Rhinoplasty & Nasal Reconstruction
Rhinoplasty, or nose surgery, is one of the most common plastic surgery procedures performed today. It can reshape, reduce or augment a person’s nose to achieve facial harmony and boost self-confidence. It may be performed as a reconstructive procedure to correct a birth defect or an injury such as a broken nose.
Rhinoplasty may be performed for functional rather than cosmetic reasons as well. Combining nose reshaping with septoplasty or endoscopic sinus surgery can effectively treat certain breathing problems, such as those caused by a deviated septum.
Goals of Rhinoplasty
Rhinoplasty is an excellent procedure for achieving the following:
- Balance the size of the nose with the other facial features
- Modify the width of the nose at the bridge
- Improve the nasal profile, including removing humps or depressions
- Contour a nasal tip that is too large, “boxy,” drooping or upturned
- Change the angle between the nose and the mouth
- Narrow and reshape the nostrils
- Correct asymmetry or deviation
The Rhinoplasty Procedure
Rhinoplasty is usually an outpatient procedure performed under IV sedation or general anesthesia.
Surgeons use one of two techniques when performing nose surgery. In a closed rhinoplasty, incisions are made within the nostrils. In an open rhinoplasty, the incision is made across the columella, the tissue between the nostrils. With both methods, the surgeon gently lifts the soft tissues covering the nose. He or she sculpts the bone and cartilage to the desired shape. Any additional cartilage needed to augment the nose can often be taken from the septum.
If the patient has a deviated septum, the surgeon will adjust the septum and the inner structures of the nose to improve breathing. Then the tissues are re-draped and stitched closed. If the patient desires nostril reshaping, this is done as the final stage of rhinoplasty.
The entire procedure generally lasts one to two hours.
Recovery and Results after Rhinoplasty
For a short time after surgery, patients may experience puffiness, nose ache or a dull headache, some swelling and bruising, bleeding or stuffiness. Most patients feel like themselves within two days and return to work in about a week.
The results of rhinoplasty become gradually apparent as the days pass after surgery and swelling recedes. Swelling may reappear from time to time in the first year after the procedure. It is typically more noticeable in the morning and fades during the day.
Contact lenses can be worn immediately, but glasses may need to be taped to your forehead or propped on your cheeks for up to seven weeks.
Patients with realistic goals for rhinoplasty are generally very happy with the new shape of their nose. The exact results depend on the patient’s nasal bone and cartilage structure, facial shape, skin thickness and age.
Many people who have undergone a rhinoplasty may be unhappy with the aesthetic and/or functional results of their procedure, and may seek additional surgery to correct their problem in order to achieve the results they desire. Unsatisfactory results may occur as a result of a complicated condition, an inexperienced surgeon, or simply due to the patient’s healing techniques.
Revision rhinoplasty, also known as secondary rhinoplasty, is a complicated procedure that is most successfully performed by a rhinoplasty specialist to reshape or resize the nose after an initial procedure.
Some of the problems patients complain of after their initial rhinoplasty procedure include:
- Pinched tip
- Pulled up nostrils
- Creases around the nostrils
- Scooped out profile
- Breathing difficulties
These problems can range from minor imperfections to severe deformities. Dr. Chaiyasate strives to help patients achieve the highest level of satisfaction from their rhinoplasty and will do his/her best to produce the results that the patient desires.
Candidates for Revision Rhinoplasty
Anyone who is unhappy with the results of their initial rhinoplasty procedure may be a candidate for revision rhinoplasty. Patients should discuss their initial procedure with either their original surgeon or a different one in order to determine the new goals for revision. It is also important for patients to be both emotionally and financially prepared for additional surgery.
Your doctor will determine whether or not revision surgery is a possibility for you after discussing your goals for surgery and performing a physical examination.
Revision Rhinoplasty Procedure
The revision rhinoplasty procedure is usually performed on an outpatient basis under deep sedation or general anesthesia to help reduce any potential discomfort. Revision rhinoplasty is usually performed using an open technique, allowing for greater visualization of the nasal cavity because the already-reshaped bone and cartilage may be more difficult to sculpt.
In cases where reshaping is difficult, a cartilage graft from the nasal septum, ear or rib may be required. Injectable fillers may also be used to correct small defects after the initial procedure, although use of the patient’s own cartilage is preferred. The entire procedure usually takes two and a half to four hours to perform.
Recovery from Revision Rhinoplasty
After the revision rhinoplasty procedure, patients will usually experience bruising and swelling for five to seven days, along with some mild pain that can be managed with medication prescribed by your doctor. Once bruising and swelling subside, patients can usually return to work and other regular activities. The nose will continue to heal and may change slightly in appearance over the course of a year after surgery, when full results will be visible.
Initial results of the revision procedure will be noticeable right away, but will continue to improve as swelling subsides and the nose heals. It is important for patients to wait until full results appear before deeming their procedure a success.
Risks and Complications
Revision rhinoplasty carries the same risks associated with the initial rhinoplasty procedure, but also involves thicker skin, scar tissue and less cartilage within the nose. The patient’s airway may also have been affected by the initial procedure, which makes revision surgery more difficult to perform.
It is important for patients to understand the risks associated with this procedure and to maintain realistic expectations for their revision rhinoplasty. The best results are achieved by choosing a highly skilled and experienced surgeon to perform your revision surgery, and by maintaining open communication with your doctor.
Reconstruction of The Nose
The dominant cosmetic impact of the nose on the central face renders any deformity of its significant, and markedly affects the patient’s overall appearance and sense of self. Dr. Chaiyasate’s principle of nasal reconstruction includes:
- The use of own tissues can be considered to represent the old standard for successful nasal reconstruction.
- Optimal results are achieved through a staged approach, allowing suitable time for healing and recovery of the tissues before the next intervention.
- All of the affected or missing parts must be restored to achieve both a cosmetic and a functional reconstruction.