Rhinoplasty

Rhinoplasty (RIE-no-plas-tee) is surgery that changes the shape of the nose. The motivation for rhinoplasty may be to change the appearance of the nose, improve breathing or both. The upper portion of the structure of the nose is bone, and the lower portion is cartilage. Rhinoplasty can change bone, cartilage, skin or all three. Talk with your surgeon about whether rhinoplasty is appropriate for you and what it can achieve. When planning rhinoplasty, your surgeon will consider your other facial features, the skin on your nose and what you would like to change. If you're a candidate for surgery, your surgeon will develop a customized plan for you. Sometimes part or all of a rhinoplasty is covered by insurance.

Why it's done

Rhinoplasty can change the size, shape or proportions of your nose. It may be done to repair deformities from an injury, correct a birth defect or improve some breathing difficulties.

Result 

Very slight changes to the structure of your nose — often measured in millimeters — can make a large difference in how your nose looks. Most of the time, an experienced surgeon can get results both of you are satisfied with. But in some cases, the slight changes aren't enough, and you and your surgeon might decide to do a second surgery for further changes. If this is the case, you must wait at least a year for the follow-up surgery, because your nose can go through changes during this time.

How you Prepare 

  • Before scheduling rhinoplasty, you must meet with your surgeon to discuss important factors that determine whether the surgery is likely to work well for you. This meeting generally includes:

    Your medical history. The most important question your doctor will ask you is about your motivation for surgery and your goals. Your doctor will also ask questions about your medical history — including a history of nasal obstruction, surgeries and any medications you take. If you have a bleeding disorder, such as hemophilia, you may not be a candidate for rhinoplasty.

    A physical exam. Your doctor will conduct a complete physical examination, including any laboratory tests, such as blood tests. He or she also will examine your facial features and the inside and outside of your nose.

    The physical exam helps your doctor determine what changes need to be made and how your physical features, such as the thickness of your skin or the strength of the cartilage at the end of your nose, may affect your results. The physical exam is also critical for determining the impact of rhinoplasty on your breathing.

    Photographs. Someone from your doctor's office will take photographs of your nose from different angles. Your surgeon may use computer software to manipulate the photos to show you what kinds of results are possible. Your doctor will use these photos for before-and-after assessments, reference during surgery and long-term reviews. Most importantly, the photos permit a specific discussion about the goals of surgery.

    A discussion of your expectations. You and your doctor should talk about your motivations and expectations. He or she will explain what rhinoplasty can and can't do for you and what your results might be. It's normal to feel a little self-conscious discussing your appearance, but it's very important that you're open with your surgeon about your desires and goals for surgery.

    If you have a small chin, your surgeon may speak with you about performing a surgery to augment your chin. This is because a small chin will create the illusion of a larger nose. It's not required to have chin surgery in those circumstances, but it may better balance the facial profile. 

    Once the surgery is scheduled, you'll need to arrange for someone to drive you home if you're having an outpatient surgery.

    For the first few days after anesthesia, you may have memory lapses, slowed reaction time and impaired judgment. So arrange for a family member or friend to stay with you a night or two to help with personal care tasks as you recover from surgery.

  

As with any major surgery, rhinoplasty carries risks such as:

Bleeding
Infection
An adverse reaction to the anesthesia

Other possible risks specific to rhinoplasty include but are not limited to:

Difficulty breathing through your nose
Permanent numbness in and around your nose
The possibility of an uneven-looking nose
Pain, discoloration or swelling that may persist
Scarring
A hole in the septum (septal perforation)
A need for additional surgery

Talk to your doctor about how these risks apply to you.

During the surgery

Rhinoplasty requires local anesthesia with sedation or general anesthesia, depending on how complex your surgery is and what your surgeon prefers. Discuss with your doctor before surgery which type of anesthesia is most appropriate for you.

Local anesthesia with sedation. This type of anesthesia is usually used in an outpatient setting. It's limited to a specific area of your body. Your doctor injects a pain-numbing medication into your nasal tissues and sedates you with medication injected through an intravenous (IV) line. This makes you groggy but not fully asleep.
General anesthesia. You receive the drug (anesthetic) by inhaling it or through a small tube (IV line) placed in a vein in your hand, neck or chest. General anesthesia affects your entire body and causes you to be unconscious during surgery. General anesthesia requires a breathing tube.

