider will cover so be sure to discuss the issue with them as well.

Risks and Complications of Rhinoplasty

Rhinoplasty is reconstructive surgery of the nose that can be used for either improving aesthetics or function.  The surgery can correct many problems of the nose caused by genetics, trauma, or disease and can fix many aesthetic problems as well. As with any surgery, however, a rhinoplasty procedure does carry some risks. Fortunately, complications are rare and even if they do occur, they are usually minor.

Risks and complications
Many of the complications from rhinoplasty are no different than those related to other types of major plastic surgery procedures. You can always expect temporary swelling and bruising around the eyes and nose after rhinoplasty. Other risks and possible complications you need to be aware of prior to proceeding with surgery include:  

• Risk of infection
• Adverse reaction to the anesthesia
• Bleeding
• Injury or holes to your septum (the wall that separates your nostrils).
• Skin problems, including skin necrosis (breakdown of skin tissue) and irritation from the tape and bandaging.
• Loss of smell for a period of time (in rare cases it could be permanent).
• Nasal blockage caused by swelling inside the nose.
• Scar tissue could develop and interfere with breathing or cause a whistling noise.

Rhinoplasty procedures are considered safe and hundreds of thousands of rhinoplasty surgeries are performed every year. However, even when a highly skilled surgeon performs your surgery, sometimes your body could react unfavorably or not heal correctly. In most cases, though, cosmetic complaints are the most common "complications" associated with rhinoplasty. Simply put, some patients are not pleased with the result, which may or may not be the surgeons fault.   

While complications may be rare, there are some things you should do to ensure the best outcome. First and foremost, it's crucial to select a skilled surgeon with solid expertise in rhinoplasty. Making sure the assisting staff members are also experienced with rhinoplasty is important as well. Be ready to improve your outcome by educating yourself about the surgery and by closely following your surgeon's instructions both before and after surgery.

If you are worried about your surgery, the top 5 rhinoplasty questions may provide some helpful insight that will make you feel more confident. Don't be burdened by anxiety, your surgeon will review with you all of the potential risks and complications that can occur prior to the surgery and answer any questions or concerns you may have.

Recovery and Downtime with Rhinoplasty

Rhinoplasty is a delicate procedure that requires sufficient recovery and downtime afterwards. The risks and complication of rhinoplasty vary from person to person, but every individual should take proper care of themselves after such an intrusive operation. The recovery and downtime after the surgery could make a huge difference in the overall outcome.

While most people assume it takes months to recover from rhinoplasty, you can actually return to your normal routine within 3-5 days after the procedure, especially if you are a student or have a desk job. However, proper post-operative care with rhinoplasty should still be maintained months following the surgery.

What to expect
Because the back of your nose connects to your throat and stomach, blood can easily be swallowed during surgery. While this is harmless, it could result in nausea and may cause you to throw up a black-looking mixture a few hours after surgery. The nausea should subside once you throw up, but if it continues contact your doctor. Other things to expect include:

• During the first day or so, your nose will probably ache, your face will look swollen and puffy and you may feel like you have a really bad head cold. Luckily, your doctor will prescribe pain medicine to help counteract any discomfort you may feel.
• You may also have problems breathing, since the nasal passages will likely be swollen, but that should go away after a few days.
• In most cases, you will be required to wear a nasal splint for the first week after rhinoplasty.
• Don't be afraid if you have deep bruising around the eyes, it is quite common and will go away after a couple weeks.
• Expect for the tip of your nose to heal the slowest, since that area get less blood flowing through it.
• After the two week mark, you will have a minor degree of swelling, but it will only be noticed by you and your surgeon. The puffiness will go away completely over the next six months and the shape of your nose will finally be apparent.  

After surgery, you should avoid strenuous activity for at least three to four weeks, but you can return to your social activities as soon as you feel up to it. Healing takes time, so be patient. You can expect to see the final results of your rhinoplasty six to twelve months after your surgery. If you have any concerns, contact your surgeon immediately.

