Nose Surgery (Rhinoplasty)
What is rhinoplasty?
Rhinoplasty is the surgical repair or reshaping of the nose. Also known as nose reshaping, rhinoplasty is one of the most common cosmetic surgical procedures in the world. Rhinoplasty can change the nose’s shape, length, width, profile, tip, nostrils, and its overall symmetry. A common name for cosmetic rhinoplasty is a “nose job.” Sometimes doctors recommend rhinoplasty for medical reasons, such as the repair of structural elements in the nose to improve breathing.
Rhinoplasty is a common but major surgery with significant risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having a rhinoplasty.
Why is rhinoplasty performed?
Rhinoplasty is a common cosmetic surgical procedure—a “nose job”—to change the size and shape of the nose for aesthetic reasons.
Your doctor may recommend rhinoplasty to treat certain medical conditions that affect the nose or your ability to breathe including:
Congenital abnormalities, such as a cleft lip and palate
Deviated septum, the displacement of the cartilage wall separating your nostrils, which can be present at birth or occur as a result of an injury to the nose
Injury or trauma to the nose, such as getting hit with a ball or trauma from a car accident
Skin cancer, which can cause skin lesions on the nose that, when removed, change the shape of the nose
Your doctor may only consider rhinoplasty for medical reasons if other treatment options that involve less risk of complications have not worked. Ask your doctor about all of your treatment options and consider getting a second opinion.
Who performs rhinoplasty?
The following specialists commonly perform rhinoplasty:
Facial plastic and reconstructive surgeons specialize in correcting facial defects that affect a person’s appearance or functional abilities, such as the ability to breathe through the nose.
Head and neck plastic surgeons specialize in correcting physical defects within the head and neck that can affect a person's appearance and ability to function.
Plastic surgeons specialize in correcting a variety of physical defects that affect a person's appearance or ability to function.
Other specialists who perform rhinoplasty include:
Otolaryngologists (ENTs) specialize in treating conditions of the ears, nose and throat.
Oral and maxillofacial surgeons specialize in the diagnosis and treatment of diseases, injuries, and defects affecting the mouth, teeth, jaws and face.
How is rhinoplasty performed?
Your surgeon will perform rhinoplasty by making an incision just outside your nose or inside the nostrils to reshape your nose cartilage and bone. To surgically reshape your nose, your surgeon will likely remove parts of cartilage in the nose and replace it with other cartilage from inside your nose or rarely, from your ear or rib. Surgeons perform rhinoplasty in the surgeon’s office or in a hospital or outpatient surgical clinic.
Surgical approaches to rhinoplasty
Your surgeon will perform rhinoplasty using one of the following approaches:
Minimally invasive surgery is performed by inserting special instruments through small incisions in the nostrils. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues. Your surgeon will make small incisions instead of a larger one used in open surgery. He or she can then thread surgical tools around cartilage and bone, instead of cutting through or displacing them as in open surgery.
Open surgery is performed by making an incision in the columella, the strip of tissue between the nostrils and above the upper lip. An open surgery incision allows your surgeon to more directly view and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. This is because it causes more trauma to tissues. Open surgery requires a larger incision and more cutting and displacement of tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.
In some cases, your surgeon may combine a minimally invasive procedure with an open surgery. In addition, your surgeon may decide after beginning a minimally invasive procedure that you require an open surgery to safely and most effectively complete your surgery.
Rhinoplasty is usually an outpatient procedure. Your surgeon will determine which type of rhinoplasty is best for you and if you need to stay in the hospital based on certain factors. These include your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different rhinoplasty procedures and ask why your doctor will use a particular type of procedure for you.
Types of anesthesia that may be used
Your surgeon will perform a rhinoplasty using either regional anesthesia or general anesthesia:
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain.
Regional anesthesiais also known as a nerve block. Your anesthesiologist or nurse anesthetist will inject anesthetic in the skin and tissues around the nose. You may also receive a sedative through your IV to keep you relaxed and comfortable. You may fall asleep and may not remember the procedure.