Rhinoplasty may be done inside your nose or through a small external cut (incision) at the base of your nose, between your nostrils. Your surgeon will likely readjust the bone and cartilage underneath your skin.

Your surgeon can change the shape of your nasal bones or cartilage in several ways, depending on how much needs to be removed or added, your nose's structure, and available materials. For small changes, the surgeon may use cartilage taken from deeper inside your nose or from your ear. For larger changes, the surgeon can use cartilage from your rib, implants or bone from other parts of your body. After these changes are made, the surgeon places the nose's skin and tissue back and stitches the incisions in your nose.

If the wall between the two sides of the nose (septum) is bent or crooked (deviated), the surgeon can also correct it to improve breathing.

After the surgery, you'll be in a recovery room, where the staff monitors your return to wakefulness. You might leave later that day or, if you have other health issues, you might stay overnight.

After the surgery

After the surgery you need to rest in bed with your head raised higher than your chest, to reduce bleeding and swelling. Your nose may be congested because of swelling or from the splints placed inside your nose during surgery.

In most cases, the internal dressings remain in place for one to seven days after surgery. Your doctor also tapes a splint to your nose for protection and support. It's usually in place for about one week.

Slight bleeding and drainage of mucus and old blood are common for a few days after the surgery or after removing the dressing. Your doctor may place a "drip pad" — a small piece of gauze held in place with tape — under your nose to absorb drainage. Change the gauze as directed by your doctor. Don't place the drip pad tight against your nose.

To further lower the chances of bleeding and swelling, your doctor may ask that you follow precautions for several weeks after surgery. Your doctor may ask you to:

Avoid strenuous activities such as aerobics and jogging.
Take baths instead of showers while you have bandages on your nose.
Not blow your nose.
Eat high-fiber foods, such as fruits and vegetables, to avoid constipation. Constipation can cause you to strain, putting pressure on the surgery site.
Avoid extreme facial expressions, such as smiling or laughing.
Brush your teeth gently to limit movement of your upper lip.
Wear clothes that fasten in the front. Don't pull clothing, such as shirts or sweaters, over your head.

In addition, don't rest eyeglasses or sunglasses on your nose for at least four weeks after the surgery, to prevent pressure on your nose. You can use cheek rests, or tape the glasses to your forehead until your nose has healed.

Use SPF 30 sunscreen when you're outside, especially on your nose. Too much sun may cause permanent irregular discoloration in your nose's skin.

Some temporary swelling or black-and-blue discoloration of your eyelids can occur for two to three weeks after nasal surgery. Swelling of the nose takes longer to resolve. Limiting your dietary sodium will help the swelling go away faster. Don't put anything such as ice or cold packs on your nose after surgery.

Your nose changes throughout your life whether you have surgery or not. For this reason, it's difficult to say when you have obtained your "final result." However, most of the swelling is gone within a year.

Before - After 

 

Frequently Asked Questions 

What are the different types of Rhinoplasty procedures?

Reduction Rhinoplasty - Commonly known as a nose job, Reduction Rhinoplasty is a plastic surgery procedure for correcting and reconstructing the form, restoring the functions, and aesthetically enhancing the nose by resolving nasal trauma, congenital defect, respiratory impediment, or a failed primary rhinoplasty. Most patients ask to remove a bump, narrow nostril width, change the angle between the nose and the mouth, as well as correct injuries, birth defects, or other problems that affect breathing, such as deviated nasal septum or a sinus condition.

Augmentation Rhinoplasty - A cosmetic surgery procedure performed to increase the size of specific parts of a person’s nose to give it a more aesthetically pleasing appearance. The procedure, among others, can add height to the nose bridge or alter the shape of the nasal tip to increase its projection.

Post-Traumatic Rhinoplasty - A procedure to address injuries to the nose that can lead to damaged airways, deformation, broken bones, and lost cartilage support. The most common causes of these injuries are usually a result from sports injuries, car accidents, and fights.

Reconstructive Rhinoplasty - Following surgery to remove cancer or occasionally following facial trauma, the nose may be left severely disfigured due to the lack of tissue that has been removed or lost. Reconstructive Rhinoplasty refers to surgery required to restore tissue that is absent or has been damaged beyond repair. Surgical repair requires the use of grafts and flaps from various parts of the body to restore the missing component tissues.

