Rhinoplasty

Written by Teresa Bergen | Published on July 5, 2012
Medically Reviewed by George Krucik, MD

Rhinoplasty

Rhinoplasty, commonly called a nose job, is surgery to change the shape of your nose by modifying the bone and/or cartilage. Rhinoplasty is one of the most common types of plastic surgery.

Reasons for Rhinoplasty

People have rhinoplasty to repair their nose after an injury, to correct breathing problems or a birth defect, or because they’re unhappy with the appearance of their nose.

Possible changes to your nose through rhinoplasty include:

  • change in size
  • change in angle
  • straightening of bridge
  • reshaping tip
  • narrowing nostrils

If your rhinoplasty is cosmetic—that is, to improve your appearance rather than your health—you should wait until your nasal bone is fully grown. For girls, this is about age 15. Boys might still be growing until a little later. However, if the surgery is being done because of a breathing impairment, it can be performed at a younger age.

Preparing for Rhinoplasty

You must first meet with a surgeon to discuss whether you’re a good candidate for rhinoplasty. You will also talk about why you want the surgery and what you hope to accomplish by having it.

The surgeon will examine your medical history. He or she will ask about your current medications and medical conditions. If you have hemophilia, which is a disorder that causes excessive bleeding, the surgeon will likely recommend against any elective surgery.

Your surgeon will physically examine you. He or she will look closely at the skin on the outside and inside of your nose to determine what kind of changes can be made. The surgeon might order blood or other laboratory tests.

Your surgeon will also consider whether any additional surgery should be done at the same time. For example, some patients get chin augmentation—a procedure to better define the chin—at the same time as rhinoplasty.

This consultation also includes photographing your nose from various angles. These shots will be used for assessing the long-term results, and may be referred to during the surgery.

Make sure you understand the costs of the surgery. If your rhinoplasty is for cosmetic reasons, it’s much less likely to be covered by insurance.

You should avoid painkillers containing ibuprofen or aspirin for two weeks before and two weeks after your surgery. These medications slow down the blood-clotting process. Taking these medications can make you bleed more. Let the surgeon know exactly what medications and supplements you’re taking, so he or she can advise you whether or not to continue them.

Smokers have more difficulty healing from rhinoplasty, as cigarettes slow the recovery process. One of the effects nicotine has is to constrict your blood vessels. The result of this is less oxygen and blood getting to healing tissues, so quitting smoking before and after surgery can help the healing process.

Rhinoplasty Procedure

Rhinoplasty can be done in a hospital, a doctor’s office, or an outpatient surgical facility. Your doctor will use local or general anesthesia. If the doctor expects a simple procedure, you might get local anesthesia. In this case, the doctor injects medication into your nose that will numb your face. You may also get medication through an IV line to make you groggy, but you will still be awake. With general anesthesia, you’ll inhale a drug or get one through an IV that will make you unconscious. Children are usually given general anesthesia.

Once you’re numb or unconscious, the surgeon will make cuts between or inside the nostrils. He or she will separate your skin from your cartilage or bone, and then start the reshaping. If your new nose needs a small amount of additional cartilage, the doctor may remove some from your ear or deep inside your nose. If more is needed, you might get an implant or a bone graft. A bone graft means additional bone will be added to the bone in your nose.

The procedure usually takes between one and two hours. If the problem is complex, it can take longer.

After surgery, your doctor may place a plastic or metal splint on your nose. The splint will help your nose retain its new shape while it heals. You might also have nasal packs or splints inside your nostrils to stabilize your septum, the part of your nose between the nostrils.

You might have to stay in the hospital for a day or two if you had a more complicated procedure.

Recovery from Rhinoplasty

You’ll be in a recovery room for at least a few hours after surgery. This way the healthcare staff can monitor you. If everything seems okay, you’ll leave later that day. You’ll need someone to drive you home, since the anesthesia will still affect you. Or, if you’re in a hospital, you might stay overnight.

To reduce bleeding and swelling, you’ll want to rest with your head elevated above your chest. If your nose is swollen or packed with cotton, you might feel congested. Patients are usually required to leave splints and dressings in place for up to a week after surgery. Your stitches might be absorbable, meaning they’ll dissolve and won’t require removal. However, if this is not the case, you may have to go back a week after surgery to get stitches taken out.

Memory lapses, impaired judgment, and slow reaction time are common after-effects of surgery. If possible, have a friend or relative stay with you the first night.

For a few days after the surgery, you might experience drainage and bleeding. A drip pad, which is a little piece of gauze taped below your nose, can absorb blood and mucus. Your doctor will tell you how often to change your drip pad.

You might get headaches. Your face will feel puffy. Your doctor might prescribe pain medication.

Your doctor may tell you to avoid the following for a few weeks after your surgery:

  • running and other strenuous physical activities
  • swimming
  • blowing your nose
  • excessive chewing
  • laughing, smiling, or other facial expressions that require lots of movement
  • pulling clothing over your head
  • resting eyeglasses on your nose
  • vigorous tooth brushing

Be especially careful about sun exposure. Too much could permanently discolor the skin around your nose.

You should be able to return to work or school in a week.

Rhinoplasty can affect the eye area. You might have temporary numbness, swelling, or discoloration around your eyelids for a few weeks. In rare cases, this can last for six months, and slight swelling could persist for even longer. You can apply cold compresses or ice packs to decrease discoloration and swelling.

Follow-up care is important after rhinoplasty. Be sure to keep your appointments and follow your doctor’s instructions.

Results of Rhinoplasty

Healing from rhinoplasty can take a while. You might be fully recovered in a few weeks, but some after-effects can linger for months. It could be a whole year before you can fully appreciate the end result of your surgery. The tip of your nose is especially sensitive. It can remain numb and swollen for months.

Risks of Rhinoplasty

All surgeries carry some risks, including infection, bleeding, or a bad reaction to anesthesia. Rhinoplasty may also put you at risk for:

  • breathing difficulties
  • nosebleeds
  • a numb nose
  • an asymmetrical nose
  • scars

Occasionally patients aren’t satisfied with the surgery. If you want a second surgery, you must wait until your nose is fully healed before operating again. This may take a whole year.

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