Rhinoplasty

This popular procedure can improve a disproportionate appearance by altering the size or shape of the nose, the span of the nostrils, or the angle between the nose and the upper lip. In addition, nose reshaping may be performed to correct a nasal birth defect, an injury, or to improve breathing problems. Rhinoplasty may be performed using an open or closed method. Closed rhinoplasty, modifies the structure of the nose through internal incisions, and open rhinoplasty includes an additional incision at the base of the nose between the nostrils.

Anatomy

A brief overview of structures inside the nose will help you understand the nose reshaping process. The upper third of the nose, called the bridge, consists of bone, while the mid and lower portions of the nose are supported by cartilage. A dorsal hump is an area of built up cartilage or bone that forms along the dorsum, or ridge of the nose. Cartilage in the lower portion of the nose, called alar cartilage, is what determines the shape and appearance of the nasal tip. A thin layer of cartilage, called the septum, separates the nose in the center. The columella is the tissue that lies between the nostrils at the base of the nose.

Preparation

Rhinoplasty surgery may be performed under general anesthesia, which causes you to sleep during the procedure. Alternatively, you may be given local anesthesia with sedation, in which the nose and surrounding areas are numb and you are relaxed but may not be asleep. Prior to making incisions, the physician may draw small guidelines on or around your nose.

Incisions

To begin an open rhinoplasty procedure, a small incision is made across the columella at the base of your nose, followed by an incision inside each nostril in order to fully expose the nasal framework. In a closed rhinoplasty procedure, which is shown for the remainder of this animation, your surgeon will generally make two small incisions inside each nostril in order to gain access to the cartilage and bone.

Procedure

In patients whose nasal tip is wide or bulbous, the surgeon may choose to remove a portion of the alar cartilage from the tip of the nose. Depending on your particular nasal structure and the extent of treatment necessary, sutures may be used to bend or pull the alar cartilage inward to create a narrower tip or adjust its position. Additionally, the surgeon may choose to remove a dorsal hump by carving away areas of cartilage and bone. Once any bone or cartilage has been removed, your nose may have an open space between the nasal bones, known as an open roof. Nasal bones may be divided or a piece of bone may be removed. This is called an osteotomy and can create a narrower base of the nose as well as helping close an open roof. An open roof will be closed as the surgeon smoothes the ridges and repositions the nasal bones by pushing them together in the center.

Incision Closure and Dressings

After the surgeon has finished reshaping your nose, the incisions will usually be closed with dissolvable stitches. Nasal airway splints will likely be placed inside your nostrils to provide support and stabilize the nose as it heals. Bandages will be applied to the outside of your nose and if the nasal bones were adjusted during the procedure, a splint will be applied as well. The bandages and splint help the tissues heal and conform to the new cartilage and bone structure.

Recovery & Results

As with any surgical procedure, you may experience some pain, bruising, and swelling, particularly in the upper portion of your face and around your eyes. Your physician will likely recommend pain medication to help keep you as comfortable as possible until the pain subsides. Stitches, bandages, and nasal splints will be removed in approximately one week. Although the majority of the swelling will subside quickly, some minor swelling may persist for a few months and it may take up to a year before the final results are complete.