For many people, an undesirable nose appearance makes them feel self-conscious. Cosmetic surgery of the nose, also known as rhinoplasty, is one of the oldest and most commonly performed plastic surgery operations. It is performed to change the shape and size of the nose, but also has the potential to change the function of the nose-the nasal airway.
Rhinoplasty is one of the most challenging operations performed by plastic surgeons. Experience and attention to detail are required to achieve a consistent and predictable outcome. Dr. Jones, being double board certified in Plastic Surgery and Otolaryongology (Ear, Nose and Throat, or ENT), has almost 2 decades of experience in rhinoplasty and nasal surgery. Because of his extensive experience, Dr. Jones is recognized by his peers for his skill in this field. He is also a member of The Rhinoplasty Society.
To learn more about rhinoplasty in St. Louis from Dr. Jones, Request Your Consultation at Genesis Cosmetic Surgery and Laser Center.
Patients who want to enhance their self-image and have sound emotional and physical maturity are usually very satisfied with their decision to undergo rhinoplasty.
Under certain conditions, rhinoplasty is necessary to improve both the appearance of the nose and the functionality of the nasal airways. Correction of the nasal airway by reconstructing a deviated nasal septum is often performed at the same time as rhinoplasty. The goal is to produce a nose with open nasal airways and a natural appearance-one that does not look “operated on” and harmonizes with the other facial features.
Rhinoplasty can correct a variety of conditions, including:
In general, rhinoplasty can be done once the facial skeleton has matured, usually age 14 to 17. There is no upper age limit.
The initial consultation will begin in our office in St. Louis, Missouri, with a complete medical history and exam. You should tell Dr. Jones about any previous nose or sinus surgery, nasal allergies, facial or nasal fractures, or problems breathing through your nose. If you have problems breathing through your nose, the inside of the nose may be examined with a small-lighted hose, a fiberoptic scope. Your skin quality, as well as the size and shape of your nose and its relationship to your other facial features, will be carefully studied. Other options available to you will be discussed along with risks and limitations. In some instances, we may recommend surgery of your chin, making it either more or less prominent, to improve facial harmony.
The location where the surgery will take place, the estimated duration of the procedure, the type of anesthesia required and the costs of the surgery will be explained. “Before and after” photographs of patients who have had rhinoplasty will be available for your review.
Your photograph will be taken and can be viewed with the computer imaging system. Computer visual imaging allows you to have a general idea of what you may look like after the procedure. While it is not a guarantee of results, it is a very helpful tool to explain to you what areas can be refined and to make sure you and our physicians have mutual expectations.
Every year, many thousands of people undergo rhinoplasty and experience the desired result with no major problems. However, anyone undergoing any type of surgery must be aware of both the benefits and the risks. The philosophy of Genesis is to keep you well-inside and out. For some patients with medical conditions, we may ask you to have a complete preoperative medical exam by your primary care doctor. If you have a history of sinus problems, nasal allergies or breathing problems, Dr. Jones may treat you preoperatively with medications for these conditions.
As with any surgical procedures, there are risks of bleeding and infection. Both of these complications are infrequent. Other potential problems from rhinoplasty include a worsening of the nasal airway or an unsatisfactory cosmetic result. Occasionally, if the surgical outcome needs further refinement, additional surgery may be needed. These issues are best discussed with us after the consultation.
If you are a smoker, you will be asked to stop smoking well in advance of surgery. Certain medications, such as aspirin, anti-inflammatory drugs and many vitamins and supplements, can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. If surgery is to be performed on an outpatient basis, be sure to arrange for someone to drive you home after surgery and to stay with you at least the first night following surgery. The week before surgery, get the medications and supplies you will need after the surgery so that you will have them at home. The Genesis staff will provide these.
If you have problems breathing through your nose as a result of a deviated septum, health insurance may cover part of the procedure to correct this. You should contact your insurance company to find out whether this is a covered benefit. We highly recommend you obtain written verification if this is a covered service. Our office is happy to provide you and/or the insurance company with a letter of medical necessity if it is appropriate.
There are two basic approaches to rhinoplasty-an “open” approach and a “closed” approach. The open approach places a small, inconspicuous incision at the base of the nose and allows the most precise refinements of the nose structures. A closed approach avoids the incision across the base of the nose, but does not provide the exposure that the open approach provides. Dr. Jones is experienced in both approaches, and uses the open approach more commonly. The closed approach is used for smaller refinements.
