Monday, June 20, 2011

Cosmetic Surgery of the nose (Rhinoplasty)

Cosmetic Surgery of the nose (Rhinoplasty)

Rhinoplasty or nose job is a highly specialized surgical procedure, used to change the size, shape, and overall appearance of the nose.

Rhinoplasty dates back to ancient Indian civilization and has evolved from purely reconstructive to cosmetic surgery. The ancient Hindu surgeons had ample opportunities in the art of making new noses because of the practice of chopping off the nose and ears as the mode of punishment. The modern practice in rhinoplasty surgery is based on Indian rhinoplasty.

The external nasal deformities can be in form of hump, bump, saddle shaped, crooked, bulbous or big nose. Many patients however, with deformed noses especially in the present era due to increasing social pressures are particularly conscious about their appearances and seek the esthetic improvement. There is no other single feature on the face except nose, which provides so much conspicuous and prominent definition for the facial features and perhaps no other operation except rhinoplasty that alters radically the facial appearance. Most of the times, rhinoplasty is performed because of the patient’s desire to improve the facial appearance. Some patients are motivated by the glamorous modeling career and even for matrimonial considerations. Rhinoplastic surgery requires an artistic aptitude and skillful craftsmanship to perform the operation successfully and to achieve long lasting and pleasing results.

A corrective Rhinoplasty is used to change the size, shape and overall appearance of the nose, which suits the face. Rhinoplasty can improve a patient’s appearance dramatically, offering greater confidence and self-esteem. A short nose will not fit a long face and a big nose will not fit on a short face. A male nose will not fit on a female face and vice versa. Nose jobs are different in each case, which also depends on the patient’s ethnic origin & type of external nasal deformity. An aesthetically pleasing nose and the concept of a beautiful nose has changed as surgical techniques became more refined and also as surgeons learnt to create the nose that suits on the face and not the nose that suits to surgeon. The objective is to create a natural-looking nose that matches with other facial features

Sometimes changing just the nose will not give you facial balance. For this reason sometimes it is necessary augmenting the chin & alter the size of lips to give better facial and profile appearance.

Nose job can be done by both open and closed technique. Each technique has its own advantage & disadvantages, which are discussed during consultation. In closed techniques no outside scar is visible on the nose, while Open technique is done in difficult and revision cases for wide exposure but gives a scar over columella of nose. Generally scar of columella heals quite well with no apparent mark. In open approach healing also takes more time.

Good communication between you and your physician is very essential. In your initial consultation, the surgeon will ask your desire about the nose and will discuss the possibilities with you. I will also explain the factors that can influence the procedure and the results. These factors include the size of nasal bones and cartilages, the shape of face, the thickness of skin, age, and your expectations. Nasal breathing problems can also be corrected along with rhinoplasty by doing simultaneously septoplasty and turbinoplasty procedures. The techniques and type of anesthesia used during surgery and the type of facility where the surgery will be performed, the risks and costs involved will also be discussed.

TYPES OF ANESTHESIA Rhinoplasty can be performed under local or general anesthesia, depending on the extent of the procedure and on what you and your surgeon prefer. With local anesthesia, you will be lightly sedated and your nose and the surrounding area will be numbed; you will be awake during the surgery and relaxed & there will not be any pain. Local anesthesia is usually preferred except in extremely apprehensive patient.


Rhinoplasty surgery usually takes one & half hours, though complicated procedures may take longer. During the surgery, the skin of the nose is separated from its supporting framework of bone and cartilage, which is then sculptured to the desired shape. Finally, the skin is redraped over the new framework. When the surgery is complete, a splint will be applied to help the nose to maintain its new shape. Nasal packs are placed inside the nose after the surgery.

The best candidates for rhinoplasty are, who are looking for improvement, not perfection. If you are physically healthy, psychologically stable and realistic in expectations then you are a good candidate for corrective Rhinoplasty.


SWELLING: The swelling or oedema around the eyelids and the cheek may develop on first day. The development of swelling of the soft tissues varies considerably from person to person. To help prevention of swelling, the following measures are suggested:

•Semi sitting position as early as possible after operation.

•Ice cold compresses on the eyelids intermittently on first day of surgery.

DIET: Soft diet for first day after surgery and then gradually normal diet.

SLEEPING: Sleep on back. Avoid sleeping on the sides to prevent pressure or movement of the nasal splint.

MEDICINES: Antibiotics & anti-inflammatory medicines for a week to prevent infection & swelling of eyes and any other medicines if required.

NASAL PACKS: The nasal packs are removed after 2-3 days. Start using nasal drops in right and left lateral head down position after removal of nasal pakes. The nose should be gently blown for two weeks. In case you want to sneeze, then you can do gently with mouth open.

NASAL SPLINT: Nasal splint is removed between 1-2 weeks. After the removal of splint and skin tapes, the nose may appear numb or heavy for few days due to residual swelling.

SUTURES: Generally absorbable types of sutures are used inside the nose and are not removed.

PHYSICAL ACTIVITIES: You may resume your work or start going to college after the removal of splint but avoid any strenuous physical activity. You should be careful to prevent any nasal injury or scratching inside the nose with your finger. Avoid prolonged exposure to sunlight or excessive dusty environment for 2-3 weeks. Outdoor games or any external nasal injury should be avoided for about three months.

The swelling of the eyes and cheek will subside within a week and redness in the corner of the eyeball will disappear within three weeks. The residual minimal swelling of the nose, which is not visible, subsides gradually and may even take six months depending on the healing of a particular person.

REVISION RHINOPLASTY: I do not perform revision surgery before one year of last operation, as many small problems that are due to oedema and scar tissue reaction may subside and many small defects disappear & revision rhinoplasty may not be required.

The Revision surgery is more difficult because of distorted anatomy, reduced blood supply and lot of scar tissue formation. The accurate assessment of nasal structures that have been altered or resected is done. It is not infrequent to see that the tip has not been touched at all during the primary surgery and the patient present with relatively bulbous tip, the hump may have been excessively or inadequately removed. Hump may have been excised but osteotomy has not been done. The deviated nasal septum and enlarged turbinates may have been ignored to improve nasal breathing.

I discuss with the patients all the aspects of revision surgery since most of the patients for revision surgery are psychologically disturbed due to unsatisfactory results after first surgery. Rhinoplasty whether first time or revision carries some risk factors. When a qualified surgeon performs rhinoplasty, complications are infrequent and usually minor. But, there is always a possibility of infection, bleeding from the nose or a reaction to the anesthesia. You can reduce any risk factor by following the instructions of your doctor.

Acknowledgement: This information has been taken from Dr. VP Sood website who is my mentor for this kind of surgery. Thank you sir for your love and teachings!

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