Post Operative Care with Rhinoplasty

Because rhinoplasty is usually performed as an outpatient procedure, it's important to understand your post-operative care requirements before you undergo the surgery. While the results of rhinoplasty vary depending on what kind of correction you want, it is vital that you and your plastic surgeon agree on the goals of the surgery beforehand. The results of rhinoplasty are permanent, so making sure everything goes as planned is essential to a successful surgery and recovery.

After the surgery
Rhinoplasty is a complex surgical procedure dealing with the delicate tissue and bones in the nose, so it's going to take time and rest before it gets back to normal. Recovery and downtime with rhinoplasty is just as important to the outcome of your procedure as the surgery was. After all, complications that arise during the healing process could have serious repercussions on your nose's function and appearance.

Things to avoid

• Don't participate in sport activities (swimming, playing sport games) or any activities that increase your blood pressure for more than two weeks.
• Avoid rubbing your nose or getting it sunburned for at least eight weeks.
• Be careful while washing your hair and face and be gentle using cosmetics.
• To help your healing nose maintain its shape, you won't be able to wear eyeglasses or sunglasses on the bridge of your nose for approximately four weeks; however, you can wear contacts.
• Avoid chewing gum as well as foods that are hard to chew because they cause too much facial movement.
• Don't consume alcohol because it thins the blood and can lead to bleeding.

Rhinoplasty "red flags"
Certain red flags may indicate that your rhinoplasty recovery is not going smoothly.  For example, a fever may be a sign that there is an infection.  It is important to monitor your temperature regularly, and to take your antibiotics as prescribed. The risks and complications of rhinoplasty may be rare, but it's important to know what the signs are so you can get the problem handled before it gets worse. Luckily, your will have numerous doctor visits with your surgeon after the surgery so he can evaluate how you're healing and potentially clean the inside of your nose. During this time you can express any concerns and consult with your doctor about any unusual symptoms you may be having.

Top Facial Plastic Myths

All of the rumors and conflicting information about plastic surgery has made researching the subject quite confusing. While the internet has made it easy to share information, it has also made it hard to distinguish what is fact and what is fallacy. The following is an assembled list of some of the most commonly repeated myths, accompanied by the facts.

Myth: Only one plastic surgery procedure can be done at a time.
Fact: While many people choose to get only one plastic surgery procedure at a time, it is indeed possible to have more than one procedure in one sitting. However, combined procedures require more time under anesthesia; so to protect your safety you will get a physical examination in order to be medically cleared by a doctor before undergoing surgery.

Myth: All plastic surgeons are equally qualified.
Fact: All surgeons are not equally qualified. Board certification is an essential criterion, but even board certified surgeons vary widely in qualifications and skills. Just because a plastic surgeon flaunts many different kinds of certifications, has their degree and passed a rigorous written test, it doesn't mean they are the best. Even though many cosmetic surgeons advertise themselves as having many different kinds of certifications, only the American Board of Facial Plastic and Reconstructive Surgery certifies that someone is fully trained in plastic surgery of the face and body.

Myth: Plastic surgery does not require follow-up examinations.
Fact: For your safety and benefit, follow-up visits after surgery are highly recommended. The follow-up appointments allow your surgeon to examine your healing process and make any changes to your post-operative care if necessary. It is important to keep follow-up appointments, because it may save you from having to undergo a revision operation or having to withstand painful complications. Not to mention, plastic surgeons are trained to be able to identify early signs of problems, so they can catch them before they get worse.

Myth: Plastic surgery is just for the wealthy.
Fact: Most people consider plastic surgery as something that only the wealthy can afford. However, in recent years, statistics from the American Society of Plastic Surgery show that the vast majority of patients undergoing plastic surgery are middle-class patients who use their own disposable income. From young women to older men, facial plastic surgery has become increasingly popular among people from all walks of life. Many plastic surgeons even offer a variety of flexible financing options for those who need the added assistance.

Ultimately, the decision to undergo plastic surgery should not stem from the cost, but from what underlying issue you are trying to improve- be it aesthetics or function. If you have any other questions or concerns regarding facial plastics, contact your doctor.