The term rhinoplasty means "nose molding" or "nose forming." It refers to a procedure in plastic surgery in which the structure of the nose is changed. The change can be made by adding or removing bone or cartilage, grafting tissue from another part of the body, or implanting synthetic material to alter the shape of the nose.
Description
The external nose is composed of a series of interrelated parts which include the skin, the bony pyramid, cartilage, and the tip of the nose, which is both cartilage and skin. The strip of skin separating the nostrils is called the columella.
Surgical approaches to nasal reconstruction are varied. Internal rhinoplasty involves making all incisions inside the nasal cavity. The external or "open" technique involves a skin incision across the base of the nasal columella. An external incision allows the surgeon to expose the bone and cartilage more fully and is most often used for complicated procedures. During surgery, the surgeon will separate the skin from the bone and cartilage support. The framework of the nose is then reshaped in the desired form. Shape can be altered by removing bone, cartilage, or skin. The remaining skin is then replaced over the new framework. If the procedure requires adding to the structure of the nose, the donated bone, cartilage, or skin can come from the patient or from a synthetic source.
When the operation is over, the surgeon will apply a splint to help the bones maintain their new shape. The nose may also be packed, or stuffed with a dressing, to help stabilize the septum.
When a local anesthetic is used, light sedation is usually given first, after which the operative area is numbed. It will remain insensitive to pain for the length of the surgery. A general anesthetic is used for lengthy or complex procedures or if the doctor and patient agree that it is the best option.
Simple rhinoplasty is usually performed in an outpatient surgery center or in the surgeon's office. Most procedures take only an hour or two, and patients go home right away. Complex procedures may be done in the hospital and require a short stay.
Who Performs the Procedure and Where Is It Performed?
Simple rhinoplasty is usually performed in an outpatient surgery center or in the surgeon's office. Most procedures take only an hour or two, and patients go home right away. Complex procedures may be performed in a hospital and require a short stay.
Rhinoplasty is usually performed by a surgeon with advanced training in plastic and reconstructive surgery.
Questions to Ask the Doctor
What will be the resulting appearance? (Often, computer programs are available to assist in visualizing the final result.)
Is the surgeon board certified in plastic and reconstructive surgery?
How many rhinoplasty procedures has the surgeon performed?
What is the surgeon's complication rate?
Will this surgery really make a huge difference to my life or am I trying to live up to an impossible media stereotype of beauty?
Definition
The term rhinoplasty means "nose molding" or "nose forming." It refers to a procedure in plastic surgery in which the structure of the nose is changed. The change can be made by adding or removing bone or cartilage, grafting tissue from another part of the body, or implanting synthetic material to alter the shape of the nose.
Purpose
Rhinoplasty is most often performed for cosmetic reasons. A nose that is too large, crooked, misshapen, malformed at birth, or deformed by an injury can be given a more pleasing appearance. If breathing is impaired due to the form of the nose or to an injury, it can often be improved with rhinoplasty.
Demographics
Rhinoplasty is the third most common cosmetic procedure among both men and women. Total number of rhinoplasty procedures in the United States in 1999 was 133,058. More than 13,100 of those procedures were performed on men.
Description
The external nose is composed of a series of interrelated parts that include the skin, the bony pyramid, cartilage, and the tip of the nose, which is composed of cartilage and skin. The strip of skin separating the nostrils is called the columella.
Surgical approaches to nasal reconstruction are varied. Internal rhinoplasty involves making all incisions from inside the nasal cavity. The external, or "open," technique involves a skin incision across the base of the nasal columella. An external incision allows the surgeon to expose the bone and cartilage more fully and is most often used for complicated procedures. During surgery, the surgeon will separate the skin from the bone and cartilage support. The framework of the nose is then reshaped in the desired form. Shape can be altered by removing or adding bone, cartilage, or skin. The remaining skin is then replaced over the new framework. If the procedure requires adding to the structure of the nose, the donated bone, cartilage, or skin can come from another location on the patient's body or from a synthetic source.
