Posted by Dr. Hardesty
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Rhinoplasty or “nose job” is a surgery that changes the shape and appearance of the nose. The “tipping point” for a decision to undergo a rhinoplasty procedure is usually when the individual reaches a point where the change in the appearance of the nose, improve breathing or both have been made out of necessity or self-improvement. Rhinoplasty procedures are designed to refine a normally functional nose, repair deformities from an injury, correct a birth defect or improve breathing difficulties.
Depending on the desired appearance and underlying structure various rhinoplasty techniques can change the size, shape, and proportions of one’s nose while improving or maintaining breathing resulting in a natural appearance and a more functional nose. Based on a nasal examination, your anatomy and your desires a plan will be made to alter the structure of the nose. The four main structural components are:
- upper nasal underly is bone
- the lower nose (side portion) is flat section of cartilage
- the tip consists of curved cartilage
- the septum (is an internal nasal cartilage).
All are covered by nasal skin or nasal lining. Rhinoplasty or “nose job”, when needed can change the bone, cartilage, and skin. There are several different techniques that can be utilized for each of the components above depending on the desired appearance and breathing findings.
Rhinoplasty is not a “cookie-cutter” operation. However, once the plan is made an ordered series of steps will be taken to achieve the desired results. Each surgery is unique and customized for the specific anatomy and goals of the person having the surgery. Realistic expectations are paramount for understanding what can and can’t be accomplished based on one’s wishes and your anatomy. The following will explain the usual steps taken and the process to reach one’s desired goal.
Before performing a rhinoplasty, you will meet with Dr. Hardesty, a highly experienced Board Certified Plastic Surgeon, to discuss important factors that determine whether a rhinoplasty is likely to reach your goals. Since this is a surgical procedure, a thorough understanding of your current and past medical condition(s) is important and necessary.
Your expectations: Dr. Hardesty will listen and discuss your motivations and expectations. It’s normal to feel self-conscious discussing your appearance, however, it’s very important that you’re open with Dr. Hardesty about your desires and goals for surgery.
Your goals: The most important question Dr. Hardesty will ask you is about your expectations for surgery and your goals. Please be ready to be as specific as you can be.
Your medical history: Dr. Hardesty will ask questions about your medical history which includes your history of any allergies, medications you take and a history of nasal obstruction and surgeries.
A physical exam: Dr. Hardesty will conduct a physical examination. He will examine your facial features and the inside and outside of your nose. The physical examination is critical and helps Dr. Hardesty will determine what changes need to be made and how your physical features such as the thickness of your skin, the current structure of the cartilage at the end of your nose and internal position/shape of the nasal septum.
Photographs: The staff at Dr. Hardesty’s office will take standardized photographs of your nose and face from different angles. Most importantly, the photos allow for a specific discussion about your current anatomy, appearance and the goals you have
Additional and additive procedures: If you have a small chin, Dr. Hardesty, may recommend an additional 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 however it may better balance the facial profile. Occasionally the base of the nose will be narrowed by removing small slices of nostril tissue called a Weir wedge will bring the nose into better balance
The plan: Having obtained the needed information, Dr. Hardesty will discuss “realistic” expectations. He will explain what rhinoplasty can and can’t do for. Based on the above Dr. Hardesty will formulate a surgical plan.
Depending on what is needed to reach your goals, the rhinoplasty procedure can be performed under local anesthesia with/without sedation or general anesthesia. This decision will depend on how complex your surgery and what needs to be done based on your desires.
- Local Anesthesia only. Dr. Hardesty will inject the nose with numbing medicine directly. This usually reserved for “tip rhinoplasty” or minor revisions.
- Local anesthesia with sedation. This type of anesthesia is usually used in an outpatient setting. Under Dr. Hardesty direction the anesthesiologist will sedate you with medication injected through an intravenous (IV) line. This makes you groggy but not fully asleep. Then Dr. Hardesty will numb the area so you won’t feel pain.
- General anesthesia. You receive the drug (anesthetic) by inhaling it and through a small tube (IV line) placed in a vein in your hand or arm. General anesthesia affects your entire body and causes you to be unconscious during surgery. For safety general anesthesia requires a breathing tube.
The access incision may be made inside your nose, through a small external incision at the columella of your nose (the skin between your nostrils) or both. Dr. Hardesty will 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 rhinoplasty may only need to resect cartilage, rearrange tissue and narrow the base and refine the tip of the nose.
- For other changes: The use of cartilage taken from deeper inside your nose or from your ear. In addition, the use of cartilage from your rib, implants or rarely bone from other parts of your body. After these changes are made, the nasal skin incisions are closed.
- Deviated Septum: If the partition between the two sides of the nose (septum) is bent or crooked (deviated), can be corrected to improve breathing.
- Large Turbinates: There are a total of 6 turbinates two of lower ones which may contribute to airway obstruction. If so, they will be reduced in size to improve airflow.
As with any surgery there are always general risks of rhinoplasty, these unglued but not limited to:
Some rare, but still possible risks specific to rhinoplasty include but are not limited to:
- Difficulty breathing through your nose
- Numbness in and around your nose.