Ethnic Rhinoplasty - A nasal surgery where the nose is surgically altered to create a symmetrical, aesthetically pleasing nose that suits the individual patient’s face without diminishing the patient’s ethnic characteristics.

Refinement Rhinoplasty - Complaints about the nasal tip rank among the top reasons for rhinoplasty surgery. Many patients are unhappy with the way their nose points up or down at the tip, how bulbous or round the tip appears, or how pointy the tip is. Refinement Rhinoplasty can involve various tactics to fine-tune the nasal tip in a more pleasing fashion, one that complements the other features of the face. Your surgeon may add or remove cartilage and tissue in order to perfect the tip’s shape or direction.

Revision Rhinoplasty - A surgical procedure designed to repair both form and function of a nose that has previously been operated on. Many people have difficult breathing from their nose or are dissatisfied with the cosmetic appearance of their nose as a result of prior nasal surgery.

Septoplasty - A surgical procedure that’s done to fix a deviated nasal septum. The septum is the wall of bone and cartilage that divides your nose into two separate nostrils. A deviated septum occurs when your septum is moved to one side of your nose. Some people are born with a deviated septum, but it can also be caused by an injury to your nose.

Turbinoplasty - A procedure to decrease the size of the turbinates. In short, turbinates are structures along the side wall of the nose that can swell and cause obstruction. By reducing their size, your breathing can be improved.

Alarplasty - A procedure where the sides of the nose at the bottom which are referred to as the alar are reshaped. In most cases this involves narrowing or reshaping the nose to improve the balance in relation to the base and the other structures of the nose.

Is Rhinoplasty covered by health insurance?

If you have had a significant nasal trauma in the past, it is possible that insurance may cover corrective nasal surgery for breathing and appearance. However, in most cases, insurance will not cover rhinoplasty to change the appearance of your nose, especially if you have no history of trauma.

Who are the best candidates for Rhinoplasty?

Most commonly, the best candidate for a rhinoplasty is someone who doesn't like the way their nose looks and has been troubled by one or more of its features. Often this is a nose that appears too large, or droops, or has a prominent bump on top. Others seek treatment after an injury, or when they develop trouble breathing through the nose.

What is the best age for Rhinoplasty?

Most 13-year-old girls and 15-year-old boys are old enough physically for a rhinoplasty–that is, the nose is adult size. However, a patient’s emotional maturity also plays a role in timing a rhinoplasty. Teens and young adults need to approach this procedure for what it is: a better nose.

For elderly patient's, there is no predetermined cutoff age for having rhinoplasty. An elderly adult in good health may be perfectly fit to have the procedure. There have been cases of patient's 70 - 80 years old having a Rhinoplasty performed with minimal to no complications.

The ideal age range for Rhinoplasty are patients aged 20 - 40 years old, during this time your facial skin is still mostly elastic and can accommodate surgical procedures without complications.

What is the success rate of Rhinoplasty?

In actuality, rhinoplasty is widely regarded as the most difficult of all cosmetic procedures. Even a modest change in nasal contour requires a sophisticated understanding of nasal anatomy, precise surgical technique, and familiarity with the myriad pitfalls that can lead to potential complications. For most surgeons, near total dedication to the study and practice of this demanding operation is needed to achieve mastery. For this same reason, rhinoplasty is also perhaps the least commonly mastered of all cosmetic procedures, and naïve or misguided surgical strategies often result from under-appreciation of this exacting and complex operation. And while your local surgeon may have a justifiably stellar reputation for other types of cosmetic surgery, his or her mastery of this highly specialized operation may be far from cutting edge.

Medical literature has suggested that the revision rate of Rhinoplasty or cosmetic nose surgery is between 10 and 15 percent, therefore Rhinoplasty has about an 85 to 90 percent success rate, although this could be higher if the operation is performed by board-certified plastic surgeons specializing in this procedure.

Is Rhinoplasty painful?

