Blog by Dr. Kristina Tansavatdi / August 10, 2013
Rhinoplasty or nose reshaping is a surgery that is very safe, but requires precision and an eye for detail. You should do your research before proceeding with surgery. The initial consultation with a rhinoplasty surgeon is a very important process in choosing the right surgeon for you; one that understands your perspective on the final appearance you are looking for your nose.
Providing pictures will help guide your surgeon. Additionally, having your surgeon morph the pictures to show you what they expect results to look like will provide an additional level of reassurance that your expectations are realistic and in line with your surgeon
An experienced surgeon should also be able to balance form and function appropriately to give you a good result while preventing breathing complications that can occur 10-20 years down the road. Therefore, knowing a surgeon’s long-term revision rates is important as well. This is usually hard to obtain unless the surgeon is critical of his or her own results. Find a surgeon that is meticulous and who analyzes his or her own work.
In addition to doing research on surgeons out there, it is important that you have some knowledge of what rhinoplasty surgery entails, the amount of downtime to expect, and what the postoperative healing period will be like.
Below you will find answers to some questions that are commonly asked by patients during consultation that may be helpful for you to know as you make your decision to pursue rhinoplasty surgery.
Is Rhinoplasty Safe?
Rhinoplasty is like any other surgery in that it is very safe from a life/death scenario. The biggest risk is from the side effects of anesthesia, but even this carries less than 1 in 100,000 chance of a life-threatening complication. There is more risk driving your car to the hospital or surgery center than from having anesthesia. Rhinoplasty, however, is a complex delicate procedure that should be done by a credentialed surgeon with experience operating on the nose.
The nose is important for breathing, which is often overlooked by inexperienced surgeons who aim to achieve a beautiful nose with disregard to the late effects on the function of the nose. Thus, if a rhinoplasty procedure is performed poorly one could have more problems with breathing from the nose several years down the line. This fine balance between function and form (cosmesis) is what an experienced rhinoplasty surgeon should weigh and ultimately what you should discuss when researching your options. Safely performing the surgery while minimizing untoward risks should be the goal of your rhinoplasty surgeon.
How Painful is Rhinoplasty?
Rhinoplasty surgery requires incisions and meticulous dissection. The amount of pain depends on the amount of dissection and work. Ultimately, the pain varies from case to case and patient to patient. Some patients have a high pain tolerance and are able to return to work in 3 days while others take weeks to recover. Any work on the septum or inside of the nose will contribute to additional pain. Also, any work on the bones will contribute to pain, external bruising and swelling. It is difficult to determine the degree of pain prior to surgery. However, a good rule of thumb is that most people require narcotics for pain control for the first week after surgery and the most intense pain occurs within this time frame.
Is Rhinoplasty Permanent?
Rhinoplasty can involve adding or subtracting to the baseline structure to create the end result. This adding or subtracting is usually in the form of cartilage or bone. After surgery, the body heals around this new underlying framework and structure of the nose to give the final cosmetic appearance. When the body heals after surgery, collagen is laid down with scar formation. The results of rhinoplasty are essentially permanent but the scar formation can continue to transform the nose even 10-15 years after the initial surgery. This can lead to breathing difficulties and even cosmetic deformities. Problems after rhinoplasty can be modified by “revision” surgery.
Unfortunately, revision surgery is always much more difficult than the initial surgery when there was no scarring to deal with and natural pristine structures were present. For example, revision surgery after overresection of the cartilage framework of the nose can require obtaining additional cartilage from elsewhere on the body (ex. Ear or rib) to repair the damage. A rhinoplasty surgeon who also specializes in revision surgery will have the knowledge to prevent these problems from occurring. Therefore, it is always best to have it done correctly the first time and spend extra time researching your options before proceeding with surgery.
Here is some additional information you should know about rhinoplasty:
- The best candidates for rhinoplasty surgery are patients with thin nasal skin, a visible underlying strong cartilage framework, good general health without history of healing problems, and realistic expectations with defined goals.
- The usual downtime after rhinoplasty surgery is two weeks. The cast and tape come off at one week. The bruising and swelling is still noticeable at one week but gone by two weeks. Most people can return to work at two weeks. Acquaintances will barely notice signs of surgery at two weeks, while close friends and family will notice changes. If you are planning to appear at any social event, give yourself four weeks of healing time.
- Every effort is made to conceal scars in both a “closed” and an “open” rhinoplasty approach. An open rhinoplasty allows precise manipulation of the cartilages of the nasal tip but requires a tiny incision at the base of the nose that is usually quite imperceptible. The nasal tip cartilages are quite visible because the nasal skin is raised off the framework for proper manipulation. A closed rhinoplasty approach is done through incisions inside the nose and is a good approach for work on the nasal bridge with minimal or no work on the nasal tip. This approach allows for faster healing and less swelling in the nasal tip.
- Surgical swelling in the nose can take months to resolve. No matter how much I stress this, invariably a patient will get distressed and concerned about the amount of distortion from the swelling. The nose may look like a large ball without distinct structures for sometimes a few months and the final results are not reliable for up to ONE YEAR. This swelling will be even more pronounced in patients with thick skin. The nose may even look asymmetric and it is common to question whether your surgeon performed at his or her best. Be patient. If you chose your surgeon carefully, he or she will guide you through the process and the results will speak for themselves in time.
- There are limitations with rhinoplasty and requesting a particular style may not be attainable by surgery. An honest surgeon will point out these limitations with you.
- Rhinoplasty is not an exact science and is sometimes as much an art as it is skill. Asking for perfection is unrealistic, but asking for a good cosmetic outcome should be attainable by a skilled and experienced surgeon.