Primary Rhinoplasty

Rhinoplasty, or nose reshaping surgery, is becoming one of the most widely performed operations in facial plastic surgery. Reasons for having a rhinoplasty performed are highly variable and range from purely cosmetic changes, due to a dorsal hump or wide nasal tip, to more functional reasons like severe nasal/septal deformities, nasal obstruction due to collapse or blockage, or previous nasal bone fracture.

The surgical approach remains the same across all rationale, but results are highly tailored towards each patient’s desires and individuality. The surgery is typically done as an outpatient, with the operation performed in a surgical suite under general anesthesia. Procedures can vary widely depending on patients’ goals and aesthetic desires. Both open and closed approaches are utilized, depending on the situation and the patient’s anatomy, and would be discussed beforehand. Preoperative computer imaging or “photo-morphing” is done with all rhinoplasty patients before surgery so that they may have an active role in determining the desired outcome.

Revision Rhinoplasty

Revision rhinoplasty, or secondary rhinoplasty, is an operation aimed at correcting deformities encountered after a previous rhinoplasty or from multiple previous rhinoplasties. The nose can change extensively over time after a rhinoplasty especially if there is weakened structural support of the nose. Problems can range from contour deformities of the bridge to septal perforations and alar retraction.

Revision rhinoplasty often becomes a structural operation aimed at restoring the natural support of the nose that was disrupted by previous trauma or surgery. A variety of grafting materials may be utilized in revision surgery including cartilage grafting from the septum, ears or from the rib. As in primary rhinoplasty, realistic goals and expectations for revision surgery will be discussed at length at the consultation and preoperative computer imaging will be performed with all patients so that patients can feel comfortable and have input into the desired outcome.

Ethnic Rhinoplasty

Ethnic rhinoplasty is a broad categorization of rhinoplasty which describes primarily patients of Asian, African and Hispanic descent. It is absolutely paramount to understand that noses vary substantially across races and that maintaining an individual, natural appearance is of utmost importance to all people.

It is the goal of St. Louis Facial Plastic Surgery to create a heavily personalized experience for each patient, considering their preferences, culture, and ethnicity. Preoperative computer imaging or “photo- morphing” is done with all rhinoplasty patients before surgery so that they may have an active role in determining the desired outcome.

How can rhinoplasty improve the function of my nose?

Not all noses are created for breathing well and many patients present with a deviated septum, nasal valve collapse or previous fracture that has left them with a nose that doesn’t function like it should. These can all be addressed during rhinoplasty to improve the form and function of the nose.

Recovery From Nose Surgery

Patients will have a plastic splint on the outside of the nose that remains in place for 7 days. The splints primary function is to reduce swelling and stabilize the structural changes to the nose during the immediate recovery period.

Pain is usually pretty minimal after rhinoplasty. Most patients are off any pain medication after 1-2 days but may have some residual discomfort. There may be some additional pain if other grafting material is needed from the rib or the ear, but in general this is well tolerated.

The acute swelling from surgery will go down in the first couple of weeks around the eyes and the upper lip. Bruising is short lived and usually resolves within the first week, if there is any. The long-term swelling from rhinoplasty goes down over much greater periods of time usually 9-12 months. Some changes continue to occur for years after rhinoplasty, but these are generally very subtle.

Is the Rhinoplasty procedure painful?

The use of anesthesia techniques during surgery keeps patients completely comfortable during their rhinoplasty. After surgery we use different medications to maintain adequate pain control.

The Nose Surgery Consultation

Each patient will spend time with the team discussing goals for cosmetic and functional improvements of the nose. We will discuss medical history, expectations and the plan for surgery.

After a consultation, We will conduct a thorough examination of the nose and face as a whole. Photographs are often taken to provide a clear before and after perspective. At this point we will morph the photos to get on the same page in terms of the aesthetic changes to the nose.

Preparing For Your Rhinoplasty procedure

Relax!  Know you are in good hands with us and move forward with your surgery comfortably. Avoiding smoking and nicotine use will help speed up the recovery process.  Patients should also stop any nasal sprays before the surgery if possible, you will also be instructed to avoid certain medications, but this is covered in depth at your consultation.

Risks Of Nose Surgery

While risks of rhinoplasty are minimal and it is overall an incredibly safe operation, some of the risks discussed at the consultation are:

  • Scarring or poor wound healing
  • Lingering pain or numbness in the nose
  • Difficulty breathing through the nose
  • Prolonged swelling or skin discoloration
  • Perforation of the nasal septum is rare but possible
  • Unsatisfactory outcome requiring revision surgery

There may be additional risks associated with cartilage harvest from other sites such as rib cartilage harvest or ear cartilage. These are also very uncommon complications and are discussed in detail during the consultation.

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