About the Rhinoplasty Procedure
The term rhinoplasty is also known as “nose job” is the reshaping of the nose for aesthetic concerns. This can be a simple procedure if only minor changes are needed or it can be a difficult and complex operation. Many surgeons and residents find this operation to be difficult because they do not have significant experience in the procedure.
The consultation is very important. The patient should have a concrete idea of what he or she does not like or wants to change. Those changes should be explained to the surgeon, possibly placing them in order of importance. It is also important to interview the surgeon to see if their plan fits with your concerns.
Some changes are easy to obtain and others are more difficult. Some changes cannot be achieved. There are the questions you must ask so you can understand whether the surgeon is or is not comfortable with the desired changes. The patient must listen and hear the surgeon’s experience and concerns. The patient’s desires, the surgeon’s abilities, and the potential reasonable clinical changes all have to come together for the operation to be a success.
Some patients have a misconception that rhinoplasty is like carving the new shape of the nose. If that were the case, rhinoplasty would be easy and consistent. Rhinoplasty is a delicate operation to make the underlying structures take on the new desired shape, have it healed that way, and at the same time maintaining the function of the nose.
Types of Rhinoplasty
Closed vs. Open Rhinoplasty
Two main types of rhinoplasties are done; closed or open procedures. In the closed procedures all the incisions are inside the nasal opening. In an open rhinoplasty, there is a small inconspicuous incision at the base of the columella. This allows complete visualization of the nasal structures which the closed rhinoplasty does not. In most cases, Dr. Yousif feels that open rhinoplasty allows a greater ability to create symmetry and correct anatomic variations.
Dr. Yousif does many surgeries to correct patients that have had poor outcomes. Some patients have had as many as 6-7 previous rhinoplasty operations. When patients consider having surgery again after having had a previously bad outcome it is a difficult decision to make. Consultations for secondary corrective surgeries should be in-depth and with a long discussion about achievable results. Dr. Yousif will review all previous operative reports and have an in-depth discussion with the patients. This might take 2-3 office visits.
Cleft Lip Rhinoplasty
Cleft lip and palate are the results of tissues of the face not joining properly during embryonic development. The lack of fusion of the labial tissue can continue to create deformities of the nose on one or both sides. The separation of the lip is usually closed early on after birth. The repair of the nose however is usually delayed to some point in the future. The nasal structures have normally completed their growth around the 16th birthday, so many surgeons wait until those structures have finished their growth to return to surgery to correct any deformities that may be present.
Each surgeon may approach the issue in a different manner. Dr. Yousif’s technique is to perform an open rhinoplasty which means that the cartilage of the nose is completely exposed with a central incision. Dr. Yousif feels that the structures are all there, just out of place. Those structures require careful exposure and rebuilding. Sutures and cartilage grafts are used to rebuild the nasal framework. Cartilage grafts are usually harvested from the ear “concha” or the central portion. There is little or no changes to the shape of the ears. Grafts may be placed in the nose or even at the base of the nose to support the nasal structures and bring the maxilla forward.
Of course, the function of the nose is breathing. At times, breathing can be obstructed, either by septal deviation or deviation of the nasal structures. Correction of a deviated septum or nose can be done alone or combined with aesthetic procedures. All or a portion of the procedure can be, at times, covered by the patient’s insurance if breathing issues are to be corrected.
Non-surgical rhinoplasty refers to reshaping the nose with injectable substances rather than surgical means of altering the shape and structure of the nose. It is also called a “non-surgical rhinoplasty”, and is performed in the office. These injections may require more than one treatment but usually last for 1-2 years.
What To Expect
Anesthesia and Surgery Facility
Dr. Yousif performs almost all of the rhinoplasties under general anesthesia. Operative time approximately 2-3 hours unless it is a more complicated case.
A rhinoplasty can be done either under general or under local anesthesia but in most instances Dr. yousif performs these under general anesthesia as open procedures. The operation takes approximately 2-3 hours depending on the complexity of the changes. The incisions are made and the skin and fat are lifted off the cartilage and bone which are the structural elements of the nose. Reshaping is done by some removal or re-shaping of the cartilage or bone. At times sutures can be used to help remodel the cartilage and at other times cartilage or bone grafts can be used to augment change or hide the shape of the native structures. If the septum needs correction that is typically done first. Nasal shaping is then done addressing the tip and then the nasal dorsum. That can be done by rasping the tissue or by direct removal. Removal of the dorsal bump usually leaves what’s called an open sky deformity which means there is an open space on the top of the nose. That typically requires fracturing the side bones of the nose to bring them together on top. That can be done either internally or externally depending on the surgeon’s preference. At that point the incisions are closed, the nose is packed and an external splint is applied. Variations from these techniques are done depending on each individual patient and the surgeon.
Dressings and a splint are applied and potentially internal packing. The surgery is not usually very painful but the packing is annoying because one is not being able to breathe while it is in. The packing is usually removed after 2-3 days. If a fracture is required, healing of the bone usually takes 4-6 weeks to solidify, so be careful. Bruising and swelling is variable for each person but that is usually gone by 1-2 weeks.
The patient usually returns home after the surgery. A short course of antibiotics, pain medications may be used after surgery. Most people choose to remain home for a week, although it is safe to be outdoors. If there are external sutures, they are usually removed 4 to 5 days after surgery. The external cast is removed at one week to 10 days. If there are internal stents, they are usually removed two weeks. The periorbital bruising resolves after a week or two. Due to wound healing, there is moderate shifting and settling of the nose and final results may take up to 1 year.
Although uncommon, post-operative complications can include bleeding which often resolves without treatment. Infection is very rare butt may require antibiotics.
Final results for the shape of the nose may take up to 6 months. The final results depend on the surgery but it may also vary with the thickness of the skin or internal scar tissue which may reduce the visibility of the underlying shape that was created..