During the procedure you will be under local or general anesthesia and won't feel any pain during that time. Slight bleeding and drainage of mucus and old blood are common for a few days after the surgery which might cause discomfort or pain at times. Because everyone heals differently, it's important to continue to be patient during your rhinoplasty recovery. It is normal to still be experiencing swelling, slight pain, bruising, and even headaches four weeks after your procedure. It's always a great idea to visit your surgeon to make sure you're healing properly during this time.

Will the scars from Rhinoplasty be visible and/or permanent?

When Rhinoplasty is performed from inside the nose (Closed Rhinoplasty), there is no visible scarring at all; when an open technique is used, or when the procedure calls for the narrowing of flared nostrils (Alarplasty), the small scars on the base of the nose are usually not visible.

Will my breathing be affected by Rhinoplasty surgery?

After surgery for up to one year, there will be swelling that will occur inside the nose. This often results in some minor trouble breathing early on but quickly resolves within 1-3 months. Most swelling usually resolves within 6 weeks after surgery, but can last up to one year. During recovery, you can treat the swelling that may occur with ice or ice packs. This will help relieve inflammation and may help if you are experiencing any problems breathing. As internal swelling resolves the internal space becomes more open and breathing becomes much better.

Does the nose become more vulnerable after a Rhinoplasty?

The nasal bones regain their strength by about six weeks post-rhinoplasty. After six weeks or so, the nose should be able to sustain an injury in the same fashion as it did before your procedure. The only caveat is in rhinoplasty cases were significant amounts of cartilage has been removed from the lower part of the septum. In such cases, the lower part of the nose may become slightly weaker.

What is the best time of year for a Rhinoplasty?

Winter - December thru March - Universally, this is an ideal time to undergo just about any type of cosmetic surgery, from Rhinoplasty to Liposuction. Cooler weather allows bulkier clothing to conceal swelling and bruising and keeps the body in a state of healing. During winter there are more holidays as well, so you don't have to take as much time off of work for recovery.

What can I expect during my Rhinoplasty consultation?

In a rhinoplasty consultation, the surgeon examines the inside and outside of the nose. The bones, cartilage, and breathing are evaluated. Digital photographs are taken and then viewed on a computer. The surgeon will ask the patient what he or she does not like about their nose. The images on the computer will be manipulated, in an attempt to create a better-looking nose. If the surgeon and patient cannot agree on what the nose should look like through computer simulations, it is unlikely that he or she will be pleased with the ultimate outcome. If the surgeon and patient do agree on what the nose should look like, an operative plan is designed.

A surgeon often spends hours preparing for a rhinoplasty, using his photographs in much the same way an architect uses blueprints to design a house. The computerized digital imaging system has made rhinoplasty planning much easier, and accurate to half a millimeter.

What should I bring to my first Rhinoplasty consultation?

1: A list of questions you may have for the surgeon, it could be about the surgery itself or about his experience with rhinoplasty surgery or accreditations.

2: List of medications and medical history for reference.

3: Some rhinoplasty photos to provide an idea of what you want or don't want.

What questions should I ask my surgeon before my Rhinoplasty?

1: What made you decide to become a cosmetic surgeon? How long have you been practicing as a cosmetic surgeon?

2: Are you board certified? If so, by what board and for how long?

3: Have you ever been disciplined by the board or by the state?

4: How many rhinoplasties have you performed?

5: How many revisions of your own work, on average, do you have to perform?

6: How many rhinoplasties do you perform on average, annually?

7: Have you or would you be willing to perform this procedure on a loved one or family member?

8: Would there be any reason that I would not be a good candidate for a rhinoplasty?

9: What are the complications for rhinoplasty?

10: Do you prefer to perform your procedures open or closed? Why?

11: Are there other techniques, newer ones perhaps, that I am not aware of?

12: Do you have a video of a rhinoplasty being performed that I can watch?

13: How long do you recommend I take off from work, school, etc. to heal properly?

14: What types of medications will I be given and which pain medications do you normally prescribe?

15: What kind of anesthesia do you use for rhinoplasty? Why?

16: Can I look at a portfolio of before-and-after photos, and not just your perfect ones?

17: Where will the surgery be performed? If the surgery will not be done in a hospital, is the surgery center or suite accredited?

18: Do you have hospital privileges and, if so, at what hospitals? If you don't have hospital privileges, why not?

19: Who will administer anesthesia and what are that person's credentials?

20: What tips do you have for me to ease some discomfort and pain?