- An uneven-looking nose
- Discoloration or swelling
- Abnormal scarring
- If septoplasty, a hole in the septum (septal perforation)
- Need for additional surgery
- To reduce bleeding stop all blood thinners and blood thing over the counter medications such as aspirin, ibuprofen, Aleve, etc. In addition, vit. E, fish oils and some supplements can cause excessive bleeding
- Abnormal swelling can be avoided by abstaining from strenuous high impact activities such as aerobics and jogging. The alternative is a stationary bike or elliptical trainer.
- Taking baths instead of showers while you have bandages on your nose.
- Do 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.
- Don’t place eyeglasses on your nose for at least four weeks after the surgery. This is to prevent unwanted pressure on your nose while healing. Alternatively, use cheek rests, or tape the glasses to your forehead until your nose has healed.
- Avoid direct sunlight, Use sunscreen when you’re outside. The sun may cause permanent irregular discoloration on your nose’s skin.
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. You will need to arrange for someone to drive you home if you’re having 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.
Slight bleeding and drainage of mucus and old blood are common for a few days after the surgery or after removing the dressing. A “drip pad”, a small piece of gauze held in place with tape will be placed under your nose to absorb drainage. Change the gauze as becomes saturated.
In most cases, an external splint will be placed. It will be removed on the 10th day after surgery. If a septoplasty is performed a thin internal splint with small incorporate breathing tubes will remain in place for seven days after surgery. After the external splint is removed Dr. Hardesty will show you how to tape your nose for protection and support. Fortunately, “nasal packing” rarely has to be utilized in modern rhinoplasty 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 thin internal splints placed inside your nose during surgery. Some temporary swelling or black-and-blue discoloration of your eyelids can occur for several weeks after nasal surgery. After the external splint is removed you will immediately see a difference in the nasal shape and look. Complete resolvement of subtle swelling of the nose takes longer to resolve.
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 Plastic Surgeon such as Dr. Hardesty can attain results that both of you are satisfied with. 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.” The majority of swelling usually resolves in weeks to months. However, in most, positive subtle changes continue swelling resolves within a year.
However, in some cases, the changes aren’t enough, and you and Dr. Hardesty might decide to perform 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.
Alternatives to a surgical procedure include injecting “fillers” to fill in depressions, add balance and disguise minor irregularities.
The fees are based on the anesthesia used (local vs sedation or general anesthesia), the facility (minor surgical suite, outpatient operating room or hospital setting) and if combined with other procedures. All pre and post-operative care are included. Some preoperative laboratory analysis may be required (usually covered by your medical insurance). To view a more detailed guide to pricing click here.
Please click here to find answers to commonly asked questions about rhinoplasty, septoplasty and turbinate reduction.
Rhinoplasty or “nose job” surgery performed for cosmetic Improvement or functional improvement of breathing has high-level satisfaction for both the patient and the Plastic Surgeon.
The most important factor to consider is seeking the opinion and services of a skilled, experienced and Board Certified Plastic Surgeon such as Dr. Hardesty who is an expert in rhinoplasty techniques. The Imagine Plastic Surgery team uniquely provides the full array of both nonsurgical and surgical alternatives to rhinoplasty thus filling our motto of “One Goal, Many Options”. For more information, call and schedule a consultation.
Since 2003 the Staff of Imagine Plastic Surgery has provided comprehensive Cosmetic Plastic Surgery services and procedures for the many communities of the greater Inland Empire, California including but limited to Riverside, Redlands, Rancho Cucamonga, Ontario, Corona, Upland, Chino Hills, Temecula, Murrieta, Clairemont, the High Desert Cities of Victorville and Apple Valley.
Plan to take a week to 10 days off from work, school or other obligations. You will feel progressively better each day during the first week. Several days after surgery, rhinoplasty patients usually feel like they are themselves again. After surgery, there will be some normal and anticipated swelling and bruising. The majority of the surgical swelling and bruising has resolved in a week’s time. Most patients are usually back to performing routine daily activities after a week and resuming all activities after two to four weeks.
Highly unlikely. It is unheard for the insurance company to pay for a cosmetic rhinoplasty. However, if you are having functional breathing problems some insurance companies will cover the expenses for the septoplasty or turbinate reduction portion of the surgical procedure, but it depends on the insurance policy.
The cost of a rhinoplasty depends on several factors, including the complexity of the surgery, the surgeon’s training and experience, and geography. Please see our blog on “Costs.”
Not for most people. Most patients complain more of discomfort that is readily relieved by pain pills. One day after surgery, most people rate their pain between 0 and 4 out of 10.
No. Packing can be very uncomfortable. If you have undergone a septoplasty or turbinate reduction, you’ll likely have some soft thin splints in your nose. These splints have a hole in them to make it possible to breathe through them. They are easily removed at the one-week visit.
Some bruising is common. You will be given anti-swelling and bruising medication. If you do have some minor bruising, it usually lasts a week or so.
What is the cost?
At Imagine Plastic Surgery, we offer a variety a different procedures that all vary in prices. We strive in being transparent to all potential patients and being up front with how much our services may cost. For more information regarding the costs and prices, visit our plastic surgery prices page!COST OF PLASTIC SURGERY