Nose Surgery or Rhinoplasty
Nose Job | Corrective nose surgery
Before proceeding with any discussion of surgical details, it seems appropriate to answer a number of general questions which are posed quite frequently. At what age is this operation best performed? The answer relates more to the degree of physical and emotional development than it does to chronological age. There are many youngsters of fifteen or sixteen years who are not quite fully-grown physically, but who are emotionally compromised by lack of confidence in their personal appearance.
There are few circumstances where being in a middle to older age group disqualifies the patient as a candidate. As previously noted, modified rhinoplasty procedures have become more desirable in association with facelift surgery, to supplement overall results in achieving a more youthful appearance. Quite frequently the operation may be performed in the fifties and sixties.
Changes in the nasal contour are made by removing, shifting, or altering the underlying bone and cartilage structures. The skin over the surface can then be moulded or draped over a new foundation to achieve the desired result. This operation is performed from inside the nose, leaving no external scars except in special circumstances. One might consider this procedure similar to raising or lowering the central support of a tent, resulting in change of its outside appearance.
Final decisions are best left to the surgeon for judgment. Drastic changes are not reasonable objectives and generally are not compatible with already existing bone and soft tissue contour nor are such corrections likely to harmonize with other facial features. The goal should be removal of major bone deviations or deformities and subtle refinements of cartilage and soft tissue contour. Total change which eliminates all definition of ethnic character is anatomically and aesthetically as well as psychologically undesirable.
In planning the nose job procedure, photographs are made to provide a permanent record and permit careful study. These are frequently helpful in showing the relationship of the nose to other facial features. The upper lip and chin are important contiguous structures which under some circumstances may require modification in order to achieve maximum benefit; their relationship may become more evident in simple profile photography (see mentoplasty).
While nose surgery is usually performed through the inside of the nose without external incisions or noticeable residual scars, there are a few special circumstances that require external incisions, particularly at the base of the nose near the normal fold. These incisions heal well and are difficult to detect. Discomfort is quite limited after the first twenty-four hours.
At the end of the operation a small splint is used over the outside to maintain proper position and limit nasal swelling. This splint affords some protection from injury during the healing process. Varying degrees of swelling and discolouration around the eyes will become evident within the first twenty-four hours and will gradually decrease within the first week. Nasal swelling will persist somewhat longer but a significant amount of it will disappear in ten to fourteen days. After that time most patients can return to their customary activities.
Some numbness and limited swelling in the nasal tip area will normally persist. It varies depending upon the exact nature of the surgical procedure. It is not conspicuous but can be detected by a feeling of tissue firmness for some time after surgery. Final settling and softening may take twelve months, during which time all of the final contour changes take place. It is a rather gradual process that cannot be hurried. While many patients want to see the final result immediately upon removal of the dressing, the presence of the early swelling can be misleading and premature judgments should not be made.
Perhaps the greatest risk is that of a result that appears undesirable from the patient’s point of view. Several conditions seem to invite this risk. One of the most significant factors is a desire on the part of both the surgeon and the patient to accomplish more than the local tissues will permit. Overly ambitious attempts to correct severe deformities are frequently destined to failure. It is much better to settle for lesser degrees of change so as to avoid totally unfavourable results. The problem is essentially one of unrealistic expectations on the part of the patient, who prevails upon the surgeon to attempt an impossible task.
Lesser degrees of temporary dissatisfaction may be encountered when minor irregularities of contour (bone or soft tissue) are noted after surgery. Some of these are difficult to control. Fortunately, a significant degree of change can be expected spontaneously during the first three to six months. Often the irregularities are noticed only by the patient and the surgeon and are not detected by others.
Instructions will be provided regarding specific do’s and don’ts after the operation. They will vary to some extent, but all are directed toward avoiding injury or distortion during the early post-operative period.
Finally, please remember that improvement is the goal of the operation. Larger changes are easier to accomplish; smaller corrections require the surgeon to work within narrower limits. Subtle differences – the last to become evident – are best seen after all swelling has subsided. Think positively when the operation is over and be patient while waiting for the final result.
You will be hospitalised for a period of two days and recovery will take approximately seven days.
Plastic Surgeon Dr. Saul Braun operates from the Netcare Rosebank Hospital, situated in the up-market Northern Suburbs of Johannesburg.