21: I wear eyeglasses. Will I be able to wear them the day after surgery on top of the cast? When can I wear my glasses normally?

22: I take (birth control, diet pills, antidepressants, etc.). Will I have any adverse reactions from the prescribed medications or anesthesia?

23: If my results are not what I wanted, what is your policy on a revision?

24: Do you believe my expectations can be met?

25: What if I change my mind and back out, will my money be refunded?

26: If I have an emergency the night after surgery, what should I do?

27: If I will need sutures, when will they be taken out?

28: Are there any hidden costs that I should know about, such as for lab work, postoperative check-ups, or additional medications?

29: If I need anything after-hours after the surgery, how can I get in touch with you or your staff?

30: What are your policies on postoperative care?

31: Do you offer financing? Do you expect full payment up front? Can I pay in increments?

32: Will I need a graft? If so, what kind?

33: After surgery, will my nose be packed? With what type of packing? For how long?

34: Who will be present in the recovery room with me, and what are their qualifications?

35: How far in advance is it necessary to schedule a surgery date?

What should I do before my Rhinoplasty?

Stop Taking Aspirin - It is important to discontinue the use of any aspirin, ibuprofen, vitamin E, and herbal supplements two weeks before and two weeks after your rhinoplasty surgery. Aspirin is a non steroidal anti-inflammatory drug, which affects platelet function. Despite platelet count being correct they do not function correctly. The process of regeneration usually takes two weeks for the bone marrow to generate new platelets to replace the affected platelets.

Prescriptions - Don't forget to stock up on your prescriptions, you don't want to run out when your in the recovery stage of your procedure and you can't do much. If your surgeon has given you any prescriptions for pain relievers to take after your surgery, fill those prescriptions before you go in for the procedure as well.

Supplements - Supplements before surgery can be a tricky subject. Some supplements, such as certain herbs or vitamin E, can increase bleeding. Either at your consultation or at some point a few weeks before your procedure, make a list of all the supplements you take and show it to your surgeon. He will let you know which ones you should stop taking before the surgery and when it is safe to start taking them again after the procedure.
Your surgeon may also recommend that you start taking certain supplements, to help reduce bleeding or swelling or to generally improve the healing process. For example, some surgeons recommend taking arnica after the procedure, as it can help reduce swelling or inflammation. Other vitamins your surgeon may recommend include vitamin A, vitamin K and bromelain. Only take supplements as recommended by your surgeon or after getting the go-ahead from your surgeon.

Home Prep - Set up an area of your home to rest and recover in, whether it’s a chair in your living room or your bed. After rhinoplasty and other facial surgery, you’ll want to keep your head elevated, so make sure there are enough pillows to prop you up.

What should I eat and drink before my Rhinoplasty?

What you eat before surgery is important. You want to aim for a nutritious, balanced diet in the weeks before and after your procedure. If you don’t already eat a lot of vegetables and fruits each day, increase the amount you eat, so that you’re eating some sort of produce at each meal.
It’s also a good idea to watch your salt intake in the weeks leading up surgery. Salt can raise your blood pressure, which can increase your risk for complications during or after surgery.

What supplies should I get before my Rhinoplasty?

Stock up on ice packs or freeze ice cubes, then transfer them into zip-top bags so that you have plenty of ice ready to apply to the site, to reduce and keep swelling down. lip balm is crucial, you're going to have dry mouth, and lips like you've never had before. You're going to want a thermometer to keep tabs on your temp. If you start getting chills, you need to check if you have a fever and, if so, report it to your doctor right away.

Can I still smoke before my Rhinoplasty?

It is highly recommended that all smoking be stopped at least 2 weeks before your Rhinoplasty procedure. Carbon monoxide introduced during smoking affects our tissue and the nicotine found in tobacco products can cause blood vessels to restrict, limiting the amount of oxygen that can get to the rest of our body. Because of these very serious complications, some plastic surgeons will refuse to perform surgery on patients who smoke. Others will require patients to commit to giving up smoking for several weeks prior to surgery.

What is the difference between open and closed Rhinoplasty?

Perhaps one of the most confusing dilemmas confronting the prospective rhinoplasty patient is the choice of open versus closed rhinoplasty. These terms, while puzzling, simply refer to the two possible surgical approaches — that is, the access method used to temporarily remove the nasal skin and facilitate exposure of the skeletal framework.

