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Rhinoplasty Surgery
What is rhinoplasty?
Rhinoplasty is a cosmetic surgery procedure to reshape the nose. While you and your friends may casually refer to this surgery as a "nose job," in fact, the word rhinoplasty comes from the Greek words for "nose" (rhino) and "shaping" (plasty).
The overall goal of rhinoplasty surgery is to sculpt the underlying structure of cartilage or bone to make your nose more complementary to your face and, in some cases to eliminate problems with breathing. In this context, your nose can be reshaped in a number of ways:
- A large nose can be reduced in size so that it is more proportional to your face.
- A bump or "hawk shape" can be eliminated to straighten your nose's profile.
- Excessive width or flaring of your nostrils can be eliminated.
- A nose that is crooked, whether from injury or from a birth defect, can be straightened.
- The tip of your nose can be adjusted so that it is more complementary with your face.
- The underlying boney structure of your nose can be altered to correct breathing difficulties associated with deviated septum and other problems.
Factors to be taken into consideration in planning reshaping of your nose include your ethnic background, skin type, underlying facial and nasal structure and realistic expectations. The intent of rhinoplasty is not to create the "perfect" nose but rather one that is both appealing and appropriate to your face.
In cases in which it is performed to correct medical problems such as breathing difficulties or a birth defect, rhinoplasty may be at least partially covered by health insurance. However, if it is a straightforward cosmetic surgery procedure, it is unlikely to be covered by most health insurance plans. Your doctor can advise you as to whether it's likely to be considered medically necessary. If you think it can be justified as a medical procedure, you should check with your insurance plan ahead of time.
In some cases, you might want to also consider other cosmetic procedures — such as reshaping of your chin — to ensure a more balanced look. Your surgeon will discuss any such considerations with you if you are interested.
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How frequently is rhinoplasty performed?
Rhinoplasty was the most frequently done cosmetic surgery procedure in the United States in 2001, according to the American Society of Plastic Surgery. It represented 23 percent of all cosmetic surgery procedures performed that year. Just under 371,000 individuals underwent rhinoplasty in the United States in 2001. Of these, 235,000 were women and 136,000 were men.
Rhinoplasty is performed on patients of all ages, although it is preferable not to operate on adolescents who are still growing — girls younger than 14 or 15 or on boys younger than 16 or 17.
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What are some considerations about having a rhinoplasty procedure?
If you are extremely dissatisfied with your appearance because of the size and shape of your nose, then rhinoplasty can certainly help you improve your appearance. However, you should have a realistic expectation of the effect on your life. Keep in mind that cosmetic surgery can enhance your appearance but it cannot solve all your problems or make you perfect. A solid psychological mindset is essential. If your goals are reasonable, the results of your rhinoplasty can be gratifying and satisfying.
And creating a "perfect" nose is not necessarily the right objective. It is more important that your new nose complement the rest of your face, and factors such as size and shape of your face, ethnic background and skin color and tone should also be taken into account.
Depending on your situation, you may want to consider undergoing other cosmetic changes at the same time, such as a chin augmentation that might create more balance in your face vis-à-vis your new nose.
You should also keep in mind that any surgical procedure leaves scars. In the case of rhinoplasty, most of the incisions involved are made within the nose and are not visible, but sometimes a scar is placed across the base of the columella, the vertical tissue that separates the nostrils. Procedures to narrow the base of the nose or eliminate flaring of the nostrils will require tiny external incisions. Your surgeon will try to place these at the juncture where the nostril and the cheek meet, so that they will be barely noticeable.
You should also keep in mind that rhinoplasty is a surgical procedure, and any surgery carries with it very small-but-possible risks of complications such as reaction to anesthesia, bleeding and infection.
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What do I do to prepare for my rhinoplasty?
During your initial consultation, your doctor will check your medical history and such factors as any problems you may have with breathing. He or she will also seek to assess the underlying bone and cartilage structure of your nose. Together, you'll talk about the type of nose you want to end up with, its relationship to other areas of your face, what's physically possible and ways that the procedure would be done.
You should feel free to talk frankly with your surgeon about your expectations and the details of your planned surgery. Don't be afraid to ask questions.
You should prepare for your surgery by making sure you don't take certain vitamins or aspirin, ibuprofen or other blood-thinning analgesics for at least two weeks before your procedure. Any herbal remedies you are using may need to be discontinued. If you smoke, you should stop for at least three weeks before and three weeks after your surgery, as nicotine interferes with blood supply and can adversely affect the healing of your incisions (and the final appearance of your scars). You will be asked not to eat or drink after midnight of the night before your surgery.
