Rhinoplasty is an operation performed on the nose to improve its appearance. The root words are rhino, meaning nose and plasty, meaning to form or shape. Operations on the nose for reconstructive purposes have been done as long ago as the 16th century. Only in the late 19th century were surgical approaches devised to change the shape of the external nose. In the early part of the 20th century, great strides were made, particularly by a surgeon in Berlin, Germany, Jacque Joseph, M.D., who actually had been trained as an orthopedic surgeon. He saw the operation as merely another bone, and an exercise in bone and cartilage removal. Initially, his approach was done through an external incision running the length of the nose, but it was quickly obvious that that would not bode well with prospective patients. He then extended his talents to develop a technique to perform the operation from entirely within the nose. Such is the origin of the "closed rhinoplasty." Following Joseph's lead, other surgeons, both in Europe and the United States refined the operation and by the 1950's and 1960's, the operation had become orthodox and successful to the point where rhinoplasty became a popular operation.
As time has passed there have been evolutions in the art form such that today it is possible for surgeons to deliver a nose that is natural appearing, proportional to the face and which also can breathe well.
Rhinoplasty operation has essentially several core components. The most common segments of the operation are as follows:
Some patients also require narrowing of the nostril walls when the floor or sill of the nostrils is quite wide. This occurs most commonly in certain ethnic populations such as Black and Asian patients.
Typically, the operation is done under a combination of local anesthesia and either heavy sedation or general anesthesia such that the patient is unaware that the operation is being performed. There is no pain. The operation may last from one to several hours, depending on the complexity, but ideally, the shorter the operation the less swelling and bruising that follows. Experienced surgeons are capable of performing a cosmetic nasal operation in well under one hour. Typically, when performing the operation entirely through the internal or "closed" approach, all internal incisions are closed with absorbable stitches. Generally, a splint or plastic shield is placed on the nose for up to 7 days to protect the nose from accidental jarring while the healing and union of the parts commence. With respect to the inside of the nose, if the operation is done only for cosmetic purposes, generally a light pad or pack is placed into the nose to absorb some of the bloody drainage or perhaps act as a wick for antibiotics or other medications that are deemed desirable. This pack may be removed after one or two days by which time whatever bleeding there has been has stopped.
Recovery from the operation is prompt since this is an operation only on the bone and cartilage of the nose. The skin shrinks down to conform to the new skeleton; by 7-10 days the nose looks quite good and most people are able to return to normal social and business functions. Athletic activity should be limited for the first 10 days, in deference to the possibility of blood pressure elevation which may accompany strenuous exercise, causing some leakage of blood vessels that translates to swelling and bruising.
As healing continues for the next several months, the nose becomes more refined. This means that the minute swelling that is left after the first several weeks continues to abate and refinement and enhancement of the nasal architecture increases spontaneously.
The nose is considered "solid" at five to six weeks after surgery, meaning that the nasal bones have now welded themselves together and are not likely to be accidentally separated unless a major blow is dealt to the nose.
Some surgeons advocate an open rhinoplasty approach whereby their exposure to perform the operation is enhanced by an external incision that is made in the columella, which is the external vertical beam that separates the two nostrils. This does allow the surgeon to lift the skin of the lower third of the nose, as one would raise the hood of a car, to achieve direct visualization of the cartilage structures that are to be sculpted. While it does allow for a bit easier access technically, as in many things, there are some negative factors that accompany such an incision. One is the possibility that the incision, if it does not heal well, will be visible and secondly, each incision exerts a certain contractile force upon the healing which may distort the end-result and compromise the patient's satisfaction. Most surgeons recognize that in all surgical procedures, the fewer number of incisions that are made the better since each incision can exert forces beyond the surgeon's control in the postoperative healing period.
Rhinoplasty is appropriate for women, typically, at age 15 and older, and for young men 17 or older. There is no upper limit on age, but one always must consider the patient's general health and psychological issues that may be present in the senior wanting to have nasal surgery.
The psychological benefits of nasal surgery for young people are not to be underestimated. There is great value in young people being comfortable with their appearance and particularly that of their nose, which is the most prominent facial feature. For that reason, a popular time in a young person's life to have the surgery is between high school and college, when there is time to have the procedure and recover. This doorway to a new period of their life is thus opened with a more satisfactory appearance.
Appearance in recovery room after nasal surgery.
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