Nose Reshaping Surgery - Rhinoplasty
Consider your nose. It sits squarely in the center of your face. To a lesser or greater extent, it is your face. If you're not happy with it, you can change it through a medical procedure called "rhinoplasty," or surgery to re-shape the nose.
It is best to be conservative with rhinoplasty
Rhinoplasty should enhance one's natural appearance in subtle and appealing ways...not cry out "nose job!" to all who see it. The most aesthetically pleasing rhinoplasties improve upon nature, they don't take it away.
Nature (genetics) often determines the appearance of one's nose. Sometimes, defects occurring during development in the mother's womb can affect the look of one's nose, as can "trauma" or severe injury to the face. Rhinoplasty can correct birth defects, help to minimize the effects of trauma, reduce overly prominent features, such as bumps or humps, or improve the appearance of noses that hang down or have enlarged tips. It can also help to reduce asymmetries, when one side of the nose looks different form the other side. People with breathing problems caused by a deviated septum frequently undergo rhinoplasty.
At what age should rhinoplasty be performed?
There is no real "right" or "wrong" time to perform rhinoplasty, but I don't usually recommend it before 15 or 16 years of age in female, nor before age 17 or 18 in a male. This is because growth and development are still going on in younger individuals. The face must be close to its final form before altering its features with cosmetic surgery, or anticipating the final results can be difficult and results may not be as favorable as desired.
On the other end of the age spectrum, older individuals usually don't fare as well with rhinoplasty as middle age and younger adults. When age has caused tissue to fall and the tissue has become a little more fatty, a little less supple, it's harder for the plastic surgeon to create a sculpted nose at that point. But you can still get some improvement, so I don't think one can say "absolutely not."
What happens during rhinoplasty?
I usually do the procedure under a general anesthetic; it's almost always an outpatient surgery (that is, one does not stay overnight in the hospital). Rhinoplasty usually takes an hour or two, depending on how much work the surgeon must do, the surgeon's technique, and other factors.
During the surgery, your tissue, cartilage, and bones will be carefully shaped and sculpted in relationship to the features of your entire face. And, although this is unquestionably a medical procedure, requiring the skill, extensive training, and knowledge of a medical doctor who is specially trained as a surgeon, it is also a form of artistry, similar to sculpture, painting, or other forms of creative art.
There are two general approaches to the surgery itself: a "closed" approach or "an open" approach. In the former, there is no scar on the outside of the nose. In the latter, there is a very small scar between the two nostrils. Which one to be used is something that the surgeon will decide, depending on the procedure to be done and the surgeon's chosen technique.
How long does it take to recover...and see the results
After surgery, you'll be swollen and sore. Your surgeon will place a nasal splint on your nose, and you'll have some nasal packing inside your nose for about a day. You may also notice some bleeding for the first few days after surgery. A little bleeding is normal, and it should not be a cause for concern.
Pain medications will be prescribed to make you more comfortable, and antibiotics will be prescribed to help prevent infection. You'll be advised to sleep with your head up, and to put ice packs on your face. Depending on the extent of your surgery, you may notice swelling and a "black and blue" or green/yellowish discoloration around your eyes. This will probably appear most severe about two or three days after the surgery, but you'll generally feel better than you look. The bruising around your eyes will start to clear after about a week.
Most of my rhinoplasty patients decrease activity during the first few days following rhinoplasty - that is, they minimize their activities, and just give themselves some time to rest and recuperate. Most patients can return to work or school within about a week, but I advise them not to participate in aerobics, sports, or any vigorous physical activity for about three weeks after surgery. The splint on your nose will be removed within two weeks or less. Usually, after the splint is taken off, almost every patient can see a change, but to appreciate the full effects of a rhinoplasty, I think one has to wait six months to a year. It can take this long for all of the swelling to go down and for all of the healing to take place, depending on skin and tissue types of each.
Cost and insurance considerations
A rhinoplasty, including surgical fees, can cost anywhere from $7,000 to $10,000, depending on the cost of the surgical facility, anesthesia used, and other factors, such as the city and state in which your surgeon practices.
Insurances will cover the procedure if the patient has a problem with breathing (nasal airway obstruction). Or, if nose problems are the result of trauma, insurance may cover a corrective procedure. But insurance will usually not cover the part of the nose surgery that is "cosmetic."
Take home message
I can't emphasize enough not to do too much on a nose. I think the majority of people don't want super-radical changes to their noses. Many want to retain their ethnicity to some extent, and keep the unique character of their face. Most people want a modification - more delicate, a tiny bit smaller; they really don't want to change their appearance in unnatural-looking ways. If one does too much surgery on a nose, tissue is basically destroyed and then to restore it, one has to use foreign implant material or tissue from other parts of the body. Then the surgery can become more extreme - and more difficult.
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