Rhinoplasty is usually performed on a day-surgery basis, but it is conceivable the doctor may have you held overnight in the hospital following your procedure. Depending on the extent of the procedure, it may be done with either local anesthesia, in which case you would be awake but sedated and without sensation or pain in the area of surgery, or general anesthesia, in which case you would be asleep. You should have a family member or friend drive you home after you are discharged, as you cannot drive yourself.
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How is the surgery performed?
For some procedures, the incisions will be located within the nostrils, and bone and cartilage will be accessed from within the nose, avoiding the problem of visible scars. Through these incisions, bone and cartilage will be removed or rearranged to reshape the underlying structure of your nose in line with the goals you and your surgeon have discussed. Bone, for example, can be removed from the ridge of your nose to eliminate a hump and straighten its profile, cartilage can be removed from the tip to reduce its size or adjust its angle, or a crooked angle left in the bone by an old injury can be adjusted. Bone and cartilage may be moved around to build up certain elements of the underlying structure over which the skin is arranged. And, a deviated septum or other issues that may cause breathing problems can be corrected.
In some cases, an "open rhinoplasty" will be necessary using incisions inside the nostrils as well as an incision across the columella. This improves access to the cartilage and bone.
For some procedures, such as diminishing the flaring of nostrils or narrowing the base of the nose, it may be necessary to remove small wedges of tissue along the base of the nostrils. In these cases, incisions will be hidden in the creases where the nose joins the cheek and will be barely noticeable.
Once the underlying structure is reshaped, the skin will be redraped over it. When your procedure is completed, a splint may be placed over your nose to support its new shape while it heals, and nasal packing may be placed within your nostrils.
Depending on the specifics of the work done, your rhinoplasty should take one to two hours to perform.
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What can I expect following rhinoplasty?
After your surgery, you will experience some swelling, bruising and minor pain. The duration of this varies among patients from a few days to several weeks. To facilitate healing, you should keep your head elevated and use cold compresses for several days. You should plan on staying in bed (with your head elevated) for a day or two. Nasal packing, if used, will be removed in a few days. Bruising and swelling should disappear in about three weeks, although you will have some very subtle and barely noticeable swelling for a matter of months.
You will feel nasal stuffiness for several weeks, but should avoid blowing your nose for at least three weeks. You need to avoid hitting or bumping your nose for two months. You can wear contact lenses immediately, but you should avoid wearing eyeglasses that rest on your nose for about two months; they'll have to be taped to your forehead or rest on your cheeks. You should avoid straining, bending, lifting, strenuous exercise, sexual relations or other activities that could increase your blood pressure (it interferes with healing) during the initial three weeks following surgery.
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Is rhinoplasty a successful procedure?
More than 300,000 people in the United States have rhinoplasty each year, with a high rate of satisfaction. As suggested earlier, you should keep in mind that cosmetic surgery can improve your appearance but it cannot solve all your problems or make you perfect.
If your goals related to cosmetic surgery are realistic, the results of rhinoplasty can be very fulfilling and gratifying.
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Frequently asked questions
Will I see the final appearance of my new nose immediately?
You'll see a new and improved nose immediately, but since it takes time for tissues to heal and settle in, it may take as long as a year before you see the final effect of your rhinoplasty.
How long can I expect the results of my rhinoplasty to last?
Your rhinoplasty should last for the rest of your life. However, as you age some changes in your appearance are inevitable.
Does health insurance cover rhinoplasty?
Except in special circumstances, rhinoplasty is usually considered a strictly cosmetic procedure and is not covered by health insurance. Your physician will advise you if there is any medical therapeutic basis for your surgery.
If my rhinoplasty is not covered by insurance, how much does it cost?
The average cost for rhinoplasty is $5,000, although the cost can vary depending on the extensiveness of the procedure needed.
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For additional information
You can find additional information about rhinoplasty at web sites sponsored by government agencies, societies and healthcare institutions. It should perhaps be noted that the World Wide Web is open to many sources posting questionable information and promises, and you are encouraged to seek information from established, reputable organizations.
Likely sources include:
The American Society of Plastic Surgeons
(www.plasticsurgery.org)
The American Academy of Facial Plastic and Reconstructive Surgery
(www.aafprs.org)
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