When the operation is completed, the surgeon will apply a splint to help the bones maintain their new shape. The nose may also be packed, or stuffed with a dressing, to help stabilize the septum.
When a local anesthetic is used, light sedation is usually given first, after which the operative area is numbed. It will remain insensitive to pain for the length of the surgery. A general anesthetic is used for lengthy or complex procedures, or if the doctor and patient agree that it is the best option.
Diagnosis/Preparation
The quality of the skin plays a major role in the outcome of rhinoplasty. Persons with extremely thick skin
During an open rhinoplasty, an incision is made in the skin between the nostrils (A). Closed rhinoplasty involves only incisions inside the nose. Rhinoplasty may involve a change in nostril width (B) or removal of a hump on the nose (C) using bone sculpting. After surgery, a splint supports the nose (D), and a cold compress reduces swelling (E). (Illustration by GGS Inc.)
may not see a significant change in the underlying bone structure after surgery. On the other hand, thin skin provides almost no cushion to hide many minor bone irregularities or imperfections.
Rhinoplasty should not be performed until the pubertal growth spurt is complete, ages 14–15 for girls and older for boys.
During the initial consultation, the candidate and surgeon will determine what changes can be made in the shape of the nose. Most doctors take photographs during that consult. The surgeon will also explain the techniques and anesthesia options available to the candidate.
The candidate and surgeon should also discuss guidelines for eating, drinking, smoking, taking or avoiding certain medications, and washing the face for the weeks immediately following surgery.
Aftercare
Patients usually feel fine immediately after surgery. As a precaution, most surgery centers do not allow patients to drive themselves home after an operation.
The first day after surgery, there will be some swelling of the face. Persons should stay in bed with their heads elevated for at least a day. The nose may hurt and a headache is common. The surgeon will prescribe medication to relieve these conditions. Swelling and bruising around the eyes will increase for a few days, but will begin to diminish after about the third day. Slight bleeding and stuffiness are normal, and vary according to the extent of the surgery performed. Most people are walking in two days, and back to work or school in a week. No strenuous activities are allowed for two to three weeks.
Patients are given a list of postoperative instructions, which include requirements for hygiene, exercise, eating, and follow-up visits to the doctor. Patients should not blow their noses for the first week to avoid disruption of healing. It is extremely important to keep the surgical dressing dry. Dressings, splints, and stitches are removed in one to two weeks. Patients should avoid excessive sun or sunburn.
Risks
Any type of surgery carries a degree of risk. There is always the possibility of unexpected events such as an infection or a reaction to the anesthesia.
When the nose is reshaped or repaired from inside, the scars are not visible. If the surgeon needs to make the incision on the outside of the nose, there will be some slight scarring. In addition, tiny blood vessels may burst, leaving small red spots on the skin. These spots are barely visible, but may be permanent.
Normal Results
The best candidates for rhinoplasty are those persons with relatively minor deformities. Nasal anatomy and proportions are quite varied and the final look of any rhinoplasty operation depends on a person's anatomy, as well as the surgeon's skill.
A cosmetic change of the nose will change a person's appearance, but it will not change self-image. A person who expects a different lifestyle after rhinoplasty is likely to be disappointed.
The cost of rhinoplasty depends on the difficulty of the work required and on the specialist chosen. If the problem was caused by an injury, insurance will usually cover the cost. A rhinoplasty done only to change a person's appearance is not usually covered by insurance.
Morbidity and Mortality Rates
Death from a rhinoplasty procedure is exceedingly rare. When it occurs, the cause is often due to an adverse reaction to anesthesia or postoperative medications or to an infection. About 10% of persons receiving rhinoplasty require a second procedure.
Alternatives
The alternative to cosmetic rhinoplasty is to accept oneself, literally, at face value. Persons contemplating rhinoplasty may want to question some of the conventional standards of beauty and work on their body image issues to improve their self-confidence.
Engler, Alan M. BodySculpture: Plastic Surgery of the Body for Men and Women, 2nd Edition. Poughkeepsie, NY: Hudson Pub, 2000.
Irwin, Brandith, and Mark McPherson. Your Best Face: Looking Your Best without Plastic Surgery. Carlsbad, CA: Hay House, Inc, 2002.
