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Rhinoplasty

Rhinoplasty

If you are not satisfied with the shape of your nose or if your nose does not function properly you can consider a rhinoplasty. This surgical treatment can be performed to reduce the size of the nose or to improve the shape. A nose correction is done under general anesthesia. Small corrections can also be performed under local anesthesia. The procedure usually takes place as a day treatment.

Together with the surgeon you will discuss your motivation and your wishes during a first consultation. It is important here that the expectations are realistic. In addition, the operative procedure and any complications are discussed in detail. Because a rhinoplasty can give a permanent change of appearance, it is recommended that a second consultation should follow the first consultation.

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A rhinoplasty, also referred to as a nose job, can improve the shape and the function of a nose. Defects of the nose can be congenital or as a result of trauma from multiple surgeries. It can be that a rhinoplasty is performed to improve on your functional complaints, such as a blocked nose or headaches. It can also be that you are not content with the shape and appearance of the nose. The operative treatment of the shape of the nose can be to make the nose smaller, improve the shape of the tip of the nose, remove the hump of the nose and/or to straighten a crooked nose. The shape of the nose is very personal and needs to be assessed individually. It has to be clear that the patient wants a correction and that it is not a request from others. The results of a rhinoplasty are permanent.

During the first consultation your motivation and desires are discussed and whether your expectations can be met but your expectations must be realistic. Pictures will be made and with the aid of a morphing program a simulation is made of your nose correction to obtain an idea of your goals. The simulation is a useful tool for communication, it but does not guarantee that the actual final result will be exactly the same. Furthermore, the procedure, management before and after and the possible complications will all be discussed. Because a rhinoplasty will result in a permanent change to the appearance of your face, it is desirable that a second consultation will take place before the correction occurs. This is to provide you with sufficient time to process all the information and to have any questions and uncertainties cleared during a second consultation. Before any appointment is made for the actual procedure both you and your surgeon need to be in agreement with regards to the goals of the correction and have realistic expectations with regard to the possible outcome.

A rhinoplasty is normally performed under general anesthetic, but small corrections can be done under local anesthetic. Normally, the procedure takes place as a day case.  A “closed” rhinoplasty is performed through incisions within the nostrils and scars will not be visible. Often, a “closed” rhinoplasty is performed where the incision in the nostrils are connected to the columella between them, after which the skin of the nose is lifted upwards. This creates a direct vision of the underlying bone and cartilaginous framework of the nose for accurate adjustment and correction. When the alars are wide and enlarged, a wedge excision can be performed which will result in well-hidden scars in the alar groove. Also, the scar in the columella heals well and becomes unobtrusive.

In general, there is little pain after a rhinoplasty. Often plugs will be placed through the nostrils, which necessitates breathing through the mouth. Normally the plugs will be removed the next day. After removal of a dorsal hump or a correction of a crooked nose the nasal bone needs to be fractured. This can cause significant swelling of the eyelids which mostly will have settled down after a week. It is therefore important to raise your head with an extra pillow at night and use a cold compress on the eyelids. There will be a synthetic splint on the nose and a gauze under the nose to collect any drainage. The splint and the stitches will be removed after a week. Initially, most of the swelling will subside quickly, but the residual swelling may take many months to settle. Bear in mind that if the nasal bone has been fractured you cannot wear glasses for 4 weeks. The nose and the scars should be protected from the sun in the first couple of months with a sun block. In most cases you can continue with your normal daily activities, such as school and work, within ten days. Strenuous activities should be avoided for four to six weeks.

The success of a rhinoplasty is not only determined by the surgeon, but also by the quality of the tissues of the nose and the healing process. The procedure offers improvement, not perfection. Often after a rhinoplasty self-confidence improves. The final goal is that you are content with the improvement. To achieve this the expectations should be realistic through comprehensive preoperative information.

As with any operation complications can occur, for instance anesthetic problems, thrombosis, bleeding, infection, complicated healing, necrosis of tissue, numbness, asymmetries or a disappointing result. Even in the hands of the most talented plastic surgeon a patient can be disappointed with the result. Esthetic surgery and plastic surgery is not an exact science. No guarantee on uncomplicated healing can ever be given. Sometimes it is necessary to perform an additional procedure to obtain a decent final result. Follow up operations can only be performed after one year when the healing process is complete and the tissues have settled and may involve additional costs. Also, for second procedures there should be realistic expectations.