Rhinoplasty

Rhinoplasty is a nose reshaping procedure by molding the nasal bone and cartilage. Through rhinoplasty, a nose can be made bigger or smaller by adding or reducing the bulge of nasal bone; straighter or thinner nose can be gained by also molding the cartilage. It is the most performed plastic surgery procedure in western countries as well as some Asian countries.

Candidates of rhinoplasty are those who wish to refine nasal form to improve facial harmony and post trauma patients who have nasal deformity.

Before the surgery, you need to:

  • Consult your plastic surgeon about your desired nasal form

  • Inform your plastic surgeon about your previous nasal surgery or abnormality (if any)

  • Undergo laboratory examinations to evaluate vital organ conditions

  • Stop smoking and alcohol consumption for 2 weeks

  • Stop taking supplement containing ginkgo biloba, ginseng, vitamin E, garlic, pien tze huang, and blood thinner medications

On the day of surgery, you need to fast 4-6 hours prior to the surgery, which will done under general anesthesia. The surgery can also be done with the aid of local anesthesia and/or sedation. The procedure may last for 1-4 hours. The plastic surgeon may perform closed or open rhinoplasty. In closed rhinoplasty, incision is made inside the nostril. Therefore, the scar is not visible, but the field of operation for the surgeon is very limited. A rubber-like silicone implant is usually needed. In open rhinoplasty, another additional incision is made on the columella (the bridging structure between the nostrils). This technique is done for more difficult cases or if it is technically needed for a better result. Some donor tissue may be needed (e.g. ear or rib cartilage, fascia structure taken from temporal or thigh, or skin-fat tissue).

Another technique for nose refinement could also be performed without involving surgery, on which a synthetic material is inserted using a needle to shape the nose. The use of this technique is limited and it is not a primary choice for rhinoplasty.

After the surgery, you may experience mild to moderate pain for 2-10 days. This can be managed by medication. Swelling and bruises can take place for 1-3 weeks (for closed rhinoplasty) and 1 month or more (for open rhinoplasty). You may experience numbness on your nose for several weeks. Other complications that may happen are bleeding, nasal deformity, and infection. The final outcome can be seen in 3 months-1 year.

Postoperative management includes:

  • The nose will be stabilized with a splint which will be removed during follow-up 1 week after surgery

  • Cold compression on the eyes for the first 2 days

  • Bandage is replaced after 3-5 days; after which care is done in an open condition

  • Head must be upright to reduce swelling

  • Avoid sneezing (although this might be unpreventable) or picking your nose for 3 weeks-1 month

  • Don’t use nasal medication for 3 months

  • Use nasal saline spray for 2 weeks to help reduce the formation of dried nasal mucus

  • It is recommended to use sunblock for several months after surgery

  • For 6 months after surgery, avoid strenuous physical activity, including bowing down

  • There is a 20% chance that you will need secondary surgery to refine the outcome of the first surgery. Revision should wait at least 1 year after the first procedure.

(Source: Prasetyono TOH. Rhinoplasty. Bazaar 2009 Feb;Chapter 4:47-8.)

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