Open Rhinoplasty - Unlike the closed rhinoplasty, the open or external rhinoplasty approach employs a small bridging incision, called a trans-columellar incision, to connect the right and left nostril incisions. In exchange for this 4-5 mm visible segment, the nasal skin can be folded upward (similar to opening a car hood) and unimpeded visibility of the lower nasal skeleton can be achieved. In addition to direct visibility of almost the entire nasal framework, distortion of the nasal cartilage is minimized and individual components can be evaluated in their natural, undisturbed alignment. Thus, the hallmark of the open rhinoplasty is the vastly improved surgical access permitted by the trans-columellar incision.

Closed Rhinoplasty - In the closed rhinoplasty approach, also called endonasal rhinoplasty, all of the surgical incisions are positioned inside the nostrils. Although parallel incisions encircle nearly half of the nostril lining, no part of the incision can be seen externally and a visible scar is avoided. However, because the right and left nostril incisions remain disconnected, repositioning of the nasal skin is difficult and the entire operation must be conducted through narrow surgical openings with limited visibility. Because access to the nasal framework requires vigorous stretching of the nasal skin, distortion of the nasal cartilage is also inevitable. While a visible scar is prevented, considerable challenges and technical limitations are associated with the relative lack of surgical access. Hence, closed rhinoplasty merely refers to the relative lack of surgical exposure associated with the endonasal approach.

How long does a typical Rhinoplasty take to perform?

It depends on the extent of the changes being made to the nose. Minimal changes will generally take 1 to 1.5 hours. If there are more extensive changes taking place, then the surgery could last between 2 to 4 hours.

What types of Anesthesia are used during a Rhinoplasty? A:

Local Anesthesia - Regardless of which type of anesthesia is selected, rhinoplasty is always performed with local anesthesia (lidocaine mixed with epinephrine) to directly numb the nose and reduce the amount of bleeding encountered during surgery. Except for very minor revisions few surgeons use local anesthesia alone due to the discomfort associated with the injection and the difficulty performing a complex operation on a fully awake patient.

IV Sedation - relies upon the skillful dosing of powerful anesthetics through an intravenous catheter without the use of a breathing tube. For several reasons doctors typically prefer to avoid this type of anesthesia during rhinoplasty surgery. IV sedation must render the patient unconscious and motionless while at the same time avoiding breathing suppression. There is a fine balance between having a patient fully unconscious and breathing on their own versus not being fully unconscious and having sudden movement or having the patient stop breathing from too deep sedation. Also, bleeding occurs in all rhinoplasty procedures so there is always the concern that blood can drain back and be aspirated (inhaled) into the lungs during surgery if the airway is not protected with a breathing tube. Lastly, in more prolonged rhinoplasty surgery lasting several hours, it can become even more difficult to keep patients comfortable with IV sedation as patients can become restless and develop muscle soreness or a full bladder.

General Anesthesia - The above concerns pointed out with IV sedation in rhinoplasty are better addressed with general anesthesia. In many ways general anesthesia creates the most controlled situation possible during your rhinoplasty surgery. With the addition of controlling the airway with a breathing tube your anesthesiologist is able to protect your windpipe from dripping blood during surgery. Also, you don't have to maintain your own respiration as the anesthesiologist is able to fully manage your breathing with a breathing machine. This allows for a deeper level of anesthesia which can be adjusted to keep the blood pressure low to help minimize bleeding, bruising, and swelling. Since the nose is rendered fairly numb from the local anesthesia injection, comparable levels of anesthetic are used as with IV sedation so the anesthesia after effects are usually quite mild and short lived. This more controlled, stable environment allows much better operating conditions and surgical outcomes.

Where is a Rhinoplasty typically performed?

Most Rhinoplasties are performed in your surgeons office-based surgical facility that should be fully accredited by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) or, if they don't have their own surgical facility, your surgeon should have the ability to perform surgery at an accredited hospitals nearest to them where they can operate in a safe and comfortable environment.

What are the side effects of Rhinoplasty?