Rhinoplasty is performed primarily by altering the bony and cartilage framework of the nose. The skin and other “soft tissues” are altered less frequently, except for the nostrils if indicated. During rhinoplasty, the deviated septum can be corrected and the cartilage used to refine other areas if necessary. In some circumstances, the nasal bones may need to be repositioned to achieve the desired result.
Rhinoplasty patient shown before surgery with large nose, nasal hump, enlarged tip and nose that hangs slightly where it meets the upper lip.
Incisions are made inside the nose to provide access to cartilage and bone which can be cut and reshaped to alter the external appearance of the nose. The bridge of the nose can be narrowed by moving the bone inward, as shown by the arrow.
Areas where cartilage and bone have been readjusted to improve the shape of the nose are shown.
The postoperative patient with smaller nose, a straight nasal bridge, better defined nasal tip and an improved angle between nose and upper lip.
Rhinoplasty patient shown before surgery with large nose, nasal hump, enlarged tip and nose that hangs slightly where it meets the upper lip. Incisions are made inside the nose to provide access to cartilage and bone which can be cut and reshaped to alter the external appearance of the nose. The bridge of the nose can be narrowed by moving the bone inward, as shown by the arrow.
Areas where cartilage and bone have been readjusted to improve the shape of the nose are shown. The postoperative patient with smaller nose, a straight nasal bridge, better defined nasal tip and an improved angle between nose and upper lip.
Rhinoplasty may be performed safely in an office-based surgical suite, an outpatient surgery center or a hospital. The place of surgery depends on the extent and length of surgery, which can vary from one to five hours. Rhinoplasty can be performed under general anesthesia-in which case you are completely asleep-or local anesthesia with sedation, in which case you are given medication to make you drowsy, so that you remain awake, but relaxed. You will not feel pain, but you may notice some gentle tugging. Most patients undergo rhinoplasty under general anesthesia at an accredited outpatient surgery center. If the deviated septum is addressed, patients often stay overnight and go home the next day.
Discomfort is greatest the first three to four days. Of course, you will be provided with sufficient pain medication in the postoperative period.
A splint made of tape will be placed on the outside of the nose and will be removed in about a week. You should avoid wearing your glasses until Dr. Jones gives you permission. Lightweight cold compresses will be placed on the outside of the nose.
If a deviated septum was realigned, you may have soft splints inside the nose. These will be removed in about a week. Nasal packing, if used at all, is used very sparingly and will be removed the next day.
Bruising and swelling around the nose and eyes is common, especially if the nasal bones had to be repositioned. You should keep your head elevated 45 degrees for the first three days to help relieve the swelling. Cold compresses used 10 minutes every hour while awake for the first three days will help reduce swelling. Avoid a heavy compress. A Ziploc bag filled with frozen peas works well. Swelling will start to improve after three days. In addition, we will prescribe supplements that will help minimize the bruising and swelling. Salt water (Ocean Nasal Spray) can be sprayed in the nose as needed and will help loosen the crusting and dried secretions.
You may start wearing makeup within the first few days after surgery. You may resume non-strenuous activities within the first week. The fine stitches will dissolve or be removed five to seven days after surgery. You should avoid straining, bending and lifting during the early postoperative period, the first seven to 10 days. You will be advised to wait two to three weeks before resuming strenuous activity and exercise. Most people will face the public in a week to 10 days.
Noticeable swelling may last for several weeks. Minor residual swelling, most commonly affecting the tip area, may continue for many months, but generally this is not apparent to others.
You should temporarily avoid exposure to direct sunlight and, for the long-term, be conscientious about the use of a sunblock to protect your skin.
Many people undergoing rhinoplasty blossom with self-confidence after this procedure. Temporary blues after the procedure are not uncommon and resolve as the swelling resolves and you adjust to the changes. Since the healing process is gradual, it is important to be patient during the postoperative period and allow up to 12 months for all of the swelling to resolve and the tissues to fully “re-drape.”
The results of rhinoplasty are permanent, except for the age-related changes. Occasionally, a touch-up may be desired. If this is the case, you should wait a year before proceeding with revision surgery.