Jay M. Dutton, MD FACS
The term “rhinoplasty” , also referred to as a “nosejob”, is plastic surgery of the nose that involves making changes in the structure of the external nose. This may be performed to improve the form and/or function of the nose, and may be performed at the same time as a “septoplasty” which involves straigtening the wall between the two sides of the nasal passages to improve breathing.
The indications for a rhinoplasty include, but are not limited to:
- Obstructed breathing (functional)
- Unsatisfactory appearance
- Nasal injury (trauma) causing unsatisfactory appearance or breathing
- Nasal birth defect impairing form or function
- Acquired deformity due to trauma, tumor or infection
A rhinoplasty may be performed under different types of anesthesia depending on patient and physician preference, including local, intravenous sedation (i.e. “twilight”) or general anesthesia. Incisions are made to allow access to the underlying cartilage and bone. When these incisions are hidden completely inside the nostrils, it is referred to as a “closed” rhinoplasty. Often, a small incision may need to be performed at the base of the nose to improve exposure, in which case it would be an “open” rhinoplasty.
Depending on the needs of the patient, cartilage and bone may need to be removed or actually added. There has been a move away from extensive cartilage removal (“reduction rhinoplasty”) and a greater emphasis on cartilage grafting to improve the contour of various parts of the tip or bridge of the nose. These cartilage grafts are often taken from the nasal septum itself, although sometimes ear or even rib cartilage may need to be harvested. Further reshaping may need to be performed with sutures to the cartilage. “Osteotomies” – or deliberate fracturing of the nasal bones – are often performed to straighten or narrow the nasal bones themselves.
At the conclusion of the procedure, the outside of the nose is taped and some form of external cast may be applied. Plastic sheets and/or packing may also be temporarily placed inside the nose depending on the procedure and the surgeon’s preference.
Studies have shown that most rhinoplasties heal without adverse sequelae and patient satisfaction is high. However, there are potential complications that every rhinoplasty candidate should be aware of before proceeding with the procedure, and these include (but are not limited to):
- Complications of anesthesia
- Epistaxis (nosebleed)
- Septal perforation (hole in internal wall of nose)
- Unsatisfactory appearance
- Revision surgery
- Nasal obstruction
The primary benefit of a cosmetic rhinoplasty is the improved appearance of the external nose, which may significantly help the patient’s self esteem. An improvement in nasal breathing is the primary benefit of a rhinoplasty performed for functional reasons.
Rhinoplasty is a procedure to improve the form and/or function of the external nose, and may entail a great range of techniques depending on the patient’s goals, the anatomic problems, and the surgeon’s preferences. The procedure may be done with the patient awake or under anesthesia, as a primary surgery or revision surgery, may involve reducing or adding tissue, may be performed “closed” or “open”, and may involve a brief or protracted recovery. Patients should enter into discussions with their surgeon with specific goals in mind, and should understand the procedure itself, its risks and its benefits after consulting with their surgeon
©American Rhinologic Society