Pain - Because Rhinoplasty requires extensive alterations of nasal bone and cartilage, patients may experience pain or discomfort following the procedure. Fortunately, this discomfort is usually minor and most patients find that over-the-counter analgesics are enough to manage this pain. For patients who are particularly sensitive to pain, your rhinoplasty surgeon may be able to prescribe stronger pain medication.

Swelling - One of the most common side effects from rhinoplasty is swelling around the eyes and nose. The swelling is most noticeable in the days following surgery, but largely subsides after about two weeks. It is important to note, however, that some minor swelling may be present for up to six months following rhinoplasty surgery.

Bruising - The degree of bruising that follows surgery will vary depending on patient sensitivity and the extent of the surgery itself. This bruising is usually contained to the area around the eyes and can last for up to ten days. While bruising is not a sign of any more serious complications, you should monitor your condition in the days following surgery. If anything seems abnormal, your physician can advise you as to whether any measures besides rest and time are necessary during your rhinoplasty recovery.

What are the risks and complications with Rhinoplasty?

Some of the potential risks include anaesthesia risks, bleeding and haematoma (requiring return to the operating theatre), unfavourable scarring (potentially requiring scar treatment or scar revision), swelling (that may persist for many months), infection, delayed wound healing, asymmetry, pain, altered sensation to the nose, altered sense of smell, rupture of surface vessels of the nose, altered breathing, change in the quality of sounds when singing and speaking, septal perforation, irregularities in the contour of the nose, suture extrusion, potential for revisionary surgery and general complications such as a heart attack and pulmonary embolism (blood clot in the lungs).

Is nasal packing needed after a Rhinoplasty?

Packing is placed whenever septal work is performed to apply pressure and reduce the post-op risk of hemorrhage. If your Rhinoplasty does not have a concurrent septoplasty then packing is not necessary is that situation.

Can I drive home after my Rhinoplasty?

You definitely cannot drive yourself after rhinoplasty. You have to have someone drive you home and stay with you the first 24 hours after your rhinoplasty mostly due to anesthesia but also due to the rhinoplasty itself. Alternatively you can choose to stay overnight at the hospital if possible and have the nurses take care of you.

What can I eat and drink after my Rhinoplasty?

Soft Foods - You might be a bit hungry after you get home from surgery, or even right after the anesthesia or sedative wears off. Soft foods that are somewhat mild or bland are usually ideal right after surgery. Reach for the yogurt, oatmeal or not-to-hot soup. Depending on how nauseated you feel, you may want to stick with clear liquids right after surgery, just in case eating makes you throw up. Continue with the diet of soft foods for a few days after surgery, or until you feel well enough to add different textures to your diet.

Fiber - Although you want to stick to soft-ish foods for a few days after rhinoplasty, it’s important to make sure you get a decent amount of fiber in your diet during those first few days. Constipation is fairly common after the surgery, due to a combination of the medications prescribed, not moving about as much as you usually do, and eating a limited diet. While you probably want to continue to take an medicines prescribed by your surgeon and should continue to limit physical activity, you can help move things along by adding some fiber to your diet. Soft fruits, such as peaches and berries, are good sources of fiber, as is oatmeal, very well cooked vegetables such as carrots, and whole grain breads.

Avoid Chewy Foods - Before you have surgery, place your hand on your nose while you chew a particularly chewy food, such as a steak or even a piece of gum. Your nose moves slightly with the chewing motion. While under usual circumstances, a little movement is fine, as your nose heals from surgery, you want it to remain as still as possible to reduce the chance of any complications. Hold of on enjoying a steak dinner, tearing into some taffy, or even popping a piece of chewing gum in your mouth until your surgeon says it’s OK to do so. Keep in mind that you aren’t limit to a diet of very soft, mushy foods for weeks after surgery. You just want to avoid the particularly chewy options.

Avoid Alcohol and Caffeine - Alcoholic beverages and caffeinated drinks, such as coffee or soda, are best avoided for several days after your procedure, if not for longer. Alcohol is a blood thinner and can increase your risk for post-surgery bleeding. It also increases your risk for hematoma, or a collection of blood beneath the skin, and can make swelling worse. Caffeine can increase your blood pressure, which can be problematic for some patients. Your surgeon will let you know if he strongly advises against drinking coffee or another beverage with caffeine after rhinoplasty and how long you’ll need to avoid it.