Man, Daniel, and L. C. Faye. New Art of Man: Faces of PlasticSurgery: Your Guide to the Latest Cosmetic Surgery Procedures, 3rd Edition. New York: BeautyArt Press, 2003.
Papel, I. D., and S. S. Park. Facial Plastic and ReconstructiveSurgery, 2nd Edition. New York: Thieme Medical Publishers, 2000.
Periodicals
Ahn, M. S., C. S. Maas, and N. Monhian. "A Novel, Conformable, Rapidly Setting Nasal Splint Material: Results of a Prospective Study." Archives of Facial Plastic Surgery 5, no.2 (2003): 189–192.
Bagal, A. A., and P. A. Adamson. "Revision Rhinoplasty." Facial Plastic Surgery 18, no.4 (2002): 233–244.
Lascaratos, J. G., J. V. Segas, C. C. Trompoukis, and D. A. Assimakopoulos. "From the Roots of Rhinology: The Reconstruction of Nasal Injuries by Hippocrates." Annals of Otolology Rhinology and Laryngology 112, no.2 (2003): 159–162.
Rohrich, R. J., and A. R. Muzaffar. "Rhinoplasty in the African-American Patient." Plastic and Reconstructive Surgery 111, no.3 (2003): 1322–1339.
Russell, P., and C. Nduka. "Digital Photography for Rhinoplasty." Plastic and Reconstructive Surgery 111, no.3 (2003): 1266–1267.
Organizations
American Board of Plastic Surgery. Seven Penn Center, Suite 400, 1635 Market Street, Philadelphia, PA 19103-2204. (215) 587-9322. http://www.abplsurg.org/.
American College of Surgeons. 633 North Saint Claire Street, Chicago, IL 60611. (312) 202-5000. http://www.facs.org/.
American Society for Aesthetic Plastic Surgery. 11081 Winners Circle, Los Alamitos, CA 90720. (800) 364-2147 or (562) 799-2356. http://www.surgery.org/.
American Society for Dermatologic Surgery. 930 N. Meacham Road, P.O. Box 4014, Schaumburg, IL 60168-4014. (847) 330-9830. http://www.asds-net.org.
American Society of Plastic and Reconstructive Surgeons. 44 E. Algonquin Rd., Arlington Heights, IL 60005. (847) 228-9900. http://www.plasticsurgery.org.
American Society of Plastic Surgeons. 444 E. Algonquin Rd., Arlington Heights, IL 60005. (888) 475-2784. http://www.plasticsurgery.org/.
Rhinoplasty (Greek: Rhinos, "Nose" + Plastikos, "to shape") is a cosmetic surgical procedure performed by an oral and maxillofacial surgeon, plastic surgeon,
or ENT surgeon, in order to improve the function (reconstructive surgery) and/or the
appearance (cosmetic surgery) of a person's nose. Rhinoplasty is also commonly called a "nose
job". Rhinoplasty can be performed to meet aesthetic goals or for reconstructive purposes to correct birth defects or
breathing problems. It can be combined with other surgical procedures such as chin
augmentation to enhance the aesthetic results.
History
Rhinoplasty was first developed by Sushruta, an important physician (often regarded as the
"father of plastic surgery") who lived in ancient India circa 500 BC, which he first described in his text Susrutha Samhita. He and his later students and disciples
used rhinoplasty to reconstruct noses that were amputated as a punishment for crimes. The techniques of forehead flap rhinoplasty
he developed are practiced almost unchanged to this day. This knowledge of plastic surgery existed in India up to the late 18th century as can be seen from the reports published in Gentleman's Magazine
(October 1794).[1]
The first intranasal rhinoplasty in the West was performed by John Orlando Roe in
1887. It was later used for cosmetic purposes by Jacques
Joseph (b. Jakob Lewin Joseph) in 1898 to help those who felt that the shape or size of
their nose caused them embarrassment and social discomfort. His first rhinoplasty patient was a young man whose large nose caused
him such embarrassment that he felt unable to appear in public. He approached Joseph because he had heard of a previous
successful otoplasty, or "ear job," which the surgeon had performed.