What to expect the day of your rhinoplasty
The day of your surgery, you can expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure that you understand and sign the surgical consent.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member if possible. The surgical team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube will be placed in your windpipe to protect and control your breathing during general anesthesia. You will not feel or remember this or the surgical procedure as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout surgery and recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of rhinoplasty?
As with all surgeries, rhinoplasty involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications can develop during the procedure or throughout your recovery.
General risks of surgery
The general risks of surgical procedures include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Potential complications of rhinoplasty
The vast majority of rhinoplasty procedures are successful. However, complications of rhinoplasty can occur and become serious. Potential complications include:
Burst blood vessels on the surface of the skin of the nose, which are permanent
Emerging sutures that need to be manually removed (instead of dissolving on their own)
Hole in the septum (also called a nasal septal perforation)
Irregularities in skin contour or coloring
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery
Informing your doctor if you are nursing or there is any possibility that you may be pregnant
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my rhinoplasty?
You are an important member of your own healthcare team. The steps you take before surgery can significantly improve your outcome after the procedure. You can prepare for rhinoplasty by:
Answering all questions about your medical history and medications you take. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing weight before surgery through a healthy diet and exercise plan
Not eating or drinking just prior to surgery as directed. Your doctor may cancel your surgery if you eat or drink too close to the start of the procedure because you can choke on stomach contents during general anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with questions or concerns before surgery and between appointments.
It is also a good idea to bring a list of questions to your preoperative appointment. Questions can include:
I am a good candidate for rhinoplasty? Are there any other options for treating my condition?
What type of rhinoplasty procedure will I need?
How long will the procedure take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
When can I shower after rhinoplasty and how should I care for my incisions?
How will I look after the surgery?
What kind of assistance will I need at home?
What medications will I need before and after the surgery? How do I take my usual medications?
How will you manage my pain?
When should follow up with you?
How should I contact you? Ask for numbers to call during and after regular office hours.
What can I expect after my rhinoplasty?
Knowing what to expect can help make your road to recovery after rhinoplasty as smooth as possible.
How long will it take to recover?
Most people stay in the surgeon’s office, surgical center, or hospital for an hour or two after a rhinoplasty. Your care team will discharge you when you are alert, breathing normally, and your vital signs, such as blood pressure and pulse, are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You may still be drowsy from sedation or anesthesia so you will need a friend or family member to give you a ride home from your surgery.
When you awake from your rhinoplasty, you will most likely have a plastic or metal splint taped to the outside of your nose. The splint will help temporarily stabilize and maintain the new nose shape. You may also have nasal packs or soft splints inside your nose to stabilize the bones and cartilage and to absorb bleeding. Your surgeon will remove your splints and nasal packs about three to seven days after rhinoplasty.
You will mostly likely have swelling and bruising on your nose and face after the rhinoplasty. The bruises should lessen within a few weeks.
Recovery after surgery is a gradual process. Recovery time varies depending on the specific type of rhinoplasty, your general health, age, and other factors. Full recovery may take weeks to months. It may take up to a year for nose swelling to completely go away and to show your permanent nose shape.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your procedure. Your doctor and care team will manage your pain so you are comfortable and can get the rest you need. Contact your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after rhinoplasty. Call your doctor if you have questions or concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Change in alertness, such as passing out, unresponsiveness, or confusion
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery. It is not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate, pass gas, or have a bowel movement
Pain that is not controlled by your pain medication or pain that changes or gets worse
Unexpected drainage, pus, redness or swelling from your nose or incision
How might rhinoplasty affect my everyday life?
If you have a rhinoplasty for a medical disease, disorder or condition, the rhinoplasty may cure your condition or reduce your breathing problems.
If you have a rhinoplasty for cosmetic reasons, the new appearance of your nose may give you increased satisfaction with your appearance and increase your self-confidence. Many surgeons caution to be realistic about how much a rhinoplasty may improve your self-image, so be aware of what a cosmetic rhinoplasty can and cannot do for your overall appearance and self-image.