Salty Foods - As you recover from rhinoplasty, relying on prepared foods can seem like the easiest option, since it requires only a minimal amount of effort to get them ready. But, you might be a bit concerned about the salt content in a prepared meal, such as a package of frozen macaroni and cheese, and how it will affect any swelling you have after surgery. While sodium intake can lead to water retention and make swelling worse, it’s usually not that big of a concern for many patients. If you are worried about it, or if you have a health issue that requires you to limit sodium, it’s best to speak with your surgeon before your procedure to find out what you should do.

How should I sleep after my Rhinoplasty?

35 - 40 Degree Angle - After having rhinoplasty, to minimize swelling, it’s best if your head and nose are above the heart – at least for awhile after surgery. Ideally, if you have a reclining chair, it would be best to sleep in it for about a week after surgery. Failing that you could use a few pillows to prop up your head. Sleeping in a midline position will not only reduce swelling but nasal congestion making it easier for you to fall asleep.

If you normally sleep with your spouse/partner or even allow a pet on your bed, now is the time to go solo for awhile. You don’t want to have someone’s hand or paw accidentally hit your nose. Not only would that be painful, but it could affect the end result of your surgery – not something you want to risk.

Can I exercise after a Rhinoplasty?

It's recommended that patients wait 2 weeks before going back to heavy exercise, head-down yoga positions, or generally any activity that is likely to get the heart racing and push blood flow up into the face. Light activity like walking is fine and so is intimacy so long as you go a bit easy and avoid smacking your nose! For any activity that involves prolonged submersion in water, major pressure changes such as diving, or potential contact to the nose, you generally should wait about a month to six weeks.

Why avoid exercise right after surgery? We’re not so much worried about bleeding as the risk for any serious bleeding is very low and unlikely more than several days after surgery. What we do want to prevent is swelling. Most noticeable swelling is gone within one week, and light activity such as walking is helpful in mobilizing this fluid and helping it to drain away faster. But, too vigorous activity too soon after surgery will drive more fluid to the area and make you appear more swollen.

When can I go back to work after my Rhinoplasty?

If you have a nonphysical sedentary occupation you can literally return to work after a few days. However, you would be still be bandaged and bruised. Most patients wait till the bandaging is removed to venture out of home. That usually occurs no later then one week after surgery. However, even after a week there is residual bruising in many cases. If you do not want your coworkers to see you bruised you might have to hide for as many as 2 weeks after surgery.

When can I fly after a Rhinoplasty?

A patient must not fly for at least 5 days after the surgery. While unlikely, the possibility that you will have a nose bleed during the flight, which could be an emergency situation, is avoided. It is still not recommended to fly for an additional week (in total 2 weeks), but many patients cannot stay in town for that long of a period. If you must fly during the second week of your recovery, it is important to take Sudafed and spray a nasal decongestant (Afrin or other) prior to take off. If not, the pressure changes during the flight may be very painful. It is also typical to have renewed swelling after the flight, which will last about 1-2 days.

When will I see the final results of my Rhinoplasty?

Bruising and swelling are a normal part of rhinoplasty recovery. They are dependent on several factors related to both the surgical technique and the patient. Techniques that increase bruising and swelling include whether or not the nasal bones were broken (osteotomies), the extent of soft tissue dissection/elevation from the bony-cartilaginous framework, and whether the surgery was performed open or closed.

Swelling following rhinoplasty resolves at variable rates. For the initial two weeks, the nose is markedly swollen and noticable to anyone. After the second week, the swelling usually subsides such that it is not obvious to the casual observer that anything has been done to the nose; however, the nose will look "puffy" to the patient for several months. Usually by 4 months, the vast majority of the swelling will dissipate, but it may take a full year (or longer in some cases) for all of the swelling to resolve and for the final result to be achieved.

How long should I wait after my Rhinoplasty before I get a Revision Rhinoplasty?

In general, most rhinoplasty surgeons prefer to wait for one year before performing a revision rhinoplasty because it can take as long as a year for the swelling to subside and for scar tissue to mature. Often, some problems after rhinoplasty will resolve with time and a revision can be avoided. Other times, waiting a full year may allow for other problems that are not readily apparent in the early healing phase to become visible and all of the problems can be addressed with a single surgery.