How rhinoplasty is performed
It can be performed under a general anesthetic or with local anesthetic, depending on
patient or doctor preference. Incisions are made inside the nostrils (closed rhinoplasty). Sometimes, tiny, inconspicuous
incisions are also made on the columella, the bit of skin that separates the nostrils (open
rhinoplasty). The surgeon first separates soft tissues of the nose from the underlying structures, then reshapes the
cartilage and bone causing the deformity.
In some cases, the surgeon may shape a small piece of the patient's own cartilage or bone to strengthen or increase the
structure of the nose. Sometimes this is done for cosmetic reasons (to improve the shape of the nasal tip, for example), or it
may be done to improve breathing and function of the nose.
In rarer cases, a synthetic implant may be used to reconstruct the nose if the normal
structure of bone and cartilage is badly damaged or weakened. Alloplastic synthetic materials are often associated with long-term
complications such as migration and extrusion. Alternatively, cartilage from the septum, ear or rib may be used.
To improve nasal breathing function, a septoplasty may be performed, with or without
cosmetic changes. The cartilage that is removed may be used as a graft to improve the appearance and structure of the nose.
In the entertainment industry
The Los Angeles Examiner of May 5, 1930, stated that:
"Having one's nose shaped to fit the talkies is the most popular thing in Hollywood now. Hollywood plastic surgeons agree
that more than 2000 facial beautification operations have been performed among film players within the past few years."
Siblings Michael, Janet and La Toya Jackson's are among the most prominent rhinoplasties in show business with a dramatic reduction
of nose size and change of shape. Like many starlets, a young Marilyn Monroe had work
carried out on her nose before her first film roles at the advice of her mentor Johnny Hyde.
Jennifer Grey is another famous movie star whose looks transformed completely after a nose
job.
Ethnic Nose Rhinoplasty
Many African-Americans or Asian-Americans, or those who have an “ethnic nose” choose to have an aesthetic rhinoplasty.
Although techniques and methods employed during rhinoplasty surgeries are the same regardless of race, there are some trends
that apply to patients of certain ethnic backgrounds.
Asian-American Rhinoplasty: Asian patients often want their noses to appear narrower. This can be done through the use of
infractures, where the nasal bones are broken and moved in or reset to thin out the nasal area and add projection in the process.
(Outfractures, where the nasal bones are broken and moved outwards, are used to widen a too-narrow dorsum.)
African-American Rhinoplasty: One common trend in African American Rhinoplasty is to narrow wide nostrils. This procedure may
include removing sections of the base of the nostrils or sections of the nose where it meets the face. The tip of the nose can be
restructured by removing tiny sections of cartilage.
Revision rhinoplasty
Revision rhinoplasty is a nose operation carried out to correct or revise an unsatisfactory outcome from a previous
rhinoplasty. It is also known as secondary rhinoplasty or tertiary rhinoplasty. There are two main reasons for performing
secondary or tertiary rhinoplasty. The first is purely cosmetic. A patient may be unsatisfied with all or part of a previous nose
“job,” because of the way their nose appears after rhinoplasty surgery. A nasal hump may not have been reduced enough, or too
much. A prominent or bulbous nasal tip may have not been addressed appropriately, or over-aggressively. The nose may looked
pinched, it may look like a parrot’s beak, or like a boxer’s nose. There are many ways in which previous nose surgery may have
left a nose aesthetically unappealing to a patient. The second reason is functional. The original nasal surgery may have been
carried out to help with difficulties in breathing, and the outcome may have been unsatisfactory. Alternatively, the original
surgery may have been performed for cosmetic reasons, but may have disrupted a normal physiologic mechanism involving the
inspiration or expiration of air, making it difficult to breathe. Secondary rhinoplasty, and especially tertiary rhinoplasty, are
extremely complicated procedures. This is self-evident because it is clear that even when the patient was operated upon for the
first time, even when the tissues were “virginal,” and untouched the desired result could not be obtained.
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